Lenox Hill (2020) s01e06 Episode Script

1
I need to go back to work.
It's been super fun with him,
but I need to get back in there.
I need to see people again.
The tumor was about this big.
I got operated.
The year passed, and I was in remission.
And then I got it again.
You're the eighth patient in the country
- to get this treatment.
- Yeah?
So, you're a special girl.
Thank you for your patience
and your courage.
You know, I'm gonna be a statistic
just like everybody else.
Let me manage Mitch's practice
as best I can.
I want to be the point person for this.
I'm taking responsibility for Mitch.
This guy you're looking at now
is not here anymore.
You have a newly-diagnosed
brain tumor
that's enhancing that grew in a month.
His daughter's wedding is in four months.
And I gotta make sure that he can make it.
We just feel
like she's going to be okay,
we hope that she is.
Right now that's all we have, kind of.
And now it's back again,
and it looks worse.
A little bit more suspicious
for tumor growth.
How much time before you think
it becomes time for hospice
if it doesn't work?
I remember
my very first experience with death
that I ever had in my life.
When I traveled
to my dad's country, Uruguay.
I think I was 11 or 12 years old.
And my grandmother was very ill.
Back then,
your family gathered around you.
We spent her last dying moments
with her,
and it was very surreal to me.
But I remember not feeling very scared
about it.
I was a teenager,
and I'm spending the night in the room
where my grandmother just died.
I never forgot the sight, the smell.
Looking back, I thought to myself,
"Why wasn't I more scared of that?"
But I wasn't.
Because I continued to connect
with that feeling
that vision of seeing someone die.
I revisited that moment
over and over again,
and then I realized
this is something I could do.
Hello?
Jack?
Dr. Boockvar.
What's going on?
I'm here to ask you that.
I think you're safe to leave the hospital
into an environment that you…
I don't want to leave.
You don't want to leave? Okay.
- No.
- I got an e-mail from Annie.
I'm gonna communicate with her, okay?
I'm not prepared.
I know. We want to make sure
you're prepared.
If you want…
We're still going to look
into options for whether you can get
Avastin in the next couple weeks.
You have to tell me what you want to do.
I don't know.
And it's hard. I know it's hard.
But I think
if you have some fight in you left
it's reasonable to keep fighting.
I don't know if I can.
I know.
Well, that's not a decision
you have to make now.
Okay.
Okay?
Look, I want to keep you happy
and comfortable
and with your family no matter what.
And I'm not crazy
about going to another facility.
You know.
But where else would you go?
I don't know.
Somewhere to die.
We can't just go to die.
I don't know, Doc.
Well, I think what I'd like you to do is,
let's have a discussion
with our palliative and hospice people,
and help you get some understanding
of what it all means, okay?
One hour at a time.
I'll see you later, okay?
I'll talk to you later, Jack. Okay?
All right.
- Did you see him?
- We did.
And?
His daughter's getting married
in February.
- We want him to make it. If he wants to
- Why can't they get married earlier?
I can't get a feeling
whether he wants to die before the wedding
- or stay alive to the wedding.
- Keep him alive until the wedding.
But that may not be his wish.
He wants to, "Go somewhere to die."
So the question is, do we just give him
Decadron for eight weeks,
and you go to the wedding,
then he goes to hospice?
All right. I'll call the family,
see if that's what they want.
What is that?
My daughter made this from camp.
What's it called, a hamsa?
- That's cute.
- I use it for a good luck charm.
- It's smooth?
- Yeah, because I rub it so much.
- See ya later.
- It's one of my nervous twitches.
You know what my other nervous twitch is?
I twirl my hair.
That I know. That I've seen you do.
We deal with death and dying,
and you know, I always say,
"Death dies, but regret lives."
And you don't want to have this regret
that lives on.
Why do you have cat ears
on your desk, may I ask?
This actually was
my Halloween costume this year.
- One of my patients gave these to me.
- Oh.
- A young girl who died.
- No.
You don't remember that?
Her family brought these in?
That's why I keep them,
because they represent her.
No, she was, like, 20 years old.
It was terrible.
So, I just leave them there to remind me.
That's all.
Let me find John.
Who are we seeing first?
- Let's see Marie first.
- Who?
Marie first.
Then we'll go see the other lady.
Her whole family's here from Brazil.
Hello.
- Hi, Dr. Langer.
- This is Dr. Boockvar, my partner.
- Hi.
- Hi.
- Nice to meet you.
- Hello.
Just to remind you
that my right is your left.
We're going after this growth.
It's going to be about right here.
- All right.
- Okay?
And we were just talking
when we came up here is
- We have to take this out.
- Yeah.
Sometimes we have to, then,
take out some extra.
That's called a margin, okay?
- Okay.
- Behind your motor strip.
I think the risk
of you having weakness is low,
- not zero.
- Okay.
