Boston Med (2010) s01e04 Episode Script
Episode 4
Previously on Boston med.
Are you asking me out? I was gonna get down on one knee.
You would think work would be a great place to meet somebody, but you know what? There's no mcdreamys or mcsteamys.
You take some people out of this environment, and then they're not so cute.
What does that mean? boston--home to three of America's greatest hospitals-- mass general, the brigham and children's.
These are the stories of the men and women who work in them.
I've never seen a guy piss off more nurses than you on rounds.
Are you in love? I like her.
Code blue, e.
D.
Code team.
Can anyone feel a pulse? I got nothing.
whoa! Mass general, I have paramedic 47 coming in with the female driver of a motor vehicle, unconscious and entrapped.
E.
T.
A.
Ten.
Proceed to acute when you get here.
Mass general, clear.
Speed unknown.
Lost consciousness twice at the scene.
She's got a large laceration going down her head.
Chest is okay? What's that? Is that a bruise? She's got the bruising and then she's got pretty good, breath sounds, but I-- okay, quick chest and then--and then C.
T.
nose.
So we'll get everything scanned from head to toe-- brain, chest, abdomen-- and we'll see.
Go from there.
I don't find being upset or showing emotion or being angry about something and expressing that-- I don't-- I don't find that terrible.
That's good enough for the moment.
It'll need to be redone.
If it's in the name of helping a patient, getting dirty is no problem.
So far, I'm, uh-- nothing.
Wait.
Let me get the trauma head.
Very good news for her.
Nothing in the brain.
Is that propofol running? No.
Good.
No, she--I got fentanyl and versed.
She doesn't need versed, though, either.
Okay.
She didn't get any versed, right? She didn't get anything.
Good.
Thank you.
No, she didn't get anything.
Good.
Good.
I just have it in case.
Uh, the one with the scalp laceration? Yeah.
Her pressure had dropped down a bit, like, within the last hour, but now it's back up.
Propofol.
She's on propofol.
Uh, actually-- She's on morphine and versed.
Uh, she's on, actually, propofol-- if she's on versed, I am gonna be so Pissed, because I specifically said, "no benzos in that patient.
" If you give somebody a really strong medication like versed, you're going to prolong the period of time that they have to have a breathing tube in place.
We gave--we snowed her to sew a lac? Come on, guys.
You know what? It was a lac.
It was--her pressures were 50 at that time.
Holy .
You give them a medication that really tends to hang out for a long period of time, it's gonna mess around with their ability to be extubated.
Why did she get versed? Not me.
In the scanner.
Why? Why did she get versed? I was very specific.
This woman has no injury.
She's got no brain injury.
She doesn't need to be intubated.
Here's my problem--we have a patient who got intubated, probably didn't need to, 'cause she has no head injury, and now we've given her a benzo, so we're not gonna be able to extubate her.
So now we've just extended the period of time and made her more vulnerable to pneumonia.
I get so feisty about benzos.
I do.
I wasn't yelling, was I? Oh, yeah.
Yeah, you were.
No, it was-- it was perfect.
Then at one point, you actually grabbed your face, and I thought you were gonna rip it off.
? So there's a rule in the hospital that before you go into any patient's room, and when you walk out of a patient's room, you always have to use purell on your hands.
I'm big into the rules, so always wash your hands.
You can just-- you can relax right now.
This month, I'm in the emergency department.
I-I really like the change of pace.
Just a different scene.
Uh, I think variety's good.
Whoo-whoo-whoo.
A 49-year-old gentleman with a long history of alcohol and heroin abuse, and he was found lying down on the street earlier today.
And, uh, now he's just a little bit too high.
Ooh-ooh-ooh! What are you guys laughing about? I don't think if someone's having a manic episode, you want to be laughing.
That guy was pretty entertaining, I have to admit.
You seem extremely happy at the moment.
Oh, yeah.
You're bouncing up and down, and you're, you know Yeah, now.
I'm bouncing.
Making a lot of noise.
But I'm--I'm okay.
Okay.
all right.
Did anybody ever talk to you about the-- about the possibility of you having bipolar disorder? Bipolar disorder? Yeah.
Damn.
No? Talk to me now, doctor, because I don't know.
No? What is that? Well, bipolar disorder is when, sometimes you feel very depressed and other times, you feel very, uh, very happy, very excited.
Sometime-- well, a lot of times-- a lot of times? Yeah.
Can we give you a sandwich? Are you hungry? Yes! Yeah? Yes, I am.
Okay.
All right.
I need some food.
Bring me a lot of food, doctor.
You know, he's either manic or he's psychotic.
Um, a very happy.
Uh, he's certainly not suicidal or homicidal.
I-I mean, so that's all good stuff.
Uh-huh.
Medicine, you know, really saved my brother's life.
My brother, growing up, had hodgkin's disease, and had to go through nine months of chemo and three months of radiation treatments.
That's a sandwich? I'm-a eat it all.
Mmm.
I am very hungry.
I love America.
This is the land of the honey.
The rule is, you always purell every patient, but maybe him, I gave a couple of extra pumps on the purell station.
? Just got a page for a 39-year-old woman who is 27 weeks pregnant and was shot in the left chest.
In order to protect the baby, protect her as well, optimize her care, and then we'll be able to optimize the care of the baby.
Excuse me.
Excuse me.
And if she is dying, then we may have to make the decision to take the baby.
Going in.
We'll just have to see what she looks like.
This is a 39-year-old female, gunshot wound to the right upper arm through and through and right chest.
Everybody not running the trauma, get out.
Obvious entry wound with large hematoma of the right chest.
Can we please get a chest tube in on the right? All right.
How you guys doing on the left? Chest tube on the left? We got a problem, guys.
There's blood in the left chest.
There's blood in the left chest.
Let's get a stat chest X-ray, and then we need to go to the O.
R.
Let us know when you want us to look at the baby.
I don't care about the fast to the baby.
I want to know about the chest right now, okay? When you see a pregnant woman, people tend to start to get confused about the priorities, because if mom goes bad because you didn't do something, then you've done the baby no service.
No, no, no more lines.
No more lines.
I'm trying to make a decision-- we're going to the O.
R.
Or we're going to the scanner.
What's coming outta that chest? Let me take a quick look at the X-ray.
I have to see a chest X-ray.
If there's a chest full of blood, I'm not gonna waste time at cat scan.
She'll bleed to death.
We'll just need to go find the hole and fix the hole now.
There you are.
Not good, and she's got a left chest that's got a bunch of blood in it.
We need to find that bleed now.
We've got to get her to the O.
R.
right now.
? Those are aviators.
Yeah, I know, but I don't like 'em.
Oh, jeez.
Those are beastly.
It's like Tom cruise.
When I was 4, I was diagnosed with hypertrophic cardiomyopathy.
It's pretty much when the septum of the heart is, like, enlarged, so it's harder for the heart to function and pump blood.
Ooh, those are intense.
I need a heart transplant.
I don't care for the waiting, but I'm willing to wait, because after, it's gonna be worth it.
I don't even think I'm allowed to go to the junior prom Oh, really? Why? Since I'm not in school.
Oh, that's true.
Granted, they'd probably, like, jump through hoops for me, but Aww.
You know what? That's okay.
I'm not--I'm probably not going to junior prom either.
I think Sara is an incredible, incredible kid with an amazing amount of strength and determination.
And I-I think that's gonna only help her through this process.
here's my room.
Those are all, like, college application letters and stuff.
That whole, like, stack was just when I was in the hospital.
A lot of people ask if I think about it every day-- "oh, is a heart gonna come today? Is it gonna come today?" It's not really like that.
That is one of my favorite people on earth right there-- Andrew mcmahon.
He's a singer and a pianist.
He actually had leukemia.
One of his lyrics was, "it's good to be alive.
" So it's more, like, inspirational stuff rather than, like, "woe is me.
I can't, like, live and deal with this problem.
" all right, let's take a quick listen.
I keep making her do all of her p.
