The Resident (2018) s01e03 Episode Script
Comrades in Arms
1 Previously on The Resident Everything you thought you knew about medicine is wrong.
All the rules you followed, we'll break.
You don't have the right to play God, Conrad.
CONRAD: I will do whatever it takes to get you back.
Chief of surgery.
Resident.
Try to remember that.
Dr.
Okafor.
Don't be nervous.
I'll talk you through it.
Acute leukemic, on chemo.
CONRAD: Lily means a lot to all of us.
She's been in and out of the ER so often we're all invested.
- NIC: Where's Lily Kendall? - NURSE: She went home.
Her count improved substantially.
You're getting way too big for your boots You're never too big for the boot I've got the big size 12s on my feet Your face ain't big for my boot Kick up the yout, man, know that I - We're in third place.
- Now or never.
Sir, yes, sir.
(WHOOPS) Second place.
Oh, I know how you feel about losing.
How dare you twist up the truth, look I'm too hot Lunch money in my shoebox Still steal meat from the stew pot Mandem go sick when my tune drops, little man That's a Hublot, not a Hublot, wait Wait, I'm bound to ride for Flipz Real Gs gonna ride around - We got this.
- We do? I do.
I never left my 9:00 to 5:00 for this - (GRUNTS) - (GRUNTS) (GRUNTING) - (UPBEAT MUSIC PLAYING) - (INDISTINCT CONVERSATIONS) 15th Marine Expeditionary.
Valor, honor Whoa - Victory.
- Yo! Dudes.
Awesome race! MAN: Of course random drunk guy.
DRUNK GUY: Cold ones on me.
- (GRUNTS, SHOUTS) - (BONE CRUNCHES) Aah aah! My leg! (CRYING): I need a doct It's broke.
Doctor! (CRYING, GRUNTING) Right fibula.
Compound fracture.
- (MAN GROANING) - We need a splint.
- Oh, it hurts.
It hurts so bad.
- Deep breaths, buddy, we don't want you going into shock.
What's your name? - Ooh.
Hank.
- That's the best we got.
- We'll just wrap him up.
- Like old times medic and surgeon? He's about to tell us how much he misses the good ol' days when we were in Afghanistan together.
Give me some credit, hey.
All right, listen, this is gonna sting.
Might want to bite down on that.
- But I do miss it sometimes.
Don't you? - I don't miss being shot at.
No sane person would.
Not trying to take that personally.
Setting the leg - now! -(CRUNCH) - (SHOUTS, CRIES) There we go.
All right.
- Doing great, buddy.
- (MOANING) I was born for this - Let's go! - (TAPS WINDOW) Baby, I was born (INDISTINCT CONVERSATIONS) Lily, hey.
Oh, hey, Nic.
You left Chastain so abruptly the other day.
I was worried.
Yeah, I'm fine.
Thank you.
Just grabbing a prescription.
- (CLEARS THROAT) - You feeling okay? You want to come upstairs? I can take your temperature, - make sure you don't have a fever.
- No, no, I'm good.
Yeah, I'll stop by Dr.
Hunter's clinic if I need anything.
- You sure? - Mm-hmm.
- 'Kay.
- Thanks.
(PAGER BEEPING) Come on, Mr.
Rosenthal.
I got to take you for some fresh air, and then to PT.
No, thanks.
What I need is a drink and smoke.
Good morning, Mr.
Rosenthal.
Lucky you a free ride with Louisa, our most popular transpo worker.
Ah, just a quick spin.
Don't want a spin around nothing.
- You need sunshine.
- Vitamin D, helps you absorb calcium.
Which promotes bone density.
You don't want to break your hip again, do you? You know, you should really listen to Louisa.
You know why? - No, why? - She's studying to be a doctor.
ROSENTHAL: Med school, huh? You got a ways to go.
How old are you, 12? Ah, close.
22.
And she volunteered at Chastain all through high school.
- Hmm.
- Hi, Louisa.
- Hey.
- Nic, seriously, what is this mandatory meeting about? I have 30 patients to see.
- Billing.
- LOUISA: Billing? Whoa, sign me up.
Love me some billing.
ROSENTHAL: Enough already.
- (LOUISA GROANS SOFTLY) - You okay? Yeah.
Diagnosed myself with a muscle pull this morning.
Some kind of softball injury.
Might have to, uh, skip out early today.
Plus, I have to cram.
Midterms next week.
Bio and calc.
Well, if you need any help at all, I got a 132 on the bio section of my MCATs.
Kid brags a lot, doesn't he? LOUISA: Thanks, Dr.
Pravesh.
I might take you up on that offer.
(PUSHES BUTTON) (SIGHS) (GROANING) Compound fracture of the right fibula.
Now, we reset it in the field, but he might need surgery.
All right.
I'll be right there.
- We'll see you inside.
- Okay.
- Thanks, Doc.
- Let's go.
- (HANK COUGHS) - You did great, Hank.
Yeah, except for the crying.
- And screaming for a doctor.
- And breaking all those beer bottles.
The truth? That was like old times.
Well, you miss it so much, why don't you go back? Yeah, I've been meaning to tell you.
Jude, I was joking.
Thinking about re-enlisting.
- Back into the Marines? - Yeah.
- Do boys ever grow up? - Yes.
- No.
- Mandatory meeting, we're late.
I thought you were gonna get us out of this? Yeah, well, I told her we had seven open cases - All residents, all nurses.
Let's go.
- (CONRAD SIGHS) NIC: You smell like a barn.
- I like barns.
- Never been in one.
What? I grew up in Queens.
I've smelled worse, trust me.
- Excuse me.
- BARB: Morning, everyone.
We're here today to talk about reimbursement.
No one's favorite part of the day, right? Okay, put that away, sweetie.
Now, to simplify, doctors and nurses at Chastain need to charge more per procedure.
For example: ear infection.
Typically billed to insurance as service code one at about yeah? $200.
BARB: But what if that ear infection took a trip to the brain? That's now a code four.
Serious.
Costly.
We can bill in the thousands.
Illness is unpredictable, so billing must be proactive.
Right? It's called upcoding.
Think CUTE.
Code.
Up.
To.
Excellence.
- (DEVON GROANS) - Enjoy.
I'm out.
Third year.
First year.
Welcome to American healthcare 101.
BARB: Okay, what are we all concerned about? How much did you have to drink today? Not really sure.
You were at the race all morning? Which Conrad and I won, by the way.
I had a beer before the race.
Jaundiced skin, scleral icterus.
I'm sending him for a liver panel and an ultrasound.
How's our number one fan? JUDE: You see this? This is a stateside doctor, doing what he was born to do running liver function tests in a cushy, big-city ER.
(IRVING CLEARS THROAT) I am the very model Of a modern major-general I've information vegetable, animal and mineral I know the kings of England and I quote the fights historical I was also born to sing.
You get out on the boat this weekend? Yeah, the fish weren't biting.
You? Well, a little golf.
You know, actually, I had a question for you.
Old guy I was playing with has developed a bit of a tremor.
And it's giving him the yips.
And I prescribed the standard beta blockers but it hasn't helped.
You know, I know there's surgery, but it seems a little drastic.
Well, cracking open his head for a missed putt is a bit much, huh? Yeah, what about benzodiazepines? Last resort, he can try 'em.
But the side effects are gonna be - Aggression and cognitive impairment.
- Yeah.
I guess it just depends how desperate the guy is, though.
- Cheers.
- Cheers.
(EXHALES) Rosenthal in 5931 catheter out and discharge.
Anderson 5942 Monitor her rhythm.
Where were you and Dr.
Silva deployed? Afghanistan.
If she spikes a fever, you add IV piperacillin.
My brother was in the army, two tours in Iraq.
He came back a very different guy.
Did you see any action? I was a corpsman in the Marines.
