Three Rivers s01e12 Episode Script
Case Histories
Would you like another juice? Yes, please.
(Passengers screaming and gasping) This is the Captain speaking.
Sorry, ladies and gentlemen.
We're running into a little bit of turbulence.
I'm going to need you to remain seated with your seat belts fastened.
Flight attendant: Can I get you something? (Passengers screaming) David: It's a big day, Andy.
Dr.
Jordan's back from her conference.
Yeah, she gets to go to Paris, and I got risk management briefings, on-call scheduling and supply requisition forms.
Which you had me doing.
Delegation is the cornerstone of all good management.
Oh, then may I delegate one of these to you? You got a beef, you take it up with Dr.
Jordan.
Andy: And there she is.
Miranda: And she's not alone.
Who is that guy? That is Dr.
Luc Bovell.
He and I studied under her dad.
He's one of the reasons Dr.
Jordan went to the Medtech Conference.
He's on the cutting edge of cardiothoracic medicine.
So, he's a heart guy? The best.
So scarred we couldn't even see the liver.
It was like trying to look through a wall of dirty ice.
Andrew, you remember.
Oh, the Skidman transplant.
Oh, of course.
Yeah, okay, so what happened? Well, we were losing him.
Andrew was assisting me-- he was doing an admirable job, but neither one of us could get to the organ.
Then, William comes in.
Oh, that would be Dr.
Foster to the rest of us.
Yes.
Right.
So, anyway, he comes in, takes one look at the body, grabs four clamps, reaches in with his bare hands, and a second later, extracts the liver, tosses it in a pan and leaves.
Never said a word.
(Chuckling) Would've been more impressive if she'd lived.
She didn't? No, a week later, her body rejected the liver.
You don't remember? Oh, yes.
Yes, now I I remember.
Well, the transplant surgery was a A success, though.
I thought you were in Madrid, holed up at that research facility.
It's nice to see that you're up with my career.
Keeping up with yours is easy.
You're always here, so What brings you back to Three Rivers? Dr.
Bovell has been at the Clinica San Marco, working with the Raposo Surgical System.
I brought him here for implementation and instruction.
So, let's impress him.
Get back to work.
Dr.
Lee and Mr.
Abbott, bring me up to speed.
Nice to meet you.
Nice meeting you.
Well, the Raposo is an amazing system.
Yes.
Yes, you should, uh, thank Dr.
Jordan for that.
She fought very hard to make that happen.
We should grab a drink before you leave, Luc.
And when will that be, exactly? Don't worry.
You have me for a couple of days.
I have a lot of old friends to catch up with.
(woman over P.
A.
) Remember, shoppers, today is the last day for our two-for-one sale.
Yo, Bobby, I should be home in 20 minutes, and I swear to God, if that tv's still on when I get there, I'm putting my boot through it.
Ma'am think you should come with me.
I wasn't doing anything.
Yeah? Then, what's in the bag? I was going to pay for this.
I left my cash in the car, and I was just running out to get it.
Yeah, never heard that before.
You calling me a liar? Ma'am, don't make this worse.
This is Lee in the front of the store.
I need help.
I got a pregnant woman who just went through the front window.
I need help now, please.
â« Three Rivers 1x12 â« Case Histories Take care of it.
Yes, sir.
So, what exactly is this Raposo thing? Again, it's the Raposo Surgical System.
It's a robotic, computer-assisted platform.
It, uh Well, it does what these can, except with laser precision.
I could show you, if you'd like.
Maybe another time.
So, uh Where were you three years ago? I was still in Birmingham.
England? Alabama.
(Chuckles) I should have guessed.
You you possess a Southern beauty.
(Chuckles) I'm actually from Connecticut.
So, how long have you been at Three Rivers? Long enough to meet me.
Ah.
Well, it's been a pleasure.
Patient's name is Jill Hollis.
Arterial pumper.
Probably sliced the radial, lost maybe two units before we got there to control it.
All right.
Neuro and tendon function okay? Yeah, seems to be.
Bp 120/70, pulse 110, resps 16, pulse ox 98.
Lisa: Okay, let's move her-- on my count.
One, two, three.
Okay.
Hang another liter of saline.
Nurse: Yes, doctor.
Okay.
How far along are you, Jill? Around six months.
How's my baby? (Hyperventilating) Okay.
Okay, check fetal heart tones with the Doppler.
(Hyperventilating) Okay.
Jill, you have to control your breathing.
You're hyperventilating.
Breathe.
What's up? There's no heartbeat.
(Hyperventilating) Andy: Okay, this is great.
This is great, but take another look at this.
Okay? Okay.
Excuse me.
Lester.
Hey.
Hey.
We have an appointment today? Hey, Dr.
Yablonski.
No, no, no.
Uh, you just said, if I ever had a chest pain that was new and different, don't call, come in.
No, that's that's exactly right.
We don't We don't mess around with coronary artery disease.
Well, I got a new one.
You get pain with extension? I haven't been doing that much.
I told you, Lester, you've got to stay as active as possible.
Keep the heart pumping and the blood flowing.
You'll be happy to hear, I just came from the driving range.
With the kids out of the house, there's no one to tell me what a waste of time that is.
Okay, you know that's not exercise.
It's not not exercise.
Okay, smart guy.
Where's it hurt? My chest.
My side.
When I stand up.
And when I do (Groans) That, it's like somebody's stabbing me.
Hmm.
What does that mean? "Hmm.
" It's, uh, medical shorthand for, "let's go do a bunch of tests"" Lisa, I got your page.
Hi.
What's up? Hi.
Um, I wanted you to consult on a patient for me.
Girl crashed through a window this morning.
Cut herself pretty good, but we got her patched up.
Don't think you need me for that.
Well, she thinks she's pregnant.
What do you mean, she thinks? Yeah, well, looks like it, too, but she's not.
There's no fetus.
Then, what is it? Fluid.
Hi, Jill? Hi.
I'm Dr.
Foster.
Why am I in here? I keep asking these nurses, and they keep telling me to wait.
Is my baby okay? Look, there's no easy way to tell you this, but we couldn't find the pregnancy.
You mean I lost the baby? No.
I'm afraid you were never pregnant.
What? Yeah.
Now, Jill, tell me, who's the doctor that you've been seeing for the last six months? Jill? Look, I can't afford one, okay, so I haven't been.
But I figured everything was fine.
Well, it's not.
Well, I don't understand.