T.
I make her do her-- I collapsed on the hallway floor.
You collapsed on the hallway floor 'cause your muscles were so tired or 'cause you were sick of-- no, 'cause I was out of breath.
You were out of breath.
It would be okay to stop right before collapsing.
You ready? Yep.
Sara's gotten sicker and sicker over the last six months.
I worry that if we don't find her heart soon, that she'll die.
Little more.
Little bit more.
? ? Listen up, everybody.
She is diabetic, she is allergic to penicillin.
We don't see pregnant women who are that severely injured all that often--a couple times a year, perhaps.
Do you want us to put the monitor on the baby, and then you'll prep over it? No, you can't have the belly.
You don't want to monitor the baby through the surgery? No.
The baby's heart rate was 130.
That's not terrible.
The best way to save the baby is save mom.
I-I just--I can't see the bullet on a chest X-ray, so I don't know where it went.
Did it go through the pericardium to the heart? Does she have a heart injury? You know, we need to find out what's bleeding.
Incision.
We're starting.
Someone in the room, please turn on the other circular light.
I know you guys don't know.
Just find the switch somewhere.
So you--you guys know what we're dealing with right now? Right now we know we got two holes in the heart.
And the bullet must be back here somewhere, right? This--it's right-- this is what's bleeding.
All right, see this end here? This is making me nervous that it's bleeding.
So put a stitch in that thing.
Start with that, please.
Very few circumstances require you to think and think as clearly and methodically-- on the run, on the fly, with limited information-- as does trauma surgery.
She's lucky.
That bullet grazed the heart.
It could have just as easily passed through the heart, penetrating the heart, and she would've bled to death.
Both she and the baby would've died within seconds.
They found the bullet? Really? Oh, I feel so much better knowing where it is.
Okay, take it out.
Okay.
Actually, can we call security, please? And, uh, do we have an evidence bag? So, uh, do you have a metal tray? Ready? Okay.
This could've been much worse.
I mean, she's far from out of the woods.
You know, just get the mom well, and you get the baby well.
The drama in medicine is that you do the best you can for every patient, but you never know what the outcome will be.
I mean, look at the dumas family.
Look at the challenges that family is facing.
Sara tried pushing herself a little bit too hard probably about a month and a half ago at school.
Like, I don't think anyone else has ever felt That kind of chest pain.
And it's just excruciating.
After transplant, like, I'm not a very athletic person, but it'll be, like, I want to try to run a mile Understatement of the day.
You know? "I'm not a very athletic person"? Yeah.
Understatement of the day.
My brother also has hypertrophic cardiomyopathy.
He's actually gonna begin the transplant process probably within the next year.
Next year, you should run a marathon.
That'd be so funny to watch.
I think I'll do What did I do when I found out I was gonna get a transplant? I can't even remember when you did find out? How did I react? I don't remember.
I personally was having An internal freak-out session.
When they were talking about transplant for both of them, I was not It--it wasn't even in the realm of possibility in my mind.
Yeah, it wasn't for me either.
But afterwards, I guess I, like, figured out, "oh, this is kind of the only option for me," you know? And, you know, I'll have, like, a life after this, and it'll be, like, completely different.
The transplanted heart could last 20 years, maybe longer.
If we can keep her alive the trand healthyheart to take advantage of some of the new scientific discoveries 20 years from now, this would be a bridge to something new, and maybe she can have a long and normal life.
You never know what's gonna happen in the emergency department.
Every day's a little different.
Aah! Hi.
Did she say You never know what's coming at you, and you just sort of roll with-- with whatever happens.
Good night, guys.
? come on.
Let's go wait for papa.
Come on, mama.
When their dad let's them know that he's on his way home, then they love to-- to stake it out.
They get excited to see him if he hasn't been home for awhile.
Come on, mama.
Papa! Mommy, come on! Are you getting on? I wanna ride.
You steering? Yeah.
Okay.
Nikko and I have been cooking like this for a long time, right, nik? And before that, Ella.
To be able to deal with these horrible things that you know are sending patients and families reeling, and reeling for years, perhaps, and then to be able, in some way, to set that aside and go home and--and, you know, have a picnic with the kids-- it's--it's--there's-- there's a disconnect there that oftentimes feels surreal, like He picked a lot of intense things in his life.
He picked a high-maintenance job, a high-maintenance wife, and then a family that he really wants to be very involved with.
So he keeps-- he's amazing at keeping a lot of balls in the air, but they're all bowling balls.
All right, new recipe.
Everybody taste it.
Oh! Oh! Spicy, spicy, spicy.
How is it? Good.
? When we were driving in, I was thinking, I can either be really freaked out and waste my time being freaked out or I can be calm.
Yeah! So I'm choosing the second option.
Hi.
Can I help you? Um, my daughter is here.
They have a heart for her.
You can go right on up.
Transplantation often occurs in the middle of the night for various different reasons.
Hi, Sara.
How you doing? I'm good.
Yeah? Tired.
Tired? Yeah, and starving.
We've all been quite concerned about Sara, 'cause the risk of sudden death is quite high in patients who have her condition.
The surgery has different components.
If you don't want me to go into the details, Sara, you tell me.
No, she wants to hear the details.
No, I like the details.
You do? You like to hear the details? Okay.
Yeah.
We'll go on the, uh, heart-lung machine, uh, and then we'll take out the old heart.
And then when the new heart gets there, we'll start that, uh, reimplantation process.
The moment of truth is when we take the clamp off and reperfuse the heart.
Mm-hmm.
Um-- to see if it starts beating on its own? Uh, not to see if it starts beating, but anticipating that it will start beating, yes, absolutely.
That it will start beating? Okay.
The surgical team just left to go harvest the heart, and in reality, we won't know if it's any good for Sara till they actually get there and get a chance to examine it.
To see previous episodes of "boston med," go to ? We just got a 90-year-old guy that came in that fell on the escalator at the mall and hit his head.
I'm Amanda, one of the nurses.
There's gonna be lots going on right now, okay? Behind every diagnosis is a patient.
I always try to put myself in their shoes.
Like, if this was my grandmother, what would I want them to do for her, and how would I want the nurse to act? So, sir, you were going up an escalator and you fell.
That was pretty dumb.
Well, I don't know that it was your fault.
Sir, I'm gonna put an I.
V.
In your arm over here, okay? You're gonna feel a poke.
One, two, three.
My parents got divorced when I was, like, 9 years old.
I didn't have anybody there to kinda say, "do your homework, get your homework done, you need to study for this test," or anything like that.
I don't know.
I just did it.
Maybe because I kinda had to take care of myself a lot growing up is why I went into this profession, to help take care of other people.
I think your girlfriend's here.
My name's Amanda.
I'm his nurse.
He has a good sense of humor, but I don't think you're gonna see it right now.
You gave me a big scare.
Well, you went down with a bang, dear.
Did I break the escalator? No, it broke you.
I think it's so sweet-- little old people in love.
I hope that I can be that lucky someday.
Rob's a nice guy, but it didn't end up going anywhere.
Your ring is beautiful.
When is your wedding shower? I don't know.
That's what we're talking about.
Oh, right, you wouldn't know.
It's a surprise.
My wedding shower's gonna have to be, like, handicap accessible 'cause I'm probably not gonna get married till I'm like 90.
? It's 5:30, and they're giving me the, uh, go-ahead to sign out.
Whenever, just sign out, seriously.
See ya later.
Yeah, nice to meet you.
Thanks.
You, too.
This is pretty sweet.
It's before 6:00 P.
M.
, and I'm getting to go home.
? Oh, man.
Third quarter, we're up, uh, 5 points.
Not bad, not bad.
We need to do this all the time, man.
We do do it all the time.
Bardouche--uh, Andrew-- he's definitely my best friend in our intern class, someone who I'll be friends with my whole life.
The two of us are very outgoing people and like to certainly have fun.
You know, I'm big into nicknames.
So my name is Andrew elbardissi.
