The Resident (2018) s03e10 Episode Script

- Previously on The Resident - You want Conrad to go down.
Whistleblowers like Hawkins cost hospitals millions.
It's him or you.
If it were easy, everyone would be a doctor because this is the best job in the world, despite everything, because of everything.
Cardiac issues can escalate quickly for pregnant women.
Worsening heart failure could kill both you and the baby.
So, guys, hey.
These are the doctors that are gonna be helping Dr.
Cain save Mom.
There is only a slim hope this will buy you more time.
I will do anything to stay with my kids - as long as I can.
- When is she gonna wake up? Dawn has endured 17 hours of surgery.
Her body is struggling to recover.
She hasn't regained consciousness and as yet, isn't able to breathe on her own.
- What? - Mina, I think it's happening.
What do you mean it's happening? - The baby.
- It's five weeks early.
- How far apart are your contractions? - Hang on a sec.
20 minutes maybe.
I think some are coming sooner.
- I think they're getting stronger.
- Use the app.
It's important to log each one.
- Did your water break? - N-No.
- Where are you? - I'm at Peachtree and 4th.
It's a big sale.
First come, first serve.
I need a crib.
- I'm in line.
- Sit down immediately.
- Yes, Doctor.
- Okay, I'm on my way.
I'm taking you to Chastain.
Okay.
Okay.
- Hey, what's up? - Adaku is in labor, and in line at a box store, if you can believe it.
- I'm gonna get her right now.
- She's five weeks early.
Yeah.
So to be safe, I'm taking her to the ER.
Well, of course.
With her heart condition, she needs - to be monitored.
- Obviously, I will not make lunch today.
- What was that? - Um, I, uh, almost hit a car.
All good.
- Okay.
I'm coming to meet you both at the ER.
- Uh, no.
It's your day off.
Enjoy your yoga.
On a scale from one to ten, your stress level sounds like a 12.
Emotional support is required, and that happens to be my superpower, so I will see you at the hospital.
Now turn off your phone and slow down.
I will.
I promise.
And we're done here.
Dr.
Voss, the hip is all yours.
He's bradying down.
Coleman, push two grams of mannitol and open up the drain.
His brain is swelling again.
What's your issue, Dr.
Voss? He had advanced dementia even before he fell.
Uh, he's 89.
Yes, I've had the pleasure of reading his chart.
Your point? His ICP's increasing.
He's gonna herniate.
There's no way this is gonna end well.
Given his physical and mental status before surgery and this complication, he'll have zero quality of life, if you could even call it life.
Are you suggesting we let him die? He'll be a body in a bed.
A vegetable.
It's the compassionate choice at this point.
I'm gonna say this once and never again.
Nobody and I mean nobody dies in my OR! Coleman, proceed.
Pushing two grams of mannitol and opening the drain.
So, the son is expecting an update.
Why don't you go out there and talk to him, tell him the surgery went well.
Tell him his father is stable and in the ICU.
Remember to smile.
It shows you take pleasure when delivering good news.
Understood? Last day as an intern for Dr.
Devon Pravesh.
Yeah! - My, how time flies.
- Seriously? - Thank you.
- That felt like the longest year in history.
- 12 more hours, you'll be free of me.
- I will never escape you since you're going to be chief resident.
Oh, yeah.
- Good point.
- As a second-year resident with interns of your own, you'll need to up your wardrobe game.
I could definitely see him in a bow tie.
Oh, yeah, I've already got three picked out for him.
- What? No.
No.
- Nic leans towards plaid, but I think he's more - of a polka dot kind of guy.
- Oh Uh Batman, Robin, you're needed in Bay Two.
Hello.
I'm Dr.
Hawkins, this is my intern Dr.
Pravesh.
Hi.
Now, can you tell us what happened? Uh, I, um, I think Tyler took a bunch of these I'm not sure how many and a few sleeping pills.
Okay.
Sleeping pills.
I it-it's not what you think.
H-He's been having trouble sleeping and lots of pain from sports injuries.
I think he took too much acetaminophen by mistake.
Okay.
Thank you.
We will let you know as soon as we have an update, - okay? - Nurse Hundley? Would you mind taking Tyler's mom outside - where she can wait, please? - Sure.
- Excuse me.
- Come on.
Vitals are stable.
Pulse 80s, BP 120/70.