Jude was a base surgeon.
We tried to save lives, not take them.
But mostly, we had each other's back.
Now let's move on to medicine.
We have a busy day ahead of us.
Let me know if there's anything in the marketing department (WHISPERS): Look busy.
- RENATA: the upcoding system.
- BARB: Don't forget testing.
A well-insured patient should be tested for all possible outcomes, no matter how unlikely.
Dr.
Hawkins, have you met Barb Olsen? She's our billing consultant.
Here for two weeks to help Chastain become more efficient.
(LAUGHS): Of course.
The bike shorts.
Yeah, I already saw you at my presentation well, briefly.
I got paged.
Didn't I get paged? I didn't hear anything.
Well, nice meeting you.
Barb, there's, um Payback.
For making me sit in that presentation.
What's your problem? A strong kid like you can't you go any faster? I got a life to lead.
Hey, Louisa, how's my man Rosenthal treating you? Like the daughter he never had.
A nightmare.
The Chastain softball team crushed Emory yesterday.
Yeah, we did.
(GRUNTS) Is your back still bothering you? Uh, yeah, it's no big deal.
Now I'm thinking it's a pinched nerve, lumbar spine.
Pain that, uh, radiates along the affected nerve.
That's impressive, but you're not quite a doctor yet.
Let me have a look.
Uh, maybe later.
I told Joey in Ped Onc I'd take him to the play area.
Man, that munchkin is cute.
(ELEVATOR BELL DINGS) Check back in with her in an hour.
I just want to examine her and make sure - (LOUISA GRUNTS) - (LOUD CLATTERING) ROSENTHAL: Hey! We need some help in here! - Oh, my God, I'm sorry.
- It's okay.
(GROANS) It's okay, stay still.
We got you.
I'm too young for kidney stones.
I'm thinking it's just a gas bubble.
It's really no big deal.
How long have you been short of breath? Just a few days.
I was thinking it was from the pain.
Your lungs sound congested.
We need a full workup.
This could be serious.
No, I'm okay.
I swear.
I can't be sick, they'll send me back home.
And I need every dime to make ends meet.
And a CT scan as well.
MRI's probably the better option.
Actually, maybe we should check her insurance first.
- Uh, can this wait? - No.
Can I a moment with the patient, please? We're conducting an exam here.
Dr.
Hawkins, the administration has given me license to inspect all hospital finances.
You're a subcontractor to the hospital, right? Yes.
Is this really necessary? I'm feeling better.
I just want to go home.
Rest up.
She wants to go home.
Great.
She can't.
She needs an MRI.
Do you know if your company will cover an MRI? Does anyone know that stuff? Then if it doesn't, an X-ray is more than sufficient.
Actually, it isn't.
Louisa is part of the Chastain family.
- She deserves our best care.
- Well, I can see that she's a wonderful young woman I can't do this.
(GRUNTS) I'm sorry, thank you, but I'll just leave.
It would be wise for you to let her go.
Wow.
Really? Louisa (PAINED GROAN) Easy.
Easy.
There you go.
Pulse is weak.
Distant heart sounds, distended jugular veins.
Cardiac tamponade.
Too unstable to move.
I need 18-gauge spinal needle with a 20cc syringe.
I'll prep the ultrasound in exam room four.
Good.
Go.
Louisa, you have fluid around your heart.
We're going to relieve the pressure.
You cut, I draw.
(GASPS SHALLOWLY) Quickly, we're losing her.
Ready.
Now, Louisa, you're gonna feel pressure and then stinging.
(GASPING, GROANING) (BREATHING EASIER) You're okay, Louisa.
- (BUZZING) - DEVON (ON SPEAKER): Another loud noise and we're almost done.
Don't worry, just a few more minutes.
(DOOR OPENS) Get her out of that machine.
- We're almost finished.
- She's not insured.
She can't pay for her treatment, that's why she ran away.
Or maybe she didn't want to burden the hospital.
Well, it's a little late for that, 'cause Chastain is gonna have to eat the cost of that MRI.
That's $10,000.
$10,000 is what they charge the insurance company.
It doesn't cost the hospital anything like that.
- Are you offering to pay? - (SIGHS) BARB: Here, for your intake files.
I will call her employer, see what I can negotiate.
God, I hate that woman.
You and I will run point on Louisa's care.
We need to get as much done as we can before the administration pulls the plug.
We can't let them kick her out.
Well, don't panic yet.
Worst case, we guide her to another hospital.
Where she never even makes it past ER triage.
Trust me.
(SIGHS) JUDE: LFT panel.
Hank, you have acute hepatitis.
Is that bad? It means that you've consumed so much alcohol that your liver's temporarily paralyzed.
- It's quite a feat, actually.
- Exactly how many beers did you have? - Two - Two beers? Two dozen.
If you don't cut back, your liver's gonna stop functioning.
Your stomach will swell, you're gonna become confused, then sleepy, you slip into a coma, then you die.
I'm not trying to scare you, it's just the truth.
You're drinking yourself to death.
I know.
Help me? I can get you into a rehab facility.
I can't do rehab.
I'd lose my job.
But the rest of it, yeah.
I'm ready to quit.
I am.
I've struggled with alcohol my whole life.
Look, the moment I walk out of there, I swear, I will go straight to a meeting.
I'll get a sponsor, I'll stay in AA the rest of my life.
That's easy to say, pal.
It's hard to do.
Atwood, Henry, two of Lorazepam for withdrawal.
Thank you, Doctor.
You can do whatever you want, it's not gonna help.
His problem is self-inflicted.
Hell, 90% of the patients that come in here have done stupid stuff to themselves.
Remind me how you got that scar on your thumb.
- Wasn't it field-dressing a possum? - I was nine years old.
And I treated the injury myself.
Of course you did.
It still doesn't explain why you eat possum.
JUDE: Yeah, we all didn't have moms who would shop and cook for us.
Or dads who were sober enough to drive us to the ER.
Exactly, and that's why I'm here to help whoever walks in that door who can't help themselves.
It doesn't matter whether they eat lobster or road kill.
I take care of them.
All right.
Let me ask you this.
What is the most fun you have had in the last week? My guess? You and me fixing up Hank in the back of that pickup truck.
Seat-of-our-pants medicine.
Nobody telling us what to do or making us fill out forms.
Then what happens? We come back to work, and a patient is trying to run away because she doesn't have insurance.
We can't even treat someone who's worked at Chastain for the past two years.
How many wounded Marines did you ever ask for proof of insurance? Well (SIGHS) I guess I got my work cut out for me, then, don't I? You keep tilting at windmills, huh? - Currently on any medications? - No, but I'm Have you eaten anything in the last eight hours? I'm not having surgery today.
It says here, "Reynolds, hernia surgery, 2:15.
" - I'll be assisting.
- I'm having some more tests.
- Excuse me? - A very nice lady came in and talked my doctor into ordering some more blood work.
Another CT scan and an MRI.
You don't need an MRI, you need hernia surgery.
She said I needed it to be on the safe side.
She was very convincing.
Why is my hernia patient having more tests? - He doesn't need more tests.
- Another Barb victim.
Profit before patients the new healthcare mantra.
Barb is like a migraine.
You can feel it coming, but you can't stop it.
Then it gets worse and worse, and you throw up.
What do you guys think of the name "Say Ah" for a resident-nurse a cappella group? "Say Ah"? Yeah, you know, to serenade patients.
No one wants you to sing them a song.
The meaner she is to me, the more I'm in awe of her.
Yeah, that's kind of how it works.
Wow.
You got Louisa's results? This is a T2 hyperintense, enhancing mass, encasing the spleen, kidney, and vertebral bodies.
Most consistent with A retroperitoneal sarcoma.
Which would explain the fluid in her heart.
She lied to us.
And to her employer.