Bardouche, uh, you know, it evolved like--like-- removing the "el" from the bardissi, removing the "dissi" from the bardissi, and just combining "bar" and "douche.
" You know, he, uh, just has this sort of essence about him.
A lot of people, uh, started Started calling him, uh, a douche or a douche bag for some reason.
And I love it, honestly.
I mean, I-- you know, nurses-- nurses will page doctor-- Dr.
bardouche, Dr.
elbardouche.
People really think that's his name.
I convinced him it was a compliment, so he agreed to take on the name bardouche.
The amount of drama that occurs in those four towers An intern who slept with a fellow.
We have a fellow who's sleeping with a physician assistant.
It's crazy.
I'm not going into some of the other things, 'cause then it gets personal.
Should we head out? I think we should go.
Let's do it.
? Ah, give me a hug.
I love you.
I'm gonna watch "Goblet of fire.
" Harry Potter? Hello.
We are taking off in a few minutes.
And there's a question whether or not the O.
R.
time over there is gonna be delayed.
When you have a better sense for the timing, why don't you give me another call? This particular donor for Sara's transplant, there are many teams coming from all over the United States, and so there are inherently gonna be unexpected delays.
Here, this is.
Wait, wait, wait.
Let's play.
Let's play.
Ready? Rock, paper, scissors Oh! Ian and Sara, the whole way up here And talking, talking, talking, talking really super, super fast.
Hey.
Hey, how you doing? They're waiting for us to tell them that the heart looks good so they can just take the-- take the recipient to the O.
R.
Back in Boston.
All right.
Not a bad crowd tonight, so we'll see what happens.
I agree with that.
I am single, I don't have a family.
I probably like to go out more than most of the people in our residency program.
So payal is at the liberty once again Yes.
Looking very beautiful.
Thank you, Rick.
You're a good wingman, I'll tell you that.
I tried to set her up with prashant.
It sounds like it didn't go so well, though.
I mean, I just don't know him.
Okay.
I talked to him like ten minutes.
But you guys are both Indian.
You should be able to get along.
Yeah, so just automatically, right? Stop.
No, no, no.
I think that's absolutely appropriate.
So Indian people automatically get along with other Indian people? Yeah, that's what-- unequivocally, yes, Indian people-- and they should only date other Indian people? I'm egyptian, and I think that it wouldn't be bad if only egyptians dated egyptians.
Bardouche, I totally disagree with you.
Oh, my gosh.
So--so I just want to clarify I think it's absolutely true.
You're only gonna date someone that's your race, right? No, no, no.
I think the probability of me actually having a successful relationship with someone of my race is much higher than me having a successful relationship of--let's say with you or Or him.
Richard, if he were to be a female.
? You know, I'm pretty happy right now as is.
I can work late and not have to worry about coming home and I can go out whenever I want to.
However, I-I don't want to wake up and be 40 or 50 and, you know, not have a family.
? Hello.
Okay.
Um, I-I-I mean, I would say that this--this type of delay is--is--is--is Is now, um, close to being unacceptable.
My concern, obviously, is you've been in there for over three hours, three and a half hours now with both the chest and the belly open.
Each half-hour that you're in there, you know, there's risk of losing the donor organ, so We can't wait indefinitely.
? to learn more about congenital heart disease, go to ? You guys gonna go check out the baby? Yeah, we'll check the baby now.
Good.
Our shot pregnant woman appears to be stable now.
The bullet took out one of the arteries that supplies the muscle of the heart itself.
So we'll get an ultrasound at this point in time and see how it looks.
It looks like it might be outside.
She's got some abnormality in the atrium adjacent to the area that was injured.
The bullet was intact, so I don't think it's a fragment.
But she could have a clot in there.
I'm just trying to guess what-- 'cause it looks like it e-- you know, it almost looks like it has a brighter tip.
We don't know what this is.
Is this some blood clot? Is this a bullet fragment, uh, that we missed? I need a cardiologist here now.
Hi, this is mindy.
I can't find a fellow to come, um, up and take a look at this echo.
I'm trying to figure out why they're giving her a hard time about coming down and taking care of this thing.
All right, so I'll do a focused study then.
The guy could've been down here and back in the time it takes to argue why you shouldn't come down here.
If no one's able to come down, then I'll just bring the pictures back up.
Goddamn it.
No one's available to come down right now.
One of the fellow's is out.
So what's the turnaround time on this? As soon as I--as soon as I take the images, I go up.
Where do you--where is up? Do you want to take it off or leave it on the monitor? Going down.
Um, second floor.
So no one can walk up two floors? Who's the attending? Hi.
Oops.
These folks get into their little worlds, you know, and they just read images and they forget that there's a patient on the other end.
It's like, okay, here's someone who you can't sit and wait for the image report.
So get your ass down here and look at the patient and do what needs to be done.
You know, it's not that hard.
What we've got going, basically, is, um, some type of echogenic structure.
This is not gonna be an artifact.
It looks like it's in the tissue, not-- because it-- not in the lumen.
Ultimately, this wonderful cardiologist came down, interpreted the images, said this was not a bullet fragment.
She sees this routinely on valve repairs of the heart, and the heart would heal on its own.
? Just swallow that.
Swallow it? No, it's a swallow.
Yep.
Stop.
How was it? Oh Pretty bad.
Yeah, that face says it all.
It has, like, a tingle to it.
My colleagues just called.
They are headed back with the organ now.
Everything went well.
Hey, uh, this is Francis.
We can probably start, um, you know, work on getting her down to the operating room.
Keep your hands inside, okay, Sara? She's got quite a bit of family up there.
It's gonna take you at least half an hour to get her down there.
I think she's ready.
I think she's more ready than I am.
Bye! I love you.
Bye! Love you.
Bye.
See you on the other side.
Bye.
Bye.
Bye-bye.
Love you.
Bye.
Bye, sweetheart.
Bye.
We'll see you in a while.
Any other byes, I say them.
Bye, Sara.
Good luck.
? we're going on a cruise.
Now I've recrui-recruited one more for the girls' cruise.
Let me see this.
Um, oh, my God.
I'm so excited.
Me, too.
You don't even know.
Yay! I haven't been on vacation without my children, ever.
You're lying.
No, I'm not.
It should be fun.
It's hot.
Final out.
It's fun to hang out with friends at work, but it's even more fun when it's unsupervised.
It's party time.
? this is my very first cruise, so I wasn't expecting the electric slide right off the bat.
I thought we'd be able to, like, ease into it a little bit, but they're, like, going all out right off the bat.
? I need another one, too.
I'm not giving her one.
Be generous.
I love it! Do, like, a Marilyn Monroe thing.
All right.
Oh, there we go.
Cin-cin.
Good stuff.
I know.
Cheers.
So-and-so is shampooing their hair.
Yeah.
So-and-so is going to the bank.
Damn facebook.
Facebook brings back a lot of people you don't need to be seeing again.
My friend is friends with my ex-boyfriend on facebook.
And I, uh Made her go sign on, and I went on his account and saw all kinds of pictures with him and his new girlfriend.
Yeah.
It's like a kick in the gut.
Owie.
Yeah, and-- this was a very long-term, right? Six years.
Six years.
Mm-hmm.
We met when I was 20 years old.
So I just saw my other single girlfriends going out and having fun and thought I was missing out, but really, I wasn't missing out on anything.
Mnh-mnh.
Grass is always greener on the other side.
Right.
Like I love being married and I love my husband, but I miss the the drop of the hat, you know? Do whatever the heck you want to do.
Boom.
Go.
See, I hate having, like, random losers hit on you.
And the last time we went out, I got told by two different guys that I have big shoulders and big hips, in one night.
Nice.
That's the equivalent of saying, you have the biggest beer gut or man boobs I have ever seen in my entire life.
Mm-hmm.
That's not okay to say.
And why did they feel they needed to tell you this exactly? He wanted to dance with me.
I was like, "no, I'm all set.
You know, I'm here hanging out with my friends, whatever.
