The Resident (2018) s05e09 Episode Script
He'd Really Like to Put in a Central Line
1
Previously on The Resident
Hope it's okay that I'm here.
- HANNAH: How dare you? - What happened here? CONRAD: If you stepped out of line, then it won't just be Pravesh who comes for you.
Surgery is a dangerous place.
Especially considering your condition.
You mean my dyslexia? CONRAD: Tell me why you aren't a scientist yet.
This is obviously your future.
You just got to go for it.
I would like to start shifting my professional focus to clinical trials.
Have a proposal on my desk by Monday.
("THE WEIGHT" BY THE BAND PLAYING) (PHONE CHIMING) (EXHALES) I pulled into Nazareth No eggs, Daddy, please, no eggs.
I want cereal.
And a banana.
Whoa, whoa, excuse me.
Coming right up.
(PAGER BEEPING) Hey, mister, can you tell me Where a man might find a bed? He just grinned and shook my hand Daddy, did you forget to go to the market again? Take a load off I did.
I am a bad daddy.
No, you're not.
Take a load off, Fanny Let's grab your backpack.
We'll get something great for you takeout on the way to school.
You put the load right on me Ooh-ooh-ooh-ooh I picked up my bag I went looking for a place to hide - (SIGHS) - When I saw Carmen And the devil walking side by side That's another all-nighter.
This has got to stop.
- I know.
- You're wearing yourself out.
I know.
But I don't know how to stop.
I got to go, but my friend can stick around (GRUNTS) Take a load off, Fanny Take a load for free - Take a load off, Fanny - And, and And you put the load right on me You put the load right on me (PHONE CHIMES) - Crazy Chester followed me - And he caught me in the fog (PHONE CHIMES) He said, "I will fix your rack - If you'll take Jack my dog" - I said, "Wait a minute, Chester - You know I'm a peaceful man" - He said, "That's okay, boy (PHONE CHIMES) Won't you feed him when you can?" - Yeah, take a load off, Fanny - Take a load for free Take a load off, Fanny And, and And you put the load right on me Put the load right on me (BIRDS CHIRPING) JANICE: Dude, I lanced this massive abscess, and the pus exploded all over Dr.
Feldman.
- Ah.
- He was pissed.
- Pus-wise, better him than you.
- Definitely.
Trevor, we know you made the highlight reel.
TREVOR: Yeah, yeah.
No eruptions of bodily fluids, though.
You had that awesome spinal tap.
- Hello.
Beer-gate? Legendary.
- (LAUGHTER) Okay, Pravesh almost cut me, so Sure, but then Hawkins swooped in and took you under his wing.
Please, golden boy.
- "Golden boy".
- I don't think anyone has any strong feelings about me either way.
All right, well, I'd really like to put in a central line.
Hey.
Five-car pileup on Peachtree, multiple injuries headed our way.
All hands on deck.
It's game time.
Dr.
Hawkins, Bay 2.
- On it.
- All right, let's get him to Bay 4.
- Zach, with me.
- Gemma, Bay 9.
Pravesh, Bay 10.
We're gonna need - another set of hands in there.
- Okay, Janice, Trevor, you come with me.
Pravesh! - Give me Trevor.
- Go see what he needs.
CONRAD: Grab the ultrasound.
Right.
Assess her for internal injuries, then we'll deal with the lower-extremity lacerations.
Got it.
Whoa.
- Ma'am, what's wrong? - It's not my stomach.
I'm okay.
But he's not.
I watched him turn his bike and drive right into traffic.
He caused all of this.
There's something definitely wrong with him.
CONRAD: Hey, Zach.
I need you to do a quick FAST exam and suture up some lacs.
Trevor, come with me.
The X-rays showed a fractured rib but fortunately no broken ankle.
You're gonna be fine.
- You're in good hands here.
- Thank you.
You're welcome.
I-I really don't know what happened.
One minute I'm riding my bike, next I'm on the ground and cars are skidding and crashing.
I feel terrible.
Sounds like you might have passed out? You got lucky.
You could've been killed.
Getting lucky is kind of my thing.
Yeah? How's that? I was on a charter boat once, it sunk.
Everyone drowned except me.
