Three Rivers s01e07 Episode Script
The Luckiest Man
The Luckiest Man Roll call! Dishes? Check.
Beds? Check.
Laundry? Check.
Leaves raked into a pile? Check.
Timber! Michael, bury me.
Bury me.
It's my turn! It's my turn! Mikey? Mike? Michael! Mike? Mike?! Mike! Mike? Mike! Whoa, whoa! Slow down, Kuol.
That's a Ventricular Assist Device, not a rocket pack.
So you say.
I have not felt my oats in this way since I was a child playing football in the refugee camp.
Okay, well, just dial it down a notch, okay? The VAD helps, but your heart and your immune system are still weak.
Yes.
Good morning, ladies.
Okay, guys, a little to the left.
Yeah, now to the left.
Yeah, a little higher on your end.
Perfect.
Hello, Ryan.
I'm Barbara Harris.
I was told that you were Party Central.
Are you one of our recipients? Dr.
Wilson did my transplant last October.
I just want everything to be perfect when I meet my donor's family.
Yeah.
I was supposed to be here first thing, to set up, but my flight was horribly delayed I think you'll be okay.
The donor-recipient party is not until tomorrow, so I will go bug the caterers.
We know a thing or two about barbecue in Dallas.
Hi, Cookie.
It's Daddy.
You were right, as usual.
I should have charged my scooter battery.
I'm heading home with my power cord between my legs.
Three Rivers 1x07 The Luckiest Man sync, corrections Hey, who's the surgeon on trauma call? Uh, Dr.
Jordan.
She's on her way.
We ready? One, two, three.
Multi-trauma ALS patient.
He's hemodynamically unstable.
Multiple rib fractures and a flail chest segment.
That's bad news with his ALS.
Put him on a vent.
He's going to need it.
You better have Andy come down and have a look at him.
Before my heart transplant, your father personally came in to wish me well, Dr.
Foster.
Uh-huh.
It's good to see you carrying on his welcoming spirit.
Oh, yeah.
What in the world is chipped ham? It's a Pittsburgh delicacy.
The things you Yankees eat.
I see you got sucked into the Welcome Wagon, too.
No.
Are you kidding? I just love a party.
Barbara? Barbara! Barbara! Barbara! Okay, okay, okay.
Call an ER right now! Mr.
Downing, I'm Dr.
Lee, one of the transplant surgery residents.
The ER doc asked me to look you over, okay? Call-Call me Michael.
Okay, Michael.
The report? Thank you.
Okay.
Let's up the O2, give him 125 of Solu-Medrol, repeat the nebulizer.
Thanks.
You had 50 to 60 ER visits over - the past few years because of your lungs? - Yeah.
Why haven't you followed up with any of the doctors you were referred to? I couldn't afford health insurance.
A year ago, his lungs got so bad, he qualified for Medicare disability, so he could finally see a lung specialist.
But then, his lungs were trashed.
And that's when you finally found underlying pulmonary hypertension? - Yeah.
- Hmm.
Where are your parents? Dead.
Michael takes care of us.
Okay.
Is this why you signed out against medical advice so many times? I can't stay in the hospital.
One time, when he got admitted, they put us all in separate foster homes.
Let's get you turned around.
I need to repeat the pulmonary function test, all right? No admission.
We're gonna jump off that bridge when we come to it, okay? He's all right? Yes, he's stable, but we noticed he has ALS.
He may be in for a really rough ride.
Oh, Daddy.
Are you okay? It hurts.
Can you give him something? We have.
Mr.
Stone? Mmm? I don't want surgery.
No, no surgery, but we need to do some CAT scans to look to see if there's any more major injuries.
ALS is winning, Cookie.
Don't say that.
Don't ever say that.
What's wrong with me? I don't know yet.
Please tell me I'm not rejecting this heart.
Hey, hey, hey, hey, listen, calm down.
The echo's not showing anything like that so far.
Thank God.
Then why did I pass out? That's what we're trying to figure out.
And so far, everything looks normal, except for your low white cell count.
You've got to get me better by tomorrow.
I can't be sick when I meet Rachel's family.
Listen, listen, listen to me.
I don't want you to worry about this.
All right? We're gonna sort it out.
Hello.
I'm Kuol.
Would you like something to read? What happened to you? I was in a car crash.
I have ALS.
It's a nerve disease where you get weaker and weaker till you croak.
Also called Lou Gehrig's Disease.
That I've heard of.
Yes.
Lou Gehrig is perhaps the greatest Yankee.
I'm a Pirates fan.
I hate the Yankees.
How can you hate the Yankees? I love the Yankees.
They are like America itself mighty and proud.
Mazeroski's homer to beat them in the '60 Series the high point in baseball history, as far as I'm concerned.
Compared to Mr.
Gehrig's good-bye speech? People say say, say I've had a bad break, break But today, today, today I consider myself, myself, myself the luckiest man, man, man on the face of the earth, earth, earth, earth.
Thank you.
That's the first laugh I've had in ages.
What are you doing here? Oh, I'm waiting for a heart transplant from the great Dr.
Yablonski.
Oh.
That's sad.
You're such a young guy.
What's that? My chest.
I will get help.
Nurse! Nurse! Well, your wheezing's getting better.
But you're still not moving much air.