" And he got mad and he said, "well, it's fine, 'cause you have big hips anyway.
" And I said, "well, that's fine, because you probably have a small penis anyway.
" What a jackass.
Yeah.
Exactly.
walking back in here, it's like a punch in the face.
All the smells and sounds come right back to you.
We're about ten minutes out.
He does have major oral trauma and a large laceration through the chin.
Back in the trenches.
The party is over.
? breathe in.
This is Sara dumas for a heart transplant.
Absolutely, Sara.
Whenever your kids are sick, as a parent, you want to fix them.
And when you can't fix them, you feel as though you're-- you're helpless.
We're gonna go ahead and, uh, get her chest all opened up.
As soon as the harvesting team lands at the airport, we'll go on the heart-lung machine.
Once they arrive in the hospital, we'll cut out her old heart and we'll be ready to, uh, implant the new one.
So this is like, uh, little bit like being a cook.
You're sort of setting the table, and when the heart gets here, it's like making the meal.
Hi, Victor.
Hey, guys.
How you doing? Welcome.
This is yours.
So we're getting ready to cut out the old heart.
Richard, this is the central line.
Here you go.
The old heart is clearly very sick, very stiff.
Watch.
It's still beating.
Look, you can make the heart beat.
Are you ready for the heart? Yes, sir.
That looks great.
Okay.
Okay.
? my son, he's seeing everything that's happening, and he's gonna be put on the transplant list.
So he knows that all of this is coming his way.
I'm glad I'm going second so that I know sort of what it's gonna be like.
Scissors, please.
You can see that the heart's starting to beat.
You can see the e.
K.
G.
So that's always a reassuring moment.
Before we close the chest, we want to be sure that everything is dry.
Goddamn it.
Linda, uh, we got some bleeding from the back of the heart, which is impossible to repair without going back on bypass.
We're just going back on the heart machine to fix the bleeding site.
It's been, what, six hours? I'm anxious about getting information, because it's difficult when I don't know what's happening.
Rotate the table back towards me, Mike, please.
Teenagers like Sara are very resilient.
It's very hard to deal with bleeding from the back of the heart.
But we got it fixed, so it's good as new.
Okay, great.
We're all done.
Okay.
We're gonna close the chest, and, uh, and then I'll go out and talk to the folks.
I would imagine the family is, uh, pretty anxious.
I'm sure they're exhausted.
I-I'm not sure what they know.
Hi, guys.
Hi.
Hi.
You have a seat? So we're, uh, we're all done.
She's doing okay.
We got her old heart explanted, and that went fine.
Got the new heart in, and that seems to be working just fine for her.
We came off bypass and had some bleeding behind, uh, the heart, so I decided to just go back on briefly.
Went back on and stopped the heart for, you know, ten minutes and were able to get the bleeding controlled.
All right? So I'll be right back with you, okay? Thank you very much.
Thank you.
All right.
Good.
It's my pleasure.
Sure.
All right.
Thanks so much.
Sure.
This is terrible.
Why is he gonna come back in a minute? I don't know.
He just got a call.
He's gonna go check something out I know.
And then he's gonna come back.
My point Getting paged, uh, back to the O.
R.
after you've closed is never a good thing.
Perhaps she's bleeding again.
? it's, uh, 11 days after Patricia Baker was, uh, shot in the heart.
She's now 28 weeks pregnant, and we'll see how mom and baby are doing.
I remember everything that happened up until the point where I told my neighbor that I was shot.
I fell in the hallway, and no one knew that I had been shot but me.
Watching a movie on DVD and, uh, that's how it all started, 2:00 A.
M.
and the wrong people came over.
When he saw the kid with the gun, he shut the door to the living room And he shot through the door, and Patricia happened to be right there, 10 feet away.
So all I could think about was, get the baby out so that they baby can live.
I still shut my eyes at night and think about it, you know? I thought it was over.
I'm, like, I just lost a child and--and--and a good girl, you know? Oh, my.
This is my oldest daughter when she was probably about 17, Amanda when she was about 10, Samantha when she was 2.
Hello.
Ms.
Baker? It's Jeff ustin.
Hi.
You look like a new person.
Every day seems a little bit better.
Have the obstetricians been by or did they Yes, they come by once a day to ultrasound the baby.
Okay, and they said everything's okay? Yes, the baby's great.
I mean, you could see that it was a boy, you know? Good.
And, um, they're like, "wow.
He's well-endowed.
" I was like, "oh, my God.
" Well, good.
All right.
Glad to see you're doing well.
All right.
Just grateful to be alive.
Okay.
All right.
All right? She's doing well.
That's-- yeah, I mean, that's very rewarding, you know? It's huge.
Huge, huge, huge.
? Sara's really put us through a roller coaster today.
Uh, I don't know if she's bleeding or why she's so unstable, but we-- I need to get back in there and take a look.
What's going on? She got really hypotensive.
It was just so dramatic.
It went straight down to like 45 or so.
There's been too many swings in her blood pressure.
I'm--I'm not gonna be able to handle this really too much longer, so somebody better say something.
Keep having these unexplained swings in blood pressure, prep her, she goes to 150, and then she's down to the 40s.
Think now we gotta get her up to the I.
C.
U.
So she can be closely monitored.
I'm not sure there's anything else for us to do down here in the operating room.
She has these profound spikes in blood pressure.
We've seen this with a couple of transplant patients I know.
I-- but I don't recall it being this acute after transplant.
That is pretty--pretty strange that she-- she has these swings in blood pressure.
Hi.
So I wanted to give you another update.
She's fine.
She's stable.
But she, um, you know, she's exhibiting these kind of swings in blood pressure.
Blood pressure gets pretty high, then it gets low, then she's stable for a while.
So we'll just have to see how the next 12 to 24 hours go.
For a moment there, Sara gave us a-a real scare.
Uh, but, uh, as I expected from Sara, she made a remarkable recovery.
And, uh, I'm very pleased overall with how she's done, and I think she's gonna go on and do very well.
How you doing, Sara? Good.
Up and around, you know? Up and around? Good.
And outta here tomorrow.
Perfect.
Yeah.
You excited about getting-- getting out tomorrow? Oh, yeah.
You tried to slow me down a little bit there Yeah, she did.
Yeah.
Early on at the beginning, but I think we caught up.
Yep.
You did great.
Oh-ho! She looks fantastic.
She's back to being the old Sara.
It's really just Very gratifying.
It'll be interesting Again.
To be able to, like, go up stairs or run or swim or anything, really, without being out of breath.
That's why I wrote what I wrote on the window.
"It's good to be alive"-- backwards, so you can read it from outside, I hope.
The birdie looked like this.
Oh.
Aah! Back again.
Aah! Listen, would you stop startling me? Done! You can see the eyes.
This is the cheek and the chin.
I'm just so glad he's safe.
it's amazing, the turnaround that's happened.
I feel like I'm exactly where I'm supposed to be.
Life is really good right now.
When I went on the cruise, I never thought that I would be talking again to my ex-boyfriend, and now we're engaged and planning our wedding.
So it's exciting times.
Now I have the house and the guy, and, um Babies will be A few more years before that happens.
Jay's home.
Hi.
Hey.
There's no other person I want to be with.
She's my best friend.
She always has been.
She always will be.
It's been eight months since we reunited.
And it feels so good.
Engaged.
We're engaged.
You ready? oh! Strike.
before the transplant, I could never have done this.
next on An 8 year old with some kind of cardiac arrest.
You just make sure she's got a good pulse.
Her heart goes crazy.
I have a 5-year-old son, and I can't imagine how it must feel.
She's in v-tach.
Clear.
They can't get a baby out.
This is stat.
I know it's scary.
Aah! Come on.
Can I have an available o.
B.
? I would not want to date me right now.
Rachel's the one that I want to marry.
I may not be the marrying kind.
Jeff should definitely dump me.
If this guy dies 'cause his insurance company wouldn't approve a visit We don't have anything else to offer.