- Satting 100% on room air.
- Tyler.
Tyler, can you hear me? - Where's my mom at? - She's here.
We got you.
I'll order a set of labs with an acetaminophen and aspirin level.
- Don't forget - Coags.
- I know.
- We'll add a liter of saline.
Labs could be hours and we have a high index of suspicion.
- Let's start him on NAC.
- Hmm.
Hey.
I think it, he says it.
It's like I taught him everything he knows.
Hey.
I was also involved.
- Eh.
- Okay, guys.
Chill out.
Katie and I cooked dinner yesterday.
Tim cleaned.
Well He sort of cleaned.
We always have to wash his dishes twice.
I miss you.
I bet your mother loves hearing about your day.
Do you really think so, Dr.
Cain? She never squeezes my hand or makes any sign that she even knows I'm here.
Well, I have some good news.
Your mother is ready to leave the ICU and go to a great rehab facility.
Rehab? She, she doesn't even move.
Hmm? Give her some time.
Don't count her out.
Your mother is a fighter.
She survived the Mother of All Surgeries.
She's being transferred today.
Just let her settle into her new home and then you can go visit her.
And, Malia, don't give up before the miracle.
Okay? Where are you taking this patient? Long-term acute care facility.
- On whose orders? - Dr.
Cain, at the family's request.
Adaku? So, this is your baby's birthday.
- So excited.
Scared and excited.
- Where is her OB? I texted her to meet us half an hour ago.
Dr.
Lin has a patient but will be here soon.
Put her in Trauma Bay 11.
How is that good enough? I'm going to call the OB chief and complain.
Dr.
Lin is the OB chief, Mina.
That's why you chose her.
Remember? - Breathe.
- I'm not having a contraction.
He means me.
- Mina, darling.
One minute.
- What? Do you have pain? - Is your heart racing? - I'm fine.
Soon we will meet my baby, the child I've wanted my whole life.
And you'll be her godmother.
You are my dearest friend.
I've known you half my life.
It's time for us to be happy.
Together.
Okay.
Got a new one for the vent farm.
- From Chastain.
Dr.
Cain's patient.
- Another? We won't have a room ready for her - until later today.
- Got to put her somewhere.
She can't go back to the hospital.
Doctor's orders.
Okay.
Stash her there with the others who are waiting.
How you doing, Tyler? Uh, I'm-I'm better.
Thanks.
Do you want to tell us what happened? Sophomore year, I was tackling a fullback.
He was a big guy and I dislocated my elbow.
Painful.
Yeah, and junior year, I lost sight of the quarterback.
- Got blindsided.
- Did you get this bruise playing football? Uh, that one, I don't know.
I'm not sure.
When's your next game? For me? Never, 'cause I got cut.
And then Tilly, my girlfriend, she broke up with me the next day, so Did that happen today? Tilly was yesterday and team was the day before.
Um Then, this morning uh, my parents told me that they're calling it quits.
Filing for divorce.
That is a lot to deal with, man.
I-I did something really stupid, um I I tried to kill myself.
Yeah.
- Tyler? - Yeah.
Listen, have you been thinking about taking pills for a while? No, man, no.
It was gosh, it was a spur-of-the-moment thing.
I was just I was, I was angry and I I'm not like that, like, I'm-I'm not I, uh Where am I ? - Hey, Tyler, look at me.
- Oh - Huh? - Open your eyes.
- Okay, okay.
- Bruising, confusion, - scleral icterus.
- No, guys.
I'm good, I'm okay.
I'm okay Whoa, whoa.
Okay, okay.
I'm okay, I'm okay, I'm good.
And what time did the contractions start? Her first contraction was at 6:42, second at 7:15, - third at 7:33.
- It sounds like early labor, which isn't great, considering she's five weeks early.
We can deal with that, and we'll give her steroids to help - the baby's lungs mature.
- Her heart rate has raised from 100 to 125 in the past hour.
She has a history of dilated cardiomyopathy.
She cannot handle a sustained tachycardia.
Believe it or not, she can be a ton of fun.
You should see her when she has a few drinks in her.
Mina, I'm sure Dr.
Lin is very well versed in her patient's medical needs.
An excess of caution is appropriate in this case.
So, normally, if your contractions stopped, we would watch you, we might even consider sending you home.