- I won the lottery twice.
- TREVOR: Cool.
Maybe you take a look at the numbers I've been playing.
Happy to, Doc.
(CHUCKLES) Wow, you got the odds of the gods on your side.
I have always felt protected in an otherworldly way.
A-And those are just the highlights.
I also got diagnosed with this thing, sarcoid? - Mm-hmm.
- Supposed to be bad, but it's never been a problem.
TREVOR: Sarcoid? What medications are you taking for that? None.
I'm not one to take meds I don't need.
Too many side effects.
- Whoa, whoa.
- Oh, Wyatt.
Wyatt? We need to get him on the monitor now.
- Hey.
- Hey.
Sorry you had to come in on your day off.
It's killing me.
I've got to get my grant proposal done.
- How are you? - Surgery went long.
Don't ask.
Man, it's crazy in here today.
I know.
Hi, Brit.
- (PAGER BEEPING) - This is Dr.
Devi.
She's the surgical consultant I told you about.
Uh, I'm so sorry.
Hi, Brit.
I probably shouldn't have come.
I've had this pain on and off for months.
But I realized I'd lost ten pounds.
Without trying, really, so I'm a little spooked.
I'm probably overreacting, right? LEELA: Let's just start with an exam.
Ow! Right there.
Can you describe your pain for me? Throbbing.
Or maybe stabbing.
Are you having any nausea or vomiting? I thought I was just nervous at first, you know, existential angst, which I am prone to, and it is kind of my occupational wheelhouse.
I'm a cartoonist.
Life's a Joke.
- That's my strip.
- Hmm.
So, yes to the nausea and vomiting? Oh, right, yes.
Krakatoa, east of Java, man.
Just keeps on coming up.
We'll start with a CT scan to take a closer look, and we can admit you to get control over your pain and we'll go from there.
- Okay? - Cool.
DEVON: All right, we'll be back.
It's a large hepatic hemangioma.
That's a good catch, Dr.
Devi.
LEELA: I haven't seen one of these before.
Well, they're more common than you'd think.
They're benign tumors made up of clusters of blood-filled cavities.
And usually they don't cause symptoms.
Well, I'm relieved it's benign.
My patient will be, too.
She's a little kooky.
Sweet, though.
Should I book an OR for us this afternoon? Oh, not so fast.
Surgery's not a slam dunk here.
A benign tumor causing pain? Well, surgery on the liver is always high-risk, even in the best hands, and pain can be managed.
Okay, so I tell her we're not operating, and I need a repeat scan in two months.
And that's not the answer, either.
This is not something we can decide here.
You need to talk to your patient and get a sense of her risk tolerance and the seriousness of her symptoms, and then you tell me what path you think makes sense.
All right.
Can you come with? Nope.
She's your patient, you handle it.
Then meet me in OR 3 an, uh, emergent splenectomy.
Uh, 15 minutes.
LEELA: So, you have two options.
If you go with the surgery and it goes well, - your symptoms go away.
- Awesome.
But surgery on the liver is never an easy call to make.
It's an organ with many large blood vessels, which means we could run into significant bleeding.
Oh.
Not awesome.
And that circumstance would require a much larger abdominal surgery with complications and a long recovery.
Are you with me? Uh, sort of.
Uh, you understand, right? I'm not a doctor.
I'm a cartoonist.
Right.
Um Do you take risks? If you do, then we go with the surgery.
Are you cautious? Then we hold off for now, so long as your pain is tolerable.
(SIGHS) I don't know, Dr.
Devi.
Okay, you know what? Look.
It's okay.
Big decision.
Think about it, and I will check in as soon as I'm back from surgery, okay? Okay.
Heart block.
What is that? Because of the sarcoid, your heart's electric circuit isn't working correctly, so your heartbeat slows to a dangerously low rate.
In some cases, it can stop completely.
Which, to state the obvious, is fatal.
This morning, your heartbeat slowed so much that you fainted and you crashed your bike.
AUSTIN: But there is some good news.
Told you guys.
The solution to your problem is safe and simple.
We put in a pacemaker, and your heart goes back to beating normally again.
So you're saying I need a surgery? Yeah, and it's just an outpatient procedure.