Michael, the pulmonary hypertension has progressed to the point where you need to be admitted for a transplant assessment.
I told you, I can't stay in the hospital.
Well, I can't get you listed if you leave.
Can't someone watch these kids? There's no one but me.
You're too sick to go home.
Well, I'll tough it out.
You will be no good to them if you die.
You need to be treated, Michael.
- This isn't jail.
- Chill, Michael.
I'll sign out against medical advice, so you're off the hook.
It is not about that.
Look at you.
Please, Doc my family needs me.
Write me some prescriptions so I can go home.
If I get worse, I'll come back.
I promise.
All right.
All right.
First sign of trouble, you get back in here.
That's my cell number.
If he gets worse, I'll get an ambulance to bring him back here to me, okay? What's going on? Hi, Laura.
This right here This a tear in the pericardial sac around your heart, and the heart muscle is wedged in that hole.
And I'm gonna have to operate to repair it.
With his ALS, will he survive that kind of surgery? Absolutely.
With time, I'll get you back to the functional level - you were at before the accident, okay? - Oh.
I'm not sure I want to go through major surgery.
Can it heal on its own? I'm afraid not.
What if we let it be? Victor this is going to affect your heart's ability to go on pumping.
And time is a factor here.
So I have two choices: Fight this or die? Yes, that's the bottom line.
Then do the surgery.
Okay.
Yeah.
Let's do it.
The doctor's coming.
We're here.
Hey, there.
How you feeling? Like I was run over by a truck.
Yes, I can have that effect on people.
Like I discussed with Laura earlier, we discovered a more complicated injury when we were in there.
Your heart is fine, but not only is there a tear in the sac around your heart, there's also a tear in the diaphragm.
The diaphragm injury is a bad thing to have on top of your ALS.
You're going to need to be on a ventilator for life support.
If I wasn't breathing on a vent? You'd go into respiratory failure.
How long will I need it? It's hard to say.
Permanently? Maybe.
It's okay, Daddy.
I'll move back into my old room and we can get the hospital to help us set up the living room for you.
I've got home health services on standby right now.
Okay? So I'm going to be stuck in bed? We're going to work on getting you into a chair, so you can at least have a degree of mobility.
Don't worry.
I'm going to take care of everything.
Hey, Ryan.
The Krebs citric acid cycle is blowing my mind.
Nice to know.
Look, I've got a sick patient I need to get him on the lung transplant list, okay? Can you find out how many patients we currently have waiting? Break it down-- O negative or B uh, LAS above 50.
Hello, Dr.
Lee.
Okay, okay, try to calm down.
What's your address? I'll call the paramedics; I'll meet you in the ER.
Male or female? Male! Michael? Michael? It's Dr.
Lee.
Can you hear me? He's gone into respiratory failure.
I've got to RSI and intubate.
The pulse ox isn't reading.
He needs an airway.
You let this guy go home? It was that or he was leaving AMA.
Start with the Versed.
Apply cricoid pressure.
Follow with the sux.
Sux in.
Okay, give me some suction.
Damn it.
Suction! All right, push on his trachea.
Harder Okay, I'm in.
Inflate the balloon, check a CO2.
Come on, Michael.
Good bilateral breath sounds.
All right, chest for tube placement, give me a blood gas.
Where are the kids? What kids? She's hypoxic, her pulse is up.
She's getting confused.
Hi, Barbara.
I'm Dr.
Jordan.
I understand you're one of our visiting dignitaries.
What are you thinking? Well, she just flew in from Texas.
Let's try this.
One foot.
Yep.
Positive Homan's sign.
She could have a deep vein clot that's showering pieces to her lungs.
Pam, chest and urine? Both normal.
Low white count's the only thing out of whack.
You need to rule out a pulmonary embolism.
What about infection? WBC count's low, and she's afebrile.
You need to consider meningitis, as well.
Meningitis? Do the spinal tap.
Yes? I came to check on how you're doing.
I heard you had a big operation.
Fat lady's about to sing.
Which fat lady? The one who sings when it's over.
It's not over.
We're alike, you and me.
We're both fighters tooth and nail.
Do you ever think about dying? I once feared it.
Now, I feel if I were to die tomorrow, or if I were to get a new heart and live for a hundred years, I will have lived a beautiful life.
So, Michael, your right heart pressure's off the charts.
And your PPH is no longer responding to medical treatment.
Yeah.
Here.
Now you need a lung transplant.
Do you know where your brothers and sister are? Because they're afraid of being separated? Ryan said you needed to speak with a social worker? I have a patient Michael he's the legal guardian of his three minor siblings.
He has end-stage lung disease, so he can't go home.
The kids are hiding, because they're scared they're going to be put into different foster homes.
Can you convince the kids to come in? Well, I think so.
If you can, I'll give you a voucher for the MedStay for two weeks.
Fair enough.
Anything longer than two weeks, we go to Child Services, that's off the record or not.
Agreed.
Thank you.
Well, the Doppler showed a lower leg clot, but the CT came back negative for a lung embolism.
- A leg clot wouldn't make her sick like this.
- Mm-mmm.
And she was fine on the flight from Dallas.
But she did say the flight was delayed.
And it could've been one of those sitting on the runways, toilet overflowing, - AC off deals.
- Exactly.
And she could've picked up an infection - that's being masked by her rejection meds, right? - Yeah.