But with your cardiac history, I think the safest choice is to get you comfortable in labor and delivery, and we will monitor you and the baby.
And you'll be back to check on her shortly.
- Thank you, Dr.
Lin.
- You're welcome.
I'm getting Dr.
Austin.
A full cardiac exam should put everyone's mind at ease, especially All right, good news.
Tyler's brain CT is negative.
No bleeding and no signs of cerebral edema what about the labs? Not good news.
Let me guess.
Fulminant hepatic failure from all the acetaminophen he took? He needs a liver transplant or he'll die.
I wish I could say I haven't seen this before, but I've seen it too many times.
Acetaminophen overdose is the leading cause of liver failure in the U.
S.
He's young, otherwise in good health.
That should put him at the top of the transplant list.
He could get an organ quickly.
If we tell the transplant board that Tyler attempted suicide, he will be ruled ineligible.
He won't be at the top of the transplant list.
He won't be on the list at all.
That is a rule here at Chastain.
As long as we get him counseling, I say what suicide attempt? Wait, did I hear that right? Is that Dr.
Pravesh or is that an imposter? Look, I'm the same man that I've always been, but I see more shades of gray than I used to.
Sometimes, to do right, you can't follow the rules.
I think the short answer is, I'm not an intern anymore.
I'll transfer him to the ICU.
And I'll contact the transplant team.
Well, you're definitely still pregnant, but I'm guessing you already knew that.
Shallow breaths, use your abdomen like this.
What do you see? Heart's beating a little fast.
But you're pumping for two, so that's totally normal.
What is it? All good.
Listen, I've got some instructions for your ladies in waiting on how to best take care for you.
- So, they'll be right back.
- Okay.
One of her heart valves is failing.
It's leaking severely.
Mitral regurg.
It's causing fluid to back up into her lungs.
We have to, uh, get her in surgery right away.
I'm gonna book an OR and scrub in.
Whoa, wait, take your foot off the gas.
The regurg isn't emergent.
The valve needs to be replaced.
With the continued stress of pregnancy, she could - decompensate rapidly.
- Or it could last another week or another month.
There's no way to predict.
Do not play Russian roulette with Adaku's life.
No delay, we need to get her to surgery right now.
No I'm gonna close my eyes and pretend the last 15 seconds of this conversation never happened.
And when I open them, history will be erased, and I will know that you still have unlimited faith in my ability to deliver the best care possible to your friend.
We obviously trust your judgment.
What I think Mina's trying to say is, we need to save Mom and baby.
No, that is not what I want to say.
The mother is priority number one.
There is no choice to be made, Mina.
We save both baby and the mama.
Adaku is a high-risk pregnancy.
We need to get our ducks in a row - before surgery, Mina.
- Thank you, Nic.
Now, that means we have to line up the best anesthesiologist, the best neonatologist, have an on-call perfusionist, and put blood on hold.
It's gonna take a few hours, and once everything is in place, Dr.
Lin will deliver the baby and we will repair the valve.
And there is every reason to believe it's going to be fine.
If her condition changes, page me.
Look, if you are frightened, you are gonna transfer that anxiety onto Adaku.
The only thing we can do now is show rock-solid support.
And to restate the obvious, Mina, I'm here for you.
Okay? So, your patient, Dawn Long, you moved her to an LTACH? Family didn't want to let her go, so in deference to their wishes, I admitted her to a facility where she can be safe and comfortable.
Yeah, just wondering about the timing.
Meaning? Well, if you keep her alive past the 90-day mark, then her outcome won't be tracked anymore and you can claim your patient survived - the Mother of All Surgeries.
- As can the hospital.
Better outcomes mean more patients and better Medicare reimbursements.
Yeah, agreed, except neither of those are appropriate reasons for a medical decision.
So, tell me, what's the harm in allowing a family to live with hope for just a little while longer? In a facility owned by Red Rock costing thousands of dollars a day.
Exactly you're making my case for me.
Tyler's an excellent candidate for a liver transplant.
The patient is otherwise healthy, no underlying medical conditions? None, and he's a teenager with his whole life ahead of him.
According to your notes, he presented with an overdose of painkillers.
Yeah, acetaminophen.
He's a football player.
Tried to self-treat his back pain.
Took too many.
Ah, this was a a-a therapeutic misadventure.