My period stopped and everything.
What's wrong with me? Miranda: You have a condition called ascites.
It's a fluid buildup in the abdomen.
It could be your heart, liver, kidney, pancreas.
We'd like to admit you to see what's going on.
So, there was never a baby.
No.
No baby.
It's impressive.
We always wanted a place to honor our donors.
The new wing made so much possible, Luc.
You should have stayed.
Well, if I had, I wouldn't be here now to make your new wing even better.
You're the first to get the Raposo.
That's the best thing about being at the top of your game.
You get the best toys.
Walk with me.
Jordan: Oh, this is great.
You're going to love the stress echo lab.
Mr.
Dimes.
Hey, Dr.
Jordan.
I haven't seen you in, what, a year? Almost.
How is Elena? Just went off to college.
She's up at Middlebury.
It must be tough with the house all empty and quiet.
And what's the tough part? (Laughing) You suffer from coronary artery disease? Yeah.
Dr.
Yablonski's been holding it back for four years.
Which is why I'm batting cleanup on the UNOS list.
Luc: Status? Two.
Luc: Age? Fifty-six.
Oh, come on.
At least pretend to act surprised.
I look damn good for a man with a bad heart.
Luc: Uh, what kind of chest pain? Heavy pressure.
Any nausea, sweating, palpitations with it? All of the above.
Hmm.
I think he could be a good candidate for bypass grafting surgery.
Oh, I am sure Dr.
Yablonski has considered it.
Not with the Raposo Surgical System.
I can create new routes around your narrowed and blocked arteries, restore the flow to the oxygen-starved parts of your heart.
I don't remember Dr.
Yablonski saying anything about it.
Like I said, I am sure there's a reason.
You should ask him.
This could postpone the need for a transplant for up to a decade.
Doesn't make it come any faster.
No, but it bugs you, so the time passes by more quickly.
Dr.
Lee, I've been looking for you.
(Laughing) That is funny.
You're an ophthalmologist.
Looking for you? I'm gonna take the stairs now.
(Sighs) Yeah.
So, I got a woman who came in on a short hop from Cleveland.
Lost her vision mid-flight.
What happened? Looks like someone did a shoddy radial keratotomy on her.
Cut the lenses too thin.
Hmm.
The cabin lost pressure, and she ruptured her corneas.
And you want my opinion as the owner and pilot of a Cessna 210? No, but thanks for rubbing that in.
Um, my patient's from Korea.
Only speaks Korean? Pretty much.
You think you could talk to her, explain her situation? She was here on business and on her way home to Seoul, and she's completely alone.
Aren't we better off getting her a translator? I've made some calls.
She's pretty upset right now.
I'd rather not make her wait.
(Woman singing pop song in Korean) (Speaking Korean): Cornea transplant? Um (Woman over P.
A.
) Pediatric nurse to orthopedics.
Pediatric nurse to orthopedics.
(Laughs) Miranda Foster? Oh, my gosh, you look so official with that white coat, I almost didn't recognize you.
I almost didn't recognize you with all that gray hair.
Hey, listen, while I'm still here, let's try and catch up.
We just did.
Haven't changed a bit.
(Laughs) So, that's it.
That's the story, Bobby.
Thought I was pregnant, turns out, it was like a water balloon.
But anyway, you must be thrilled.
Come on, don't say that.
The day I told you I was pregnant, what did you do, huh? Let me refresh your memory.
You freaked out and got drunk with Mitch and Evan.
Of course I freaked.
We'd been together, what, like, three months? Yeah, well, now you're free to go.
Why do you always do this? This? I do this all the time? Come on, you know what I mean.
I don't know squat.
Just go, Bobby, okay? We're done.
Look, I'm-I'm I'm sorry to interrupt.
You're not interrupting anything.
(Woman over P.
A.
) Dr.
Cullen to endocrinology, please.
(Sighs) Okay.
That's going into me? Yeah, I'm afraid so.
We have to drain the fluid to see which organ is causing your condition.
Here.
Now, look, I'm gonna numb you up.
But I'm not gonna lie.
This will hurt.
Yeah.
What doesn't? Oh.
I'm guessing I'm the only one that Mmm.
Likes these things.
Well, you and all of our toothless patients.
(Laughs) What's the word? The word is, you pulled a latissimus dorsi muscle.
In your chest.
It's not a heart thing? No.
Oh, thank the lord.
So, what do I do? Ride the couch till I'm better? Call the kids home, have 'em wait on me? Nice try, Lester.
This one's gonna heal with ice and anti-inflammatories.
Hey, let me ask you something.
Mm-hmm.
I met this new doctor working here.
He mentioned bypass grafting surgery.
Really? Did I say something wrong? No, Lester, not at all.
At the moment, I don't think bypass is the right way to go, but let me consult with Dr.
Bovell.
I'll get back to you.
Okay.
Oh, God, I could use a drink.
Or ten.
Look, there's got to be an upside to not being pregnant anymore, right? Oh, yeah, you're right, 'cause that's the only reason why ten drinks would be bad for you.
You're a real ray of sunshine, you know that? Yeah, I get that a lot, thanks.
Me, too.
I (Alarm sounds) Whoa.
Her bp's crashing.
Jill? 60 palp.
How much fluid is drained? Little more than four liters.
Okay, open the saline wide, start a dopamine drip, titrate to a systolic of 90.
Thank you.
Okay, Jill.
Come on, come on.
No.
Bovell: Turn on camera two.
I need the-the full diagnostics in an hour.
I know you're eager, Andrew, but I'm not ready yet.
Did you talk to Lester Dimes? Who's that? He's my patient with coronary artery disease, who, now, apparently, wants to explore the possibilities of bypass grafting surgery.
It's a perfect opportunity for him.
No.
It's a perfect opportunity for you, Luc, to use the Raposo hey, hey.
Hey! Oh, sorry.
Oh, this is something new for you, Luc, creating problems.
I'm just used to cleaning your messes up after the fact.
I don't create messes.
Really? What about the Skidman transplant? Who went to tell her family that she died? You're good at that kind of thing.
Nobody is good at that kind of thing, Luc, but it's a part of the job that you don't want to do.
You're right.
And why should I? People die, Andrew.
Start attaching emotions to it, and you lose the bigger picture.
It's like Dr.
Foster said.
"Death is a learning experience"" you use it to move the medicine forward.
Okay, so is that how you see Lester? As a possible learning experience? Oh, I'm sorry if it bothers you, but there it is.