Hey, you.
I need you to track something on Barbara Harris, - in ICU 2.
- How's she doing? She's not good she flew in from Dallas yesterday on a delayed flight that got in around noon.
I need you to see if there was anybody else sick on that plane.
Hey.
Hi.
- Hi, there.
- Oh, okay.
I'm going to have a little listen, okay? That's just like her mother.
Doesn't the Great Dr.
Yablonski ever sleep? You've obviously met Kuol.
- Yes, I have.
- Mm-hmm.
You believe in fate, Doc? No.
I don't.
Neither did I.
Maybe it's the cold breath on my neck but I feel a greater hand moving things.
I don't know.
It-It all seems pretty random to me.
Fate kept me alive.
Brought me to a transplant hospital.
Introduced me to Kuol.
To what end? I thought I had two options to fight or to die.
Now I see I have three.
I want to terminate life support.
I want to donate my heart to Kuol.
In order for me to get a new heart, I knew a person had to die.
I never expected one would choose to, on my behalf.
We're not even sure if a person can do what Victor wants to do.
Not to mention the matching issues.
Because he's older than me and has that disease? No, not necessarily.
His heart is good.
I'm not even sure whether to feel happy or sad.
I wouldn't lean too far either way until Social Services, psych, UNOS and the ethics committee figure it out this morning.
How do you feel? I want you to get a heart, Kuol.
More than you know.
I just don't know if this is the best way to do it.
I am 100% opposed to letting a man commit suicide by doctor.
Victor has a right to refuse medical care.
Not when doing so will kill him.
Whoa, whoa, wait- before we get too far into this, - how is the match? - No problem there.
Victor Stone is O-neg, universal donor.
Okay, Dr.
Margolis, you did the psych eval.
The man has to be depressed.
He understands the decision.
As far as I'm concerned, he is psychiatrically cleared to make an informed choice.
He just fought like hell through major surgery.
He's down right now.
With time to heal and antidepressants, we can get him back to almost as good as he was.
But he was dying of ALS even before the accident.
We need to revisit this decision after he is stabilized.
That may not happen.
The trauma has left him ventilator dependent and hemodynamically unstable.
Melissa, you've been on the phone with UNOS.
What did they decide? UNOS says it's entirely our decision.
What about the list? I mean, is this fair to the other potential recipients waiting out there? They said, as long as all parties were listed, we should treat it like a direct donation after cardiac death.
Kuol's not even listed.
We can list him provisionally.
We do not want to be known as the place that did not transplant a donated heart because of a technicality.
Okay, what about the ethics committee? You guys can't possibly support this.
There was quite a bit of back and forth, but the committee voted to approve it.
Kuol is your patient, Andy.
He stands to gain from this most.
You don't think I know that? I feel for Kuol I also feel for Victor but we're supposed to be helping him fight death.
We're not supposed to be helping him invite it in.
Okay, okay.
All right, all right, hang on.
Hang on, people.
Listen, it is time to settle this with a vote.
Wait.
Sophia, we haven't finished discussing this.
We can talk till we're blue in the face.
It's time to settle it, Andy, the way we always do when opinions have been formed.
All in favor aye.
Opposed? Ayes have it.
Transplant approved.
- Next case.
- Are you kidding me? - Ethics? Ethics? -People.
It's time to move on.
Michael Downing.
Age 22.
End stage pulmonary disease.
Where's Laura? I sent her home for a shower.
Since the ALS forced me to retire, it's been rough on her.
What did you retire from? Regional Sales Manager.
Redman Tools.
I traveled a lot when, uh I traveled a lot when she was a kid.
Wasn't a very good dad, even when I was home.
Up on your side.
Well, she seems to love you very much.
She's not going to like me deciding to you know pull the plug.
Can I help you? I'm Jackie.
Uh, I'd like you to meet my daughter Melissa.
Mom, everybody calls me Missy.
She needs a liver transplant.
I heard Mr.
Stone is willing to, uh I'm going to have to ask you to leave.
No.
It's all right.
Hi, Missy.
Hi.
I'm Victor.
Missy, can I speak to your mom for a second? - Okay.
- Thank you.
Uh, what were you doing in there? That man has offered to donate part of his liver to Missy.
Um, um, I'm sorry.
You asked him to donate his liver? Yes.
I'd do anything to save my daughter's life.
Hey.
How'd you get your patient in to see Victor? I didn't.
And I think it's atrocious.
I have a patient who's in desperate need of lungs.
David, a potential recipient's doctor does not go trolling around for organs.
It violates every single ethical principle in the book.
Miranda, this is uncharted water, okay? Who's to say who's right or wrong? That's wrong.
My patient is 22, okay? He's been at the back of the line his whole life.
This is my chance to help him catch a break.
It's still wrong.
You owe me a hat.
A what? Like Sherlock Holmes wears.
I don't get it.
Why? Barbara Harris sat on the runway for six hours.
Now, she was in seat 33A.
In 33B, was a Mr.
Javier Colon.
Are you ready? - I'm ready.
What? - I spoke to Mrs.
Colon.
Mr.
C.
, he couldn't come to the phone because he was recovering from a night in the East Stroudsberg ER, where he was being treated for vomiting - and diarrhea.
- Food poisoning.
Well, maybe the ER did cultures.