No general anesthesia, no operating room.
It's super simple.
TREVOR: Another narrow escape from death.
The Wyatt Barnes legend grows.
- Hey.
- (LAUGHTER) I'd like to admit you for observation, and then we'll schedule the procedure as soon as possible.
Oh, I don't want the pacemaker.
A-Admit me, fine, but, you know, finish fixing me up and (TONGUE CLICKS) send me home.
No, you don't understand.
If we don't put the pacemaker in, you will almost certainly die.
Almost? I'll take those odds.
AUSTIN: We are doctors, advising you on a procedure that will save your life.
Sorry, but it's my body, my decision.
No pacemaker.
No, thanks.
- Hey, we need a cart over here! - Now that you're spending more time on research and clinical trials, we need a new ER doctor.
And I'd like you to do the interviews today.
I would, of course, but I'm only filling in for a few hours today.
And I didn't set aside time for that.
There must be someone else who can help.
There's no one.
And I worked here all night.
I'm sorry.
Here are the candidates.
Dr.
Voss, I have to get my grant proposal in by 6:00 p.
m.
Your proposal will have to wait.
And I don't need to remind you why we're short-staffed in the ER.
Yeah.
I get it.
- (PAGER BEEPING) - Thank you.
I'm counting on you.
Happy to help.
(PHONE CHIMING AND BUZZING) So, our Mr.
Lucky has complete AV block with wide ventricular escape.
He's not gonna live long enough to cash in his third lotto ticket without a pacemaker.
(SIGHS) I mean, you think he wants to die? (PHONE RINGING) Yeah, the guy's super cheerful.
It's bizarre.
Mom, listen, I'm in the middle of Well, is-is the cough getting any better? Did you call the oncologist? Mom, just do it now, please.
Yes, I will see you before I go to the airport.
Tell Carol I'll call her, talk her through some options for her respiratory symptoms.
Appreciate it, man.
Look, I-I wish I could engage.
All right? I-If there were 28 hours in the day, I would gladly wax poetic with the patient about the benefits of a pacemaker, but I do not have the time.
I have way too many patients who would kill for an easy cure.
I got too many, too many obligations.
All right, you get him to see reason, I have no doubt that you will, then I will come back, I'll put in the pacer.
(EXHALES) Okay.
Have you, uh you seen this problem before? All the time during the pandemic.
We had a lot of patients who died claiming COVID was made up.
Well, what do we do next? He agreed to a brief admission, so we bring him up to the ICU, start him on isoproterenol to raise his heart rate while I figure out a way to respectfully get him to see reason.
I will watch and learn.
Hey, Brit, have you had some time to review your options? She was here a minute ago.
She should be back soon.
And if you had to change one thing about emergency medicine, what would it be? Well, we're letting money walk out the door.
That's for sure.
Uh, I personally would deploy a-a number of strategies that would be more lucrative for the hospital.
Uh, I mean, you can't fix all the inefficiencies at once, you know? You got to let this, uh, this pig work its way through the-the boa constrictor, so to speak.
So, I created some slides here, uh, with ideas for how to capitalize on low-hanging fruit.
I'll talk you through it.
Uh, shouldn't be more than, uh, an hour.
Or two.
Brit? I've been looking everywhere for you.
Has your abdominal pain gotten worse? You shouldn't be out here.
We should get you back inside.
It's not that, Dr.
Devi.
I had to get some air so I could think.
Okay.
I can't decide about the surgery.
I tell myself, "Go for it".
Then I think it's too dangerous.
What if I bleed to death in the OR and my cat dies alone? Or I go home and die and no one finds me and Tinkerbell eats me.
- You have to take it easy, Brit.
- Sometimes I wake up and she's staring at me like I'm a goldfish.
There's a darkness in her.
I'm indecisive.
Even about things that don't matter.
My cartoons poke fun at people like me.
Brit.
What can I do to help you make this decision? Make it for me? Just be my doctor.
I'll do whatever you say.
(MONITOR BEEPING STEADILY) How am I doing? CONRAD: Your heart rate is dangerously slow.
Meds helped transiently, but they can't fix this, and it's getting worse.
I feel fine.
That's impossible, okay? You have to be tired, light-headed Not really.