Unbelievable.
Andy: Dr.
Jordan? Sneaking a peek? You know, I don't think I officially said welcome back.
Welcome back.
When is Luc leaving? This is about Lester Dimes, isn't it? You knew about this? I considered bypass grafting surgery and decided against it.
When it was an open heart procedure that Lester might not have survived.
Luc should never have talked to my patient.
You are absolutely right, but Luc is not wrong in his assessment.
Oh, come on, Andy.
The Raposo has tangible, immediate uses.
S-so what you're saying is It's Lester's choice now.
How's she doing? Well, her pressure dropped due to the blood loss earlier this morning.
However, we supported her blood pressure while we replaced her vascular volume, so I think she's out of the woods now.
And the, um The results on the fluid in her stomach? We're still waiting.
Do you know anything about her family history that could help? Oh, you mean like diseases and stuff? Yeah.
Look, all I know is they mentally messed her up.
Dad took off, her mom was always in some kind of trouble.
When I met her, she was crashing at the bar she worked at.
Sleeping on a cot in the keg room.
You believe that? Yeah, I do.
Try and be there for her, you know.
I mean, I love her.
That's why this-this baby We were gonna be really good to that kid.
How are you doing? I don't know.
She pretty much just dumped me in there, so Look, sometimes people push you away just to see if you'll actually go.
Trust me, whether she meant it or not, she meant it.
Just, uh, give these to her, will you? Let her know I'm at Mitch's If she cares.
Okay, here's the thing, Lester.
The bypass surgery Dr.
Bovell told you about-- it pushes transplant down the road, but eventually, you will need a new heart.
And if you wait for transplant, you'll have one surgery instead of two.
Let's say I get a heart tomorrow.
Mm-hmm.
Won't it eventually wear out? Yeah, well, that That may take up to 25 years.
Or my body could reject it.
The statistics are in your favor, and the anti-rejection medications are They're very effective.
With the Raposo thing, I don't need any meds.
Sure.
But bypass buys you ten years, maximum.
That's it.
Which sounds like a lot of time.
You're also gonna be ten years older.
It's gonna be harder to get you re-listed.
Yeah.
What would you do? I would wait for transplant.
But if you're going to have bypass, Dr.
Bovell and the Raposo are the only way to go.
Aah! Either way, I'm gonna have one kind of surgery or another.
Mm.
But I like my heart.
Let's do the bypass.
Okay, let's do it.
Of course.
Miranda: Hi.
So, look, we got the results back from your fluid tests, and the ascites is being caused by your liver.
(Scoffs) Figures.
I quit drinking for five months and it gets pissed off.
Yeah, well, it's a little bit more than pissed off.
The results from your function studies show end-stage liver disease, which means you will need a transplant very soon.
You've got to be kidding.
I'm not.
So what now? We get you listed with UNOS.
It's an organization that governs transplants.
But I can't pay for this.
I can't even afford baby clothes, remember? I know, I know, I know, I know, Jill, but I've already processed the forms with Medicaid.
A social worker is going to come and talk to you, and she's going to evaluate your fitness for the transplant.
I have to pass a mental test? You just have to be honest.
It's important.
(Sighs) Hey.
Hey.
Some science fiction happening here, Dr.
Yablonski.
This machine go to med school? Yeah, MIT.
It graduated with honors.
(Laughs) You ready? Yeah, yeah.
Yeah, I am.
Okay.
I'll see you back in your room.
Okay.
Woman: All right, Mr.
Dimes, just breathe normally.
These are my hands, those are my eyes, amplified 20 times.
It's the kind of precision we dreamed of as students.
Now what? My assistants are going to place some transducers, and Then we'll be ready to go.
Okay, let's get this show on the road.
Sit back and enjoy, my friend.
(Whirring) Hey, what are you doing? Reprocessing Jill's data before the committee meeting.
Why? I found some Ana and sma antibodies in her liver enzymes.
Feels like I'm missing something.
What you missed is the surgery-- Dr.
Bovell using the Raposo system.
(Sighs) So? It was cool.
That's all.
It was like a-- like it's a robot, you know? The guy's unstoppable.
You know what I was thinking? Wait, wait, Ryan, hold that thought.
Jill Hollis is not a viable candidate.
She can barely take care of herself.
She's got Hi, hi, I apologize, I'm sorry I'm late.
Come on, we're talking about your patient right now.
Woman: May I continue? Yeah, please, go ahead.
I cannot recommend Jill Hollis for transplant.
Per my interview with her, she's an admitted drinker who just terminated the only long-term relationship she's had, leaving her with no means of support.
Additionally, she had a false pregnancy that she carried into its sixth month without any regard for medical care.
No, no, no, no, no, there was no baby.
She didn't know that.
Well, you're right, but because she believed she was pregnant, she gave up every bad habit she had, which I think shows an ability to be a good steward for the liver.
The fact remains, though, Jill Hollis needs a liver transplant because she drank this one into disuse.
No, she didn't.
I ran a liver biopsy, and all the symptoms that made Jill believe she was pregnant-- the fatigue, the nausea, the belly distension, even the loss of her periods-- are all indicative of autoimmune hepatitis, which is a congenital condition.
So her liver was going to fail regardless.
Exactly.
Look, we can't just overlook her personal instability.
And we also can't overlook all the efforts she's made.
I believe she can do this.
I do, too.
So let's put it to a vote.
Hi.
We got you listed.
And now what? We go the distance-- keep you clean, keep you healthy, wait for a good liver.
And then I just walk off into the sunset? Pretty much, with some very strong antirejection meds, yeah.
And what about drinking, smoking, you know, living? No, those are things that you're past now.
No, they aren't.
Well They're going to have to be.
Otherwise I will take you off that list.
Then take me off.
Jill Do you want me to lie to you, tell you that I'll be clean and sober and love this liver like a baby? Is that what you want? No, I want you to get counseling.
I want you to go to meetings.
I want you to see this as a thing that you can handle, something you've been handling.
That's when I thought I was pregnant.
What's the point now? The point now is that you get to live.
I'm not going to do it, no way.
(Monitor beeping) How's she doing? Already gave her the local.
Okay.
Okay.
Hand me the trephine.
You're still a resident, right? Yeah.
Mm-hmm.
Large forceps.
So where do you plan to end up? Well, I'm still exploring my options.
You should think about coming over here.