I rather have a little consequence,
but have the whole tumor out.
We're gonna take the whole tumor out.
I guarantee.
- Oh, my God. Thank you so much.
- Okay?
Sometimes we have to take out
a little bit extra.
- Okay.
- That's called a supramaximal resection.
You're the kind of kid
we want to do this on.
- All right, yeah.
- What I would do if it were my daughter.
- I have two of you.
- Okay. Thank you so much.
I don't think she's gonna be left
with something that's disabling long-term.
Could she have a little bit
of this or that? Absolutely.
But knowing her personality,
this is not gonna be a problem.
- I'll rock it.
- No. Not at all.
This redness you have. Is that normal?
- It's anxiety.
- That's normal.
- When anxious, I get red on my chest.
- You're anxious?
Dr. Langer!
It's okay. It's normal, okay?
Yes.
Ask about the saints, to put them
Can I ask you something?
Don't think I'm crazy.
But I had surgery twice in this hospital,
and I always ask them
to put something under my pillow.
- We can do that.
- Is that okay?
I have a Jesus kit.
Where should we put it under?
- Wherever.
- Under anything.
I can't put it under her butt.
That would be wrong.
- You don't wanna put Jesus under her butt.
- All right, see you inside.
- She's gonna be all right.
- Gonna be okay.
Thank you very much, Doctor.
- All right.
- I trust in you.
- I know you do.
- My turn.
We carry the emotions in too.
We all have kids, so we get it.
God drive your hands.
My Jesus kit.
But I'm looking for the hugs afterwards.
There's when I get a thrill.
- Yes. Thank you.
- Bye, Dr. Langer.
See, he will remove everything.
Everything.
Don't cry. Don't worry.
We'll take very good care.
I'm not going to die, right?
- Of course not.
- I'm not going to die?
- You've got to realize
- No.
- Dr. Langer does these all the time.
- Okay.
- Every day.
- And he's amazing, right?
- Yes.
- Dr. Langer's the best.
This is not something
When you operate
on people's children, it's an added
kind of emotional thing.
Especially once you have kids,
you start to personalize it a little.
Her parents are there.
You see and sense their emotion
they're putting their kid in your hands.
It's a big responsibility.
I love you more
than anything in the world.
Me too.
- I trust you, Dad.
- You are the reason of my life.
Hopefully, this will go well.
- Yes.
- Ready?
All right, let's do it. I'm ready.
God bless you.
Take a deep breath.
Rock on.
- Rock on.
- Yes!
Bravo.
- Bye. Love you.
- Love you.
Any day you can give good news
to a patient is a good day.
Living longer is possible.
It's true…
- It's your first time in the MRI?
- No.
Okay. Which arm can I use for your IV?
- Here.
- This arm.
Can I check the other arm to see?
Can I check the
No
You don't want to?
- The other arm is all bruised up.
- Yeah.
Really. He's covered
He's covered in bruises.
- Why? What's wrong with that arm?
- No, nothing's wrong with it.
The flow is stopping. I'm just
Is there somewhere in particular
you want me to tell them to try?
Yes.
- It's here.
- In this spot?
No, f f fucking
J just fucking thing.
- The same spot they
- T-try try to
Oh sh sh sh
I can't understand.
- We're getting someone to help you, okay?
- Yes.
- Sweetie.
- Here!
- Okay. Have a seat
- Here! Here!
- Sweetie.
- Okay.
Sit down. Sit. He's on steroids
and he's having a steroid Yeah.
- Have a seat.
- Sit down.
Have a seat.
Okay, right now, you're having
- a little bit of You're
- No! No! No!
Yes. Yes.
Here. Thing.
- Okay.
- Look!
- I got it.
- Look!
Look at me. Look at me.
You know when I talk to you about
when you're flipping out a little bit?
That's what's happening right now.
You need to calm down.
I know. I get it. Calm down.
Yeah. Yeah. Yeah. Yeah.
Chris.
Sweetheart.
Listen.
I get it. I got it.
I understand. I understand.
No. No.
Can I look again?
I won't do anything.
Let me just take a look, okay?
He wants he wants
- He wants me to come in?
- Yeah.
Okay, I'm coming.
I've got to take off the
No
- You don't want me to come in?
- No.
Okay.
I'm so fucking tired of all of this.
Ninety percent of cancers
that are cured
are cured with surgery.
In the brain, though,
for me to take out every last cell
is very challenging.
These are spider-like infiltration
where cells migrate.
They may have a central core,
but away from the central core,
even two centimeters, four centimeters,
six centimeters, there are cells.
So I take this out.
But this cell, which may be dormant,
this is called a stem cell,
it may take years for this
to just start growing.
Then you have another tumor.
This is how gioblastoma works.
You know, if I can make this
a chronic disease,
I can control these cells,
make sure they don't grow again,
maybe radiate them,
give it a pill every six months,
every couple years
How do I get the immune system
to do enough to fight cancer
without hurting my patient?