You know, people don't realize how easy it is to take too much over-the-counter pain medicine.
You talk to our ER staff, they'll tell you.
- They see it all the time.
- You understand that patients with suicidal ideations are disqualified from receiving transplants at our hospital? - Mm-hmm.
- We've had a few recent bad outcomes.
And any more could put our program in jeopardy.
Of course.
Was Tyler's overdose a suicide attempt? Absolutely not.
We'll get Tyler listed.
Notify UNOS.
With his numbers, he's first priority.
Great.
Thank you.
Torturing yourself? Facing our new reality.
The Barrett Cain Center for Neurosurgery.
He's a pot of gold at the end of Red Rock's rainbow.
I'm the chief of surgery, and I still can't control him.
You remember Dawn Long? The lovely woman with seven kids - who had the Mother of All Surgeries? - He had her transferred today to an LTACH for rehab.
You're joking.
He was gaming the system to boost his own stats at the expense of his patients.
That's what I'm here to talk to you about.
You know how I've been trying to play nice with Cain in his sandbox to find out - what he's up to? - Yes.
I've seen multiple surgeries with residents in charge, overtreatment, up-coding.
This morning he operated on a patient who shouldn't have had surgery in the first place, then condemned him to life on a vent in a vegetative state just so he wouldn't have a death in his OR.
I'm not surprised.
- We have to do something.
- No, we don't have to do anything.
You have to stay out of the line of fire.
Chastain needs good doctors like you now more than ever.
And your contract is coming up for renewal.
If he thinks that you're against him, you're gone.
What about you? My contract is virtually unbreakable, so I guess what happens next is up to me.
Chest feels heavy.
She became acutely short of breath and her O2 sat dropped.
Harsh holosystolic murmur.
We need to take another look at that valve.
Coming up.
A chord must have ruptured.
It's wide-open mitral regurgitation.
That valve is blown.
What? What does that mean? It's time to have this baby.
Page Dr.
Lin! - Mina, what's happening? - We're gonna proceed immediately with the C-section with Dr.
Lin, and then you're gonna go into surgery right after with Dr.
Austin.
It's my heart? Listen to me.
Take the baby first.
Save my, - save my - Adaku? save my baby.
Adaku? I still have a pulse, but she's hypoxic we need to bag her.
- Acute pulmonary edema.
- Get a code team in here now! She's in V tach! V fib.
We lost her pulse.
Starting compressions! We got no time to waste let's go.
Where's Dr.
Lin?! - OR Three is ready for us.
- Good.
We need to get this baby out as soon as possible.
No, no.
Adaku's coding.
We save her first, - then think about the baby.
- Negative.
We do that, then the baby dies.
Adaku made her wishes clear.
She said save the baby first.
- Austin, I swear, if you don't save Adaku - Mina! Listen to me.
We get her on bypass as Lin delivers the baby.
Then we deal with the valve.
That's the only way we save them both.
Trust me.
- How long do you need? - About a minute.
Ten blade.
Adaku won't make it.
Yes, she will.
We just have to buy her more time.
All right, baby's out.
Baby's not breathing.
Now I'll prep her for bypass.
You handle the cardiac massage.
Let's get some blood in here.
How we doing over there, Nic? Baby's still not breathing.
Okay, let's bag her.
- Heart rate's still in the 50s.
- She's been hypoxic too long.
Okay, I'm starting compressions.
Giving 0.
5 milliliters epinephrine.
Okay.
Thank God.
Welcome to the world, little one.
Let's get her to the NICU, please.
She's ready for bypass.
How we doing? I'm starting to repair the heart valve.
Mina.
Let's go to the NICU.
I can finish the surgery, Mina.
Go.
We saved the baby, but Adaku still might die.
You should have operated her hours ago.
- We shouldn't have waited.
- Mina, that's not helping.
He made the right call.
Adaku and the baby are both still alive.
- That is the best possible - I'm staying.
- No more mistakes on my watch.
- There were no mistakes! That baby is going to have her mother, and I'm going to make sure of it.
- Looks good.
- What? It's perfect.
Let's start weaning her off bypass.
She's undergone two major surgeries at once.
Her heart was already weak to begin with.
It may never restart.
Even if it does restart, she may never wake up.
Please clear.
Sinus rhythm.
Look at that.
That's a win for now.
I'm going to give you a pass on how you behaved because I know how upset you are.