Yeah, why is that? Well, first of all, nobody dies over here.
Surgery's only a couple of hours.
She'll get immediate results and walk out of here with only eyedrops.
That does sound satisfying.
No guts, all glory.
This is the corneal button.
Get me the donor cornea.
To think, these little guys are going to be speaking a whole new language.
What do you mean? I mean, everything they see, she'll know the words for.
Kind of amazing, right? Bet you never felt that kind of wonder at a kidney.
(Imitating Darth Vader): come to the light side, Dr.
Lee.
(Woman over P.
A.
) ICU, code blue.
(Beeping) Where's the pain, Mr.
Dimes? Everywhere, front and back.
What's going on, Lester? I should have listened to you.
This hurts like hell.
He's got a hard resp rate of 36, pulse ox is only 82.
Okay, switch him to a non-rebreather mask at ten liters.
Do we have a blood gas report? Po2 is only 55, pco2-- 28.
Okay, you're breathing way too hard for way too little oxygen, Lester.
Jordan: We're prepped for a thoracic ct.
Perfect-- his renal function's good.
(Muffled groaning) Lester, are you allergic to any shellfish or dye? What? No.
Okay, let's inject him.
Lester, this is going to be difficult, but you have to remain still.
Okay? You understand? Uh-huh.
Okay.
Don't usually see you prepping the ct.
If this morning's procedure caused a pulmonary embolism, mea culpa.
Let's just give it a moment and see.
Oh, my God.
That's not from the surgery.
He's got a fusiform clot in his inferior vena cava.
Look at the size of that thing.
It begins at his hepatic vein insertion, reaches to the right atrium, and is migrating through his patent foramen ovale.
That clot bursts, he'll stroke out and die.
I'm gonna have to crack his chest to retrieve the clot out of his heart, but there's no way I can get to the infra-diaphragmatic portion.
It's bisecting his liver.
You think you can get in there? I could, but I don't know if Lester can survive the trauma.
Are you thinking what I'm thinking? Yeah.
Call Dr.
Bovell.
Okay, so we're clear, I'll manually do the sternotomy and put him on cardiac bypass.
By the time I've stopped the heart and gotten to the embolism I'll have used the Raposo to incise the inferior vena cava and flank this bitch.
Beats the hell out of the Skidman transplant.
This time, the patient survives.
(Heart monitor beeping) How you doing, Luc? Still trying to locate the obstruction.
Just step on it.
Hook him up to bypass, please.
It's got nothing on it.
It's going to be Okay, I've located the interior portion of the embolism.
Great! He's on bypass.
I'm cooling him down now.
Chilled cardioplegia.
(Rapid beeping) Okay, his heart stopped.
I'm about to incise the superior vena cava dissected the inferior.
Ready to snare the clot.
Okay.
Incising.
Almost there.
Got it.
On your word, Andrew.
Okay, Luc, I'm dividing it.
Retracting my end on the count of three Two One.
Now.
We did it.
Ready to close? Like a bank vault, my friend.
(Speaking Korean) (Clears throat) And I thank you.
Very happy to be seeing.
I'm feeling a lot better about my language skills right now.
(Heart monitor beeping) Got dicey there, Lester.
What what happened exactly? An embolism traveled up from your leg.
You really weren't kidding about all that sitting.
No, it almost killed you.
Once I'm out of here, I swear to God, I am burning the couch.
(Chuckles) I'm taking up running.
Start with a good walk, okay? And my heart? It's better than it was before.
Thank you, Dr.
Yablonski.
You're very welcome, Lester.
Hey, you okay? Yeah.
I'm fine.
Did you hear what, uh, Andy and Luc pulled off today? First cyborg surgery at Three Rivers.
I'm so sick of hearing about Luc.
What's your beef with him? He didn't tell you? Hmm-mm.
That's shocking.
All right, when I was in med school, I came here to visit my father.
And Luc and I went out, and we had a few too many and Really? Doesn't matter.
(Laughs) Kind of seems like it did.
No, it didn't matter then.
And now to see him wandering around here just Reminds me of a time in my life I'd much rather forget.
Well, maybe you should embrace your past.
And maybe you should embrace yours.
Wait, hang on.
Luc! Hey.
Hell of a homecoming, huh? Yeah, well, the equipment functioned just as it should, by the way.
His embolism's completely unrelated.
I know that.
Did you go and check on Lester? No.
Well, you should go and check on him.
I'm sure Andrew's already done it.
Well, now I'm asking you to go.
With all due respect, Sophia.
I don't answer to you.
You most certainly do when you are seeing patients on my wing.
Unfortunately, there is no machine that administers patient care, Luc.
It's why Andy's so good at what he does.
Why he will eventually run this place.
I understand.
I don't think you do.
You are going to go and check on Lester.
It could be the start of a lifelong habit.
I know what you're doing.
Yeah, I'm leaving.
Jill, your condition can be reversed.
Let us help you.
Sorry, I like my margaritas.
That's not the real reason.
You know what? You don't know me.
I read the police report.
I know you just didn't steal baby clothes, there were toys and bibs.
You even took a little pink hat with matching mittens, didn't you? Okay, so what? So, I think you wanted that baby.
I think for the first time, you saw some real possibilities.
And then it got taken away from you.
And now you're scared to hope for anything.
You're so young.
And you can have whatever you want, you just have to take the first step forward.
Id already named the baby.
Veronica.
After the band.
It's a good band.
How about we get you healthy.
Then you can have that baby, and give her that name.
Bobby.
I'm in, if you're in.
(Sighs) (Woman over P.
A.
) Flight 72 to Seoul is now boarding at Gate 8.
All passengers must board at this time.
This is a final boarding call for flight 72 to Seoul.
Thank you.
(Speaking Korean) And we are them but they don't know what's in their hands it's more than you and it's more than I but it's more and everybody calls it love but I'm not really sure if it's love to Lester.
To the Raposo.
Mmm.
So, um, Dr.
Foster-- turns out he's-- he was wrong.
About what? About us working together under the same roof.
He thought it was a terrible idea.
And it was, back then.
Not today.
Yeah.
I have to admit, it worked out pretty well.
Let's not make a habit of it, though, okay? Did you, um hear about Dr.
Robinson? Cardiac surgeon? Yeah, his mother is ill.
He's taking a leave of absence, I guess.
No, I know and, um, the board's been looking around for a replacement.
How long are you staying? Well, that all depends on Dr.