Look at you.
Listeriosis.
Um, Lisa, do me a favor.
I want you to stop Harris's rejection meds, okay? And I also want you to give her three grams of amoxicillin Q4H and 100 migs gentamicin TID.
First dose is stat.
Thank you.
Aren't those, like, elephant doses? Yeah, but she needs it.
In an adult, Listeria infection only causes stomach upset, but in newborns and transplant recipients, it causes overwhelming sepsis.
Nice work, Sherlock.
And do not say, "Elementary, my dear Watson.
" I-I-I wasn't.
Yes, you were.
So, how was your day? Your pulse ox should be higher on the vent.
My condition's getting worse.
we need to talk.
Sure.
What? I'm going to donate my organs to some people in need.
You're not going to die.
Actually, I am.
Because I'm taking myself off life support.
What are you talking about? You have plenty Hear me out.
I'm taking back control while I still can.
Yes.
While something good can come of it.
I'm donating my heart to a great young man.
Your heart is going nowhere.
Don't say that.
I am not going to let you commit suicide.
There's a difference between committing suicide and choosing to die with whatever dignity I have left.
Cookie I'm ready.
Well I'm not.
I hear there was a line of people outside Victor's room today.
He wanted me to find matches for his other organs.
Now what is really behind your objection to Victor's donation? I told you I'm against donation after suicide.
You don't think patients have a right to refuse medical treatment? Only after there's no hope of a reasonable life.
As judged by whom? You? Are you playing God now? Okay.
You know what? All I know is that I have opened up a lot of chests, and I've never seen God.
I've never seen a soul.
I've never seen an afterlife.
So, until you can show me that what's on the other side of that door is better than what we have here, then I'm not sending anyone through it.
Are you doing Kuol's transplant? No, I'm not.
If Victor's the donor, then no.
What Victor is doing makes sense to Victor.
You need to talk to him then decide.
A night's rest sure does a girl good.
And some thermonuclear antibiotics, yeah.
After a stop at the beauty parlor, I'll be ready to go to the party and meet my donor's family.
No, no, no, there are no parties for you today.
You're on strict bed rest, so you're not going anywhere.
Isn't there anything you can do? Please? Victor? Huh? Are you sure you're ready to do this? Clock's winding down.
It's okay.
Give them to me.
It's the first time I've had an actual donor sign the procurement authorization.
I just spoke with my lawyer.
And when my father signed his living will, three months ago, he gave me irrevocable proxy healthcare to make his end of life decisions.
I'm not going to let you do this, daddy.
I heard that Laura stopped the donation.
So you can continue to flog me till there's nothing left to flog.
I fought for your life.
And so did she.
And I cannot get behind you throwing it away.
Death always wins.
Just a matter of when.
Or how.
I can't breathe on my own.
I can't drive.
I can't go for a walk.
Soon I won't be able to swallow.
Or talk.
You but you can feel.
You can think.
I feel angry that that's how I'm going to die.
And I think, if I could've gone out on top like I wanted, that I could've beat that bastard ALS one last time.
And a bunch of people would be better off.
Can't you see that's the best death I could have? This is a reunion for donor families and recipients.
Are you trying to make me feel bad? Seven people could be here with their families next year, because of your father.
You know, I transplanted some of these people.
They came to me, begging to stay alive.
No one ever comes to me asking to die.
But your father's at peace with it.
Then I realized I've been making it more about me than him.
Is that what you think I'm doing? My whole life I've longed craved to be close to my father.
Hugged, spun around I don't know, whatever dads do.
But he was always gone.
And even when he was home, it just wasn't in him.
And then he got sick.
And I've been his nurse and he's needed me more and more.
I finally have my father.
And I can't let him go.
I understand.
But that's not how he sees it.
This is what he wants you to think of when you think of him.
Well I've got good news this time.
We found some lungs for your brother.
A man named Victor is donating them.
Awesome! Someone has to die, Will.
Oh.
Yeah.
But it's okay.
He's, um he's ready.
My friend Victor - truly is a saint.
- Uh-huh.
How do you like Dr.
Williams? Why do you ask? Well, if you prefer the Great Dr.
Yablonski, he's available.
Oh, yes.
You will do the surgery? Yeah.
CellCept and Simulect are on board, O Great One.
Thank you very much.
Andy.
What is it? You have a fever.
Give me something for it and let's go.
It doesn't work that way, Kuol.
We can't transplant a heart into someone who has a fever.
Why not? If you have an infection, you'll reject the heart and die.
We have to do a sepsis workup and treat the source of the infection.
Well, at least I'm now on the waiting list.
It's not that simple, Kuol.
You were listed provisionally, based on the fact that it was a direct donation.
So I'm back to square one? It's It's more like square two.
My day will come.
What about Victor? His condition is worsening.
His day is today.
What will happen to Kuol? The VAD will keep him going.
And I'll keep working on getting him a new heart.
What's gonna happen to mine? Well, UNOS has a list of people waiting for a heart.
Good idea.
List it with UNOS.
I can make that happen.
One more thing.
I'd be honored if you'd do my surgery.
Absolutely.
Let's go.
Okay.
Thanks, Mr.
Stone.
God bless you.
Thank you.
I love you, Daddy.
I love you, too, Cooks.
I love you.
I'll be okay.
Me too.