I'm hungry.
This place have ice cream? Yes (CHUCKLES) but let's finish talking first.
A pacemaker is a simple device.
It is not dangerous to put in, and it will keep you from falling off your bike in the middle of traffic.
Or dying today.
Which could happen.
It's not gonna happen.
- What are you afraid of, Wyatt? - (SCOFFS) I'm not afraid.
I just don't like the idea of having a foreign object put into my body.
Do you know anyone with type 1 diabetes? Yeah.
My old boss.
Did your boss use an insulin pump? She does, but what you're talking about is putting something in to control my heart.
That's different.
No.
Not really.
Uh, complications from pacemakers are rare.
WYATT: I'm sorry, but I do my own research.
I'm part of this Facebook group.
- Oh, here we go.
- And they just published a list of unsafe products from China.
Know what's on top? Pacemakers.
Now, they're assembled here, but guess where the parts come from.
Yep.
Guy in the group got poisoned by some bad metals.
Those posts aren't truthful, Wyatt.
They are propaganda from unqualified people who have politicized health and medicine.
They either want to sow distrust in science or sell you snake oil.
TREVOR: The real truth, Wyatt? Bad metal is not a thing.
Dr.
Hawkins is who you want giving you advice.
He's an actual expert.
I form my own opinions, okay? - You have yours.
- Okay, this isn't an opinion.
It's fact versus fiction.
- Do you understand? - CONRAD: All right.
We hear you, Wyatt.
Okay? Be back to check on you in a bit.
Thanks, Doc.
He was getting more and more dug in.
- You have to know how to take a step back.
- Okay, but if Wyatt dies, it won't be sarcoid that kills him, it'll be i-irrational fear and misinformation.
And those are difficult conditions to cure.
- I - Some people only accept information that confirms their beliefs.
You have to give them the facts, tell them how important the science is, - but then if you push too hard - I get that, but if we lose what little trust we may have earned.
Even when you're 1,000% right.
- Uh He's gonna - Gentlemen.
So I don't see your patient on my cath lab schedule.
- What happened? No pacemaker? - Uh, not yet.
We were just getting ready to discuss next steps.
The guy actually believes in luck.
As in, he's too lucky to die.
He did tell us he's always felt protected in an "otherworldly" way.
An argument could be made that he doesn't have the capacity to make medical decisions for himself.
Well, if he's making his decision based on otherworldly information, you may be right.
I'll call Dr.
Malco in the psych department.
Let's hope this works.
Wyatt's running out of time.
Wyatt, why don't you tell me in your own words what's going on with your health right now? It's pretty simple.
I've never liked hospitals, but I came here because of a bike accident.
They escalated the whole thing by threatening to put in a pacemaker.
Do you know how many people get a pacemaker? They're slapping them into everybody these days.
Why don't you trust your doctors? I make up my own mind.
And, look, I'm not crazy.
You know, agreeing to have doctors I just met implant something into my body is what's crazy.
We just need to make sure that you understand the consequences of the decision you're making here.
I've been listening to those two all day.
Of course I understand.
And there's something you need to understand about me.
And what is that? You're not gonna change my mind.
And if I do die, I don't want anyone going wild and pounding on my chest, okay? Write that down in your little notepad.
We all have to die someday.
And I am not going out like that.
- Dr.
Bell? - Yeah.
- Do you have a second? - Mm-hmm.
(EXHALES) Please tell me this gets easier.
Is this about making a life-or-death decision - for a person you just met? - Yes.
It should never be easy.
This is the job.
It's not irrational for a patient to think we know more and should decide for them.
What if I can't figure out what's the best way to go? You will, because you have to.
That's what your patient needs.
So go with your gut, Dr.
Devi, informed by your experience and your schooling.
- Okay? - Okay.
PADMA: Dr.
Voss.
Tell me what you need.
I'm here to help.
Well, I'm realizing that all our doctors are in danger of burnout.
The stress at times can be unrelenting.
Maybe your program can help.
I would love that.
I offer yoga sessions, meditation, sleep counseling and positive affirmations.
Plus, fresh-baked resiliency cookies.
Gluten-free.
I think I could make everybody ten percent happier, at least.
