Three Rivers s01e06 Episode Script

Don't be nervous, honey.
I just don't want to blow it, that's all.
No, you'll be perfect.
Just watch your tuck and your dismount.
I will.
- Okay, love you honey.
- Love you too.
- Break a leg.
- I hope not.
Alyssa Sussman, beam.
Megan O'Hara, uneven bars.
Teri Sampaio, floor exercise.
Meg, are you ok sweetie? Is there a medic? Dr.
Reed, are you coming on a ride-along? Yeah, part of the ER residency.
Miss it? I would if all the residents were like you.
But back in my day, it was just me and Agnes from Lithuania.
Gassy Aggy.
She smelled like borscht.
Not pleasant in an ambulance.
No.
I did like driving fast though.
That was fun.
Good.
You need a little excitement.
I'll file it away.
Be safe out there.
- Bye.
- Bye.
David is using me like a puppy to attract all the cute nurses again.
You're right, Kuol.
What would I do without you? - You have a clipboard.
- I do.
And a serious face.
Well, it's not great news.
Your medication stopped working.
So we're going to have to put you on an LVAD.
That's a Left Ventricular Assist Device.
A device that you surgically implant in my chest to make my heart pump.
I know what a LVAD is.
I also know that it means I'm getting worse.
Yes, it does.
But it's called an "assist" device, Kuol.
Your heart still works.
It just needs a little help.
- Okay then.
- Okay.
Dr.
Yablonski I know because of financial issues, I'm having trouble getting listed for a heart.
How then can I pay for an LVAD? You don't worry about that Kuol, okay? We'll figure that out.
Right now you stay in bed.
And you rest.
And take it easy on the nurses.
Yo T.
J.
Where you goin'? This ride makes me barf, man.
I'm not going on it.
It's not called the octo-wuss.
Haha, come on.
You guys suck.
Woohoo! Dart master! I won.
I totally won.
You want a bear, a kitty or a dinosaur? Dinosaur.
That one right there.
That's awesome.
- It even moves too! - That's so cool.
How about we go celebrate with some cotton candy? You already had a pretzel and a snow cone.
How can you be hungry? - Please.
- Alright.
Here's 5 bucks.
I want some change.
- Got it mom.
- Alright.
That's not right.
That's not right.
Take it easy.
Dylan? Has anyone seen my son? Dylan? Dylan? Oh my, Dylan! Help.
Somebody help me.
Please! Dylan! Help! Transcript, corrections, by err0001 and chamallow Transcript, corrections, by err0001 and chamallow "Three Rivers -01x06 - Where We Lie" - Oh my God! - Holy crap, dude.
I told you this ride was bogus.
Hey, hey.
Hey, don't move that until we can assess the situation.
Please everyone, just stand back.
Everyone stand back.
It's my son.
My son is under here and I can't get him out.
- Ma'am, what's your name? - Laurie Campbell.
Ok Laurie, I'm Lisa.
Now I need you to step back.
Just a little bit, ok? He might have spinal injuries so we just have to take this really slowly.
Please, just trust me.
His name is Dylan.
Watch yourself.
That is very insecure.
Hand me the C-collar please.
What is she doing? She needs to immobilize his neck to protect his cervical spine.
- It's just a precaution.
- Hey buddy.
Hey, Dylan.
I'm Lisa.
I'm gonna get you out of here, ok? But I need you not to move, ok? How old are you buddy? Dylan honey, can you talk to me? So you've got your velociraptor with you.
Raptors are cool.
Did you know they were one of the smartest dinosaurs - and they could run like 25 miles an hour? - Yeah.
Yeah? Ok, I'm going to have to put this around your neck.
Under your chin, just hold still.
Good.
Ok.
Can you feel your legs? Yeah.
They hurt.
I know.
That's actually a good thing.
Can you tell me where else it hurts? My chest.
This is heavy.
I know.
We're going to get this off as fast as we can.
Hang in there for me, ok? Okay buddy? 2271 please.
Transplant Coordinator, 2271.