She didn't run away because she doesn't have insurance, she ran away because she's an undocumented immigrant.
She has a highly aggressive tumor.
If she doesn't get surgery right away, she dies.
No more tests, no more treatment on our dime.
This hospital isn't a charity.
I felt this was important enough to bring to the CEO's office right away.
Ms.
Rodriguez is an uninsured, undocumented immigrant.
She has no family in this country.
She was brought here from El Salvador as a child.
No one can take her once she leaves the hospital.
State rules are clear on this.
Ms.
Rodriguez cannot be released into her own care.
That means Chastain would be stuck with her for a long time.
She'd be living here at our expense.
She would be a Perma Patient.
Not every CEO knows that term.
Claire is not your average CEO.
Dr.
Bell, what's her prognosis? Well, the five-to ten-year survival rate is excellent if we operate right away, but the longer we wait, the worse her odds.
And if her surgery is successful, what's the rehab? Six months to a year.
Okay, best-case scenario, what is Louisa's care gonna cost us? Chastain does the surgery, it goes well, post-op, she can walk with a physical therapist down the hall half a million dollars.
And worst case? Post-op, Ms.
Rodriguez can't even get out of the bed two million dollars.
Hang in there, your count is moving in the right direction.
Lane.
Hey, Conrad.
How are you? I'd like to call you in for an oncology consult.
Okay.
Who's the patient? Louisa Rodriquez, transport worker here at Chastain.
Good person.
She's uninsured and an undocumented immigrant.
Um, a full course of radiation and chemotherapy is, uh, very expensive.
I understand, but don't you have a foundation - for cases like this? - Yes, I do, but it's not for the undocumented.
Look, I'll make some inquiries, but I can't make any promises.
- That'd be fantastic.
- Conrad.
Administration just put Louisa's surgery - on indefinite hold.
- Lane - Louisa's all alone.
- I'll see what I can do.
I forgot to tell you I saw Lily earlier.
She didn't look good.
Nic, she has cancer.
I know we've been through this, and I'm sure Lane had every reason to discharge Lily, - but my instincts are - Lane will take care of her.
Lily's in good hands.
Okay, well, I'll be going Oh, excuse me.
Oh, Nurse Nevin.
If I could just have a moment? I'm actually really busy right now.
Okay, but I don't think the nurses are getting the hang of the upcoding system and the multiple-test vectors.
Our nurses are laser-focused on patient care.
That is their primary responsibility.
NURSE: Too late to go back to sleep - It's time to trust my instincts - Excuse me.
Close my eyes And leap It's time to try Defying gravity I think I'll try Defying gravity And you can't hold me down.
A little flat.
You're a little flat.
(MONITOR BEEPING) Next! Claire, this is Jim Phillips, CEO of Atlanta General, and Stuart Green from our Lady of Mercy.
The three of us go way back.
Ms.
Thorpe took over as CEO of Chastain, - what, six months ago? - Yes.
They're all yours.
Gentlemen, it's lovely to meet you both, and thank you for coming in on such short notice.
I'll get right to the point.
We have a patient, uninsured, undocumented, with a retroperitoneal sarcoma.
Possible six months to a year rehab.
Given our fixed costs per bed, this patient represents a considerable burden on Chastain.
As they would for Atlanta General.
Yes, but Atlanta General and Our Lady of Mercy's fixed costs are much lower than ours.
What are you suggesting, Ms.
Thorpe? If either one of you will take this patient off our hands, pre-surgery, we'll pay a fee, one-time, of $250,000.
If you can funnel us five Medicare patients and up the fee to $300,000, we'll consider it.
What if I offered you five Medicaid patients and $250,000? Medicaid reimbursements are junk.
Ten Medicaid and 300 grand.
(PEN SCRATCHING) I'm offering seven Medicaid and 275.
Too low.
We're out.
Stuart, Our Lady of Mercy has a charity fund.
What if we did the surgery and you did the rehab? We could give your fund $100,000 that you could use at your discretion.
We just built a new cardiac wing.
CLAIRE: Which is a-a beautiful wing.
Cost us $40 million.
And I am sure that you will make that back in fees in no time.
My board would kill me if we took another Perma Patient.
- I'm gonna to have to pass.
- (GRUNTS) I'm sorry.
DEVON: Who can we call, Louisa? You must have family here.
My parents brought me here when I was three years old.
My mom died two years ago, and my dad moved back to El Salvador.
I'm alone.
And you support yourself? Yeah.
I guess I was crazy to think I'd make it to med school without being found out.
If Immigration gets their hands on me, they'll send me back, no questions asked.
But this is the only country I've ever known.
And to be a doctor that's my dream.
I'm so sorry to cause all this trouble, Dr.
Pravesh.
Everyone at Chastain has been nothing but good to me.
Louisa, we're going to help you, and you deserve better than this.
I looked up the surgery on my phone.
Cancer wrapped around a lot of organs.
Pretty dangerous stuff, huh? Yes.
It is.
But we both know it is the only road to a cure.
Do you know how some people say they're not afraid of dying? That's crazy, right? It scares the hell out of me.
Louisa, you're going to be a doctor someday.
Helping you get there that's our dream.
(LOUISA EXHALES) (SNIFFLES) Hey.
I, uh, checked with my foundation, and got a fast, hard no.
Our donors expect their gifts to pay for the treatment of U.
S.
citizens.
There are plenty of deserving Americans out there waiting for a chance.
Ugh.
I hate to disappoint you, Conrad, that's the hardest part.
Thanks for trying.
You know, we do the best we can, as often as we can.
But we can't save everyone.
You're all post-surgery, and you all want to go home.
So today, we're going to have a race.
Whoever gets to the end of the hallway first gets discharged.
No more poking, needles, BP checks.
You can cook your own meals, take a warm shower.
Sound good? If you can't walk to the end of the hallway, you're here for another week.
One, two, three.
Go.
(GRUNTING) Too slow, Mrs.
Pill.
You're done.
- (SIGHS) - (GRUNTING) Mr.
Farragut, the same.
(GRUNTS) No time to treat a heart attack, Mr.
Smith, off you go.
Discharge the winners.
The losers can go back to their rooms.
NURSE: Take it easy, all right? You're gonna be fine.
- Culling the herd? - Yep.
Administration won't allow.
- Louisa's surgery.
- Unfortunate.
But I heard she is undocumented.
Rules are rules.
Am I crazy, but aren't you and me supposed to be in the trenches together on situations like this? Please, tell me this is not actually how you feel.
What I feel doesn't matter.
What I feel doesn't help.
I deal in facts.
Okay.
Fine.
Because the hospital is trying to save money, Louisa might die.
Fact.
She might die from surgery, too.
Fact.
Love the optimism.
How dangerous is it, Mina? Very intricate, very demanding.
Seven, eight hours.
But glorious.
Sounds like it's right up your alley.
(SIREN WAILING IN DISTANCE) - (EXHALES) - (KNOCKING ON WINDOW) (SIGHS) Conrad, we all feel terrible for Louisa.
She's an enormous liability.
As much as two million dollars over the course of her treatment.
Look, I get that it's a bottom-line world.
You made that clear.
But I want you to think back for a moment, - to when you were in med school.
- (LAUGHS) It wasn't all about making money.
That was a long time ago.
Healthcare has changed since then.
We need to deal with the new reality.
I think we can both agree that every doctor has that singular moment when they decide they're going into medicine.
For you, to be a surgeon.
And even if it was decades ago, I'd bet everything I got you remember it like it was yesterday.
And I don't buy for one second that it had anything to do with money.
It didn't.
I fell in love with cutting.
I fell in love with the OR.
I love it.
Still.
But the money has to come from somewhere.
If we treat Louisa, our other patients will suffer.
Services will be cut.
Hours, staff.
You know, I don't like the idea of putting a price tag on a life any more than you do.