I would invest in ten percent happier.
When can you start? Shall we start now? (LAUGHS): Yes.
Sign me up.
- Come sit down.
- Oh.
Just five minutes.
- Lie down, put your feet up.
- Oh, wait, I can't.
I'd be (LAUGHING): All right.
Okay.
(CLEARS THROAT) Close your eyes.
And now just take a deep, cleansing breath.
(PAGER BEEPING) Ooh, sorry.
- Later.
I promise.
- Okay.
(LAUGHS SOFTLY) (SPEAKING SPANISH) - Do you speak Spanish? - (CHUCKLES) No.
I don't think there's room in my head for any more words I'm supposed to understand.
Do you mind turning it down? I promise to keep this simple.
(TV TURNS OFF) Based on the size of your hemangioma and your symptoms, if it were me, I would go with the surgery.
(EXHALES) Surgery it is.
When? Well, we can operate later today.
But I would like to take you through the consent.
There are risks.
Bleeding, infection, damage to your liver.
It's possible but unlikely that we'll have trouble getting you off the ventilator.
And as with any surgery, there is a risk of death.
Have you done this operation often? Uh, no, I haven't, but the senior surgeon I work with has, and he'll be there.
(EXHALES) Pen.
All right.
BRIT: Thank you.
(PEN SCRATCHING) He's clear and consistent.
I don't find him to be influenced by untreated depression, and he's not suicidal.
His choice isn't one that I would make for myself or someone I love, but it's one he has a right to make.
What do you make of his belief that he's cosmically protected? Hearing celestial voices is one thing, but it's human nature to search for explanations for our experiences.
Just describing them in ways that are fantastical doesn't signify a lack of capacity.
Um, I'm sorry, it makes no sense.
I mean, look how young he is, and he even requested a DNR? Which is a sign that he's-he's clear and coherent.
Look, lack of capacity is a high bar, and Wyatt doesn't reach it.
I'm sorry.
- You have to respect his wishes.
- All right, thank you, Leslie.
Uh Is that really it? If he's determined to have capacity, we can't force him to be treated.
Wait, hold on, I thought you were the renegade.
I heard you drilled into a guy's head and you're not even a surgeon.
But you're gonna sit here and let this man die? If the guy would've said, "Whatever you do, don't drill into my head", I wouldn't have.
It's pretty simple.
You can't do what the patient doesn't want.
Okay, this is what we're gonna do.
I did a deep dive into temporary pacers.
Wyatt passes out, we get the pads on him, shock him if we need to, slip it in - at his bedside.
- Hey.
(WYATT SHOUTING) CONRAD: Let's get him some O2.
I'm nauseous.
My stomach hurts.
What's going on? Gut ischemia from poor perfusion.
Your heart rate's too low.
Let's get him some pain meds.
Page Bell.
- Okay.
- (PANTING) (CRYING SOFTLY) BELL: Okay.
Yeah, he's-he's calmer now with the pain meds on board.
It's highly likely he has dying bowel, but he's not a viable candidate for surgery.
Unless we get him to agree to a pacer.
And, yeah, if you do, tell me, and I'll take him to the OR.
As of now, all the complications from his untreated heart condition are fixable, - but I don't know for how long.
- (PAGER BEEPING) He's refusing all intervention.
Is there anything else I can do for you? I wish there were.
Okay, just just hear me out.
All right, you know the Dax Cowart case, right? He wanted to die after suffering catastrophic burns.
He was in pain, terribly disfigured, went blind.
And he was ruled to have capacity, too, but his doctors disregarded his wishes and saved his life.
Mm-hmm.
Yeah, he had a career, he had a family, I mean, he lived until he was 71.
Wyatt can have the same thing.
Dax Cowart became a lawyer and built a career on fighting for patients' rights.
He used his own case to show what the doctors did, what you want to do to Wyatt, was a betrayal of those rights.
It's not a betrayal of his rights.
Hey, I'm as frustrated as you are.
As doctors, our purpose is to help.
And you got that part right.
But Wyatt needs to want to be helped.
No, until he's dead, I'm not giving up.
Then neither am I.
(WASHING HANDS) (DOOR OPENS) BELL: Sorry I'm late.