Dr.
Jordan? Remember when you were about to transplant Mr.
Boyle.
Last week? Right, Ok, well When I walked into that O.
R.
, I heard him say "Dr.
Foster".
And I know he didn't mean me.
Your father was Mr.
Boyle's doctor.
And Mr.
Boyle was very attached to him.
And he took it rather hard when he died.
A couple of times now, I've heard people talk about it.
So, I'm wondering did he say something about you and my dad? You do know Rudy Boyle was on pre-op sedatives? He was flying pretty high.
Yeah, but I don't even think it's just Mr.
Boyle anymore.
I mean listen.
You can tell me.
Just, what's going on? our father was my mentor, Miranda.
We were very close.
Some people might have misread that.
Okay.
I mean if that's what it is, then that's what it is, right? Right.
Now I want you to take a look at this patient, Megan O'Hara.
She's 15.
She took a fall at a gymnastics meet, but this is not a sports injury.
Why don't you have a read of that on the way to the ER.
Got it.
Thank you.
Just so you know, you guys are really freaking out my parents.
Well, once you get these CT scans, I'm going to get you back to them.
There's nothing wrong with me.
I just got a little dizzy and missed the bar.
It's no big deal.
It's not just the fall, Megan.
Your liver enzymes are elevated and we need to figure out why.
Did you eat or drink anything unusual over the last day? - No.
- Any drugs or alcohol? - The ER doctor asked me this - Now I'm asking.
Any prescription or non-prescription medications, pain relievers? - Maybe a couple.
- Yeah, pain relievers? What kind? - The extra strength kind.
- Acetaminophen? I think so.
I've had some headaches lately.
- Ok, and how many have you taken? - I don't know.
8, 10? - Over how long? - Since yesterday.
Wow.
Okay, that's over double the maximum.
Let's go this way.
What are you doing? Well, you took too many pain relievers, so I'm going to take you to ICU and we're going to give you an antidote.
The administration turned down the VAD for Kuol.
Are you kidding me? Did you tell them I dropped my fee? Happy as they are to save a hundred bucks, that's not going to cut it.
Yeah, funny.
You know what, let's just get it for him anyway and we'll figure it out later.
That's not going to work this time darlin'.
Why? I know we have a fund for patients in need.
That money has been spent.
And there won't be more until the next fiscal year.
He's not going to make it that far.
He needs a heart, Sophia.
And he should be on that list.
We have to get a VAD for Kuol or he won't survive.
Andy, we all care about Kuol.
Ok, so lets dig up some money for him.
You're better at this than I am.
D'you realize accounting thinks that Kuol's room - has been under construction for a month? - Just so that I could keep him in a bed.
See? You're way better.
You can't wish this away.
It's a hundred thousand dollar procedure and somebody's got to pay for it.
Or it doesn't get done.
Sorry, man.
Anaesthesiologist to ER stat.
Why aren't you moving? We can't get a VAD for Kuol.
No money.
We need a backup plan.
I'm not going to go away.
I'm just going to slide out here.
See, I'm right here, bud.
- Hey! You got to clear the wreckage! - No! This is as far as I go.
Let's open up the spreader and lift this sucker.
Oh God.
Hit It! It's ok buddy.
I'm still here ok? Oh good, you've got your raptor with you.
He's one strong little dude.
Hang on to him until we get you out of here.
I'm afraid Megan has acute liver failure.
Brought on by an overdose of acetaminophen.
What do you mean? That's just an over-the-counter painkiller.
You can still O.
D.
on it.
Taking more than recommended dosage, even one time can cause major damage, especially to the liver.
Megan, honey, why were you taking this in the first place? I might be able to answer that.
Megan has 2 fractured ribs.
I'm confused.
From the fall? No.
No, these aren't from today's accident.
The scar tissue indicates this happened at least a week ago.
What? Well, I kind of had this thing on the vault a while back.
Honey, how could you not tell me? Well, I didn't think it was a big deal.
I didn't want to worry you guys.
Okay, but you can fix this, right? You can clear this up.
