The Resident (2018) s02e13 Episode Script

- Previously on The Resident - No pulse.
The strut in the valve is shattered.
Seven QuoVadis heart valves.
I want to put them through the pulse duplicator.
The valves aren't strong enough for a younger, active patient.
Mark Truscott, FDA, Product Regulation.
I know that my firm is engaged in a wide-ranging fraud.
You are not a team player.
My sister, she OD'd on Oxy.
You almost died today, Jess.
You got to start making better choices.
So let's start now.
- Go home! - I can't.
- Priya's there.
- No wife and no home.
Now, use your ears as well as your eyes.
You're more likely to hear a bird before you see it.
Listen for the call of a cerulean warbler.
I saw one the last time I brought a group to this spot.
Most handsome little blue fell Hello, juvenile blue heron.
And perhaps a wood duck as well.
Swerved right off the road there.
Ran the plates.
Belong to a Julian Booth.
Open it up.
Car's empty.
Let's see if search and rescue can find a body.
Did you check the perimeter? Okay, one more thing.
Last question, I promise.
Hoop or stud? Stud, hoop? You pick.
They're both great.
You nervous? My first job interview since rehab? Yeah.
(CHUCKLES) I have your prep material.
Partner CVs and briefs on high-profile cases and clients at the firm.
And what they're looking for in a paralegal.
Five hours till go time.
Thank you so much for putting that together, Nic.
It's my pleasure.
This is exciting, Jess.
This could be the beginning of a whole new life for you.
- Call me when it's done.
- I will.
Yeah.
- Good luck.
- Bye, thanks.
You need to pull all QuoVadis valves now.
Because of one resident's science experiment? The valves worked fine when simulated for older patients, but when I mimicked the blood flow of active younger ones - Like Bradley.
- They shattered like glass.
Look, it's very clear that a defective QuoVadis valve killed Bradley, not these hands.
Well, your mentor, Abe Benedict, swears by them.
- Explain that.
- Easy.
He's on the QuoVadis payroll.
- What are you talking about? - ProPublica.
It's a site you need to make your home page, Bell.
They have a feature called Dollars for Docs.
It lists every dime every doctor takes from medical device companies.
Every dime to every doctor.
Well, that-that that proves nothing.
Billions of dollars are given to doctors every year by industry.
It's standard practice.
QuoVadis paid Dr.
Benedict a small fortune to push products that kill people.
Look, I know, as a fellow surgeon, you are not gonna stand around and allow our doctors to use products that cause harm to our patients.
Okay, well, uh, here's how I want to proceed.
I-I want to take you off all high-risk procedures.
High-risk procedures are my thing, Bell.
I understand, but if you want to prove it's the valve that caused Bradley's death, you need to keep your record clean.
You need to take the easy layups, the bread and butter procedures.
And while I do that? You have my word I will look into this.
Here is your skinny latte.
Get me a meeting with Gordon Page.
Tell him it's urgent.
So? What's so urgent that it required a face-to-face meeting? I received some information today suggesting your heart valve may be defective.
Wh-What information? From where? Well, one of our doctors tested the valve, and they're convinced you have a significant problem.
It may cause sudden death.
Look, this is absurd.
- We do all our own testing.
- Right.
Have you done follow-ups on patients that have received QuoVadis valves? What's the mortality rate at six months or a year? Naturally, some of them die due to underlying diseases or surgical errors.
Well, and some device manufacturers use that fact to hide device problems.
- Is that what you're implying? - No, I'm-I'm no.
I'm not implying anything, but I want to see data on the safety of the valves.
And if it doesn't exist, QuoVadis has to pull them from the market.
I'm sorry, are you, are you asking me to issue a recall during the run up to our IPO? Oh, yeah, while you do more testing.
Yes, yes.
Okay.
Yeah, um, okay.
I've heard just about enough of this.
You can't tell me how to run my business.
Who the hell do you think you are? You came to me desperate for money, so I made you an opinion leader.
I put you on my board.
I arranged speaking fees to get you out of whatever trouble you were in.
And I'm grateful.
I asked no questions.
I asked nothing in return except for loyalty to me.
And to our product.
Ugh, this is an extremely disappointing conversation.
I made an investment in you.
Earn it.
Hey, Jess.
What are you doing here? Okay, all right, be honest: do I look like a paralegal? Right? It's just an interview at this point, but thank you.
Wish me luck.
Good luck.
Hey, I got your text.
What's up? I just, I changed outfits and I wanted to show you.
This, this is better, right? What do you think? It's-it's softer.
It's more approachable.