If it were your wife laying in that bed, you would stop treatment?
Are you asking me out? I was gonna get down on one knee.
You would think work would be a great place to meet somebody, but you know what? There's no mcdreamys or mcsteamys.
You take some people out of this environment, and then they're not so cute.
What does that mean? boston--home to three of America's greatest hospitals-- mass general, the brigham and children's.
These are the stories of the men and women who work in them.
I've never seen a guy piss off more nurses than you on rounds.
Are you in love? I like her.
Code blue, e.
D.
Code team.
Can anyone feel a pulse? I got nothing.
whoa! Mass general, I have paramedic 47 coming in with the female driver of a motor vehicle, unconscious and entrapped.
E.
T.
A.
Ten.
Proceed to acute when you get here.
Mass general, clear.
Speed unknown.
Lost consciousness twice at the scene.
She's got a large laceration going down her head.
Chest is okay? What's that? Is that a bruise? She's got the bruising and then she's got pretty good, breath sounds, but I-- okay, quick chest and then--and then C.
T.
nose.
So we'll get everything scanned from head to toe-- brain, chest, abdomen-- and we'll see.
Go from there.
I don't find being upset or showing emotion or being angry about something and expressing that-- I don't-- I don't find that terrible.
That's good enough for the moment.
It'll need to be redone.
If it's in the name of helping a patient, getting dirty is no problem.
So far, I'm, uh-- nothing.
Wait.
Let me get the trauma head.
Very good news for her.
Nothing in the brain.
Is that propofol running? No.
Good.
No, she--I got fentanyl and versed.
She doesn't need versed, though, either.
Okay.
She didn't get any versed, right? She didn't get anything.
Good.
Thank you.
No, she didn't get anything.
Good.
Good.
I just have it in case.
Uh, the one with the scalp laceration? Yeah.
Her pressure had dropped down a bit, like, within the last hour, but now it's back up.
Propofol.
She's on propofol.
Uh, actually-- She's on morphine and versed.
Uh, she's on, actually, propofol-- if she's on versed, I am gonna be so Pissed, because I specifically said, "no benzos in that patient.
" If you give somebody a really strong medication like versed, you're going to prolong the period of time that they have to have a breathing tube in place.
We gave--we snowed her to sew a lac? Come on, guys.
You know what? It was a lac.
It was--her pressures were 50 at that time.
Holy .
You give them a medication that really tends to hang out for a long period of time, it's gonna mess around with their ability to be extubated.
Why did she get versed? Not me.
In the scanner.
Why? Why did she get versed? I was very specific.
This woman has no injury.
She's got no brain injury.
She doesn't need to be intubated.
Here's my problem--we have a patient who got intubated, probably didn't need to, 'cause she has no head injury, and now we've given her a benzo, so we're not gonna be able to extubate her.
So now we've just extended the period of time and made her more vulnerable to pneumonia.
I get so feisty about benzos.
I do.
I wasn't yelling, was I? Oh, yeah.
Yeah, you were.
No, it was-- it was perfect.
Then at one point, you actually grabbed your face, and I thought you were gonna rip it off.
? So there's a rule in the hospital that before you go into any patient's room, and when you walk out of a patient's room, you always have to use purell on your hands.
I'm big into the rules, so always wash your hands.
You can just-- you can relax right now.
This month, I'm in the emergency department.
I-I really like the change of pace.
Just a different scene.
Uh, I think variety's good.
Whoo-whoo-whoo.
A 49-year-old gentleman with a long history of alcohol and heroin abuse, and he was found lying down on the street earlier today.
And, uh, now he's just a little bit too high.
Ooh-ooh-ooh! What are you guys laughing about? I don't think if someone's having a manic episode, you want to be laughing.
That guy was pretty entertaining, I have to admit.
You seem extremely happy at the moment.
Oh, yeah.
You're bouncing up and down, and you're, you know Yeah, now.
I'm bouncing.
Making a lot of noise.
But I'm--I'm okay.
Okay.
all right.
Did anybody ever talk to you about the-- about the possibility of you having bipolar disorder? Bipolar disorder? Yeah.
Damn.
No? Talk to me now, doctor, because I don't know.
No? What is that? Well, bipolar disorder is when, sometimes you feel very depressed and other times, you feel very, uh, very happy, very excited.
Sometime-- well, a lot of times-- a lot of times? Yeah.
Can we give you a sandwich? Are you hungry? Yes! Yeah? Yes, I am.
Okay.
All right.
I need some food.
Bring me a lot of food, doctor.
You know, he's either manic or he's psychotic.
Um, a very happy.
Uh, he's certainly not suicidal or homicidal.
I-I mean, so that's all good stuff.
Uh-huh.
Medicine, you know, really saved my brother's life.
My brother, growing up, had hodgkin's disease, and had to go through nine months of chemo and three months of radiation treatments.
That's a sandwich? I'm-a eat it all.
Mmm.
I am very hungry.
I love America.
This is the land of the honey.
The rule is, you always purell every patient, but maybe him, I gave a couple of extra pumps on the purell station.
? Just got a page for a 39-year-old woman who is 27 weeks pregnant and was shot in the left chest.
In order to protect the baby, protect her as well, optimize her care, and then we'll be able to optimize the care of the baby.
Excuse me.
Excuse me.
And if she is dying, then we may have to make the decision to take the baby.
Going in.
We'll just have to see what she looks like.
This is a 39-year-old female, gunshot wound to the right upper arm through and through and right chest.
Everybody not running the trauma, get out.
Obvious entry wound with large hematoma of the right chest.
Can we please get a chest tube in on the right? All right.
How you guys doing on the left? Chest tube on the left? We got a problem, guys.
There's blood in the left chest.
There's blood in the left chest.
Let's get a stat chest X-ray, and then we need to go to the O.
R.
Let us know when you want us to look at the baby.
I don't care about the fast to the baby.
I want to know about the chest right now, okay? When you see a pregnant woman, people tend to start to get confused about the priorities, because if mom goes bad because you didn't do something, then you've done the baby no service.
No, no, no more lines.
No more lines.
I'm trying to make a decision-- we're going to the O.
R.
Or we're going to the scanner.
What's coming outta that chest? Let me take a quick look at the X-ray.
I have to see a chest X-ray.
If there's a chest full of blood, I'm not gonna waste time at cat scan.
She'll bleed to death.
We'll just need to go find the hole and fix the hole now.
There you are.
Not good, and she's got a left chest that's got a bunch of blood in it.
We need to find that bleed now.
We've got to get her to the O.
R.
right now.
? Those are aviators.
Yeah, I know, but I don't like 'em.
Oh, jeez.
Those are beastly.
It's like Tom cruise.
When I was 4, I was diagnosed with hypertrophic cardiomyopathy.
It's pretty much when the septum of the heart is, like, enlarged, so it's harder for the heart to function and pump blood.
Ooh, those are intense.
I need a heart transplant.
I don't care for the waiting, but I'm willing to wait, because after, it's gonna be worth it.
I don't even think I'm allowed to go to the junior prom Oh, really? Why? Since I'm not in school.
Oh, that's true.
Granted, they'd probably, like, jump through hoops for me, but Aww.
You know what? That's okay.
I'm not--I'm probably not going to junior prom either.
I think Sara is an incredible, incredible kid with an amazing amount of strength and determination.
And I-I think that's gonna only help her through this process.
here's my room.
Those are all, like, college application letters and stuff.
That whole, like, stack was just when I was in the hospital.
A lot of people ask if I think about it every day-- "oh, is a heart gonna come today? Is it gonna come today?" It's not really like that.
That is one of my favorite people on earth right there-- Andrew mcmahon.
He's a singer and a pianist.
He actually had leukemia.
One of his lyrics was, "it's good to be alive.
" So it's more, like, inspirational stuff rather than, like, "woe is me.
I can't, like, live and deal with this problem.
" all right, let's take a quick listen.
I keep making her do all of her p.
T.
I make her do her-- I collapsed on the hallway floor.