You're going to put
a smiling emoji over my face, right?
Yeah, we'll look it over.
- Are you okay?
- Uh
- What hurts? What hurts?
- My head. Oh, my God.
- Her head hurts.
- Yeah, my head hurts now.
Oh, God.
It's okay. I got it right here.
Two seconds. Two seconds.
Give me a number.
Like a four.
Oh, okay.
I'm just giving you a little fluid
to make sure
we flush everything through, okay?
Oh
So, in the old days,
we didn't have navigation.
Using this probe's eye, I know that
I'm behind the tumor with the opening.
Using facial surface landmarks
which tells the camera
where her head is in space,
and it's matching that to the MRI.
What that does is it gives us guidance.
Without this, we'd be
Have to just sort of wing it,
make a big opening, and find the tumor.
Because this latest young girl was 15
when she was diagnosed
with this brain tumor in Brazil.
And, uh, she down there,
it looked like a low-grade tumor.
They wanted to leave it alone,
which is debatable, but it's not crazy.
It's been growing on successive imaging,
When she was 16, she told her mother
she wanted to be an actress,
move to New York. They actually did it.
Okay, I'm just going to get
under the sheets here.
Promised her I would do this.
This is her Jesus package.
I have to put this underneath her body.
Just don't forget it.
Using this vibrating technique,
it vibrates off
the critical bone on the inside.
I'm pushing down the drill a little bit
There's a little bit of an angle.
Just think of the drill grabbing the bone
rather than pushing the drill
through the bone,
in your mind.
- It's perfect.
- Yeah.
- See how that works?
- Beautiful. Yeah.
Perfect
- I got it.
- We all carry lessons
that our teachers teach us.
And whenever I'm doing an opening,
I always think of Flamm
- who trained me, 'cause…
- Can I pull this please?
In our heads, we're always
hearing the voices of our teachers.
- Hopefully they're not yelling at you.
- I don't think so.
Well, hello to you too.
She's kicking
All righty. So
- Yeah.
- Questions.
Um, do you have questions, Kevin?
Let me see.
Has there been
any latest research findings
about how this manifests in an infant,
as a fetus?
The condition that she possibly has?
- On terms of what science…
- Well, I need to clarify something, Kevin.
This isn't possible.
This is definite.
Oh, yeah. Okay, sorry. Definite.
- Okay.
- But, like but, um
- Any other signs in the fetus?
- So far we haven't seen anything.
- Okay.
- But that's why we're monitoring.
In the babies that we see
with this particular genetic lesion,
all we have is percentages.
So 99% have the skin lesions.
The baby may not be born with them,
but will likely develop them early on.
Also the electrophysiology of the heart
can be abnormal.
We will be prepared. We know that she has
potential issues when she's born.
I know, but I don't think about it,
though. I don't know if that's naive.
Because I guess I'm the one carrying her,
I don't think
about her diagnosis every day.
I don't think that's a bad thing,
because you've made
the decision to have this baby.
Mm-hmm.
So, to harp on what could
potentially be wrong with her
could steal your joy,
and I want you to still enjoy
your pregnancy.
Normally I daydream about it,
and have a shopping list of things
I'm gonna buy her,
all these things, so it's just…
Yes. I want everyone to remember
how Kevin treated me
when he thought that
I was such a daddy's girl
when we started dating. He was like,
"Your dad spoils you.
I don't know why he does this stuff."
And I want these things to be remembered
for when he has a daughter
and he does the exact same thing.
I think I'll be
No, he's not gonna be a disciplinarian.
So, Dr. Johnson,
I also want to talk very briefly
I know you said
that you'll come in, however
- Yes, I intend to attend your delivery.
- Okay, great.
Not only are you family,
but you my mentee.
- This is my mentor. I think that's
- Yeah. So crazy.
- She knows my deepest, darkest secrets.
- No, I don't. Thank you, Dr. Johnson.
You've worked with me for four years.
You know my deepest, darkest secrets.
Before you got here,
Kevin and I were talking. I said,
"We have to meet, because haven't heard
anything about her research project."
He's like, "Research project?"
She has the project,
she has to complete her residency,
have a baby,
pass her boards, and relocate
to the other side of the country.
All in the next six months.
You gotta do what you gotta do.
What are you gonna do? Stop?
And that's my girl.
It is the way we're wired.
She will get it done. I have no doubt.
But I don't want it to be
at your own emotional or physical expense.
Today's mass shooting
at the Tree of Life Synagogue
in Pittsburgh
had an extensive anti-Semitic,
anti-Jewish digital footprint.
- Good morning.
- See this?
Hey, Jimmy. Come here.
Take a look at this.
- You just move it a little bit?
- Yeah.
This is the edge of the tumor, right here.
This is obviously all tumor.