But I certainly won't forget.
It's all you.
Conrad.
Dr.
Moore, how we doing? Your organ is perfect.
The timing is practically a miracle.
Hey.
- We have a liver.
- Incredible.
Tyler is still down here.
They had no beds in the ICU.
All right, we'll send him up to the OR now.
Let's go.
Take good care of her.
How is she? Uh alive.
We fixed the valve.
Her heart's beating, but beyond that? I don't know if I'm gonna be okay if she's not.
You want to see the baby? Hey.
How's it going? So far so good.
Three more hours and you're official.
That first day you told me, "Go be a doctor or go be something else".
Yeah, I remember.
And you said this is the best job in the world, despite everything.
Because of everything.
That day I watched a young girl die.
And today I watch good doctors save a young man's life.
And right now all I am thinking is what a privilege it is to be a part of it.
Dr.
Cain still in surgery? Uh, I don't know.
He was in OR Two.
Where is Dr.
Cain? - Uh, he left 15 minutes ago.
- Who are you? I'm his resident.
- Uh - What's going on? - Page Dr.
Cain.
- What is going on? Talk to me.
I lost control of the bypass, can't stop the bleeding.
He's losing perfusion to his brain.
Page any attending.
I need help now.
Hang on, I'm coming in! - What's happening? - I can't finish the patch.
- The artery's shredding.
- Take a deep breath.
I'm not kidding.
Take a deep breath.
Do what I say and this will be all right.
There's blood everywhere.
I've only done this in-in a sim lab.
First we need to see the field.
Suction.
Now I'm gonna help you get proximal and distal control.
- All right.
- Grab the vessel clamps and put them - where my fingers are.
- All right.
- Do you see that? - Yeah, right there.
Okay, good.
Now what? Um, reinforce the patch.
Uh-huh.
Do it.
Bajwa here.
Dr.
Cain left the hospital.
He did what? It's gonna have to wait.
I got an urgent text.
Yeah, don't worry, it's been handled.
- By whom? - Yeah by me and Dr.
Bajwa, who happened to be on deck.
I've been a surgeon a long time.
I've seen attendings come in drunk, I've seen 'em fall asleep from sheer exhaustion.
I've seen incompetence and heroics and everything in between, but this defies description.
Your patient nearly died, you left him wide open on the table.
You want an attaboy for saving one life? I save dozens every day, hundreds by the week.
- Get over it.
- Do you save them or manage not to kill them? Wheeling a patient with a blown brain into the ICU and hooking them up to a vent is not a life-saving procedure.
- It's abusive.
- Oh.
Look who's talking.
One glass of ten-year-old bourbon and your residents cannot wait to share the tales of the mighty HODAD.
Hands of Death and Destruction.
That is what they call you, isn't it? Patients dead after a routine appendectomy, catching fire in the OR? Yeah, I've made mistakes, but I was there.
With my staff in the OR, not off joyriding while my patients were left incapacitated.
I have saved the lives of kings and princesses from every corner of this world.
They worship me.
They want to name their children after me.
They will never forget who I am.
- But it seems that you have.
- No.
You're the one who's forgotten who I am: chief of surgery and your boss.
You will answer to the board.
Yeah? What do you think? Wow.
Nic let you out of the house like that? What are you doing? I've gotten a free sandwich here ever since I started.
- These guys love me.
- Is that right? Let me guess, fried egg.
Yeah.
How'd you know that? They like you, but they don't like you that much.
Have you been buying my lunch this whole time? Yeah.
Something my resident did for me.
It's a tradition.
You just pay it forward, do the same for your intern.
It's a way to say thank you for all the hard work they put in.
Last one.
Better enjoy it.
Listen.
I want you to know that I do know.
Hey, I want to show you something.
- You mean - Yeah, yeah, yeah, yeah.
Wow.
- Congratulations.
- Aah! I haven't asked her yet.
I just have to find the right moment.
- She needs to say yes.
- Oh, she will.
You guys are inevitable.
No, I know how I feel about Nic.
That's never changed.
It never will change.
She's everything.
- Hi.
- Hi.
Oh, no, no.
Come on.
How's Mina? Rumpled and grumpy.
She slept in a chair by Adaku's side last night.
And Adaku? Critical.
She's intubated and sedated.