We tried acetylcysteine.
It's an antidote.
But she's not responding to it.
Megan's liver is damaged to the point that it is no longer functioning.
So what do we do now? We're not out of options.
We can do a liver transplant.
I can get it listed right away.
Oh my God.
Oh God.
Dylan, I'm right here baby.
Okay Dylan, I need you to stay still.
Don't move.
Leg's broken.
Let's get a vacuum splint.
Dylan, can you wiggle your toes for me? Yeah? Ok.
Heart rate's going up to 140.
Pulse is thready.
Ok, it's hard to hear anything out here.
- Maybe decreased breath sounds on the right.
- What's wrong? What's happening? There may be a hemorrhage that let loose now that the weight's off.
Bolus of saline.
20 cc per kilo.
Let's get him in.
Let's go.
Go! Thanks for coming down.
8 year old trapped under a carnival ride for forty minutes.
Crush injury to the chest.
Suspect hemothorax on the right.
No breath sounds.
I got blood when I darted him in the van.
That's when I paged you.
BP 60 palp.
Pulse 140.
Resps 32, Pulse Ox only 85.
Let's strap him.
Wait, wait.
Don't throw the shoes away.
Belongs to the family.
Tibia fracture.
I agree.
It's a hemothorax.
He needs a chest tube.
I want a code green panel.
And 2 units of O neg super stat.
And set up a cell saver in case we need to transfuse.
What's going on? Your son has blood in his chest that's making it hard for him to breathe.
We're going to get it out.
I'm sorry you have to go through this, Megan.
My mom and dad were Olympic skiers.
When they got injured they competed anyway.
I mean they were just pain pills.
- I didn't think that they could hurt me.
- I know.
But the good news is we already got you listed.
What does that mean? Well, we put your information into a system and if a donor liver comes up that matches your blood type and a few other criteria, we'll get a call.
What if a liver doesn't come in time? Then there's another option.
What other option? It's very likely that one of you could be a live donor for Megan.
You mean that I could give her my liver? A part of it, yes.
If you're compatible.
How would part of a liver be enough? Livers regenerate.
They're unique that way.
The donated lobe would grow into a full liver for Megan.
And your liver would grow back as well.
I want to do this, absolutely.
Mrs.
O'Hara, it is major surgery.
I don't care.
She's my little girl.
Ok.
We'll get you tested right away.
- Test both of us.
- Even better.
Cell saver is ready Dr.
Reed.
Ok.
In toward the shoulder blade.
- Blood pressure's going up.
- Lungs are re-inflating.
Alright.
He's stable.
Let's get a CT scan of his chest, abdomen and pelvis to make sure we're not missing anything.
So? Which one of us gets to donate? I'm sorry to say, neither of you is a blood match for Megan.
But I thought it was a given that one of us would be compatible? Well the odds were high, but they're not 100 percent.
It happens sometimes.
- So what do we do now? - We wait.
Megan is high on the UNOS list.
A liver could come in at any time.
I'm going to get some air.
Mrs.
O'Hara, if you have any questions or you need to talk about anything, we're here.
- Thank you.
Thank you.
- Of course.
So are you going to talk to her? Or am I? We're going to give her time to wrap her head around this.
It's Biology 101.
I want to at least give her an hour.
If she doesn't come to us, we'll go to her.
Hey Kuol.
- I've never noticed this before.
These are all donors? - Yeah.
Each person up here could have saved 6 or 7, even 8 lives.
I've been a very lucky man, you know.
When the soldiers came to my house in the Sudan, and killed my family I was in the fields with the herd.
Two days later, my friend Lam and I fled through the desert.
We heard there were refugee camps in Ethiopia.
It took us almost a year.
He didn't make it.
But I did.
Lucky again.
Then I got to come to America.
Now I just think, perhaps my luck is done.
A donor is going to come for you, Kuol.
But right now, all you need is a VAD.
Yeah, but they're not free, as luck would have it.
Kuol, this is nowhere near over.