Well, yeah, I like it 'cause it's mine, which you borrowed without asking.
What are you doing? You're supposed to be at your interview.
Oh, yes, and I missed the bus.
Can I borrow 20 bucks for a cab? - I'll pay you back.
I promise.
- Yes, hurry up.
I'm sorry.
You're the best sister ever.
- I love you.
Okay? - (EXHALES) Got it.
I'll call you after.
Hey.
She's very happy.
What's that supposed to mean? Opioids can cause euphoria.
I-Is Jessie being tested? Unbelievable.
First, I'm codependent, now I'm not doing enough.
Conrad, Jessie's fine.
We're actually in a really good place.
Okay.
Take a deep breath.
Our time on this earth begins and ends with a heartbeat.
It is the first sign of life within the womb, and it is the last organ to stop functioning in death.
The best part is feeling like you're actually there.
Is it the seat of our emotions? No.
- Do I want you to be - Virtual reality lets me attend all my med school classes and practice virtual surgeries.
But I do miss seeing patients.
Eh, new lungs could change all that.
You would finish your fourth year of med school, maybe even come here as an intern.
I can't think of anything more amazing.
Yeah, all right.
Here we go, here we go.
Take a big breath.
Blow it out forcefully, sweetie.
Conrad, these are Eloise's parents.
Florence and Dan Camden, this is Dr.
Hawkins.
Hello.
I've asked him to do a complete workup.
Before we can move forward, we need to be certain Eloise is still healthy enough for a double lung transplant.
We heard the donor is already here at Chastain.
Can I ask who she is? She's a young woman who died of an opioid overdose.
That's awful.
I'm sorry.
And here I am, so happy.
Oh, it's okay.
You can have sympathy for the donor and still be grateful.
Because the donor was an addict, there is a very small risk of complications, but don't worry, the organs have been through testing to ensure they're safe.
When we thought a donor might not come through, Dan and I were tested.
We're both a match and we can each supply a lobe of our own lungs.
- Would that be better? - Mom, we've been through this.
That would put both of your lives at risk.
I've lived with CF all of my life.
50 pills a day, hours of breathing treatments.
Dad works three jobs to pay for all my medical bills.
Mom has had to take care of me 24/7.
Uh they have suffered enough.
The donor lungs are going to work, I'm sure of it.
As you can no doubt tell, this case is personal to me.
I've been Eloise's med school mentor since her first year.
Oh, she's frail, Kit.
- I hope we're not too late.
- I know.
Without new lungs, she won't live another year.
And that would break my heart.
They found Julian's car.
We now go live to the scene of a breaking story.
Earlier this morning birdwatchers stumbled across a car submerged in water.
It's registered to a local woman, Julian Booth, who's been missing for some time.
Dive teams are now looking for a body.
Hey, Conrad, what's up? They found Julian's car.
Where? Pulled it out of the Chattahoochee River.
Did they find her body? Still searching.
Devon, she could have made it out of the car.
Until we know more Then where is she? - Why haven't I heard from her? - Look, no matter what happens, we're all here for you.
Whatever you need.
Thanks for the call.
How long have you been in the hospital? Three weeks.
I know you're scared, but you're not alone.
Look that's me.
I was diagnosed with cystic fibrosis when I was six weeks old.
I need a new heart.
I heard.
The nurses told me.
I need new lungs.
The doctors are gonna help us both.
Eloise.
Hi, guys.
This is Jeannie.
Hello, Jeannie.
Can we borrow Eloise for a few minutes? Sure.
- Will you come back? - Absolutely.
Let's take the limo, shall we? Where to? Your room.
Your parents want to hear what we have to say.
I think, somehow, I'm going to need more oxygen to handle this.
I don't like the look on your faces.
We have the results of the tests.
Unfortunately, your previous labs have worsened.
You now have extremely elevated liver enzymes, clotting factors, and blood sugar levels.
Okay, I've been in med school long enough to know what that means.
I'm no longer eligible for a lung transplant.
Usually, that would be the case, but we've found a potential solution.
A lung, liver and pancreas transplant.
A triple transplant? How did this happen? (SIGHS) Eloise's cystic fibrosis has caused liver failure and pancreatic insufficiency, on top of her respiratory failure.
A triple transplant sounds impossible.
It's dangerous, rare, but not impossible.
This operation has been done successfully before.
How many times? Once, in Canada.
Without this surgery, how long do I have? Not long, Eloise.
Weeks? Maybe a little bit more.
It's okay.
- This isn't over.
- Mm-hmm.
We know what we have to do.
Can we get all three organs from the donor we already have? Yes.