- Yeah. Can I come in and play?
- You can play.
I hereby declare myself to be
a brain tumor doctor.
It's like that fortune cookie I once got,
"Mediocrity is self inflicted.
Genius is self-bestowed."
Like, "Behind every great man
is an astonished woman."
Or "Behind every great chair
is an amazing vice chair."
Yes. Correct.
- That was so easy, right?
- So easy.
Such a setup.
There it is, dude.
Give me a Penfield 3.
So awesome.
Does surgery play a role in the longevity
of a patient who's had a low-grade glioma?
Absolutely. Take the tumor
and then a margin that's safe,
and make sure the patient's not
neurologically compromised.
See this kind of snotty-like consistency?
That's a low-grade glioma.
He's putting a patty right between tumor
and normal brain.
You basically can almost lift this tumor
right off the adjacent area of the brain.
You can see where the snot becomes
a little bit more firm
in this whitish substance.
That's normal white matter.
- This is normal, right?
- Yes, that's normal, for sure.
I think we're good here, bro.
Check that with the nav. On.
I'm happy there. I'm happy there.
I'm happy there!
That's tumor.
Can I get, um, second frozen
What's this? That's tumor. Isn't it?
We had a margin there.
I don't buy the navigation now with that.
We had a good margin there, John.
I don't believe it.
I'm telling you, something changed. Look.
I don't agree with you.
I think this is tumor.
Let me see something.
That looks like tumor to you?
That's the problem.
Now I can't tell.
- That could be margin right there.
- Yeah. See that?
Okay, I'll buy that.
I agree.
You're good there.
- That looks more normal now.
- Yeah. Okay.
I don't think that's tumor.
Frozen.
- I think we're done.
- No, we may send you one more.
We're gonna send one more.
That's tumor right there.
Look at this right here.
- Here comes a frozen.
- This is the deepest
The most deep.
- Are we cutting it off?
- Yes, please.
Yeah, I'm very happy with it.
I think we're okay.
- Yeah.
- That's it.
Four-hand surgery, bro.
Four-hand surgery.
Four-hand.
- I'll tell the family all is well?
- Yeah, go talk to them.
Okay, have a great case.
Thank you for letting me help.
- Yeah, it was awesome.
- We'll see what the final path is.
- Finished?
- We're finished. The tumor's out.
- No way. Everything?
- Absolute?
Dr. Langer's just closing
Finishing closing the scalp, so
- Okay.
- How she is?
She's doing perfectly.
Everything so far is going perfect.
Everything
Everything's going
- Everything is so good
- Can see? Can talk?
No, we're still finishing up
the operation.
- But is
- The tumor came out.
Thank you.
Oh, I
Save some hugs for Dr. Langer.
Mom! She's fine! They took everything out.
Where is he? I want to talk to him.
Here!
Everything went fine.
- Can I give you a hug?
- Yes. Of course.
Hello.
Okay.
[chatting in Portuguese[.
Um
I don't think so,
because we then took
I don't think we can take more, do you?
I'm not I'm not convinced.
Okay, real quick.
Actually, Dr. Langer and I,
we're going to go up to pathology,
because he sent one last margin,
and that's going to be our confirmation.
Then we're done.
But she's already in recover
- No, they're closing up.
- No. They're closing. Dr. Langer,
- and then Dr. Kwon will close the scalp.
- Okay.
I'm just out of the OR.
I've got to go to patho
I've got a patient thing.
I'll call you as soon as I can.
I saw his text.
I'll call you right back.
Hello.
Because last thing,
deepest white matter. What did you see?
I want to see deepest white matter.
Yes, so that one also showed
a low-grade infiltration.
- Deepest?
- Yes, the deepest.
By three.
You can see the neurons here.
You still see these infiltrated
low-grade glio cells, right?
There's more than usual for normal brains.
They're like not evenly spaced as you
would see
with normal, you know,
reactive glio cells.
They're more like clumped.
And to compare that,
I'll show you the first one.
You closed the dura and skull?
Yeah, we can reopen.
I just told them to stop.
I mean, this is an important call,
because we're contemplating
reopening her
with the risk of making her weak.
If we compare the cytology
to the first one, they look similar,
but they don't belong there.
Let's just go back
and just go deeper there.
Let's just do it.
- Thank you.
- You're welcome.
You're going to send a deeper?
Yeah. I'm going to send one more.
Hey, Sherese.
- Hey
- No, we're going to go back in.
Um, not great. I mean, not terrible.
- Hello?
- Hello?
Sherese, I'll be right there.
Did you see the scan?
How's it look?
Awful?
Jesus Christ.
- All right, I'm sorry.
- Go back to your office.
I'll get this thing set up
- and I'll call you.
- All right. Bye.
- Going to take me 15 minutes
- What's up?
Let's just take a time out.
Give me a couple
I'm going to call you this afternoon.