But the system doesn't run on air.
No matter how much we love Louisa, her price tag is not two million dollars.
Don't say anything.
Nothing.
(SIGHS) Catch you at a bad time? I'd like to shove CUTE right up her Throw it in the trash.
You'll feel better.
Look at that.
Stress management.
I'm guessing you didn't come up here to talk to me about upcoding.
No.
It's about your boy, Conrad.
Look, he's taking things hard.
If he doesn't start to choose his battles, he's gonna burn out.
Yeah, well, I can't control Conrad.
Never could.
And he's not my boy.
Not anymore.
Sorry to hear that.
Alabama Shakes is playing Terminal West next week.
- Oh, yeah? - Mm-hmm.
I got an extra ticket.
I remember you saying you liked their music.
I do.
It's not a date.
- (LAUGHS SOFTLY) - Just a concert.
Have a little fun.
(RAPID BEEPING) Rapid response, 5922.
Let's go.
NIC: She's crashing.
- CONRAD: Blood pressure? - DEVON: 70/40.
- Cycling right now.
- Her IV blew in the MRI.
We haven't been able to get another line since.
- She's bleeding internally.
- Now it's 60/30.
She's a hard stick.
Her vessels are clamped down, she's too volume-depleted.
Emergency IO.
- Yeah, I've never done that before.
- Get the kit.
You're doing it now.
(DRILL WHIRRING) Push the needle in.
Once you hit the bone, drill.
(MONITORS BEEPING RAPIDLY) Keep it steady.
Drill.
Okay, release.
Flush.
NIC: Running in fluids.
We're in the clear.
- For now.
- DEVON: She'll keep bleeding until we get her to surgery.
There are four oncology surgeons on call.
Why can't we ask one of them to do the operation? Good idea.
Let's practice that.
I'll be Dr.
Hillis.
Go ahead, pitch me the surgery.
Hi, Dr.
Hillis, I need a surgical oncologist to operate on a patient right away.
- Okay, sure, who's the patient? - Louisa Rodriguez.
(GRUNTS) Actually, I forgot.
I'm booked solid today.
Ask Dr.
Miller.
Dr.
Miller, I need an oncology surgeon Would love to, but I'm headed to Aruba today with my fiancée.
Dr.
Singh says the failure rate for this surgery is through the roof.
Dr.
Weiss heard the administration is dead set against it - The administration is wrong.
- Maybe they are, but Dr.
Weiss makes 400K a year, really wants to keep his job.
Okay.
They're gonna wiggle their way out of it any way they can.
But we know someone dying to do the operation.
CONRAD: But it's not in your specialty.
So? I'm arrogant enough to believe I can do it.
And I'm your only option.
Just get an attending to sign off.
CONRAD: I need you to sign off on a surgery.
It's not in your specialty.
You'll just be supervising.
Yeah, and what's the catch? No catch.
Look, I know you, pal.
What rules am I gonna break? Not breaking.
Bending.
Bending, okay.
- Who's the patient? - Louisa Rodriguez.
Oh, I'm in.
Surgery's a go.
Mina's on deck.
Conrad, someone called Immigration.
They're coming for Louisa.
How can I help you, gentlemen? - Sir, you need to move aside.
- CONRAD: I will, if you tell me what's going on.
DEVON: Hospitals are sensitive areas, along with schools and churches.
And sensitive areas cannot be accessed by immigration officials without arrest warrants or under investigation of an imminent national security threat.
ICE policy letter, October 24, 2011.
You're interfering with the actions of authorized federal agents.
- You're gonna regret this.
- I doubt that.
Well then, you better drag us both out of here.
Conrad.
CLAIRE: Stop.
Step aside or you will both be fired.
It's okay.
Let them pass.
Daylight dims into grim The pressure higher than the tallest steeple We need to hurry.
For my sins your caved in The house of glass I filled with empty people It was a black and stormy night Dr.
Okafor, you may proceed.
The kind that's always pulling you in Pulling you in again NIC: Surgery's underway.
Sterile environment.
You cannot enter under any circumstance.
No one can.
The kind that's always pulling you in Pulling you in again.
Pushing us to charge more, and order endless tests.
Yeah, Dr.
Pravesh wants the feeding tube out for 4710.
Barb called Immigration.
I'm sure of it.
MRI order from Dr.
Williams.
Wait.
Give that back to me.
- Is this scheduled for right now? - Mm-hmm.
- Pull him out.
- What are you doing? Did you push his doctor to order this test? - I did.
- Without checking the patient history? Open the microphone.
Mr.
Reynolds, do you know how an MRI works? It has incredibly powerful magnets.
Magnets that will rip anything metal out of your body.
Anything at all.
Do you have anything metal in your body, Mr.
Reynolds? Mr.
Reynolds has a penile implant, a metal-based penile implant.
How much is your penis worth to you, Mr.
Reynolds? Say, in a lawsuit? A million dollars? Five million dollars? Stop the machine! You are not a doctor and you are not a nurse.
Not every test is safe.
Not every procedure should be billed for ten times what it's worth.
You're gonna end up getting someone killed.
- Now wait just a second - I'll be filing an incident report with the Comptroller's office and the CEO.
Good luck getting hired at Chastain again.
DEVON: Louisa.
Do you have any nausea? No.
I feel okay.
You've been so kind to me, all of you.
I'll never be able to repay you for this.
But I'll still need some help on my bio midterm.
Anytime.
JUDE: So the operation came off without a hitch.
You had a spectacular surgeon.
Cake.
What are her rehab markers? Well, if she can walk to the door, we're in the clear.
If not Hey.
Well, you look good.
You know, it's really important that we get you up on your feet right away.
So how about you get out of bed and show us how you can walk to the door? - Okay.
- Let's really concentrate.
Here we go.
(GRUNTS) I'm so sorry.
(WHISPERING): Two million.
It's okay.
You'll be fine.
Louisa, rehab is gonna be a long, hard road, but we all know how tough you are.
NIC: You'll get through this.
DEVON: With some time and care, you'll be right back where you were in a year or so.
We've got your back the whole way.
(ELEVATOR BELL DINGS) Hey, Art.
Randolph.
(EXHALES LOUDLY) Hey, uh, how's your golfing buddy doing? The one with the tremor? He sink any more putts? Oh, uh He just started taking the medication.
- Probably too soon to tell.
- Okay.
Well, keep me updated.
Yeah.
Yeah.
Will do.
Jude and I are gonna go grab a beer.
You want to join? DEVON: She's a lot cuter than either of you guys.
True enough.
Enjoying your victory, Dr.
Hawkins? Did you call Immigration? You had your billing consultant do it for you.
Barb Olsen's contract with this hospital has been suspended.
But I have to pull two million dollars out of thin air.
- I understand - No.
You will understand full well when I take that money out of the Internal Medicine and ER budgets.
Be prepared to be woefully understaffed for the next 12 months.
By the way, thank you for today.
- Yeah.
- (CHUCKLES) Thorpe could've had you canned on the spot.
Well, I get fired, it makes the decision for me, right? I show up tomorrow at Fort Benning, 6:00 a.
m.
Hell, you could be there with me.
Hmm? All right, so you're starting to come around.
What are you so damn happy about? Because I know exactly where I'm supposed to be tomorrow, and it's at Chastain.
Yeah.
Valor, honor Victory.
Mm.
I got these.
So, you know, I've been meaning to ask, you and Nic that still a thing? (SIGHS) She doesn't think so, but I think she's worth fighting for.
Don't you? Oh, hell yeah.
Game on.
(LAUGHS) You gave me scars Beautiful scars On my back and all You see how far I come You gave me scars, beautiful scars PARAMEDIC: 28-year-old female.
Cancer patient.
Short of breath and vomiting.
BP's dropping.