You collapsed on the hallway floor 'cause your muscles were so tired or 'cause you were sick of-- no, 'cause I was out of breath.
You were out of breath.
It would be okay to stop right before collapsing.
You ready? Yep.
Sara's gotten sicker and sicker over the last six months.
I worry that if we don't find her heart soon, that she'll die.
Little more.
Little bit more.
? ? Listen up, everybody.
She is diabetic, she is allergic to penicillin.
We don't see pregnant women who are that severely injured all that often--a couple times a year, perhaps.
Do you want us to put the monitor on the baby, and then you'll prep over it? No, you can't have the belly.
You don't want to monitor the baby through the surgery? No.
The baby's heart rate was 130.
That's not terrible.
The best way to save the baby is save mom.
I-I just--I can't see the bullet on a chest X-ray, so I don't know where it went.
Did it go through the pericardium to the heart? Does she have a heart injury? You know, we need to find out what's bleeding.
Incision.
We're starting.
Someone in the room, please turn on the other circular light.
I know you guys don't know.
Just find the switch somewhere.
So you--you guys know what we're dealing with right now? Right now we know we got two holes in the heart.
And the bullet must be back here somewhere, right? This--it's right-- this is what's bleeding.
All right, see this end here? This is making me nervous that it's bleeding.
So put a stitch in that thing.
Start with that, please.
Very few circumstances require you to think and think as clearly and methodically-- on the run, on the fly, with limited information-- as does trauma surgery.
She's lucky.
That bullet grazed the heart.
It could have just as easily passed through the heart, penetrating the heart, and she would've bled to death.
Both she and the baby would've died within seconds.
They found the bullet? Really? Oh, I feel so much better knowing where it is.
Okay, take it out.
Okay.
Actually, can we call security, please? And, uh, do we have an evidence bag? So, uh, do you have a metal tray? Ready? Okay.
This could've been much worse.
I mean, she's far from out of the woods.
You know, just get the mom well, and you get the baby well.
The drama in medicine is that you do the best you can for every patient, but you never know what the outcome will be.
I mean, look at the dumas family.
Look at the challenges that family is facing.
Sara tried pushing herself a little bit too hard probably about a month and a half ago at school.
Like, I don't think anyone else has ever felt That kind of chest pain.
And it's just excruciating.
After transplant, like, I'm not a very athletic person, but it'll be, like, I want to try to run a mile Understatement of the day.
You know? "I'm not a very athletic person"? Yeah.
Understatement of the day.
My brother also has hypertrophic cardiomyopathy.
He's actually gonna begin the transplant process probably within the next year.
Next year, you should run a marathon.
That'd be so funny to watch.
I think I'll do What did I do when I found out I was gonna get a transplant? I can't even remember when you did find out? How did I react? I don't remember.
I personally was having An internal freak-out session.
When they were talking about transplant for both of them, I was not It--it wasn't even in the realm of possibility in my mind.
Yeah, it wasn't for me either.
But afterwards, I guess I, like, figured out, "oh, this is kind of the only option for me," you know? And, you know, I'll have, like, a life after this, and it'll be, like, completely different.
The transplanted heart could last 20 years, maybe longer.
If we can keep her alive the trand healthyheart to take advantage of some of the new scientific discoveries 20 years from now, this would be a bridge to something new, and maybe she can have a long and normal life.
You never know what's gonna happen in the emergency department.
Every day's a little different.
Aah! Hi.
Did she say You never know what's coming at you, and you just sort of roll with-- with whatever happens.
Good night, guys.
? come on.
Let's go wait for papa.
Come on, mama.
When their dad let's them know that he's on his way home, then they love to-- to stake it out.
They get excited to see him if he hasn't been home for awhile.
Come on, mama.
Papa! Mommy, come on! Are you getting on? I wanna ride.
You steering? Yeah.
Okay.
Nikko and I have been cooking like this for a long time, right, nik? And before that, Ella.
To be able to deal with these horrible things that you know are sending patients and families reeling, and reeling for years, perhaps, and then to be able, in some way, to set that aside and go home and--and, you know, have a picnic with the kids-- it's--it's--there's-- there's a disconnect there that oftentimes feels surreal, like He picked a lot of intense things in his life.
He picked a high-maintenance job, a high-maintenance wife, and then a family that he really wants to be very involved with.
So he keeps-- he's amazing at keeping a lot of balls in the air, but they're all bowling balls.
All right, new recipe.
Everybody taste it.
Oh! Oh! Spicy, spicy, spicy.
How is it? Good.
? When we were driving in, I was thinking, I can either be really freaked out and waste my time being freaked out or I can be calm.
Yeah! So I'm choosing the second option.
Hi.
Can I help you? Um, my daughter is here.
They have a heart for her.
You can go right on up.
Transplantation often occurs in the middle of the night for various different reasons.
Hi, Sara.
How you doing? I'm good.
Yeah? Tired.
Tired? Yeah, and starving.
We've all been quite concerned about Sara, 'cause the risk of sudden death is quite high in patients who have her condition.
The surgery has different components.
If you don't want me to go into the details, Sara, you tell me.
No, she wants to hear the details.
No, I like the details.
You do? You like to hear the details? Okay.
Yeah.
We'll go on the, uh, heart-lung machine, uh, and then we'll take out the old heart.
And then when the new heart gets there, we'll start that, uh, reimplantation process.
The moment of truth is when we take the clamp off and reperfuse the heart.
Mm-hmm.
Um-- to see if it starts beating on its own? Uh, not to see if it starts beating, but anticipating that it will start beating, yes, absolutely.
That it will start beating? Okay.
The surgical team just left to go harvest the heart, and in reality, we won't know if it's any good for Sara till they actually get there and get a chance to examine it.
To see previous episodes of "boston med," go to ? We just got a 90-year-old guy that came in that fell on the escalator at the mall and hit his head.
I'm Amanda, one of the nurses.
There's gonna be lots going on right now, okay? Behind every diagnosis is a patient.
I always try to put myself in their shoes.
Like, if this was my grandmother, what would I want them to do for her, and how would I want the nurse to act? So, sir, you were going up an escalator and you fell.
That was pretty dumb.
Well, I don't know that it was your fault.
Sir, I'm gonna put an I.
V.
In your arm over here, okay? You're gonna feel a poke.
One, two, three.
My parents got divorced when I was, like, 9 years old.
I didn't have anybody there to kinda say, "do your homework, get your homework done, you need to study for this test," or anything like that.
I don't know.
I just did it.
Maybe because I kinda had to take care of myself a lot growing up is why I went into this profession, to help take care of other people.
I think your girlfriend's here.
My name's Amanda.
I'm his nurse.
He has a good sense of humor, but I don't think you're gonna see it right now.
You gave me a big scare.
Well, you went down with a bang, dear.
Did I break the escalator? No, it broke you.
I think it's so sweet-- little old people in love.
I hope that I can be that lucky someday.
Rob's a nice guy, but it didn't end up going anywhere.
Your ring is beautiful.
When is your wedding shower? I don't know.
That's what we're talking about.
Oh, right, you wouldn't know.
It's a surprise.
My wedding shower's gonna have to be, like, handicap accessible 'cause I'm probably not gonna get married till I'm like 90.
? It's 5:30, and they're giving me the, uh, go-ahead to sign out.
Whenever, just sign out, seriously.
See ya later.
Yeah, nice to meet you.
Thanks.
You, too.
This is pretty sweet.
It's before 6:00 P.
M.
, and I'm getting to go home.
? Oh, man.
Third quarter, we're up, uh, 5 points.
Not bad, not bad.
We need to do this all the time, man.
We do do it all the time.
Bardouche--uh, Andrew-- he's definitely my best friend in our intern class, someone who I'll be friends with my whole life.
The two of us are very outgoing people and like to certainly have fun.
You know, I'm big into nicknames.
So my name is Andrew elbardissi.