I'm just in the middle of doing something.
Nothing's going to happen
without my being involved.
I'm going to go
Agy Peña's scan looks terrible.
You're going to go talk to the family?
They're going to intercept you.
Ah. I'm going down to see Agy Peña.
She's the cop that had
all the clinical trial stuff.
This is not good news.
See this?
This part is completely exploded.
All this now is tumor.
Tumor, tumor, tumor, tumor.
Okay, let's go talk to her.
Agy, we're not going
to overthink this, okay?
You got a trial that is
one of the most novel on the planet.
We're going to see things
that nobody has seen before.
That's the only thing I can tell you.
So standard radiology'll say
there's a lot more white,
therefore I think
the tumor's getting worse.
They have no idea the novelty
That's what you said.
You said that, um, in your presentation
is how it is.
Yeah.
And the truth is,
we have no idea what's going on.
You're the, what, eighth person
in the country that's gotten this drug.
We're giving you bacteria into your brain.
That can set your whole brain on fire.
And I don't know what that's going
to look like on an MRI scan.
Some of that's going to be
frustrating to you,
but that's how
we're trying to beat this disease.
I will tell you when I'm really worried
about your longevity.
I don't necessarily understand
everything that's going on
in this image,
which is unusual for me,
but I know Avastin
is what we need to give you.
You'll start feeling better very quickly.
Okay?
Okay.
Thank you.
All right, thank you.
I know it's been a long day, okay?
Get home safe, all right?
- Thank you.
- All right.
Fuck.
Okay, my friend.
Fuck.
That is a confusing picture.
Our immunotherapy agents should cause
this mass of inflammation in the brain.
I mean, that's
That's what we're asking it to do,
and I hope to God
this is just inflammation.
Successful inflammation
that's combating her tumor.
Um
It's sad.
She, uh
Sad.
Yeah, no.
We thought we were done,
but the frozen We were surprised.
It's a couple cells in there.
It is what it is.
- But you are going
- That's great.
- No, it's good.
- That's great to find now
- Rather than do another operation.
- Yes, for sure.
- Thank you very much.
- No no no premature hugs.
Okay. But we're a hugging family.
Okay. I could tell. Me too.
This Brazilian girl
Langer and I are operating on has
a grade-two glioma.
And then, this woman Agy Peña has
a grade-three glioma.
And then you've seen guys who have had
grade-four glioblastoma, it's a spectrum.
And so
we want to prevent Marie
from ever grading to a grade three.
I don't care if I've got to get
every damn cell left behind
before we close.
That's what I would want.
Yeah. You're like a cell away.
You're a cell away.
Give me a Rhoton.
We cure cancer!
One cell at a time.
- Louder.
- One cell at a time.
- There you go.
- Monitor looks good?
All good.
Take all that.
- All the way to that margin.
- I think we're there, bud.
I really do.
I think we found what was abnormal.
Beyond that white matter is
Is no man's land for us.
I wouldn't go beyond it.
Yeah.
Okay. Let's close. Scope out.
- It's normal.
- Okay.
I'm glad we went back, bro.
Me too. This is why teamwork
makes the dream work.
Stopping
and restarting again, it's hard to do.
That's why having us both there, you have
different people pushing each other.
That's the value of having a great team.
This is the only time it's worth
This is what
I know. Look, if you're gonna
send frozen, you better…
Once they told me it was positive,
what are you going to do?
Hello?
Hi. Can we help you?
- You okay?
- You okay?
- Okay.
- She pushed the emergency button.
Emergency button going off.
It's a good way to meet everybody.
Come on.
You're good.
Yeah, she almost tricked me.
It was an accident.
Do you guys have recommendations
for baby CPR?
- American Red Cross.
- Okay.
The nurse educator for Peds does it
as well.
Thank you. But there's no hospital one?
The one we do in the NICU is
non-certification.
I don't need certification.
This is just for my baby.
You should know it. You should know.
I want to be able to know signs
and do quick resuscitation if needed
for my
- Seriously.
- Really, Amanda?
What Doesn't every new mother
have to do baby CPR?
No. It's not mandatory.
I feel like it's mandatory.
I also want to know
all the developmental milestones.
You know what? She's going to be a mess.
I really just want bases.
I want to know at two months,
what are they supposed to be doing?
But your pediatrician will go over that
with you too.
Yeah. You don't
need to necessarily do that.
'Cause, I mean, I don't
have a completely normal pregnancy.
Yeah, we have our video too.
- Oh, you have a video?
- Yeah, yeah.
- Thank you.
- Yeah, of course.
All right. Hopefully I won't see you
- for the rest of the night.
- Yeah
Where am I going?
Room two.
Thank you, Tasha.
Hi, guys.
- Hi.
- You've had a long day.
- Yeah.
- Yes.
- I'm sorry about that.
- It's all right.