- Let me see you smile? - Okay.
sync, corrections [HI.]
Beds? Check.
Laundry? Check.
Leaves raked into a pile? Check.
Timber! Michael, bury me.
Bury me.
It's my turn! It's my turn! Mikey? Mike? Michael! Mike? Mike?! Mike! Mike? Mike! Whoa, whoa! Slow down, Kuol.
That's a Ventricular Assist Device, not a rocket pack.
So you say.
I have not felt my oats in this way since I was a child playing football in the refugee camp.
Okay, well, just dial it down a notch, okay? The VAD helps, but your heart and your immune system are still weak.
Yes.
Good morning, ladies.
Okay, guys, a little to the left.
Yeah, now to the left.
Yeah, a little higher on your end.
Perfect.
Hello, Ryan.
I'm Barbara Harris.
I was told that you were Party Central.
Are you one of our recipients? Dr.
Wilson did my transplant last October.
I just want everything to be perfect when I meet my donor's family.
Yeah.
I was supposed to be here first thing, to set up, but my flight was horribly delayed I think you'll be okay.
The donor-recipient party is not until tomorrow, so I will go bug the caterers.
We know a thing or two about barbecue in Dallas.
Hi, Cookie.
It's Daddy.
You were right, as usual.
I should have charged my scooter battery.
I'm heading home with my power cord between my legs.
Three Rivers 1x07 The Luckiest Man sync, corrections Hey, who's the surgeon on trauma call? Uh, Dr.
Jordan.
She's on her way.
We ready? One, two, three.
Multi-trauma ALS patient.
He's hemodynamically unstable.
Multiple rib fractures and a flail chest segment.
That's bad news with his ALS.
Put him on a vent.
He's going to need it.
You better have Andy come down and have a look at him.
Before my heart transplant, your father personally came in to wish me well, Dr.
Foster.
Uh-huh.
It's good to see you carrying on his welcoming spirit.
Oh, yeah.
What in the world is chipped ham? It's a Pittsburgh delicacy.
The things you Yankees eat.
I see you got sucked into the Welcome Wagon, too.
No.
Are you kidding? I just love a party.
Barbara? Barbara! Barbara! Barbara! Okay, okay, okay.
Call an ER right now! Mr.
Downing, I'm Dr.
Lee, one of the transplant surgery residents.
The ER doc asked me to look you over, okay? Call-Call me Michael.
Okay, Michael.
The report? Thank you.
Okay.
Let's up the O2, give him 125 of Solu-Medrol, repeat the nebulizer.
Thanks.
You had 50 to 60 ER visits over - the past few years because of your lungs? - Yeah.
Why haven't you followed up with any of the doctors you were referred to? I couldn't afford health insurance.
A year ago, his lungs got so bad, he qualified for Medicare disability, so he could finally see a lung specialist.
But then, his lungs were trashed.
And that's when you finally found underlying pulmonary hypertension? - Yeah.
- Hmm.
Where are your parents? Dead.
Michael takes care of us.
Okay.
Is this why you signed out against medical advice so many times? I can't stay in the hospital.
One time, when he got admitted, they put us all in separate foster homes.
Let's get you turned around.
I need to repeat the pulmonary function test, all right? No admission.
We're gonna jump off that bridge when we come to it, okay? He's all right? Yes, he's stable, but we noticed he has ALS.
He may be in for a really rough ride.
Oh, Daddy.
Are you okay? It hurts.
Can you give him something? We have.
Mr.
Stone? Mmm? I don't want surgery.
No, no surgery, but we need to do some CAT scans to look to see if there's any more major injuries.
ALS is winning, Cookie.
Don't say that.
Don't ever say that.
What's wrong with me? I don't know yet.
Please tell me I'm not rejecting this heart.
Hey, hey, hey, hey, listen, calm down.
The echo's not showing anything like that so far.
Thank God.
Then why did I pass out? That's what we're trying to figure out.
And so far, everything looks normal, except for your low white cell count.
You've got to get me better by tomorrow.
I can't be sick when I meet Rachel's family.
Listen, listen, listen to me.
I don't want you to worry about this.
All right? We're gonna sort it out.
Hello.
I'm Kuol.
Would you like something to read? What happened to you? I was in a car crash.
I have ALS.
It's a nerve disease where you get weaker and weaker till you croak.
Also called Lou Gehrig's Disease.
That I've heard of.
Yes.
Lou Gehrig is perhaps the greatest Yankee.
I'm a Pirates fan.
I hate the Yankees.
How can you hate the Yankees? I love the Yankees.
They are like America itself mighty and proud.
Mazeroski's homer to beat them in the '60 Series the high point in baseball history, as far as I'm concerned.
Compared to Mr.
Gehrig's good-bye speech? People say say, say I've had a bad break, break But today, today, today I consider myself, myself, myself the luckiest man, man, man on the face of the earth, earth, earth, earth.
Thank you.
That's the first laugh I've had in ages.
What are you doing here? Oh, I'm waiting for a heart transplant from the great Dr.
Yablonski.
Oh.
That's sad.
You're such a young guy.
What's that? My chest.
I will get help.
Nurse! Nurse! Well, your wheezing's getting better.
But you're still not moving much air.
Michael, the pulmonary hypertension has progressed to the point where you need to be admitted for a transplant assessment.