Had a rough consult with Conrad's patient.
The exact opposite of Brit.
He doesn't trust Conrad, for all the wrong reasons.
And here I am tied up in knots over a patient who trusts me too much.
You made the best decision you could with the information you have.
(WATER RUNNING) You have a very unusual career path.
What brought you from oncology to emergency medicine? So much suffering and death.
The patients call you weeping at all hours of the day and night.
I-I was worn out from the stress.
Those days ruined me.
And now? Just off a shift, look at me I'm still fresh.
Well, it must have been a challenge to go back to residency and learn all the ER procedures.
Hmm, I'm not one for new techniques.
I pretty much slept through that residency.
- It was no big deal.
- I see.
(MONITOR BEEPING STEADILY) WYATT: I told you, Doc.
If God wants me to live, I'll live.
He'll reach His hand down to me.
He's always been so good to me.
TREVOR: Is this about luck now, Wyatt? Or God? He can't save you right now.
We can.
Leave me alone, Doc.
No.
Wyatt - Trevor.
- You just, you got to listen to what I'm Trevor.
Trevor, take a walk now.
He's young.
But he cares deeply.
And I respect your faith in God's will.
I'm in His hands now.
And you always have been, right? How do you know He is not using us to save you? You think he wasn't sitting beside Rune Elmqvist in Sweden half a century ago when he invented the pacemaker? He is sending you one lifeline after another.
Hey.
I'll ask Him.
Wyatt? Wyatt.
(LAUGHS) (RAGGED BREATHING) BELL: Yeah, the liver is exposed.
LEELA: Ready to begin the enucleation.
BELL: Remember, the beauty of this technique is that we, we work along existing planes to pop the mass out and we leave the liver intact.
That's how we avoid massive bleeding.
And note the vessels extending into the liver.
Divide and ligate.
Be careful.
LEELA: Ugh, I have a tiny bleeder.
Cautery.
And another one.
Okay, suction.
Okay, that's arterial.
Clamp.
JESSICA: Dr.
Bell? Here's the clamp.
LEELA: Are you okay? BELL: Uh, no.
LEELA: Jessica, I'll take it.
BELL: Uh, Dr.
Devi, I have to leave.
LEELA: What? BELL: I-I'll find someone to cover as soon as possible.
Uh, as soon as possible.
LEELA: Dr.
Bell.
JESSICA: You can do this.
LEELA: I've got the mass on the last vascular pedicle.
Any word from Bell? JESSICA: Nothing yet.
You'll probably get this sucker out of here before anyone comes.
(MONITOR BEEPING RAPIDLY) CHU: Pressure's drifting down, Dr.
Devi.
LEELA: She's losing blood.
Let's get some blood products in her.
JESSICA: Tell me what you need.
Lap pads and suction.
I'm operating underwater here.
If I can't find the source for the bleeding, I can't fix it.
CHU: Two units are in, and I activated massive transfusion protocol.
We're maxed on norepi.
LEELA: Found it.
CHU: You've got to get control.
She won't tolerate this blood loss much longer.
LEELA: I need to remove the portion of the liver the vessel is feeding.
Prepare for a hepatectomy.
JESSICA: That's a serious change in plans.
We should call Dr.
Bell first.
LEELA: No time.
Clamp, now.
Chu, give her 1:1:1 resuscitation to keep up.
- Jessica, do not stop that suction.
- JESSICA: Got it.
LEELA: Got it.
CHU: We've got a stable pressure.
- (CHUCKLES) - CHU: Strong work, Dr.
Devi.
(LEELA SIGHS) JESSICA: You did it.
- (CHUCKLES) - LEELA: Let's get her closed up and off this table.
What do you think the evidence is behind cookies for stress relief? - NOLAN: Anecdotal but robust.
- I'm really feeling - the chocolate chip.
- HUNDLEY: Dr.
Austin? Of all people.
Do raptors do yoga? I'm only here because my CEO told me I had to be here.
But I won't be here for long.
I have to round on the post-ops again before I fly to Manhattan tonight - for talk shows tomorrow.
- DEVON: Well, I'm stiff, my back is in knots.
I've been in interviews all day, looking for an actual doctor who likes actual doctoring.