Bardouche, uh, you know, it evolved like--like-- removing the "el" from the bardissi, removing the "dissi" from the bardissi, and just combining "bar" and "douche.
" You know, he, uh, just has this sort of essence about him.
A lot of people, uh, started Started calling him, uh, a douche or a douche bag for some reason.
And I love it, honestly.
I mean, I-- you know, nurses-- nurses will page doctor-- Dr.
bardouche, Dr.
elbardouche.
People really think that's his name.
I convinced him it was a compliment, so he agreed to take on the name bardouche.
The amount of drama that occurs in those four towers An intern who slept with a fellow.
We have a fellow who's sleeping with a physician assistant.
It's crazy.
I'm not going into some of the other things, 'cause then it gets personal.
Should we head out? I think we should go.
Let's do it.
? Ah, give me a hug.
I love you.
I'm gonna watch "Goblet of fire.
" Harry Potter? Hello.
We are taking off in a few minutes.
And there's a question whether or not the O.
R.
time over there is gonna be delayed.
When you have a better sense for the timing, why don't you give me another call? This particular donor for Sara's transplant, there are many teams coming from all over the United States, and so there are inherently gonna be unexpected delays.
Here, this is.
Wait, wait, wait.
Let's play.
Let's play.
Ready? Rock, paper, scissors Oh! Ian and Sara, the whole way up here And talking, talking, talking, talking really super, super fast.
Hey.
Hey, how you doing? They're waiting for us to tell them that the heart looks good so they can just take the-- take the recipient to the O.
R.
Back in Boston.
All right.
Not a bad crowd tonight, so we'll see what happens.
I agree with that.
I am single, I don't have a family.
I probably like to go out more than most of the people in our residency program.
So payal is at the liberty once again Yes.
Looking very beautiful.
Thank you, Rick.
You're a good wingman, I'll tell you that.
I tried to set her up with prashant.
It sounds like it didn't go so well, though.
I mean, I just don't know him.
Okay.
I talked to him like ten minutes.
But you guys are both Indian.
You should be able to get along.
Yeah, so just automatically, right? Stop.
No, no, no.
I think that's absolutely appropriate.
So Indian people automatically get along with other Indian people? Yeah, that's what-- unequivocally, yes, Indian people-- and they should only date other Indian people? I'm egyptian, and I think that it wouldn't be bad if only egyptians dated egyptians.
Bardouche, I totally disagree with you.
Oh, my gosh.
So--so I just want to clarify I think it's absolutely true.
You're only gonna date someone that's your race, right? No, no, no.
I think the probability of me actually having a successful relationship with someone of my race is much higher than me having a successful relationship of--let's say with you or Or him.
Richard, if he were to be a female.
? You know, I'm pretty happy right now as is.
I can work late and not have to worry about coming home and I can go out whenever I want to.
However, I-I don't want to wake up and be 40 or 50 and, you know, not have a family.
? Hello.
Okay.
Um, I-I-I mean, I would say that this--this type of delay is--is--is--is Is now, um, close to being unacceptable.
My concern, obviously, is you've been in there for over three hours, three and a half hours now with both the chest and the belly open.
Each half-hour that you're in there, you know, there's risk of losing the donor organ, so We can't wait indefinitely.
? to learn more about congenital heart disease, go to ? You guys gonna go check out the baby? Yeah, we'll check the baby now.
Good.
Our shot pregnant woman appears to be stable now.
The bullet took out one of the arteries that supplies the muscle of the heart itself.
So we'll get an ultrasound at this point in time and see how it looks.
It looks like it might be outside.
She's got some abnormality in the atrium adjacent to the area that was injured.
The bullet was intact, so I don't think it's a fragment.
But she could have a clot in there.
I'm just trying to guess what-- 'cause it looks like it e-- you know, it almost looks like it has a brighter tip.
We don't know what this is.
Is this some blood clot? Is this a bullet fragment, uh, that we missed? I need a cardiologist here now.
Hi, this is mindy.
I can't find a fellow to come, um, up and take a look at this echo.
I'm trying to figure out why they're giving her a hard time about coming down and taking care of this thing.
All right, so I'll do a focused study then.
The guy could've been down here and back in the time it takes to argue why you shouldn't come down here.
If no one's able to come down, then I'll just bring the pictures back up.
Goddamn it.
No one's available to come down right now.
One of the fellow's is out.
So what's the turnaround time on this? As soon as I--as soon as I take the images, I go up.
Where do you--where is up? Do you want to take it off or leave it on the monitor? Going down.
Um, second floor.
So no one can walk up two floors? Who's the attending? Hi.
Oops.
These folks get into their little worlds, you know, and they just read images and they forget that there's a patient on the other end.
It's like, okay, here's someone who you can't sit and wait for the image report.
So get your ass down here and look at the patient and do what needs to be done.
You know, it's not that hard.
What we've got going, basically, is, um, some type of echogenic structure.
This is not gonna be an artifact.
It looks like it's in the tissue, not-- because it-- not in the lumen.
Ultimately, this wonderful cardiologist came down, interpreted the images, said this was not a bullet fragment.
She sees this routinely on valve repairs of the heart, and the heart would heal on its own.
? Just swallow that.
Swallow it? No, it's a swallow.
Yep.
Stop.
How was it? Oh Pretty bad.
Yeah, that face says it all.
It has, like, a tingle to it.
My colleagues just called.
They are headed back with the organ now.
Everything went well.
Hey, uh, this is Francis.
We can probably start, um, you know, work on getting her down to the operating room.
Keep your hands inside, okay, Sara? She's got quite a bit of family up there.
It's gonna take you at least half an hour to get her down there.
I think she's ready.
I think she's more ready than I am.
Bye! I love you.
Bye! Love you.
Bye.
See you on the other side.
Bye.
Bye.
Bye-bye.
Love you.
Bye.
Bye, sweetheart.
Bye.
We'll see you in a while.
Any other byes, I say them.
Bye, Sara.
Good luck.
? we're going on a cruise.
Now I've recrui-recruited one more for the girls' cruise.
Let me see this.
Um, oh, my God.
I'm so excited.
Me, too.
You don't even know.
Yay! I haven't been on vacation without my children, ever.
You're lying.
No, I'm not.
It should be fun.
It's hot.
Final out.
It's fun to hang out with friends at work, but it's even more fun when it's unsupervised.
It's party time.
? this is my very first cruise, so I wasn't expecting the electric slide right off the bat.
I thought we'd be able to, like, ease into it a little bit, but they're, like, going all out right off the bat.
? I need another one, too.
I'm not giving her one.
Be generous.
I love it! Do, like, a Marilyn Monroe thing.
All right.
Oh, there we go.
Cin-cin.
Good stuff.
I know.
Cheers.
So-and-so is shampooing their hair.
Yeah.
So-and-so is going to the bank.
Damn facebook.
Facebook brings back a lot of people you don't need to be seeing again.
My friend is friends with my ex-boyfriend on facebook.
And I, uh Made her go sign on, and I went on his account and saw all kinds of pictures with him and his new girlfriend.
Yeah.
It's like a kick in the gut.
Owie.
Yeah, and-- this was a very long-term, right? Six years.
Six years.
Mm-hmm.
We met when I was 20 years old.
So I just saw my other single girlfriends going out and having fun and thought I was missing out, but really, I wasn't missing out on anything.
Mnh-mnh.
Grass is always greener on the other side.
Right.
Like I love being married and I love my husband, but I miss the the drop of the hat, you know? Do whatever the heck you want to do.
Boom.
Go.
See, I hate having, like, random losers hit on you.
And the last time we went out, I got told by two different guys that I have big shoulders and big hips, in one night.
Nice.
That's the equivalent of saying, you have the biggest beer gut or man boobs I have ever seen in my entire life.
Mm-hmm.
That's not okay to say.
And why did they feel they needed to tell you this exactly? He wanted to dance with me.
I was like, "no, I'm all set.
You know, I'm here hanging out with my friends, whatever.
" And he got mad and he said, "well, it's fine, 'cause you have big hips anyway.