I've had a long day too.
- It's not your fault.
- Yeah.
I'm going to go look at your film, okay?
- Okay.
- Okay? It's been a long day in MRI, huh?
- Yeah.
- Had trouble getting a vein?
Yeah No
Yes. That's what happened. Yeah.
- Yeah
- Okay. It's hard. I'll be right back.
- Okay.
- Okay? Let me take a look.
We're comparing his new scan
Scan looks better. Motherfucker.
I don't understand how
scan's going to look better.
Can you bring them in here?
Problem is he's not fucking speaking,
and he's going to live.
He's going to be fucking locked in.
This is good film.
I just wanted to show you.
- Yeah.
- If you don't mind.
- Wait. Say it again?
- It looks good.
Okay. Why are we going back here?
I like what I see.
Oh, God.
Yeah.
Look at this.
Oh, my God.
It's like a hornet's nest.
- Here are all the hornets.
- Yeah.
Now you just have the nest,
everything's dead inside.
Does that mean it's dead?
If we had to guess.
The hornets are dead. The nest is there.
The hornets are dead. The nest is there.
- You consider hornets the tumor itself?
- Yeah. The cells
The cells are buzzing around here
Bzz, bzz, bzz.
Then we spray with Avastin,
then they're kind of dead and dying.
I'm trying to understand,
the nest itself is still the tumor, or?
The nest is still there,
much like a hornet's nest would be there
in the bush even if you sprayed it
and killed all the hornets.
- We never get rid of the nest?
- No.
This is indicative of what we call
a positive treatment response.
What I think you're struggling is
The communication between
speech production and reception is
- There's basically something blocking it.
- Yes.
Okay. You know
what we're going to do here.
Good.
I'm pleased with this.
- Yeah.
- So am I.
I want you to be pleased with it.
- I want you to sing all the time.
- Yeah.
- He's better.
- Yeah. Yeah. Yeah.
- I'll see you in a month.
- Okay.
I want you to come in. I like seeing you.
- Okay.
- Push yourself. Don't get frustrated.
Push yourself until
you're just done pushing yourself.
- Thank you.
- I'm proud of you.
Keep up the good work.
We recently got NYPD coverage
in the ER now.
Every day,
which I'm very happy about.
Coming back, it's, uh
I felt I felt a lot safer.
There's going to be
a lot of intoxicated people tonight.
Psychiatric, intoxicated.
It'll be fun.
- Boo.
- Where's your costume?
You're playing doctor tonight. Okay.
How's the baby?
Good. Good.
We dressed him up as Chewbacca today.
I'm sure there'll be pictures.
He's so little. We walked down
the whole Halloween run by our place,
and my husband's like, "All right."
- So no gummy bears?
- No gummy bears.
All right. Damn.
Terry. What happened?
I hope it's not just one sandwich.
You hope it's not one sandwich?
- There's two sandwiches here.
- Okay.
All right?
Can I ask you something?
Yes. Here you go.
Can I ask you something?
Ask me what?
I want to die.
Terry.
My my my
I've seen you three times
this week from the BRC.
I'm asking I'm asking you,
Would they take me back?
I don't know if they'll take you back,
because you drink. And you have to stop.
If they don't
I'll roll into traffic.
No, you're not going to do that.
Yeah.
We're not gonna do that, okay, Terry?
We're not gonna say things like that.
Why don't you hang out here
for a little while, but don't shout.
Because you're going to scare
all the other patients.
Yesterday in the ER
he threw himself on the floor.
Do you want to do the lab test?
Yes. I didn't do one yet.
Hello. Dr. Little.
How are you?
- You know we're always watching baby.
- Yes.
We're always watching you.
If ever anybody appears stressed,
we come in.
Uh-oh.
- You feel another one?
- I'm going to.
You're allowed to push.
That means that's good. Let it go.
- I just push?
- Yep.
- Good. Great.
- Keep it going.
Try to keep that chin down to your chest
like you're curling down.
Eight, seven
- Good.
- Six,
five, four, three, two, one. Relax.
Everything is still perfect.
This isn't as bad as I thought
it was going to be if this is how it goes.
I'm going to regret saying that.
I was gonna say,
- "You're going to regret saying that."
- I know.
Okay, Marie. Give me a squeeze here.
- Good girl.
- Nice.
Strong right hand. Wiggle your toes.
Wiggle your toes there.
- Good girl.
- Good.
I did it! Peace and love!
Peace and love?
At least you didn't lose your personality.
I did it, Dr. Langer.
She's unbelievable.
This kid is off the charts.
Dr. Langer, peace and love. I did it.
Now I can Give a hug.
Yeah, now I'll take a hug.
Here, we had this under her
the whole time.
- Thank you.
- My God. Thank you.
Bless you.
All right. Let's see how you're doing.
What are you doing in here?
Oh!
Are you having a picnic?