Now, we just have to convince the ethics committee.
Kit? Come here.
You okay? No.
This is awful.
I put a brave face on it for the family.
Oh, but, my God, Conrad.
Where in the world are we gonna find a surgeon crazy enough to even take this on? A triple transplant? Dr.
Austin can't do it.
Bell assigned him to low-risk surgeries.
- We've been doing stents all morning.
- And you know I am royally sick of it.
This quarterback is coming off the bench.
There's no way.
Please, Randolph, as a friend, just hear me out.
This is deeply important to me.
It's bad for Austin.
It's bad for Chastain.
I mean, I mean, it looks like a just a crazy publicity stunt, and the ethics committee will never allow it.
You chair the committee, you can persuade them.
I'll help.
- We can double-team them.
- Kit, I'm sorry.
I It's-it's out of the question.
You go ahead and try if you'd like.
But I I can't help you on this one.
Mr.
and Mrs.
Basilico? (CHUCKLES) How are you doing? Nicolette Nevin.
Aw Jessie's older sister.
Do you remember, Eric? Of course.
You had blue hair.
I did.
Teen years.
How's Letty? Maybe you'd like to see her.
She's gone, Nic.
Multiple doctors confirmed.
They're keeping her on the vent because she wanted to be an organ donor.
Apparently, she's donating to a young woman here.
What happened? Opioid overdose.
She's struggled with addiction since her senior year in high school.
I know that Letty tore her ACL at the state championship.
Yeah, and her doctor gave her Oxy.
They were handing it out to everybody.
I know.
She never really got sober, although we thought she did.
I really thought she'd make it this time.
I didn't see any signs she was using.
I did.
She wasn't eating much, she'd lost weight.
Her moods were all over the place.
She'd be anxious, on edge, and then she'd be up, so up.
Why didn't you say anything? I didn't want to see it.
What are you doing? What'd you do with the money I gave you, Jess? I told you, I used it for a cab.
You're lying.
Did you even go to that job interview? So what if I didn't? Whole thing was your idea.
I don't want to be a paralegal.
Stop going through my stuff, Nic.
Hey, quit it! Quit lying to me! I know you're using.
- God, I've been so stupid.
- You are insane.
You know that? Completely insane.
I am not the problem here, you are.
Hey! Give me that, you controlling bitch! Okay, I know what you think, but it's not true, okay? I-I keep these in case I need them.
Stop.
Just stop! There is a huge amount of pressure on me.
And you are in my face day and night.
So, yes, I-I took a few.
Sometimes, okay? Be-Because of you! Y-You are driving me crazy! This is my fault? Unbelievable.
Yeah, it's always my fault with you, Jessie, huh? Oh, poor little Nic.
Always a victim.
Jessie Jessie, stop.
Listen to me.
You are using, and you are in trouble.
Remember your friend Letty from high school? She's at Chastain, Jess.
She's dead because she OD'd.
I don't want that to be you.
- No.
- It's true.
Come with me to Chastain.
I'll show you.
I don't believe you.
Fine.
Fine.
Either way, pack your bags, 'cause you're going to rehab.
I'm not going anywhere.
Then get out.
Get out.
I'm done, Jess.
I'm done trying to save you.
I'm done enabling.
I'm done worrying.
That's enough.
And if you die I won't feel guilty 'cause I gave you every chance.
So, here, you want your pills? You need them that bad? Take 'em.
Take 'em, Jess.
I can't stop you from killing yourself if that's what you want.
When I come home, I don't want to find you here.
- Can I help you? - Yeah, I'm a friend of Julian's.
Tell her she's a week behind on her rent.
She's not returning my calls.
Um, when was the last time you saw her? I don't know.
Over a week.
She left the cat all alone.
I've been feeding it, but it's driving me crazy.
I bet.
That's actually why I'm here.
Julian asked me to come pick up the cat, but I forgot her key.
If you let me in, I can take the cat home with me.
Here's the key.
Thank you.
All set.
Thank you.
Hey.
Come on.
This, my friends, is what you call a paracentesis.
It's pretty gross.
Look left, and you can see Dr.
Hawkins is removing fluid that's collected in my abdomen.
You don't have to stream this, Eloise.
People want to know how I'm doing.
I've live-streamed all my procedures for the last year to med students and the cystic fibrosis community.
As you can see, my belly is shrinking.
Maybe I'll finally get some abs.
It also means that I'm in severe liver failure.
I came in thinking I was getting some lungs.
Now, we've learned that I need a new liver and pancreas.
So, I will have a triple transplant and make history.
Okay.