Robinson's mother, now, doesn't it? To her speedy recovery.
(Passengers screaming and gasping) This is the Captain speaking.
Sorry, ladies and gentlemen.
We're running into a little bit of turbulence.
I'm going to need you to remain seated with your seat belts fastened.
Flight attendant: Can I get you something? (Passengers screaming) David: It's a big day, Andy.
Dr.
Jordan's back from her conference.
Yeah, she gets to go to Paris, and I got risk management briefings, on-call scheduling and supply requisition forms.
Which you had me doing.
Delegation is the cornerstone of all good management.
Oh, then may I delegate one of these to you? You got a beef, you take it up with Dr.
Jordan.
Andy: And there she is.
Miranda: And she's not alone.
Who is that guy? That is Dr.
Luc Bovell.
He and I studied under her dad.
He's one of the reasons Dr.
Jordan went to the Medtech Conference.
He's on the cutting edge of cardiothoracic medicine.
So, he's a heart guy? The best.
So scarred we couldn't even see the liver.
It was like trying to look through a wall of dirty ice.
Andrew, you remember.
Oh, the Skidman transplant.
Oh, of course.
Yeah, okay, so what happened? Well, we were losing him.
Andrew was assisting me-- he was doing an admirable job, but neither one of us could get to the organ.
Then, William comes in.
Oh, that would be Dr.
Foster to the rest of us.
Yes.
Right.
So, anyway, he comes in, takes one look at the body, grabs four clamps, reaches in with his bare hands, and a second later, extracts the liver, tosses it in a pan and leaves.
Never said a word.
(Chuckling) Would've been more impressive if she'd lived.
She didn't? No, a week later, her body rejected the liver.
You don't remember? Oh, yes.
Yes, now I I remember.
Well, the transplant surgery was a A success, though.
I thought you were in Madrid, holed up at that research facility.
It's nice to see that you're up with my career.
Keeping up with yours is easy.
You're always here, so What brings you back to Three Rivers? Dr.
Bovell has been at the Clinica San Marco, working with the Raposo Surgical System.
I brought him here for implementation and instruction.
So, let's impress him.
Get back to work.
Dr.
Lee and Mr.
Abbott, bring me up to speed.
Nice to meet you.
Nice meeting you.
Well, the Raposo is an amazing system.
Yes.
Yes, you should, uh, thank Dr.
Jordan for that.
She fought very hard to make that happen.
We should grab a drink before you leave, Luc.
And when will that be, exactly? Don't worry.
You have me for a couple of days.
I have a lot of old friends to catch up with.
(woman over P.
A.
) Remember, shoppers, today is the last day for our two-for-one sale.
Yo, Bobby, I should be home in 20 minutes, and I swear to God, if that tv's still on when I get there, I'm putting my boot through it.
Ma'am think you should come with me.
I wasn't doing anything.
Yeah? Then, what's in the bag? I was going to pay for this.
I left my cash in the car, and I was just running out to get it.
Yeah, never heard that before.
You calling me a liar? Ma'am, don't make this worse.
This is Lee in the front of the store.
I need help.
I got a pregnant woman who just went through the front window.
I need help now, please.
â« Three Rivers 1x12 â« Case Histories Take care of it.
Yes, sir.
So, what exactly is this Raposo thing? Again, it's the Raposo Surgical System.
It's a robotic, computer-assisted platform.
It, uh Well, it does what these can, except with laser precision.
I could show you, if you'd like.
Maybe another time.
So, uh Where were you three years ago? I was still in Birmingham.
England? Alabama.
(Chuckles) I should have guessed.
You you possess a Southern beauty.
(Chuckles) I'm actually from Connecticut.
So, how long have you been at Three Rivers? Long enough to meet me.
Ah.
Well, it's been a pleasure.
Patient's name is Jill Hollis.
Arterial pumper.
Probably sliced the radial, lost maybe two units before we got there to control it.
All right.
Neuro and tendon function okay? Yeah, seems to be.
Bp 120/70, pulse 110, resps 16, pulse ox 98.
Lisa: Okay, let's move her-- on my count.
One, two, three.
Okay.
Hang another liter of saline.
Nurse: Yes, doctor.
Okay.
How far along are you, Jill? Around six months.
How's my baby? (Hyperventilating) Okay.
Okay, check fetal heart tones with the Doppler.
(Hyperventilating) Okay.
Jill, you have to control your breathing.
You're hyperventilating.
Breathe.
What's up? There's no heartbeat.
(Hyperventilating) Andy: Okay, this is great.
This is great, but take another look at this.
Okay? Okay.
Excuse me.
Lester.
Hey.
Hey.
We have an appointment today? Hey, Dr.
Yablonski.
No, no, no.
Uh, you just said, if I ever had a chest pain that was new and different, don't call, come in.
No, that's that's exactly right.
We don't We don't mess around with coronary artery disease.
Well, I got a new one.
You get pain with extension? I haven't been doing that much.
I told you, Lester, you've got to stay as active as possible.
Keep the heart pumping and the blood flowing.
You'll be happy to hear, I just came from the driving range.
With the kids out of the house, there's no one to tell me what a waste of time that is.
Okay, you know that's not exercise.
It's not not exercise.
Okay, smart guy.
Where's it hurt? My chest.
My side.
When I stand up.
And when I do (Groans) That, it's like somebody's stabbing me.
Hmm.
What does that mean? "Hmm.
" It's, uh, medical shorthand for, "let's go do a bunch of tests"" Lisa, I got your page.
Hi.
What's up? Hi.
Um, I wanted you to consult on a patient for me.
Girl crashed through a window this morning.
Cut herself pretty good, but we got her patched up.
Don't think you need me for that.
Well, she thinks she's pregnant.
What do you mean, she thinks? Yeah, well, looks like it, too, but she's not.
There's no fetus.
Then, what is it? Fluid.
Hi, Jill? Hi.
I'm Dr.
Foster.
Why am I in here? I keep asking these nurses, and they keep telling me to wait.
Is my baby okay? Look, there's no easy way to tell you this, but we couldn't find the pregnancy.
You mean I lost the baby? No.
I'm afraid you were never pregnant.
What? Yeah.
Now, Jill, tell me, who's the doctor that you've been seeing for the last six months? Jill? Look, I can't afford one, okay, so I haven't been.
But I figured everything was fine.
Well, it's not.
Well, I don't understand.
My period stopped and everything.