I told you, I can't stay in the hospital.
Well, I can't get you listed if you leave.
Can't someone watch these kids? There's no one but me.
You're too sick to go home.
Well, I'll tough it out.
You will be no good to them if you die.
You need to be treated, Michael.
- This isn't jail.
- Chill, Michael.
I'll sign out against medical advice, so you're off the hook.
It is not about that.
Look at you.
Please, Doc my family needs me.
Write me some prescriptions so I can go home.
If I get worse, I'll come back.
I promise.
All right.
All right.
First sign of trouble, you get back in here.
That's my cell number.
If he gets worse, I'll get an ambulance to bring him back here to me, okay? What's going on? Hi, Laura.
This right here This a tear in the pericardial sac around your heart, and the heart muscle is wedged in that hole.
And I'm gonna have to operate to repair it.
With his ALS, will he survive that kind of surgery? Absolutely.
With time, I'll get you back to the functional level - you were at before the accident, okay? - Oh.
I'm not sure I want to go through major surgery.
Can it heal on its own? I'm afraid not.
What if we let it be? Victor this is going to affect your heart's ability to go on pumping.
And time is a factor here.
So I have two choices: Fight this or die? Yes, that's the bottom line.
Then do the surgery.
Okay.
Yeah.
Let's do it.
The doctor's coming.
We're here.
Hey, there.
How you feeling? Like I was run over by a truck.
Yes, I can have that effect on people.
Like I discussed with Laura earlier, we discovered a more complicated injury when we were in there.
Your heart is fine, but not only is there a tear in the sac around your heart, there's also a tear in the diaphragm.
The diaphragm injury is a bad thing to have on top of your ALS.
You're going to need to be on a ventilator for life support.
If I wasn't breathing on a vent? You'd go into respiratory failure.
How long will I need it? It's hard to say.
Permanently? Maybe.
It's okay, Daddy.
I'll move back into my old room and we can get the hospital to help us set up the living room for you.
I've got home health services on standby right now.
Okay? So I'm going to be stuck in bed? We're going to work on getting you into a chair, so you can at least have a degree of mobility.
Don't worry.
I'm going to take care of everything.
Hey, Ryan.
The Krebs citric acid cycle is blowing my mind.
Nice to know.
Look, I've got a sick patient I need to get him on the lung transplant list, okay? Can you find out how many patients we currently have waiting? Break it down-- O negative or B uh, LAS above 50.
Hello, Dr.
Lee.
Okay, okay, try to calm down.
What's your address? I'll call the paramedics; I'll meet you in the ER.
Male or female? Male! Michael? Michael? It's Dr.
Lee.
Can you hear me? He's gone into respiratory failure.
I've got to RSI and intubate.
The pulse ox isn't reading.
He needs an airway.
You let this guy go home? It was that or he was leaving AMA.
Start with the Versed.
Apply cricoid pressure.
Follow with the sux.
Sux in.
Okay, give me some suction.
Damn it.
Suction! All right, push on his trachea.
Harder Okay, I'm in.
Inflate the balloon, check a CO2.
Come on, Michael.
Good bilateral breath sounds.
All right, chest for tube placement, give me a blood gas.
Where are the kids? What kids? She's hypoxic, her pulse is up.
She's getting confused.
Hi, Barbara.
I'm Dr.
Jordan.
I understand you're one of our visiting dignitaries.
What are you thinking? Well, she just flew in from Texas.
Let's try this.
One foot.
Yep.
Positive Homan's sign.
She could have a deep vein clot that's showering pieces to her lungs.
Pam, chest and urine? Both normal.
Low white count's the only thing out of whack.
You need to rule out a pulmonary embolism.
What about infection? WBC count's low, and she's afebrile.
You need to consider meningitis, as well.
Meningitis? Do the spinal tap.
Yes? I came to check on how you're doing.
I heard you had a big operation.
Fat lady's about to sing.
Which fat lady? The one who sings when it's over.
It's not over.
We're alike, you and me.
We're both fighters tooth and nail.
Do you ever think about dying? I once feared it.
Now, I feel if I were to die tomorrow, or if I were to get a new heart and live for a hundred years, I will have lived a beautiful life.
So, Michael, your right heart pressure's off the charts.
And your PPH is no longer responding to medical treatment.
Yeah.
Here.
Now you need a lung transplant.
Do you know where your brothers and sister are? Because they're afraid of being separated? Ryan said you needed to speak with a social worker? I have a patient Michael he's the legal guardian of his three minor siblings.
He has end-stage lung disease, so he can't go home.
The kids are hiding, because they're scared they're going to be put into different foster homes.
Can you convince the kids to come in? Well, I think so.
If you can, I'll give you a voucher for the MedStay for two weeks.
Fair enough.
Anything longer than two weeks, we go to Child Services, that's off the record or not.
Agreed.
Thank you.
Well, the Doppler showed a lower leg clot, but the CT came back negative for a lung embolism.
- A leg clot wouldn't make her sick like this.
- Mm-mmm.
And she was fine on the flight from Dallas.
But she did say the flight was delayed.
And it could've been one of those sitting on the runways, toilet overflowing, - AC off deals.
- Exactly.
And she could've picked up an infection - that's being masked by her rejection meds, right? - Yeah.
Hey, you.