Yeah. We're cleaning up now.
You don't have to.
So, the reason why you've been here
so long is because the baby
keeps wheezing.
Why don't we take a look?
You guys want to see something cool?
- Yeah. Yeah.
- Okay.
So
- That's Prince?
- That's Prince.
Remember the picture we took of you?
The one thing
I've noticed after having a baby is,
it's much harder for me
to see children.
I think his chest x-ray looks great.
He doesn't have pneumonia.
It's just the emotional aspect of it.
If he doesn't stop wheezing,
I've to keep watching you.
Do you have anybody else
that can stay with the children?
Not over here,
because we live in the Bronx.
- Oh.
- We're pretty far from home.
Okay.
- The kids have school tomorrow?
- Yeah.
Oy.
- You know.
- I know, right?
It's already really late.
I know.
Well, let's see what we can do.
If he can't go home because he's wheezing,
would you be able to stay here, or
I I don't know.
I would have to see what I could do.
- If somebody could get them.
- Okay.
Do you have anybody close?
I have their grandmother,
but I don't know
if she's even going to answer right now.
Very first thing
I thought about when I saw her
was frustration.
She has no social support
and five children.
I I know from experience
within my own family that
I feel that women could easily fall
into that problem for many reasons.
That's the way I have to relate
to a lot of people here is
not getting easily frustrated.
I do get frustrated internally. I do.
- I think he's better.
- He is, right?
He is. See?
I'm so happy. Thank God.
It'd be great if we can
get her home,
and can you get her metro cards?
She has to put all the kids to bed.
- Yes.
- Okay, I'll print out the paperwork.
- Okay.
- Thank you.
Such a cutie pie.
Dad, stop crying.
I've stopped.
Stop crying.
You made it.
I'm perfect.
[WOMAN OH, MY GOD! I LOVE YOU!
Sh.
- I'm sorry.
- Rock on.
All right, I'll leave it alone.
Okay, guys.
Dr. Langer, thank you.
All right, guys. All right.
Okay?
THE FIRST TWO WORDS: "I'm perfect."
Yes yes, yes, yes, right there.
Beautiful. Four, three, two, one.
Deep breath.
Again. Use that contraction, that force.
- Press in. Go. Push down.
- Yes. Oh, beautiful.
Good.
And more, more, more.
Extra, extra, extra, extra! Yes!
- That's good. Good.
- Hold it.
Apparently in Mexican culture
when the head comes through the vagina,
they call that the ring of fire.
It's going to burn,
it's going to be painful,
but it's going to be over.
They talk about the baby
- getting power from the female ancestors.
- Oh!
It's a whole thing.
Good job.
Good job.
She's pushing well.
She feels her pressure.
- Hi.
- Are you guys getting closer?
Uh, not yet.
How are you?
Where the fuck are you?
Are you here yet?
Okay, we're upstairs. What kind of drink
do you want? I'll get it ready for you.
Whoo!
Whoo!
Hello.
- How are you doing?
- I'm okay.
Shake your hand.
You're the man.
Doing good. Good.
I'm so happy you're here. Seriously.
I need to say something.
Can I say something real quick?
You know, Mitch,
your experience and who you are
has brought us back to the core,
and has really, honestly, energized me,
because you represent
what's great about medicine,
what's great about being a neurosurgeon.
We cannot wait
until you come back full-steam.
We all miss you.
Having you here tonight is amazing.
So, the future is bright with you back.
Thank you for being here at all.
You know, when I first came here,
this was our our department, and, uh
We're living out of, like,
a single room.
The the reason why
we've been successful,
we each have filled a role.
Every one of you represents
how we've spread our wings
and developed more and more a momentum.
This all grew out of that one tiny office.
And this is just the beginning.
Looking back on this,
it's been fucking torture
But, retrospectively, it's been
the greatest experience of our lives.
Thank you for coming out tonight.
Full full respect.
Kalman's here.
Whoa!
Hey!
- You missed my speech.
- I know. I'm sorry about that.
It was played live.
Jill, thank you for everything.
Mitch is here.
- Who's here?
- Mitch.
Oh, is he really? I want to go see him.
- I'm going to go say hi.
- Go say hi.
Don't look inside, but from the outside,
you know.
If you look here I'm okay.
You're gonna do awesome.
Dr. Langer, honestly, I want to be you.
No, you want to be you.
- I want to be you.
- I'll help you be you.
- Yes.
- All right?
Thanks for everything you've done.
- So awesome.
- Thank you.
- Okay.
- Ready, ready, ready.
- Okay, ready?
- Yep.
Okay, you know what to do.
Nice, big, deep breath in. And go.
- Push down. Push down.
- Beautiful.
Oh, my God. He's like right there, right?
- Okay. He's coming.
- He's coming.
- He's coming. Just breathe.
- Relax.