Feel better? - Yeah.
Thank you, Dr.
Hawkins.
- My pleasure.
Dr.
Austin and Dr.
Okafor are gonna be your surgeons.
Wow.
We are honored.
It's Dr.
AJ Austin in the flesh! I love your lectures.
Thank you.
"Our time on this earth "begins and ends" (COUGHING) And ends with a heartbeat.
Hi, Eloise.
I have a consent form for you to read.
After the surgery, you'll be on dozens of new drugs.
I'm sure you have concerns about rejection and I may have a chest tube, breathing tube, feeding tubes, Foley catheter, and central line for weeks, maybe months.
But I've got a life to live.
- I just have one question.
- Mm-hmm.
Can we livestream my surgery to med students? Not the best idea, under these circumstances.
But since it's so rare, whether I live or die, isn't there a lot to learn from this? Tell you what.
We'll talk to the bigwigs.
And for the record I'm cool with it.
Okay.
Hang tight.
We're getting close.
Just one more hurdle left TO CROSS: the ethics committee.
Look, we can keep going around and around about this all day, but the problem is, two lungs, a liver, and a pancreas could go to four people instead of just one, all of whom have a far better chance of survival.
This is an exceptional person.
She's a top medical student who'll make a great doctor.
We understand how you feel.
But all of our patients are equally deserving.
Of course they are.
And the other candidates will get organs, too, just not from this donor.
They'll have to wait a little longer, but they'll still be next in line.
You're talking about a five percent success rate.
These odds may be long, but they are not impossible.
And it doesn't account for variables, - like the skill of the surgeons.
- Eloise started a nonprofit to empower children with disabilities.
She works for access to medications for those who can't afford them.
She's touched so many lives.
Dr.
Bell, we're deadlocked.
This is up to you, and you are worried if this doesn't succeed, it will be a blow to Chastain's reputation.
But no matter what, we advance science and we open new possibilities for thousands in the future who could benefit from this kind of surgery.
We can't just give up and say it's too difficult.
It will never be possible if we don't try.
I remember a surgeon who took on the toughest surgeries in the state of Georgia.
Who gave hope to people who had none.
Who had no fear.
He would have jumped at the chance to advance the science and make medical history.
We are taking a really big risk here.
But we are gonna try to save this life.
No second chance when it comes to a Donation after Cardiac Death.
When that heart stops, those organs stop getting perfused with blood and quickly become unusable.
When we hit that OR, we got to be lightning fast to save them.
I thought no surgery could scare me anymore, but my heart is in my throat this time.
Letty's heart has stopped.
All right, let's get this show on the road.
No, not so fast.
We still have the five-minute buffer to make sure - the heart's actually stopped.
- I think Dr.
Austin is aware of the IOM guidelines.
Just a reminder to do the right thing.
Let's dance.
Luckily, the Raptor's fearless.
Thank God.
We need his courage.
- Sternal saw.
- 10 blade.
Catheter.
Cannulate.
- Preservation fluids.
- Fast and furious, baby.
Checking the liver and the pancreas.
They both look viable.
Yours? Lungs are not viable.
There's black discoloration.
A rare complication.
The nodules must not have been detected during imaging.
(SIGHS) We can't use these lungs.
We're done.
Remove the liver and pancreas.
Put them on ice.
There's another option.
This can't be over before it starts.
It's not.
You've already been established as lung donor matches.
We are gonna use a lobe of lung from each of you and the liver and pancreas we just procured.
- If you agree.
- Of course, but she'll only have two lobes of lung.
All she needs is two lobes of lung.
And they will expand over time.
Better than her diseased ones.
Much better than her diseased ones.
But they haven't been prepped for surgery.
They haven't fasted, they could aspirate when they go under.
Anesthesia can do a rapid sequence intubation to limit the risk of aspiration.
Let's get you both to pre-op.
If we don't move forward, we may never have another opportunity like this.
You're our daughter, Elo.
The board has agreed to livestream the surgery, but only to Eloise's med school classmates, - just a limited feed.
- Like she said, no matter what, it will be a great learning tool.
This just went from an incredible long shot to virtually impossible.
Well, then, we'd better work a miracle.
There's an entire family in there counting on us.
Hey, I'm on call for thoracic.
- Said you guys could use a hand.
- Welcome to the team, bro.
Hmm.
Diseased liver and pancreas removed.
So far, so good.
Donor liver and pancreas, ready for implantation.
Mom and Dad are stable.
Here we go.
How many people are watching this? Not many.
Probably just the gunners.
They're finishing the liver and pancreas.
We need the right lower lobe of lung.