It's gonna be a long road ahead.
She'll be in the hospital for a while.
The baby, on the other hand, might be able to go home in a week.
With Mina.
Wow, that's a scary thought.
Ho I'm sorry for earlier.
The things I said.
But I was not wrong.
If we had taken her to surgery first thing Mina, stop.
Taking care of her was my job.
Look, I get it.
It's been a rough 24 hours for everybody.
And you have another challenge ahead of you now.
She's just so small.
The surgery went perfectly.
We're hopeful for a full recovery.
That's wonderful.
How you feeling? I've been better, but I can't complain.
Still here, right? I know I have you to thank for that.
Well, the person we have to thank is the donor.
He gave you a very precious gift.
Look, I promise I learned my lesson.
I'm not gonna make that mistake again, okay? I'd like to be sure of that.
I want you to start by being honest with your mom.
- I can't do that.
- No, no, no, no.
It's okay.
It's important.
She needs to know.
And this is why I want you to get counseling.
You need to talk to someone about why you tried to take your own life to make sure it doesn't happen again.
Are you sure the transplant surgeon heard you? Positive.
- What did he say? - Nothing.
He walked away without speaking to me.
Okay, this is bad.
Well, maybe, maybe not.
We don't know if he'll tell anyone.
The surgery's done, the outcome is good.
They can't turn back the clock.
This shouldn't even be an issue.
There are no guidelines from UNOS telling transplant centers whether to give organs to someone who attempted suicide.
Transplant protocol varies from hospital to hospital.
If Tyler had gone to Atlanta General, they would have approved the transplant surgery with virtually no questions asked, but Chastain doesn't work that way.
So what do we do now? Behave as if nothing happened.
Where's the board? I requested a meeting.
Your request was denied.
Well, you can't do that.
It's in the hospital charter.
The chief of surgery may request You've been stripped of that title, Dr.
Bell.
What'd you say? Dr.
Cain is Chastain's new chief of surgery.
All future requests will go through him.
Randolph, I heard.
Are you all right? Tending to my first love.
Putting my affections where they stand a chance of being returned.
Will you leave Chastain? I won't give 'em the satisfaction.
And if they fire me, they will owe me a substantial sum.
But they will fire me.
You know how the pressure drops before a storm, and you're not aware of it in any conscious way, but you know something is changing? I finalized your paperwork last night.
You have a five-year contract, ironclad.
I don't know what to say.
Just be what you are, a great surgeon.
All right, everybody, can I have your attention, please? Let's welcome our new chief resident, Dr.
Conrad Hawkins.
Speech! Oh, yeah.
If Devon wants a speech, he's gonna get a speech.
Keys to the palace.
Got your own office, a call room with a shower.
- Ooh.
- She's all yours.
Thank you, thank you.
We'll see if you're all still clapping for me when I'm busting your asses first thing in the morning.
- Did you meet your interns yet? - No.
I don't know anything about 'em.
- Nice coat, Hawkins.
- Thank you.
Not that it matters much.
I was never chief resident.
Look at me now.
So, I hear your office has a brand-new 72-inch flat-screen and an Xbox.
You got time for Call of Duty? - Oh, yeah, let's make it happen.
- All right.
- Just the man I was looking for! - Aah! I can use the new shower, right? Anytime, anytime.
Hey, how about me? Ah, not a chance.
What, the free fried egg sandwiches - weren't enough for you? - Mm This is impressive.
I've never had my name on a door.
Let me try.
Maybe they haven't programmed it yet.
Dr.
Hawkins.
Uh, I'll-I'll take that.
Thank you.
You lied to the, the transplant board.
We don't give organs to patients who are suicidal.
Wait, Tyler's not suicidal.
It was a stupid mistake.
Am I talking to you? You're fired.
Ah, that rule's arbitrary and you know it.
You don't care about Tyler Warzel, you care that I'm a whistleblower.
That's what this is about.
Huh? I blew the whistle on a bad drug, and you're afraid for your bottom line.
You're afraid of me.
And you should be.
Security will escort you out.
Give me your pager.
Thank you.
- What's going on? - They're firing Conrad.
- You can't do this.
- Whoa, whoa.
- Get your hands off me.
- Hey, hey, hey, hey! It's okay, it's okay.
Then I'll quit, too.
No, you'll stay here.
I'll see you tonight.