Okay. Remember, we're staying
What am I feeling?
You're feeling his head.
People have no idea
about the time it takes
to go through labor,
and it's painful the whole time.
A lot of women not really understanding
or knowing the complete process.
Great. Relax.
Ten, nine…
Get that head down.
But I find that for many women,
especially with pushing
or getting very close to delivery,
they still have pressure.
That pressure can be so uncomfortable.
I have no idea what that feels like.
- Push.
- Ready?
Just remember, everything is normal.
Okay. Everything is good.
When you have that pain and pressure,
just stay focused, you'll be done.
This is the ring of fire
Dr. Brennan was talking about, okay?
- Right now? Okay.
- Potentially.
It seems like it.
- Ready? Go.
- My God. It hurts!
I believe in the strength of women.
I strongly believe every woman is capable.
Eight, seven, six
It's what you can do.
You want to empower women.
- …four, three
- That's it.
- Two
- Yes.
- One.
- Yes.
Touch your baby's head right now.
- Take your hand. Feel it.
- Oh, my God!
Oh, my God.
Now we'll let you stretch some more.
Easy does it.
Now, give me one more little millimeter.
Look. Open your eyes. Look down.
- I can't see
- Open your eyes.
- Oh, my God! Oh, my God!
- Put the feet in the stirrups.
Yeah. Now, take your hand
and grab the baby's body with your hand.
Not the arms, but grab around the chest.
- Oh, my God.
- Now, in a minute,
you're going to lift him up, okay?
Ready? Lift him way high up.
- Then a little bit forward.
- My God. He's
- He's just holding…
- Yeah.
Okay, now you can lay him down
You can lay him
right there on your chest.
There it is.
You did it! You did it!
Oh, my God.
What a great job
You're okay.
- I know.
- You can open your gown
and put him right on you.
I'm, like, afraid.
You delivered him,
so you can't be afraid now.
Yeah, there's a big blood clot sitting
right here.
- Is that okay?
- Yeah.
Yeah, it's very common.
We make sure that it gets out last.
The uterus has to contract down,
so your bleeding stops it. It will.
Everything that happened to you
is completely normal and good.
Congratulations.
Thank you so much.
- Congratulations.
- Thank you.
- Thank you for everything.
- Nobody coaches like you.
Oh! You're so sweet. Thanks.
Walter, we're gonna get you
a room. Wanna come with me?
- What?
- I'm waiting for your lithium level
so we can give you your medication, okay?
Come on, Walter. Let's go.
What about your Odyssey?
- The book.
- The book.
They fought all this war for a woman.
We know Walter.
He's a rather
unfortunate gentleman who is young,
and he had his first psychotic break
I don't know when.
We're gonna ask you
to chill out here for a little while
until we get your lithium level back.
But I'm wondering
where are your medications right now?
They're at home.
Okay. Why haven't you been home?
Basically, I love being out
and about outdoors,
and I also love to be able to do my own
little security check for Halloween.
I'm not out there to plow or to prowl,
but I saw Catwoman out there.
You were admitted in the hospital
not too long ago.
You know what happens
when you don't take your medicine.
You end up here,
and we take you to Zucker Hill.
I would like to see you go home
and take your medicines at some point.
If you release me at 6:00,
I will take the medication in the morning.
How are you going to do that?
I will do it…
whenever you give me a metro card.
- A metro card.
- Exactly.
When your lithium level's back,
if your lithium level's okay,
- we're going to give you 450 milligrams.
- Okay, that's wonderful.
'Cause you don't wanna be
- on 666 on Halloween night.
- I don't want to break the 666 code.
I'll be back, okay?
- All right.
- All right.
He could go home,
but I don't think he wants to.
He likes being out on the street because
he does have an apartment, actually.
He has an apartment assisted by the city.
Schizophrenia is considered a disability,
so you can get
Medicare assistance for that,
but most of the schizophrenics that I've
met don't have an established apartment.
They live on the streets.
They check themselves into shelters.
He is one of them that has help.
The ones that don't
they're just kind of lost to the system.
Sounds like he had a normal life.
He went to college, he was a painter.
Now he's like this.
It's either genetic or a product
of how he grew up. Who knows?
It's scary, your child just be lost
to a psychiatric disease.
Now that I see young kids
coming in with alcohol intoxication,
it's a worrisome thing.
Right now we have two, four…
Six teenagers in the ER,
and they're all from alcohol or drugs. So…
We had a dad that called into the ER
and said,
"I want my teenager drug-tested."
Because he was a nerdy kid
who passed out, and his dad thinks
he's on drugs. All right.
Actually, looking back,
I understand his worry.
I may have done the same thing.
I definitely would have done
the same thing.
I would drug tested Joaquim
when he's 18 and he comes in the ER
after passing out on Halloween night.
It's the first thing I'm going to think.
"What were you doing?"
You never know. You never know.