And who says there's no such thing as a free VAD? - Yeah.
Excuse me just a minute.
- Sure.
Excuse me.
- I'm sorry to bother you.
- Oh, it's no bother.
Come on in.
Sit down.
When you said there was a chance Steve and I wouldn't be a match for Megan, how big is that chance? 25 percent normally.
But in your case, you and Steve are O-type and that's recessive, so Megan would also be type O.
- What type is she? - She's B.
I hoped I mean I Steve doesn't know, obviously.
And the only reason I'm telling you is because if Steve isn't Megan's biological I need to find Megan's father.
D'you know where he is? It was a long time ago and Steve and I were having problems.
I know his name and that's about it.
You need to know though, he may not be an organ match either.
If there is even the slightest chance, I have to try.
Ok.
Give me his name and I will use the hospital's resources.
I'll see if we can find him.
Ryan, I've got a job for you.
The companies that make VADs.
I need you to call them and see if they are running any clinical trials.
If they are, I need you to make an appointment for me, ok? No can do.
That's not an appropriate response.
I'm tracking down a guy named Jim Santos who could be a liver donor for Megan O'Hara.
Dr.
Jordan told me not to stop until I find him.
Ok.
I guess I'll do this myself.
How do I do this? Go to the main screen.
Click on Vendors, then click on Circulatory Support Devices, then click on VADs.
VADs.
Ok.
It looks like Modrotech has a clinical trial for its new VAD.
How do I find who the Modrotech rep is? click on Rep.
Right.
Samantha! - Another friend of yours.
- Not yet.
- Ok, let's get a full scan from the chest to the pelvis, please.
- Yes, doctor.
We need to clamp off his chest tube so we can get him in the machine.
Got it.
- Massive arterial bleeding.
- He's hemorrhaging again.
We don't have time for a CT.
Brad! Get me an O.
R.
right away.
Got it.
Ok.
Hang in there, buddy.
What's happening now? The bleeding in Dylan's chest has started again.
I've got to take him to an O.
R.
, open his chest and find the source of the bleeding, ok? We have to get him upstairs.
Come on guys.
Here we go.
Retract the middle lobe please.
- Retracting.
- Suction.
Oh.
There it is.
His pulmonary artery is shredded.
Andy, I'm having trouble keeping his pressure up.
- We've got to get him off the table.
- Just give me a minute, ok? We might be able to fix this thing.
Pulse Ox is going down and we've got him at 100 percent O2.
No.
It's almost completely severed.
We're going to have to do a pneumonectomy.
If we don't get this lung out of here, he's just going to keep bleeding.
Taking his lung out after trauma gives him maybe a 5 percent chance to survive.
Ok.
Well, it's better than zero.
So let's do it.
Let's do it.
Ok, So what's the deal with Jim Santos? - There is no deal.
- Come on Ryan, how hard can this be? All I have is an address from 16 years ago.
He hasn't lived there for 10.
I checked with hospital records.
He's never been through Three Rivers.
- You check with the phone company? - Yup.
- DMV? - Yup.
- Is he a registered voter? - No.
I'm sorry Miranda.
I'm trying.
Exactly how long do I have to find this guy? Megan's not going to last more than a few days, Ryan.
Hey.
Look who's awake.
- How are you feeling? - Awesome.
Where's Dad? He went for a walk.
Is he ok? Yeah, honey.
He's just worried about you.
I'm so sorry, Mom.
This is all my fault.
No, Meg.
You didn't do anything.
No I did.
I wanted to be like you.
You and Dad.
I try, but it never works.
Dr Jordan! I found Jim Santos.
I was checking patient records at Mercy General.
Turns out a Janice Santos was treated for a broken arm injury in their E.
R.
two years ago.
It's his daughter.
Does Santos still live in the vicinity? Bethel Park.
So, we're talking about one little tiny VAD here.
I would like to say yes, but the trial is already in its third week.
Yeah, but from what you say about their capabilities, three weeks should be nothing, right? Ok.
Let's say I could slip you in.