I need you to track something on Barbara Harris, - in ICU 2.
- How's she doing? She's not good she flew in from Dallas yesterday on a delayed flight that got in around noon.
I need you to see if there was anybody else sick on that plane.
Hey.
Hi.
- Hi, there.
- Oh, okay.
I'm going to have a little listen, okay? That's just like her mother.
Doesn't the Great Dr.
Yablonski ever sleep? You've obviously met Kuol.
- Yes, I have.
- Mm-hmm.
You believe in fate, Doc? No.
I don't.
Neither did I.
Maybe it's the cold breath on my neck but I feel a greater hand moving things.
I don't know.
It-It all seems pretty random to me.
Fate kept me alive.
Brought me to a transplant hospital.
Introduced me to Kuol.
To what end? I thought I had two options to fight or to die.
Now I see I have three.
I want to terminate life support.
I want to donate my heart to Kuol.
In order for me to get a new heart, I knew a person had to die.
I never expected one would choose to, on my behalf.
We're not even sure if a person can do what Victor wants to do.
Not to mention the matching issues.
Because he's older than me and has that disease? No, not necessarily.
His heart is good.
I'm not even sure whether to feel happy or sad.
I wouldn't lean too far either way until Social Services, psych, UNOS and the ethics committee figure it out this morning.
How do you feel? I want you to get a heart, Kuol.
More than you know.
I just don't know if this is the best way to do it.
I am 100% opposed to letting a man commit suicide by doctor.
Victor has a right to refuse medical care.
Not when doing so will kill him.
Whoa, whoa, wait- before we get too far into this, - how is the match? - No problem there.
Victor Stone is O-neg, universal donor.
Okay, Dr.
Margolis, you did the psych eval.
The man has to be depressed.
He understands the decision.
As far as I'm concerned, he is psychiatrically cleared to make an informed choice.
He just fought like hell through major surgery.
He's down right now.
With time to heal and antidepressants, we can get him back to almost as good as he was.
But he was dying of ALS even before the accident.
We need to revisit this decision after he is stabilized.
That may not happen.
The trauma has left him ventilator dependent and hemodynamically unstable.
Melissa, you've been on the phone with UNOS.
What did they decide? UNOS says it's entirely our decision.
What about the list? I mean, is this fair to the other potential recipients waiting out there? They said, as long as all parties were listed, we should treat it like a direct donation after cardiac death.
Kuol's not even listed.
We can list him provisionally.
We do not want to be known as the place that did not transplant a donated heart because of a technicality.
Okay, what about the ethics committee? You guys can't possibly support this.
There was quite a bit of back and forth, but the committee voted to approve it.
Kuol is your patient, Andy.
He stands to gain from this most.
You don't think I know that? I feel for Kuol I also feel for Victor but we're supposed to be helping him fight death.
We're not supposed to be helping him invite it in.
Okay, okay.
All right, all right, hang on.
Hang on, people.
Listen, it is time to settle this with a vote.
Wait.
Sophia, we haven't finished discussing this.
We can talk till we're blue in the face.
It's time to settle it, Andy, the way we always do when opinions have been formed.
All in favor aye.
Opposed? Ayes have it.
Transplant approved.
- Next case.
- Are you kidding me? - Ethics? Ethics? -People.
It's time to move on.
Michael Downing.
Age 22.
End stage pulmonary disease.
Where's Laura? I sent her home for a shower.
Since the ALS forced me to retire, it's been rough on her.
What did you retire from? Regional Sales Manager.
Redman Tools.
I traveled a lot when, uh I traveled a lot when she was a kid.
Wasn't a very good dad, even when I was home.
Up on your side.
Well, she seems to love you very much.
She's not going to like me deciding to you know pull the plug.
Can I help you? I'm Jackie.
Uh, I'd like you to meet my daughter Melissa.
Mom, everybody calls me Missy.
She needs a liver transplant.
I heard Mr.
Stone is willing to, uh I'm going to have to ask you to leave.
No.
It's all right.
Hi, Missy.
Hi.
I'm Victor.
Missy, can I speak to your mom for a second? - Okay.
- Thank you.
Uh, what were you doing in there? That man has offered to donate part of his liver to Missy.
Um, um, I'm sorry.
You asked him to donate his liver? Yes.
I'd do anything to save my daughter's life.
Hey.
How'd you get your patient in to see Victor? I didn't.
And I think it's atrocious.
I have a patient who's in desperate need of lungs.
David, a potential recipient's doctor does not go trolling around for organs.
It violates every single ethical principle in the book.
Miranda, this is uncharted water, okay? Who's to say who's right or wrong? That's wrong.
My patient is 22, okay? He's been at the back of the line his whole life.
This is my chance to help him catch a break.
It's still wrong.
You owe me a hat.
A what? Like Sherlock Holmes wears.
I don't get it.
Why? Barbara Harris sat on the runway for six hours.
Now, she was in seat 33A.
In 33B, was a Mr.
Javier Colon.
Are you ready? - I'm ready.
What? - I spoke to Mrs.
Colon.
Mr.
C.
, he couldn't come to the phone because he was recovering from a night in the East Stroudsberg ER, where he was being treated for vomiting - and diarrhea.
- Food poisoning.
Well, maybe the ER did cultures.
Look at you.
Listeriosis.
Um, Lisa, do me a favor.