Volts and a liter of saline right now (PARAMEDIC CHATTER CONTINUES INDISTINCTLY)
All the rules you followed, we'll break.
You don't have the right to play God, Conrad.
CONRAD: I will do whatever it takes to get you back.
Chief of surgery.
Resident.
Try to remember that.
Dr.
Okafor.
Don't be nervous.
I'll talk you through it.
Acute leukemic, on chemo.
CONRAD: Lily means a lot to all of us.
She's been in and out of the ER so often we're all invested.
- NIC: Where's Lily Kendall? - NURSE: She went home.
Her count improved substantially.
You're getting way too big for your boots You're never too big for the boot I've got the big size 12s on my feet Your face ain't big for my boot Kick up the yout, man, know that I - We're in third place.
- Now or never.
Sir, yes, sir.
(WHOOPS) Second place.
Oh, I know how you feel about losing.
How dare you twist up the truth, look I'm too hot Lunch money in my shoebox Still steal meat from the stew pot Mandem go sick when my tune drops, little man That's a Hublot, not a Hublot, wait Wait, I'm bound to ride for Flipz Real Gs gonna ride around - We got this.
- We do? I do.
I never left my 9:00 to 5:00 for this - (GRUNTS) - (GRUNTS) (GRUNTING) - (UPBEAT MUSIC PLAYING) - (INDISTINCT CONVERSATIONS) 15th Marine Expeditionary.
Valor, honor Whoa - Victory.
- Yo! Dudes.
Awesome race! MAN: Of course random drunk guy.
DRUNK GUY: Cold ones on me.
- (GRUNTS, SHOUTS) - (BONE CRUNCHES) Aah aah! My leg! (CRYING): I need a doct It's broke.
Doctor! (CRYING, GRUNTING) Right fibula.
Compound fracture.
- (MAN GROANING) - We need a splint.
- Oh, it hurts.
It hurts so bad.
- Deep breaths, buddy, we don't want you going into shock.
What's your name? - Ooh.
Hank.
- That's the best we got.
- We'll just wrap him up.
- Like old times medic and surgeon? He's about to tell us how much he misses the good ol' days when we were in Afghanistan together.
Give me some credit, hey.
All right, listen, this is gonna sting.
Might want to bite down on that.
- But I do miss it sometimes.
Don't you? - I don't miss being shot at.
No sane person would.
Not trying to take that personally.
Setting the leg - now! -(CRUNCH) - (SHOUTS, CRIES) There we go.
All right.
- Doing great, buddy.
- (MOANING) I was born for this - Let's go! - (TAPS WINDOW) Baby, I was born (INDISTINCT CONVERSATIONS) Lily, hey.
Oh, hey, Nic.
You left Chastain so abruptly the other day.
I was worried.
Yeah, I'm fine.
Thank you.
Just grabbing a prescription.
- (CLEARS THROAT) - You feeling okay? You want to come upstairs? I can take your temperature, - make sure you don't have a fever.
- No, no, I'm good.
Yeah, I'll stop by Dr.
Hunter's clinic if I need anything.
- You sure? - Mm-hmm.
- 'Kay.
- Thanks.
(PAGER BEEPING) Come on, Mr.
Rosenthal.
I got to take you for some fresh air, and then to PT.
No, thanks.
What I need is a drink and smoke.
Good morning, Mr.
Rosenthal.
Lucky you a free ride with Louisa, our most popular transpo worker.
Ah, just a quick spin.
Don't want a spin around nothing.
- You need sunshine.
- Vitamin D, helps you absorb calcium.
Which promotes bone density.
You don't want to break your hip again, do you? You know, you should really listen to Louisa.
You know why? - No, why? - She's studying to be a doctor.
ROSENTHAL: Med school, huh? You got a ways to go.
How old are you, 12? Ah, close.
22.
And she volunteered at Chastain all through high school.
- Hmm.
- Hi, Louisa.
- Hey.
- Nic, seriously, what is this mandatory meeting about? I have 30 patients to see.
- Billing.
- LOUISA: Billing? Whoa, sign me up.
Love me some billing.
ROSENTHAL: Enough already.
- (LOUISA GROANS SOFTLY) - You okay? Yeah.
Diagnosed myself with a muscle pull this morning.
Some kind of softball injury.
Might have to, uh, skip out early today.
Plus, I have to cram.
Midterms next week.
Bio and calc.
Well, if you need any help at all, I got a 132 on the bio section of my MCATs.
Kid brags a lot, doesn't he? LOUISA: Thanks, Dr.
Pravesh.
I might take you up on that offer.
(PUSHES BUTTON) (SIGHS) (GROANING) Compound fracture of the right fibula.
Now, we reset it in the field, but he might need surgery.
All right.
I'll be right there.
- We'll see you inside.
- Okay.
- Thanks, Doc.
- Let's go.
- (HANK COUGHS) - You did great, Hank.
Yeah, except for the crying.
- And screaming for a doctor.
- And breaking all those beer bottles.
The truth? That was like old times.
Well, you miss it so much, why don't you go back? Yeah, I've been meaning to tell you.
Jude, I was joking.
Thinking about re-enlisting.
- Back into the Marines? - Yeah.
- Do boys ever grow up? - Yes.
- No.
- Mandatory meeting, we're late.
I thought you were gonna get us out of this? Yeah, well, I told her we had seven open cases - All residents, all nurses.
Let's go.
- (CONRAD SIGHS) NIC: You smell like a barn.
- I like barns.
- Never been in one.
What? I grew up in Queens.
I've smelled worse, trust me.
- Excuse me.
- BARB: Morning, everyone.
We're here today to talk about reimbursement.
No one's favorite part of the day, right? Okay, put that away, sweetie.
Now, to simplify, doctors and nurses at Chastain need to charge more per procedure.
For example: ear infection.
Typically billed to insurance as service code one at about yeah? $200.
BARB: But what if that ear infection took a trip to the brain? That's now a code four.
Serious.
Costly.
We can bill in the thousands.
Illness is unpredictable, so billing must be proactive.
Right? It's called upcoding.
Think CUTE.
Code.
Up.
To.
Excellence.
- (DEVON GROANS) - Enjoy.
I'm out.
Third year.
First year.
Welcome to American healthcare 101.
BARB: Okay, what are we all concerned about? How much did you have to drink today? Not really sure.
You were at the race all morning? Which Conrad and I won, by the way.
I had a beer before the race.
Jaundiced skin, scleral icterus.
I'm sending him for a liver panel and an ultrasound.
How's our number one fan? JUDE: You see this? This is a stateside doctor, doing what he was born to do running liver function tests in a cushy, big-city ER.
(IRVING CLEARS THROAT) I am the very model Of a modern major-general I've information vegetable, animal and mineral I know the kings of England and I quote the fights historical I was also born to sing.
You get out on the boat this weekend? Yeah, the fish weren't biting.
You? Well, a little golf.
You know, actually, I had a question for you.
Old guy I was playing with has developed a bit of a tremor.
And it's giving him the yips.
And I prescribed the standard beta blockers but it hasn't helped.
You know, I know there's surgery, but it seems a little drastic.
Well, cracking open his head for a missed putt is a bit much, huh? Yeah, what about benzodiazepines? Last resort, he can try 'em.
But the side effects are gonna be - Aggression and cognitive impairment.
- Yeah.
I guess it just depends how desperate the guy is, though.
- Cheers.
- Cheers.
(EXHALES) Rosenthal in 5931 catheter out and discharge.
Anderson 5942 Monitor her rhythm.
Where were you and Dr.
Silva deployed? Afghanistan.
If she spikes a fever, you add IV piperacillin.
My brother was in the army, two tours in Iraq.
He came back a very different guy.
Did you see any action? I was a corpsman in the Marines.
Jude was a base surgeon.
We tried to save lives, not take them.