I am not sure that Kuol's citizenship wouldn't be an issue.
I believe your company allocates 5 percent of all its clinical patients' lots to non-citizens.
I checked.
You're good at this.
Thank you.
So are you.
Your VAD sounds incredible.
Oh, it is.
It is one of a kind.
But you know I heard that Vitner Laboratories is introducing a very, very similar model to yours.
Ok.
Now you're just trying to make me jealous.
No.
Just I would hate to see you lose an account with Three Rivers.
The number one transplant hospital in the country.
And getting a VAD for Kuol, could go a long way to keep that from happening.
I will talk to my superiors and see what I can do.
- Thank you.
- If you talk to who you can about our dilators.
And I would love it, if you could go to a couple of conferences on behalf of our company.
It helps to have a doctor's endorsement.
It's just 4, 5 weekends.
Will you be there? No.
But if you want Kuol to get a VAD, you will.
Done.
Well now that that's settled, there is something else that I would like to show you.
Check please.
- Hey there.
- Hey.
How's he doing? Well, right now his pulmonary wedge pressure is stabilizing.
I mean, so far so good.
The nurse told me his chances.
The fact is, that this period now, the period right after surgery, that's critical.
Why? Because his heart is still trying to pump blood to a lung that isn't there anymore.
The pressure can build up.
But if this little guy can push through these first crucial hours, we're going to be in great shape.
How many hours? 24 to be safe.
But we're going to know a lot more in the morning.
Ok? You know I never get used to treating kids.
You ok? Yeah.
Just, if Dylan doesn't his Mom is going to want his shoes.
And she shouldn't have to see the blood on them.
Are you sure you're ok, Lisa? You're suggesting I'm being less than professional? No.
No.
That's not what I meant.
I'm just saying - I mean kids are easy to get attached - Please Andy, - don't patronize me - Ok, wait a minute.
This isn't coming out right.
Really, Lisa Should we give your husband another 5 minutes? No.
I don't think he's coming.
Ok.
Mr Santos, I understand that Val explained to you the situation.
And I just want to say first of all that we really do appreciate you coming down here.
Sure.
And if there are any questions you have, about the surgery, or anything else, that's why I'm here.
Look, I understand my blood type matched to Megan.
The nurse said that doesn't necessarily mean that she's I'd just like to ask if you don't mind I mean how can you be sure? If it's not Steve, it's you.
That much I know.
Ok.
Tell me about the surgery.
The operation is about 5 hours.
Then you'd be in the hospital for 5 to 7 days after that.
How long would I be out of work? About a month, full time.
And then another 2 to 4 weeks part time depending on your recovery.
Risks? Side-effects? Well, like any surgery there are risks going under general anaesthesia.
Strokes, blood clotting, bleeding, infection.
But ultimately you should know that we've had great success with this surgery.
- Can I tell you about Megan? - Val She's 15, so smart, she's been on the honor roll as long as I can remember.
She's a gymnast.
I think I told you that on the phone.
Val, God you know I'd really like to help you.
This happened before I had my own family.
Before I was even married.
I have 3 kids now.
Carrie's a stay at home Mom.
I'm the only one who works.
- Jim, please - Look, this is too much.
I'm sorry I just I can't.
How are you doing, Mr.
O'Hara? My daughter's very sick.
Everything I thought about my family is a lie.
How are you? Well you should know that we located your daughter's biological father.
Yeah, I saw him in the conference room.
I couldn't go in there.
- Is he a match? - Yeah.
- But he doesn't want to donate.
- Why? He has a family too.
So we're back at the mercy of the list.
Look, Mr.
O'Hara, nothing about the situation is good, but your daughter's very sick and right now we don't have any answers for her .
She's scared and she needs you.
We'll see you inside, ok? Mrs.
Campbell.
Mrs.
Campbell.
- What is it? - It's ok.
It's ok.
He's waking up.
- He's been breathing on his own.
- Oh my God.
- We're going to take the tube out now.
- Ok.
Miss Chan, did you call Lisa? - She's on her way.