What's wrong with me? Miranda: You have a condition called ascites.
It's a fluid buildup in the abdomen.
It could be your heart, liver, kidney, pancreas.
We'd like to admit you to see what's going on.
So, there was never a baby.
No.
No baby.
It's impressive.
We always wanted a place to honor our donors.
The new wing made so much possible, Luc.
You should have stayed.
Well, if I had, I wouldn't be here now to make your new wing even better.
You're the first to get the Raposo.
That's the best thing about being at the top of your game.
You get the best toys.
Walk with me.
Jordan: Oh, this is great.
You're going to love the stress echo lab.
Mr.
Dimes.
Hey, Dr.
Jordan.
I haven't seen you in, what, a year? Almost.
How is Elena? Just went off to college.
She's up at Middlebury.
It must be tough with the house all empty and quiet.
And what's the tough part? (Laughing) You suffer from coronary artery disease? Yeah.
Dr.
Yablonski's been holding it back for four years.
Which is why I'm batting cleanup on the UNOS list.
Luc: Status? Two.
Luc: Age? Fifty-six.
Oh, come on.
At least pretend to act surprised.
I look damn good for a man with a bad heart.
Luc: Uh, what kind of chest pain? Heavy pressure.
Any nausea, sweating, palpitations with it? All of the above.
Hmm.
I think he could be a good candidate for bypass grafting surgery.
Oh, I am sure Dr.
Yablonski has considered it.
Not with the Raposo Surgical System.
I can create new routes around your narrowed and blocked arteries, restore the flow to the oxygen-starved parts of your heart.
I don't remember Dr.
Yablonski saying anything about it.
Like I said, I am sure there's a reason.
You should ask him.
This could postpone the need for a transplant for up to a decade.
Doesn't make it come any faster.
No, but it bugs you, so the time passes by more quickly.
Dr.
Lee, I've been looking for you.
(Laughing) That is funny.
You're an ophthalmologist.
Looking for you? I'm gonna take the stairs now.
(Sighs) Yeah.
So, I got a woman who came in on a short hop from Cleveland.
Lost her vision mid-flight.
What happened? Looks like someone did a shoddy radial keratotomy on her.
Cut the lenses too thin.
Hmm.
The cabin lost pressure, and she ruptured her corneas.
And you want my opinion as the owner and pilot of a Cessna 210? No, but thanks for rubbing that in.
Um, my patient's from Korea.
Only speaks Korean? Pretty much.
You think you could talk to her, explain her situation? She was here on business and on her way home to Seoul, and she's completely alone.
Aren't we better off getting her a translator? I've made some calls.
She's pretty upset right now.
I'd rather not make her wait.
(Woman singing pop song in Korean) (Speaking Korean): Cornea transplant? Um (Woman over P.
A.
) Pediatric nurse to orthopedics.
Pediatric nurse to orthopedics.
(Laughs) Miranda Foster? Oh, my gosh, you look so official with that white coat, I almost didn't recognize you.
I almost didn't recognize you with all that gray hair.
Hey, listen, while I'm still here, let's try and catch up.
We just did.
Haven't changed a bit.
(Laughs) So, that's it.
That's the story, Bobby.
Thought I was pregnant, turns out, it was like a water balloon.
But anyway, you must be thrilled.
Come on, don't say that.
The day I told you I was pregnant, what did you do, huh? Let me refresh your memory.
You freaked out and got drunk with Mitch and Evan.
Of course I freaked.
We'd been together, what, like, three months? Yeah, well, now you're free to go.
Why do you always do this? This? I do this all the time? Come on, you know what I mean.
I don't know squat.
Just go, Bobby, okay? We're done.
Look, I'm-I'm I'm sorry to interrupt.
You're not interrupting anything.
(Woman over P.
A.
) Dr.
Cullen to endocrinology, please.
(Sighs) Okay.
That's going into me? Yeah, I'm afraid so.
We have to drain the fluid to see which organ is causing your condition.
Here.
Now, look, I'm gonna numb you up.
But I'm not gonna lie.
This will hurt.
Yeah.
What doesn't? Oh.
I'm guessing I'm the only one that Mmm.
Likes these things.
Well, you and all of our toothless patients.
(Laughs) What's the word? The word is, you pulled a latissimus dorsi muscle.
In your chest.
It's not a heart thing? No.
Oh, thank the lord.
So, what do I do? Ride the couch till I'm better? Call the kids home, have 'em wait on me? Nice try, Lester.
This one's gonna heal with ice and anti-inflammatories.
Hey, let me ask you something.
Mm-hmm.
I met this new doctor working here.
He mentioned bypass grafting surgery.
Really? Did I say something wrong? No, Lester, not at all.
At the moment, I don't think bypass is the right way to go, but let me consult with Dr.
Bovell.
I'll get back to you.
Okay.
Oh, God, I could use a drink.
Or ten.
Look, there's got to be an upside to not being pregnant anymore, right? Oh, yeah, you're right, 'cause that's the only reason why ten drinks would be bad for you.
You're a real ray of sunshine, you know that? Yeah, I get that a lot, thanks.
Me, too.
I (Alarm sounds) Whoa.
Her bp's crashing.
Jill? 60 palp.
How much fluid is drained? Little more than four liters.
Okay, open the saline wide, start a dopamine drip, titrate to a systolic of 90.
Thank you.
Okay, Jill.
Come on, come on.
No.
Bovell: Turn on camera two.
I need the-the full diagnostics in an hour.
I know you're eager, Andrew, but I'm not ready yet.
Did you talk to Lester Dimes? Who's that? He's my patient with coronary artery disease, who, now, apparently, wants to explore the possibilities of bypass grafting surgery.
It's a perfect opportunity for him.
No.
It's a perfect opportunity for you, Luc, to use the Raposo hey, hey.
Hey! Oh, sorry.
Oh, this is something new for you, Luc, creating problems.
I'm just used to cleaning your messes up after the fact.
I don't create messes.
Really? What about the Skidman transplant? Who went to tell her family that she died? You're good at that kind of thing.
Nobody is good at that kind of thing, Luc, but it's a part of the job that you don't want to do.
You're right.
And why should I? People die, Andrew.
Start attaching emotions to it, and you lose the bigger picture.
It's like Dr.
Foster said.
"Death is a learning experience"" you use it to move the medicine forward.
Okay, so is that how you see Lester? As a possible learning experience? Oh, I'm sorry if it bothers you, but there it is.