But mostly, we had each other's back.
Now let's move on to medicine.
We have a busy day ahead of us.
Let me know if there's anything in the marketing department (WHISPERS): Look busy.
- RENATA: the upcoding system.
- BARB: Don't forget testing.
A well-insured patient should be tested for all possible outcomes, no matter how unlikely.
Dr.
Hawkins, have you met Barb Olsen? She's our billing consultant.
Here for two weeks to help Chastain become more efficient.
(LAUGHS): Of course.
The bike shorts.
Yeah, I already saw you at my presentation well, briefly.
I got paged.
Didn't I get paged? I didn't hear anything.
Well, nice meeting you.
Barb, there's, um Payback.
For making me sit in that presentation.
What's your problem? A strong kid like you can't you go any faster? I got a life to lead.
Hey, Louisa, how's my man Rosenthal treating you? Like the daughter he never had.
A nightmare.
The Chastain softball team crushed Emory yesterday.
Yeah, we did.
(GRUNTS) Is your back still bothering you? Uh, yeah, it's no big deal.
Now I'm thinking it's a pinched nerve, lumbar spine.
Pain that, uh, radiates along the affected nerve.
That's impressive, but you're not quite a doctor yet.
Let me have a look.
Uh, maybe later.
I told Joey in Ped Onc I'd take him to the play area.
Man, that munchkin is cute.
(ELEVATOR BELL DINGS) Check back in with her in an hour.
I just want to examine her and make sure - (LOUISA GRUNTS) - (LOUD CLATTERING) ROSENTHAL: Hey! We need some help in here! - Oh, my God, I'm sorry.
- It's okay.
(GROANS) It's okay, stay still.
We got you.
I'm too young for kidney stones.
I'm thinking it's just a gas bubble.
It's really no big deal.
How long have you been short of breath? Just a few days.
I was thinking it was from the pain.
Your lungs sound congested.
We need a full workup.
This could be serious.
No, I'm okay.
I swear.
I can't be sick, they'll send me back home.
And I need every dime to make ends meet.
And a CT scan as well.
MRI's probably the better option.
Actually, maybe we should check her insurance first.
- Uh, can this wait? - No.
Can I a moment with the patient, please? We're conducting an exam here.
Dr.
Hawkins, the administration has given me license to inspect all hospital finances.
You're a subcontractor to the hospital, right? Yes.
Is this really necessary? I'm feeling better.
I just want to go home.
Rest up.
She wants to go home.
Great.
She can't.
She needs an MRI.
Do you know if your company will cover an MRI? Does anyone know that stuff? Then if it doesn't, an X-ray is more than sufficient.
Actually, it isn't.
Louisa is part of the Chastain family.
- She deserves our best care.
- Well, I can see that she's a wonderful young woman I can't do this.
(GRUNTS) I'm sorry, thank you, but I'll just leave.
It would be wise for you to let her go.
Wow.
Really? Louisa (PAINED GROAN) Easy.
Easy.
There you go.
Pulse is weak.
Distant heart sounds, distended jugular veins.
Cardiac tamponade.
Too unstable to move.
I need 18-gauge spinal needle with a 20cc syringe.
I'll prep the ultrasound in exam room four.
Good.
Go.
Louisa, you have fluid around your heart.
We're going to relieve the pressure.
You cut, I draw.
(GASPS SHALLOWLY) Quickly, we're losing her.
Ready.
Now, Louisa, you're gonna feel pressure and then stinging.
(GASPING, GROANING) (BREATHING EASIER) You're okay, Louisa.
- (BUZZING) - DEVON (ON SPEAKER): Another loud noise and we're almost done.
Don't worry, just a few more minutes.
(DOOR OPENS) Get her out of that machine.
- We're almost finished.
- She's not insured.
She can't pay for her treatment, that's why she ran away.
Or maybe she didn't want to burden the hospital.
Well, it's a little late for that, 'cause Chastain is gonna have to eat the cost of that MRI.
That's $10,000.
$10,000 is what they charge the insurance company.
It doesn't cost the hospital anything like that.
- Are you offering to pay? - (SIGHS) BARB: Here, for your intake files.
I will call her employer, see what I can negotiate.
God, I hate that woman.
You and I will run point on Louisa's care.
We need to get as much done as we can before the administration pulls the plug.
We can't let them kick her out.
Well, don't panic yet.
Worst case, we guide her to another hospital.
Where she never even makes it past ER triage.
Trust me.
(SIGHS) JUDE: LFT panel.
Hank, you have acute hepatitis.
Is that bad? It means that you've consumed so much alcohol that your liver's temporarily paralyzed.
- It's quite a feat, actually.
- Exactly how many beers did you have? - Two - Two beers? Two dozen.
If you don't cut back, your liver's gonna stop functioning.
Your stomach will swell, you're gonna become confused, then sleepy, you slip into a coma, then you die.
I'm not trying to scare you, it's just the truth.
You're drinking yourself to death.
I know.
Help me? I can get you into a rehab facility.
I can't do rehab.
I'd lose my job.
But the rest of it, yeah.
I'm ready to quit.
I am.
I've struggled with alcohol my whole life.
Look, the moment I walk out of there, I swear, I will go straight to a meeting.
I'll get a sponsor, I'll stay in AA the rest of my life.
That's easy to say, pal.
It's hard to do.
Atwood, Henry, two of Lorazepam for withdrawal.
Thank you, Doctor.
You can do whatever you want, it's not gonna help.
His problem is self-inflicted.
Hell, 90% of the patients that come in here have done stupid stuff to themselves.
Remind me how you got that scar on your thumb.
- Wasn't it field-dressing a possum? - I was nine years old.
And I treated the injury myself.
Of course you did.
It still doesn't explain why you eat possum.
JUDE: Yeah, we all didn't have moms who would shop and cook for us.
Or dads who were sober enough to drive us to the ER.
Exactly, and that's why I'm here to help whoever walks in that door who can't help themselves.
It doesn't matter whether they eat lobster or road kill.
I take care of them.
All right.
Let me ask you this.
What is the most fun you have had in the last week? My guess? You and me fixing up Hank in the back of that pickup truck.
Seat-of-our-pants medicine.
Nobody telling us what to do or making us fill out forms.
Then what happens? We come back to work, and a patient is trying to run away because she doesn't have insurance.
We can't even treat someone who's worked at Chastain for the past two years.
How many wounded Marines did you ever ask for proof of insurance? Well (SIGHS) I guess I got my work cut out for me, then, don't I? You keep tilting at windmills, huh? - Currently on any medications? - No, but I'm Have you eaten anything in the last eight hours? I'm not having surgery today.
It says here, "Reynolds, hernia surgery, 2:15.
" - I'll be assisting.
- I'm having some more tests.
- Excuse me? - A very nice lady came in and talked my doctor into ordering some more blood work.
Another CT scan and an MRI.
You don't need an MRI, you need hernia surgery.
She said I needed it to be on the safe side.
She was very convincing.
Why is my hernia patient having more tests? - He doesn't need more tests.
- Another Barb victim.
Profit before patients the new healthcare mantra.
Barb is like a migraine.
You can feel it coming, but you can't stop it.
Then it gets worse and worse, and you throw up.
What do you guys think of the name "Say Ah" for a resident-nurse a cappella group? "Say Ah"? Yeah, you know, to serenade patients.
No one wants you to sing them a song.
The meaner she is to me, the more I'm in awe of her.
Yeah, that's kind of how it works.
Wow.
You got Louisa's results? This is a T2 hyperintense, enhancing mass, encasing the spleen, kidney, and vertebral bodies.
Most consistent with A retroperitoneal sarcoma.
Which would explain the fluid in her heart.
She lied to us.
And to her employer.
She didn't run away because she doesn't have insurance, she ran away because she's an undocumented immigrant.