I want you to stop Harris's rejection meds, okay? And I also want you to give her three grams of amoxicillin Q4H and 100 migs gentamicin TID.
First dose is stat.
Thank you.
Aren't those, like, elephant doses? Yeah, but she needs it.
In an adult, Listeria infection only causes stomach upset, but in newborns and transplant recipients, it causes overwhelming sepsis.
Nice work, Sherlock.
And do not say, "Elementary, my dear Watson.
" I-I-I wasn't.
Yes, you were.
So, how was your day? Your pulse ox should be higher on the vent.
My condition's getting worse.
we need to talk.
Sure.
What? I'm going to donate my organs to some people in need.
You're not going to die.
Actually, I am.
Because I'm taking myself off life support.
What are you talking about? You have plenty Hear me out.
I'm taking back control while I still can.
Yes.
While something good can come of it.
I'm donating my heart to a great young man.
Your heart is going nowhere.
Don't say that.
I am not going to let you commit suicide.
There's a difference between committing suicide and choosing to die with whatever dignity I have left.
Cookie I'm ready.
Well I'm not.
I hear there was a line of people outside Victor's room today.
He wanted me to find matches for his other organs.
Now what is really behind your objection to Victor's donation? I told you I'm against donation after suicide.
You don't think patients have a right to refuse medical treatment? Only after there's no hope of a reasonable life.
As judged by whom? You? Are you playing God now? Okay.
You know what? All I know is that I have opened up a lot of chests, and I've never seen God.
I've never seen a soul.
I've never seen an afterlife.
So, until you can show me that what's on the other side of that door is better than what we have here, then I'm not sending anyone through it.
Are you doing Kuol's transplant? No, I'm not.
If Victor's the donor, then no.
What Victor is doing makes sense to Victor.
You need to talk to him then decide.
A night's rest sure does a girl good.
And some thermonuclear antibiotics, yeah.
After a stop at the beauty parlor, I'll be ready to go to the party and meet my donor's family.
No, no, no, there are no parties for you today.
You're on strict bed rest, so you're not going anywhere.
Isn't there anything you can do? Please? Victor? Huh? Are you sure you're ready to do this? Clock's winding down.
It's okay.
Give them to me.
It's the first time I've had an actual donor sign the procurement authorization.
I just spoke with my lawyer.
And when my father signed his living will, three months ago, he gave me irrevocable proxy healthcare to make his end of life decisions.
I'm not going to let you do this, daddy.
I heard that Laura stopped the donation.
So you can continue to flog me till there's nothing left to flog.
I fought for your life.
And so did she.
And I cannot get behind you throwing it away.
Death always wins.
Just a matter of when.
Or how.
I can't breathe on my own.
I can't drive.
I can't go for a walk.
Soon I won't be able to swallow.
Or talk.
You but you can feel.
You can think.
I feel angry that that's how I'm going to die.
And I think, if I could've gone out on top like I wanted, that I could've beat that bastard ALS one last time.
And a bunch of people would be better off.
Can't you see that's the best death I could have? This is a reunion for donor families and recipients.
Are you trying to make me feel bad? Seven people could be here with their families next year, because of your father.
You know, I transplanted some of these people.
They came to me, begging to stay alive.
No one ever comes to me asking to die.
But your father's at peace with it.
Then I realized I've been making it more about me than him.
Is that what you think I'm doing? My whole life I've longed craved to be close to my father.
Hugged, spun around I don't know, whatever dads do.
But he was always gone.
And even when he was home, it just wasn't in him.
And then he got sick.
And I've been his nurse and he's needed me more and more.
I finally have my father.
And I can't let him go.
I understand.
But that's not how he sees it.
This is what he wants you to think of when you think of him.
Well I've got good news this time.
We found some lungs for your brother.
A man named Victor is donating them.
Awesome! Someone has to die, Will.
Oh.
Yeah.
But it's okay.
He's, um he's ready.
My friend Victor - truly is a saint.
- Uh-huh.
How do you like Dr.
Williams? Why do you ask? Well, if you prefer the Great Dr.
Yablonski, he's available.
Oh, yes.
You will do the surgery? Yeah.
CellCept and Simulect are on board, O Great One.
Thank you very much.
Andy.
What is it? You have a fever.
Give me something for it and let's go.
It doesn't work that way, Kuol.
We can't transplant a heart into someone who has a fever.
Why not? If you have an infection, you'll reject the heart and die.
We have to do a sepsis workup and treat the source of the infection.
Well, at least I'm now on the waiting list.
It's not that simple, Kuol.
You were listed provisionally, based on the fact that it was a direct donation.
So I'm back to square one? It's It's more like square two.
My day will come.
What about Victor? His condition is worsening.
His day is today.
What will happen to Kuol? The VAD will keep him going.
And I'll keep working on getting him a new heart.
What's gonna happen to mine? Well, UNOS has a list of people waiting for a heart.
Good idea.
List it with UNOS.
I can make that happen.
One more thing.
I'd be honored if you'd do my surgery.
Absolutely.
Let's go.
Okay.
Thanks, Mr.
Stone.
God bless you.
Thank you.
I love you, Daddy.
I love you, too, Cooks.
I love you.
I'll be okay.
Me too.
- Let me see you smile? - Okay.
sync, corrections [HI.]