Unbelievable.
Andy: Dr.
Jordan? Sneaking a peek? You know, I don't think I officially said welcome back.
Welcome back.
When is Luc leaving? This is about Lester Dimes, isn't it? You knew about this? I considered bypass grafting surgery and decided against it.
When it was an open heart procedure that Lester might not have survived.
Luc should never have talked to my patient.
You are absolutely right, but Luc is not wrong in his assessment.
Oh, come on, Andy.
The Raposo has tangible, immediate uses.
S-so what you're saying is It's Lester's choice now.
How's she doing? Well, her pressure dropped due to the blood loss earlier this morning.
However, we supported her blood pressure while we replaced her vascular volume, so I think she's out of the woods now.
And the, um The results on the fluid in her stomach? We're still waiting.
Do you know anything about her family history that could help? Oh, you mean like diseases and stuff? Yeah.
Look, all I know is they mentally messed her up.
Dad took off, her mom was always in some kind of trouble.
When I met her, she was crashing at the bar she worked at.
Sleeping on a cot in the keg room.
You believe that? Yeah, I do.
Try and be there for her, you know.
I mean, I love her.
That's why this-this baby We were gonna be really good to that kid.
How are you doing? I don't know.
She pretty much just dumped me in there, so Look, sometimes people push you away just to see if you'll actually go.
Trust me, whether she meant it or not, she meant it.
Just, uh, give these to her, will you? Let her know I'm at Mitch's If she cares.
Okay, here's the thing, Lester.
The bypass surgery Dr.
Bovell told you about-- it pushes transplant down the road, but eventually, you will need a new heart.
And if you wait for transplant, you'll have one surgery instead of two.
Let's say I get a heart tomorrow.
Mm-hmm.
Won't it eventually wear out? Yeah, well, that That may take up to 25 years.
Or my body could reject it.
The statistics are in your favor, and the anti-rejection medications are They're very effective.
With the Raposo thing, I don't need any meds.
Sure.
But bypass buys you ten years, maximum.
That's it.
Which sounds like a lot of time.
You're also gonna be ten years older.
It's gonna be harder to get you re-listed.
Yeah.
What would you do? I would wait for transplant.
But if you're going to have bypass, Dr.
Bovell and the Raposo are the only way to go.
Aah! Either way, I'm gonna have one kind of surgery or another.
Mm.
But I like my heart.
Let's do the bypass.
Okay, let's do it.
Of course.
Miranda: Hi.
So, look, we got the results back from your fluid tests, and the ascites is being caused by your liver.
(Scoffs) Figures.
I quit drinking for five months and it gets pissed off.
Yeah, well, it's a little bit more than pissed off.
The results from your function studies show end-stage liver disease, which means you will need a transplant very soon.
You've got to be kidding.
I'm not.
So what now? We get you listed with UNOS.
It's an organization that governs transplants.
But I can't pay for this.
I can't even afford baby clothes, remember? I know, I know, I know, I know, Jill, but I've already processed the forms with Medicaid.
A social worker is going to come and talk to you, and she's going to evaluate your fitness for the transplant.
I have to pass a mental test? You just have to be honest.
It's important.
(Sighs) Hey.
Hey.
Some science fiction happening here, Dr.
Yablonski.
This machine go to med school? Yeah, MIT.
It graduated with honors.
(Laughs) You ready? Yeah, yeah.
Yeah, I am.
Okay.
I'll see you back in your room.
Okay.
Woman: All right, Mr.
Dimes, just breathe normally.
These are my hands, those are my eyes, amplified 20 times.
It's the kind of precision we dreamed of as students.
Now what? My assistants are going to place some transducers, and Then we'll be ready to go.
Okay, let's get this show on the road.
Sit back and enjoy, my friend.
(Whirring) Hey, what are you doing? Reprocessing Jill's data before the committee meeting.
Why? I found some Ana and sma antibodies in her liver enzymes.
Feels like I'm missing something.
What you missed is the surgery-- Dr.
Bovell using the Raposo system.
(Sighs) So? It was cool.
That's all.
It was like a-- like it's a robot, you know? The guy's unstoppable.
You know what I was thinking? Wait, wait, Ryan, hold that thought.
Jill Hollis is not a viable candidate.
She can barely take care of herself.
She's got Hi, hi, I apologize, I'm sorry I'm late.
Come on, we're talking about your patient right now.
Woman: May I continue? Yeah, please, go ahead.
I cannot recommend Jill Hollis for transplant.
Per my interview with her, she's an admitted drinker who just terminated the only long-term relationship she's had, leaving her with no means of support.
Additionally, she had a false pregnancy that she carried into its sixth month without any regard for medical care.
No, no, no, no, no, there was no baby.
She didn't know that.
Well, you're right, but because she believed she was pregnant, she gave up every bad habit she had, which I think shows an ability to be a good steward for the liver.
The fact remains, though, Jill Hollis needs a liver transplant because she drank this one into disuse.
No, she didn't.
I ran a liver biopsy, and all the symptoms that made Jill believe she was pregnant-- the fatigue, the nausea, the belly distension, even the loss of her periods-- are all indicative of autoimmune hepatitis, which is a congenital condition.
So her liver was going to fail regardless.
Exactly.
Look, we can't just overlook her personal instability.
And we also can't overlook all the efforts she's made.
I believe she can do this.
I do, too.
So let's put it to a vote.
Hi.
We got you listed.
And now what? We go the distance-- keep you clean, keep you healthy, wait for a good liver.
And then I just walk off into the sunset? Pretty much, with some very strong antirejection meds, yeah.
And what about drinking, smoking, you know, living? No, those are things that you're past now.
No, they aren't.
Well They're going to have to be.
Otherwise I will take you off that list.
Then take me off.
Jill Do you want me to lie to you, tell you that I'll be clean and sober and love this liver like a baby? Is that what you want? No, I want you to get counseling.
I want you to go to meetings.
I want you to see this as a thing that you can handle, something you've been handling.
That's when I thought I was pregnant.
What's the point now? The point now is that you get to live.
I'm not going to do it, no way.
(Monitor beeping) How's she doing? Already gave her the local.
Okay.
Okay.
Hand me the trephine.
You're still a resident, right? Yeah.
Mm-hmm.
Large forceps.
So where do you plan to end up? Well, I'm still exploring my options.
You should think about coming over here.
Yeah, why is that? Well, first of all, nobody dies over here.