She has a highly aggressive tumor.
If she doesn't get surgery right away, she dies.
No more tests, no more treatment on our dime.
This hospital isn't a charity.
I felt this was important enough to bring to the CEO's office right away.
Ms.
Rodriguez is an uninsured, undocumented immigrant.
She has no family in this country.
She was brought here from El Salvador as a child.
No one can take her once she leaves the hospital.
State rules are clear on this.
Ms.
Rodriguez cannot be released into her own care.
That means Chastain would be stuck with her for a long time.
She'd be living here at our expense.
She would be a Perma Patient.
Not every CEO knows that term.
Claire is not your average CEO.
Dr.
Bell, what's her prognosis? Well, the five-to ten-year survival rate is excellent if we operate right away, but the longer we wait, the worse her odds.
And if her surgery is successful, what's the rehab? Six months to a year.
Okay, best-case scenario, what is Louisa's care gonna cost us? Chastain does the surgery, it goes well, post-op, she can walk with a physical therapist down the hall half a million dollars.
And worst case? Post-op, Ms.
Rodriguez can't even get out of the bed two million dollars.
Hang in there, your count is moving in the right direction.
Lane.
Hey, Conrad.
How are you? I'd like to call you in for an oncology consult.
Okay.
Who's the patient? Louisa Rodriquez, transport worker here at Chastain.
Good person.
She's uninsured and an undocumented immigrant.
Um, a full course of radiation and chemotherapy is, uh, very expensive.
I understand, but don't you have a foundation - for cases like this? - Yes, I do, but it's not for the undocumented.
Look, I'll make some inquiries, but I can't make any promises.
- That'd be fantastic.
- Conrad.
Administration just put Louisa's surgery - on indefinite hold.
- Lane - Louisa's all alone.
- I'll see what I can do.
I forgot to tell you I saw Lily earlier.
She didn't look good.
Nic, she has cancer.
I know we've been through this, and I'm sure Lane had every reason to discharge Lily, - but my instincts are - Lane will take care of her.
Lily's in good hands.
Okay, well, I'll be going Oh, excuse me.
Oh, Nurse Nevin.
If I could just have a moment? I'm actually really busy right now.
Okay, but I don't think the nurses are getting the hang of the upcoding system and the multiple-test vectors.
Our nurses are laser-focused on patient care.
That is their primary responsibility.
NURSE: Too late to go back to sleep - It's time to trust my instincts - Excuse me.
Close my eyes And leap It's time to try Defying gravity I think I'll try Defying gravity And you can't hold me down.
A little flat.
You're a little flat.
(MONITOR BEEPING) Next! Claire, this is Jim Phillips, CEO of Atlanta General, and Stuart Green from our Lady of Mercy.
The three of us go way back.
Ms.
Thorpe took over as CEO of Chastain, - what, six months ago? - Yes.
They're all yours.
Gentlemen, it's lovely to meet you both, and thank you for coming in on such short notice.
I'll get right to the point.
We have a patient, uninsured, undocumented, with a retroperitoneal sarcoma.
Possible six months to a year rehab.
Given our fixed costs per bed, this patient represents a considerable burden on Chastain.
As they would for Atlanta General.
Yes, but Atlanta General and Our Lady of Mercy's fixed costs are much lower than ours.
What are you suggesting, Ms.
Thorpe? If either one of you will take this patient off our hands, pre-surgery, we'll pay a fee, one-time, of $250,000.
If you can funnel us five Medicare patients and up the fee to $300,000, we'll consider it.
What if I offered you five Medicaid patients and $250,000? Medicaid reimbursements are junk.
Ten Medicaid and 300 grand.
(PEN SCRATCHING) I'm offering seven Medicaid and 275.
Too low.
We're out.
Stuart, Our Lady of Mercy has a charity fund.
What if we did the surgery and you did the rehab? We could give your fund $100,000 that you could use at your discretion.
We just built a new cardiac wing.
CLAIRE: Which is a-a beautiful wing.
Cost us $40 million.
And I am sure that you will make that back in fees in no time.
My board would kill me if we took another Perma Patient.
- I'm gonna to have to pass.
- (GRUNTS) I'm sorry.
DEVON: Who can we call, Louisa? You must have family here.
My parents brought me here when I was three years old.
My mom died two years ago, and my dad moved back to El Salvador.
I'm alone.
And you support yourself? Yeah.
I guess I was crazy to think I'd make it to med school without being found out.
If Immigration gets their hands on me, they'll send me back, no questions asked.
But this is the only country I've ever known.
And to be a doctor that's my dream.
I'm so sorry to cause all this trouble, Dr.
Pravesh.
Everyone at Chastain has been nothing but good to me.
Louisa, we're going to help you, and you deserve better than this.
I looked up the surgery on my phone.
Cancer wrapped around a lot of organs.
Pretty dangerous stuff, huh? Yes.
It is.
But we both know it is the only road to a cure.
Do you know how some people say they're not afraid of dying? That's crazy, right? It scares the hell out of me.
Louisa, you're going to be a doctor someday.
Helping you get there that's our dream.
(LOUISA EXHALES) (SNIFFLES) Hey.
I, uh, checked with my foundation, and got a fast, hard no.
Our donors expect their gifts to pay for the treatment of U.
S.
citizens.
There are plenty of deserving Americans out there waiting for a chance.
Ugh.
I hate to disappoint you, Conrad, that's the hardest part.
Thanks for trying.
You know, we do the best we can, as often as we can.
But we can't save everyone.
You're all post-surgery, and you all want to go home.
So today, we're going to have a race.
Whoever gets to the end of the hallway first gets discharged.
No more poking, needles, BP checks.
You can cook your own meals, take a warm shower.
Sound good? If you can't walk to the end of the hallway, you're here for another week.
One, two, three.
Go.
(GRUNTING) Too slow, Mrs.
Pill.
You're done.
- (SIGHS) - (GRUNTING) Mr.
Farragut, the same.
(GRUNTS) No time to treat a heart attack, Mr.
Smith, off you go.
Discharge the winners.
The losers can go back to their rooms.
NURSE: Take it easy, all right? You're gonna be fine.
- Culling the herd? - Yep.
Administration won't allow.
- Louisa's surgery.
- Unfortunate.
But I heard she is undocumented.
Rules are rules.
Am I crazy, but aren't you and me supposed to be in the trenches together on situations like this? Please, tell me this is not actually how you feel.
What I feel doesn't matter.
What I feel doesn't help.
I deal in facts.
Okay.
Fine.
Because the hospital is trying to save money, Louisa might die.
Fact.
She might die from surgery, too.
Fact.
Love the optimism.
How dangerous is it, Mina? Very intricate, very demanding.
Seven, eight hours.
But glorious.
Sounds like it's right up your alley.
(SIREN WAILING IN DISTANCE) - (EXHALES) - (KNOCKING ON WINDOW) (SIGHS) Conrad, we all feel terrible for Louisa.
She's an enormous liability.
As much as two million dollars over the course of her treatment.
Look, I get that it's a bottom-line world.
You made that clear.
But I want you to think back for a moment, - to when you were in med school.
- (LAUGHS) It wasn't all about making money.
That was a long time ago.
Healthcare has changed since then.
We need to deal with the new reality.
I think we can both agree that every doctor has that singular moment when they decide they're going into medicine.
For you, to be a surgeon.
And even if it was decades ago, I'd bet everything I got you remember it like it was yesterday.
And I don't buy for one second that it had anything to do with money.
It didn't.
I fell in love with cutting.
I fell in love with the OR.
I love it.
Still.
But the money has to come from somewhere.
If we treat Louisa, our other patients will suffer.
Services will be cut.
Hours, staff.
You know, I don't like the idea of putting a price tag on a life any more than you do.
But the system doesn't run on air.