The lobe's harder to remove than we expected.
Mom has some adhesions to the chest wall.
Stapler.
Transecting the segmental branches off the pulmonary artery.
Get Dr.
Austin.
Now! One order of lung to go.
- Mom's crashing.
They need you.
- Get this to Okafor and Bell to implant.
Page Dr.
Weiss, tell her to come close up.
Have we activated massive transfusion protocol? Yes.
I've been trying to repair the pulmonary artery, but the damage is extensive.
Artery forceps to me.
Dr.
Austin needs you to implant the lung.
- Where's Dr.
Austin? - He's helping with the mom.
- She's bleeding out.
- What? You stay.
I'll go.
- What's happening? - It's impossible to see anything.
We need to convert to open.
10 blade.
Retractor to Bell.
Put your finger on that proximal P.
A.
Getting the lung out of the field will give us a better view.
Looks like the lobe got damaged.
Implant the lung with Mina.
I'll fix the bleed.
3-0 Prolene.
On my mark, let go and I'll sew this up.
- You ready? - Yeah.
Go.
Suction.
Lap.
Had to check on a patient.
How we doing? Florence lost a lot of blood.
- They're working to save her.
- Eloise? They're putting in Florence's right lower lobe now, but it may be damaged.
(GROANS) Eloise can't live with only one lobe.
Dad's lobe on the left looks good.
Mom's lobe on the right shows some contusions.
Let's hope this works.
Dr.
Chu, get the Ambu bag.
Inflating the lungs.
The moment of truth.
Again.
Again.
I'm getting a lot of resistance.
- Is something wrong with the tube? - No, no, I checked.
Maybe it's reperfusion injury.
- We should check her airway.
- All you.
Hmm.
Plug at the carina.
Got it, try again.
Fingers crossed.
Mom's not out of the woods yet.
You go, I'll close.
KIT: How do you feel? Like I was just born.
Like I'm the luckiest person in the world.
It's never been like this, ever, just breathing.
My parents? Hey, Elo.
Your dad's procedure went great.
Your mom There were some complications with the pulmonary artery.
It can happen in difficult surgeries like this.
- Recovery's not gonna be easy.
- But we believe she can make it.
Oh Mom.
Mom, I'm here.
Right here, where you've ALWAYS BEEN: beside me, helping me.
Mom, can you hear me? You're famous.
Just think how much more insufferable you'll be.
I wouldn't count on it.
I have recently dined on humble pie, and it's a flavor I will not soon forget.
That surgery was insane.
I mean, we're all proud of the work we did and are happy for Eloise and her family, but that could have ended very badly.
A triple tragedy.
Skill certainly played a large part, but so did luck.
It was practically a miracle.
Check it out.
Our next surgery.
What are you gonna do? Uh, we are going to perform a flawless aortic valve replacement.
- With a QuoVadis valve? - A-A QuoVadis valve? Excuse me? There are no QuoVadis valves on Chastain shelves.
Are you telling me Bell pulled them? Every last one.
We've got the old reliable valves back for good.
- Well, today is truly miraculous.
- Mm.
Bell, of all people, did the right thing.
You pulled the valves.
Are you insane? It was the right thing to do.
And I believe, eventually, you'll agree with my decision.
This is way out of line.
Obviously, there will be consequences.
You'll regret this, Dr.
Bell.
Long day.
A great day.
I'm leaving, Dr.
B.
Uh, don't forget you have that dinner with the CEO of Atlanta General at 8:00.
I canceled it.
I have surgery.
Ah, that's a nice change.
See you tomorrow, boss.
To you.
Thank you for what you did.
Thank you.
Allow me.
It's a good look.
Yeah, I just had it pressed.
You've reached Mark Truscott, Director of the Center of Devices at the FDA.
Leave a message.
You broke into Julian's place? Not exactly.
The landlady let me in to get Julian's cat.
Don't ask.
- And you just took her phone bill.
- Yes.
Look at the last number that Julian called.
On the 3rd, the day I saw her in the park.
The day she disappeared.
I tried the number about an hour ago and I got an answering machine.
It was an office at the FDA.
Julian was a device rep.
She probably called them all the time.
Or maybe she found something out and she was trying to blow the whistle.
Look, you said it yourself.
Bradley died because of a defective valve.
He was my best friend.
Did QuoVadis know the valve was bad? If so, they killed him.
Julian told me that something was wrong at work.
She felt like everything was falling apart.
What do you think she meant? I think she was in danger.
Did they kill her? Did she run away? I don't know.
Something is up with QuoVadis.
Let's figure out what to do next.