- Ok.
Good.
Hey Dylan.
Hey buddy.
My name's Andy.
And I'm going to take that tube out of your throat.
What do you think of that? When I take it out, it's going to make you cough, ok.
But that's only going to last for a couple of seconds.
Ok, pal.
Ok.
Let's hyperventilate.
You're doing great baby.
Oh sweetheart.
Here we go.
Inflating the cuff.
I need gauze and an O.
R.
towel please.
Ok.
Almost there, buddy.
Ok.
Here we go.
1, 2 there we go.
You ok, sweetie? Good job.
Where is my raptor? That's my baby.
I'm Megan's Dad.
I thought you left.
I can't.
I have a daughter too.
And 2 sons.
I didn't come here to pressure you.
Actually, that's not true.
Look, I'm not going to say that this whole thing doesn't have me really pissed off.
My family's pretty screwed up right now.
But it's still my family.
She's still my daughter.
The only difference is, I can't help her.
But you can.
So I'm asking you as a father to your own children, please help mine.
- You ok? - Fine.
I'll be right back, honey.
- Dr.
Jordan? - Yes.
I just wanted to thank you.
You are so very welcome.
You know I kept that secret because I didn't want to hurt my family, but I didn't realize how much damage it was doing.
Steve and I are going to tell her when she's had some time to recover.
I think that's a good idea, Mrs.
O'Hara.
What is it they say? Sunlight is the best disinfectant.
- Is that what they say? - Yeah.
Enjoy her.
- You wanted to see me? - Hey.
Yeah.
Come on in.
I wasn't entirely forthcoming before about your father.
Miranda, I respect you.
And I want you to respect me.
So I need to be completely honest with you.
I was in love with your father.
He was in love with me.
So then everything I'm hearing is true? I don't know what you're hearing.
We cared about the medicine.
We didn't care about But you cared enough to keep it a secret.
We cared enough to keep it private.
I understand if you're angry.
I'm glad you understand because you know my Dad he spent a lot less time with us in Philly and he spent a lot more time here with you.
- With his work.
- You can call it what you want.
Regardless, my mom, she still lost her mind.
And my dad left me to take care of her and then clean up his mess.
And now I come here and I learn that everybody knew this but me.
No, that's not Don't you dare tell me I'm wrong.
It's complicated.
It's pretty clear to me.
Ok.
This part stays on your back at all times.
Because hold that please this part won't work without it.
- Will that go into my chest? - Yeah.
This attaches right to your heart.
Will it make me look more buff? It's not that miraculous.
Hey, what do you think, Dr.
Lee? Pretty sweet? Nice.
I read that a man climbed the Swiss Alps with one of these.
Easy, big guy.
We'll see you in surgery.
See ya.
So I spoke to the VAD supplier about that trial.
- Did you? - Yeah.
Like 4 times.
They said it was too late to start.
They wouldn't budge.
What did you do? Oh, I just had to jump through some serious hoops.
It's for Kuol, so Right, right.
Anything illegal? Sometimes you just gotta do what you gotta do.
- Hey.
- Hey.
Listen, I'm I'm sorry about before.
I was out of line.
No, not really.
I was thinking about it and I owe you an explanation.
When I got to the accident and I was working on Dylan.
I looked down and I saw his leg.
It was twisted and small, and then I saw his shoes, covered in blood.
My sister wore the same shoes as Dylan.
The ones with the sun on them.
She died when I was twelve.
We were, um We were riding our bikes to a friend's house and Becca was 10, and I didn't want her to come actually but she was such a tag-along.
Anyway, this guy was picking a CD up off the floor of his car and we came around the corner, and I just remember her legs, twisted.
And - I didn't know how to save her.
- You were 12 years old, Lisa.
You know.
Anyway, it's over.
Thanks for listening.
Any time.
Oh.
It's you.
Wow! You sure know how to make a guy feel special.
Kuol's prepped and ready for his VAD.
Ok.
Let's do it.
Transcript, corrections, by err0001 and chamallow