No matter how much we love Louisa, her price tag is not two million dollars.
Don't say anything.
Nothing.
(SIGHS) Catch you at a bad time? I'd like to shove CUTE right up her Throw it in the trash.
You'll feel better.
Look at that.
Stress management.
I'm guessing you didn't come up here to talk to me about upcoding.
No.
It's about your boy, Conrad.
Look, he's taking things hard.
If he doesn't start to choose his battles, he's gonna burn out.
Yeah, well, I can't control Conrad.
Never could.
And he's not my boy.
Not anymore.
Sorry to hear that.
Alabama Shakes is playing Terminal West next week.
- Oh, yeah? - Mm-hmm.
I got an extra ticket.
I remember you saying you liked their music.
I do.
It's not a date.
- (LAUGHS SOFTLY) - Just a concert.
Have a little fun.
(RAPID BEEPING) Rapid response, 5922.
Let's go.
NIC: She's crashing.
- CONRAD: Blood pressure? - DEVON: 70/40.
- Cycling right now.
- Her IV blew in the MRI.
We haven't been able to get another line since.
- She's bleeding internally.
- Now it's 60/30.
She's a hard stick.
Her vessels are clamped down, she's too volume-depleted.
Emergency IO.
- Yeah, I've never done that before.
- Get the kit.
You're doing it now.
(DRILL WHIRRING) Push the needle in.
Once you hit the bone, drill.
(MONITORS BEEPING RAPIDLY) Keep it steady.
Drill.
Okay, release.
Flush.
NIC: Running in fluids.
We're in the clear.
- For now.
- DEVON: She'll keep bleeding until we get her to surgery.
There are four oncology surgeons on call.
Why can't we ask one of them to do the operation? Good idea.
Let's practice that.
I'll be Dr.
Hillis.
Go ahead, pitch me the surgery.
Hi, Dr.
Hillis, I need a surgical oncologist to operate on a patient right away.
- Okay, sure, who's the patient? - Louisa Rodriguez.
(GRUNTS) Actually, I forgot.
I'm booked solid today.
Ask Dr.
Miller.
Dr.
Miller, I need an oncology surgeon Would love to, but I'm headed to Aruba today with my fiancée.
Dr.
Singh says the failure rate for this surgery is through the roof.
Dr.
Weiss heard the administration is dead set against it - The administration is wrong.
- Maybe they are, but Dr.
Weiss makes 400K a year, really wants to keep his job.
Okay.
They're gonna wiggle their way out of it any way they can.
But we know someone dying to do the operation.
CONRAD: But it's not in your specialty.
So? I'm arrogant enough to believe I can do it.
And I'm your only option.
Just get an attending to sign off.
CONRAD: I need you to sign off on a surgery.
It's not in your specialty.
You'll just be supervising.
Yeah, and what's the catch? No catch.
Look, I know you, pal.
What rules am I gonna break? Not breaking.
Bending.
Bending, okay.
- Who's the patient? - Louisa Rodriguez.
Oh, I'm in.
Surgery's a go.
Mina's on deck.
Conrad, someone called Immigration.
They're coming for Louisa.
How can I help you, gentlemen? - Sir, you need to move aside.
- CONRAD: I will, if you tell me what's going on.
DEVON: Hospitals are sensitive areas, along with schools and churches.
And sensitive areas cannot be accessed by immigration officials without arrest warrants or under investigation of an imminent national security threat.
ICE policy letter, October 24, 2011.
You're interfering with the actions of authorized federal agents.
- You're gonna regret this.
- I doubt that.
Well then, you better drag us both out of here.
Conrad.
CLAIRE: Stop.
Step aside or you will both be fired.
It's okay.
Let them pass.
Daylight dims into grim The pressure higher than the tallest steeple We need to hurry.
For my sins your caved in The house of glass I filled with empty people It was a black and stormy night Dr.
Okafor, you may proceed.
The kind that's always pulling you in Pulling you in again NIC: Surgery's underway.
Sterile environment.
You cannot enter under any circumstance.
No one can.
The kind that's always pulling you in Pulling you in again.
Pushing us to charge more, and order endless tests.
Yeah, Dr.
Pravesh wants the feeding tube out for 4710.
Barb called Immigration.
I'm sure of it.
MRI order from Dr.
Williams.
Wait.
Give that back to me.
- Is this scheduled for right now? - Mm-hmm.
- Pull him out.
- What are you doing? Did you push his doctor to order this test? - I did.
- Without checking the patient history? Open the microphone.
Mr.
Reynolds, do you know how an MRI works? It has incredibly powerful magnets.
Magnets that will rip anything metal out of your body.
Anything at all.
Do you have anything metal in your body, Mr.
Reynolds? Mr.
Reynolds has a penile implant, a metal-based penile implant.
How much is your penis worth to you, Mr.
Reynolds? Say, in a lawsuit? A million dollars? Five million dollars? Stop the machine! You are not a doctor and you are not a nurse.
Not every test is safe.
Not every procedure should be billed for ten times what it's worth.
You're gonna end up getting someone killed.
- Now wait just a second - I'll be filing an incident report with the Comptroller's office and the CEO.
Good luck getting hired at Chastain again.
DEVON: Louisa.
Do you have any nausea? No.
I feel okay.
You've been so kind to me, all of you.
I'll never be able to repay you for this.
But I'll still need some help on my bio midterm.
Anytime.
JUDE: So the operation came off without a hitch.
You had a spectacular surgeon.
Cake.
What are her rehab markers? Well, if she can walk to the door, we're in the clear.
If not Hey.
Well, you look good.
You know, it's really important that we get you up on your feet right away.
So how about you get out of bed and show us how you can walk to the door? - Okay.
- Let's really concentrate.
Here we go.
(GRUNTS) I'm so sorry.
(WHISPERING): Two million.
It's okay.
You'll be fine.
Louisa, rehab is gonna be a long, hard road, but we all know how tough you are.
NIC: You'll get through this.
DEVON: With some time and care, you'll be right back where you were in a year or so.
We've got your back the whole way.
(ELEVATOR BELL DINGS) Hey, Art.
Randolph.
(EXHALES LOUDLY) Hey, uh, how's your golfing buddy doing? The one with the tremor? He sink any more putts? Oh, uh He just started taking the medication.
- Probably too soon to tell.
- Okay.
Well, keep me updated.
Yeah.
Yeah.
Will do.
Jude and I are gonna go grab a beer.
You want to join? DEVON: She's a lot cuter than either of you guys.
True enough.
Enjoying your victory, Dr.
Hawkins? Did you call Immigration? You had your billing consultant do it for you.
Barb Olsen's contract with this hospital has been suspended.
But I have to pull two million dollars out of thin air.
- I understand - No.
You will understand full well when I take that money out of the Internal Medicine and ER budgets.
Be prepared to be woefully understaffed for the next 12 months.
By the way, thank you for today.
- Yeah.
- (CHUCKLES) Thorpe could've had you canned on the spot.
Well, I get fired, it makes the decision for me, right? I show up tomorrow at Fort Benning, 6:00 a.
m.
Hell, you could be there with me.
Hmm? All right, so you're starting to come around.
What are you so damn happy about? Because I know exactly where I'm supposed to be tomorrow, and it's at Chastain.
Yeah.
Valor, honor Victory.
Mm.
I got these.
So, you know, I've been meaning to ask, you and Nic that still a thing? (SIGHS) She doesn't think so, but I think she's worth fighting for.
Don't you? Oh, hell yeah.
Game on.
(LAUGHS) You gave me scars Beautiful scars On my back and all You see how far I come You gave me scars, beautiful scars PARAMEDIC: 28-year-old female.
Cancer patient.
Short of breath and vomiting.
BP's dropping.
Volts and a liter of saline right now (PARAMEDIC CHATTER CONTINUES INDISTINCTLY)