" And I said, "well, that's fine, because you probably have a small penis anyway.
" What a jackass.
Yeah.
Exactly.
walking back in here, it's like a punch in the face.
All the smells and sounds come right back to you.
We're about ten minutes out.
He does have major oral trauma and a large laceration through the chin.
Back in the trenches.
The party is over.
? breathe in.
This is Sara dumas for a heart transplant.
Absolutely, Sara.
Whenever your kids are sick, as a parent, you want to fix them.
And when you can't fix them, you feel as though you're-- you're helpless.
We're gonna go ahead and, uh, get her chest all opened up.
As soon as the harvesting team lands at the airport, we'll go on the heart-lung machine.
Once they arrive in the hospital, we'll cut out her old heart and we'll be ready to, uh, implant the new one.
So this is like, uh, little bit like being a cook.
You're sort of setting the table, and when the heart gets here, it's like making the meal.
Hi, Victor.
Hey, guys.
How you doing? Welcome.
This is yours.
So we're getting ready to cut out the old heart.
Richard, this is the central line.
Here you go.
The old heart is clearly very sick, very stiff.
Watch.
It's still beating.
Look, you can make the heart beat.
Are you ready for the heart? Yes, sir.
That looks great.
Okay.
Okay.
? my son, he's seeing everything that's happening, and he's gonna be put on the transplant list.
So he knows that all of this is coming his way.
I'm glad I'm going second so that I know sort of what it's gonna be like.
Scissors, please.
You can see that the heart's starting to beat.
You can see the e.
K.
G.
So that's always a reassuring moment.
Before we close the chest, we want to be sure that everything is dry.
Goddamn it.
Linda, uh, we got some bleeding from the back of the heart, which is impossible to repair without going back on bypass.
We're just going back on the heart machine to fix the bleeding site.
It's been, what, six hours? I'm anxious about getting information, because it's difficult when I don't know what's happening.
Rotate the table back towards me, Mike, please.
Teenagers like Sara are very resilient.
It's very hard to deal with bleeding from the back of the heart.
But we got it fixed, so it's good as new.
Okay, great.
We're all done.
Okay.
We're gonna close the chest, and, uh, and then I'll go out and talk to the folks.
I would imagine the family is, uh, pretty anxious.
I'm sure they're exhausted.
I-I'm not sure what they know.
Hi, guys.
Hi.
Hi.
You have a seat? So we're, uh, we're all done.
She's doing okay.
We got her old heart explanted, and that went fine.
Got the new heart in, and that seems to be working just fine for her.
We came off bypass and had some bleeding behind, uh, the heart, so I decided to just go back on briefly.
Went back on and stopped the heart for, you know, ten minutes and were able to get the bleeding controlled.
All right? So I'll be right back with you, okay? Thank you very much.
Thank you.
All right.
Good.
It's my pleasure.
Sure.
All right.
Thanks so much.
Sure.
This is terrible.
Why is he gonna come back in a minute? I don't know.
He just got a call.
He's gonna go check something out I know.
And then he's gonna come back.
My point Getting paged, uh, back to the O.
R.
after you've closed is never a good thing.
Perhaps she's bleeding again.
? it's, uh, 11 days after Patricia Baker was, uh, shot in the heart.
She's now 28 weeks pregnant, and we'll see how mom and baby are doing.
I remember everything that happened up until the point where I told my neighbor that I was shot.
I fell in the hallway, and no one knew that I had been shot but me.
Watching a movie on DVD and, uh, that's how it all started, 2:00 A.
M.
and the wrong people came over.
When he saw the kid with the gun, he shut the door to the living room And he shot through the door, and Patricia happened to be right there, 10 feet away.
So all I could think about was, get the baby out so that they baby can live.
I still shut my eyes at night and think about it, you know? I thought it was over.
I'm, like, I just lost a child and--and--and a good girl, you know? Oh, my.
This is my oldest daughter when she was probably about 17, Amanda when she was about 10, Samantha when she was 2.
Hello.
Ms.
Baker? It's Jeff ustin.
Hi.
You look like a new person.
Every day seems a little bit better.
Have the obstetricians been by or did they Yes, they come by once a day to ultrasound the baby.
Okay, and they said everything's okay? Yes, the baby's great.
I mean, you could see that it was a boy, you know? Good.
And, um, they're like, "wow.
He's well-endowed.
" I was like, "oh, my God.
" Well, good.
All right.
Glad to see you're doing well.
All right.
Just grateful to be alive.
Okay.
All right.
All right? She's doing well.
That's-- yeah, I mean, that's very rewarding, you know? It's huge.
Huge, huge, huge.
? Sara's really put us through a roller coaster today.
Uh, I don't know if she's bleeding or why she's so unstable, but we-- I need to get back in there and take a look.
What's going on? She got really hypotensive.
It was just so dramatic.
It went straight down to like 45 or so.
There's been too many swings in her blood pressure.
I'm--I'm not gonna be able to handle this really too much longer, so somebody better say something.
Keep having these unexplained swings in blood pressure, prep her, she goes to 150, and then she's down to the 40s.
Think now we gotta get her up to the I.
C.
U.
So she can be closely monitored.
I'm not sure there's anything else for us to do down here in the operating room.
She has these profound spikes in blood pressure.
We've seen this with a couple of transplant patients I know.
I-- but I don't recall it being this acute after transplant.
That is pretty--pretty strange that she-- she has these swings in blood pressure.
Hi.
So I wanted to give you another update.
She's fine.
She's stable.
But she, um, you know, she's exhibiting these kind of swings in blood pressure.
Blood pressure gets pretty high, then it gets low, then she's stable for a while.
So we'll just have to see how the next 12 to 24 hours go.
For a moment there, Sara gave us a-a real scare.
Uh, but, uh, as I expected from Sara, she made a remarkable recovery.
And, uh, I'm very pleased overall with how she's done, and I think she's gonna go on and do very well.
How you doing, Sara? Good.
Up and around, you know? Up and around? Good.
And outta here tomorrow.
Perfect.
Yeah.
You excited about getting-- getting out tomorrow? Oh, yeah.
You tried to slow me down a little bit there Yeah, she did.
Yeah.
Early on at the beginning, but I think we caught up.
Yep.
You did great.
Oh-ho! She looks fantastic.
She's back to being the old Sara.
It's really just Very gratifying.
It'll be interesting Again.
To be able to, like, go up stairs or run or swim or anything, really, without being out of breath.
That's why I wrote what I wrote on the window.
"It's good to be alive"-- backwards, so you can read it from outside, I hope.
The birdie looked like this.
Oh.
Aah! Back again.
Aah! Listen, would you stop startling me? Done! You can see the eyes.
This is the cheek and the chin.
I'm just so glad he's safe.
it's amazing, the turnaround that's happened.
I feel like I'm exactly where I'm supposed to be.
Life is really good right now.
When I went on the cruise, I never thought that I would be talking again to my ex-boyfriend, and now we're engaged and planning our wedding.
So it's exciting times.
Now I have the house and the guy, and, um Babies will be A few more years before that happens.
Jay's home.
Hi.
Hey.
There's no other person I want to be with.
She's my best friend.
She always has been.
She always will be.
It's been eight months since we reunited.
And it feels so good.
Engaged.
We're engaged.
You ready? oh! Strike.
before the transplant, I could never have done this.
next on An 8 year old with some kind of cardiac arrest.
You just make sure she's got a good pulse.
Her heart goes crazy.
I have a 5-year-old son, and I can't imagine how it must feel.
She's in v-tach.
Clear.
They can't get a baby out.
This is stat.
I know it's scary.
Aah! Come on.
Can I have an available o.
B.
? I would not want to date me right now.
Rachel's the one that I want to marry.
I may not be the marrying kind.
Jeff should definitely dump me.
If this guy dies 'cause his insurance company wouldn't approve a visit We don't have anything else to offer.
If it were your wife laying in that bed, you would stop treatment?