Surgery's only a couple of hours.
She'll get immediate results and walk out of here with only eyedrops.
That does sound satisfying.
No guts, all glory.
This is the corneal button.
Get me the donor cornea.
To think, these little guys are going to be speaking a whole new language.
What do you mean? I mean, everything they see, she'll know the words for.
Kind of amazing, right? Bet you never felt that kind of wonder at a kidney.
(Imitating Darth Vader): come to the light side, Dr.
Lee.
(Woman over P.
A.
) ICU, code blue.
(Beeping) Where's the pain, Mr.
Dimes? Everywhere, front and back.
What's going on, Lester? I should have listened to you.
This hurts like hell.
He's got a hard resp rate of 36, pulse ox is only 82.
Okay, switch him to a non-rebreather mask at ten liters.
Do we have a blood gas report? Po2 is only 55, pco2-- 28.
Okay, you're breathing way too hard for way too little oxygen, Lester.
Jordan: We're prepped for a thoracic ct.
Perfect-- his renal function's good.
(Muffled groaning) Lester, are you allergic to any shellfish or dye? What? No.
Okay, let's inject him.
Lester, this is going to be difficult, but you have to remain still.
Okay? You understand? Uh-huh.
Okay.
Don't usually see you prepping the ct.
If this morning's procedure caused a pulmonary embolism, mea culpa.
Let's just give it a moment and see.
Oh, my God.
That's not from the surgery.
He's got a fusiform clot in his inferior vena cava.
Look at the size of that thing.
It begins at his hepatic vein insertion, reaches to the right atrium, and is migrating through his patent foramen ovale.
That clot bursts, he'll stroke out and die.
I'm gonna have to crack his chest to retrieve the clot out of his heart, but there's no way I can get to the infra-diaphragmatic portion.
It's bisecting his liver.
You think you can get in there? I could, but I don't know if Lester can survive the trauma.
Are you thinking what I'm thinking? Yeah.
Call Dr.
Bovell.
Okay, so we're clear, I'll manually do the sternotomy and put him on cardiac bypass.
By the time I've stopped the heart and gotten to the embolism I'll have used the Raposo to incise the inferior vena cava and flank this bitch.
Beats the hell out of the Skidman transplant.
This time, the patient survives.
(Heart monitor beeping) How you doing, Luc? Still trying to locate the obstruction.
Just step on it.
Hook him up to bypass, please.
It's got nothing on it.
It's going to be Okay, I've located the interior portion of the embolism.
Great! He's on bypass.
I'm cooling him down now.
Chilled cardioplegia.
(Rapid beeping) Okay, his heart stopped.
I'm about to incise the superior vena cava dissected the inferior.
Ready to snare the clot.
Okay.
Incising.
Almost there.
Got it.
On your word, Andrew.
Okay, Luc, I'm dividing it.
Retracting my end on the count of three Two One.
Now.
We did it.
Ready to close? Like a bank vault, my friend.
(Speaking Korean) (Clears throat) And I thank you.
Very happy to be seeing.
I'm feeling a lot better about my language skills right now.
(Heart monitor beeping) Got dicey there, Lester.
What what happened exactly? An embolism traveled up from your leg.
You really weren't kidding about all that sitting.
No, it almost killed you.
Once I'm out of here, I swear to God, I am burning the couch.
(Chuckles) I'm taking up running.
Start with a good walk, okay? And my heart? It's better than it was before.
Thank you, Dr.
Yablonski.
You're very welcome, Lester.
Hey, you okay? Yeah.
I'm fine.
Did you hear what, uh, Andy and Luc pulled off today? First cyborg surgery at Three Rivers.
I'm so sick of hearing about Luc.
What's your beef with him? He didn't tell you? Hmm-mm.
That's shocking.
All right, when I was in med school, I came here to visit my father.
And Luc and I went out, and we had a few too many and Really? Doesn't matter.
(Laughs) Kind of seems like it did.
No, it didn't matter then.
And now to see him wandering around here just Reminds me of a time in my life I'd much rather forget.
Well, maybe you should embrace your past.
And maybe you should embrace yours.
Wait, hang on.
Luc! Hey.
Hell of a homecoming, huh? Yeah, well, the equipment functioned just as it should, by the way.
His embolism's completely unrelated.
I know that.
Did you go and check on Lester? No.
Well, you should go and check on him.
I'm sure Andrew's already done it.
Well, now I'm asking you to go.
With all due respect, Sophia.
I don't answer to you.
You most certainly do when you are seeing patients on my wing.
Unfortunately, there is no machine that administers patient care, Luc.
It's why Andy's so good at what he does.
Why he will eventually run this place.
I understand.
I don't think you do.
You are going to go and check on Lester.
It could be the start of a lifelong habit.
I know what you're doing.
Yeah, I'm leaving.
Jill, your condition can be reversed.
Let us help you.
Sorry, I like my margaritas.
That's not the real reason.
You know what? You don't know me.
I read the police report.
I know you just didn't steal baby clothes, there were toys and bibs.
You even took a little pink hat with matching mittens, didn't you? Okay, so what? So, I think you wanted that baby.
I think for the first time, you saw some real possibilities.
And then it got taken away from you.
And now you're scared to hope for anything.
You're so young.
And you can have whatever you want, you just have to take the first step forward.
Id already named the baby.
Veronica.
After the band.
It's a good band.
How about we get you healthy.
Then you can have that baby, and give her that name.
Bobby.
I'm in, if you're in.
(Sighs) (Woman over P.
A.
) Flight 72 to Seoul is now boarding at Gate 8.
All passengers must board at this time.
This is a final boarding call for flight 72 to Seoul.
Thank you.
(Speaking Korean) And we are them but they don't know what's in their hands it's more than you and it's more than I but it's more and everybody calls it love but I'm not really sure if it's love to Lester.
To the Raposo.
Mmm.
So, um, Dr.
Foster-- turns out he's-- he was wrong.
About what? About us working together under the same roof.
He thought it was a terrible idea.
And it was, back then.
Not today.
Yeah.
I have to admit, it worked out pretty well.
Let's not make a habit of it, though, okay? Did you, um hear about Dr.
Robinson? Cardiac surgeon? Yeah, his mother is ill.
He's taking a leave of absence, I guess.
No, I know and, um, the board's been looking around for a replacement.
How long are you staying? Well, that all depends on Dr.
Robinson's mother, now, doesn't it? To her speedy recovery.