PADMA: Welcome, health care heroes.
Uh, listen, I am not a man that you will find in Child's Pose.
So I'm just gonna be on my way to AJ, I happen to know from personal experience that you could really benefit from a little extra flexibility.
- (LAUGHTER) - All right, come lie down and grab a mat.
- Close your eyes.
- (GRUNTING) Let the world fade away and just relax.
- (PAGER BEEPS) - It's the ER.
(PAGERS BEEPING) Oh, that's my next interview.
Med-surg floor.
My mother's having another complication.
- (BEEPING STOPS) - I mean, I feel so blissed out right now.
I feel like I'm back to zero.
I feel great.
You know, after this is all done, I think that you and I should go to this great little vegan place that I know about in Inman Park.
It-It's wonderful.
It's the best tempeh à la King you will ever have.
You're cute.
Not a chance.
(SIGHS) - That's a, that's a no, then? - (PAGER BEEPS) Okay, Wyatt Barnes' heart rate is in the 20s.
He has gut ischemia, his kidneys are failing.
Without a pacer, he's dying.
We're running out of time, and he's waiting for the hand of God to reach down - and-and save him from - First of all, back up.
You're in my personal space.
And you have intern coffee breath, which I do not like.
Okay, look, look, look, with all due respect, Dr.
Hawkins seems to have lost his edge, it's gonna cost a young dude his life.
Can you please just put in a pacer, please? - I have one right here, come on.
- Put that away.
You are a green recruit questioning the general on the field.
W-Wait, hold up.
If someone came into this hospital after slitting their wrists or-or taking pills, we'd save them, right? Wyatt Barnes is doing the same thing.
This is not a suicide.
This is a man with capacity refusing intervention.
That's a right we cannot abridge.
His recalcitrance is not jeopardizing anyone else's health.
- He's only hurting himself.
- Okay, but he is hurting himself Trevor, stop.
Now you go back to your patient's room.
You watch Dr.
Hawkins and you do what he says.
Stop second-guessing him.
You might learn something.
(MONITOR BEEPING STEADILY) Please let me save you, Wyatt.
I have everything we need.
You just say the word.
Think of all the beautiful things you'll never be able to experience again.
I don't know what happens when you die, but I bet you don't get to kiss a woman and know you want to be with her for the rest of your life.
Don't you want to wake up on the first day of fall? Eat a peach? (LAUGHS) Laugh your ass off with your best friends? You don't have to give up any of that.
Think of how lucky that makes you.
(LAUGHS SOFTLY) Is he still saying no? (EXHALES) Do it.
Please.
What are we here for, anyway, huh? To watch people we could save just just die? I was here to save him.
Now we're just here to make sure he doesn't die alone.
(SNIFFLES) (FLATLINING) He's your first death.
Yeah.
Not how I imagined it would go down.
You pictured a different kind of heroism, blood spattered all over your white coat.
(EXHALES) Do you ever get used to it? It never gets easier.
It just It just gets different.
But today was no small accomplishment.
Dr.
Daniels.
We allowed him to live and die according to his principles, and because of that, we managed to keep ours.
Look, again, I'm-I'm sorry about what happened in there.
Well, I'm relieved you're okay.
No, I-I'll be fine, it's just It's a pinched nerve and little bit of vertigo that came on suddenly.
I think, you know, I-I overreacted, but in the moment, I-I thought if I stayed in the OR, you'd have two patients to deal with, so Well, then, you did the right thing.
So did you.
This time.
But, to be honest, it could have gone either way.
- Hi.
- So? Did you find anything else horrible inside me? I'm vaguely optimistic because I have a familiar sense of existential dread, and I'm pretty sure that can't be removed surgically.
The surgery went great.
You're going to be fine.
Thanks to Dr.
Devi.
There was a complication during surgery.
We had to remove a small piece of your liver.
But it will grow back.
And the hemangioma is gone for good.
Thank you.
I mean, really, thank you.
And you made the right decision for me, too.
Can I call you next time I'm buying a new car? - (LAUGHS) - Or don't know what to do when I get in a fight with my mom? I actually am a triple board-certified mother vanquisher.
(CHUCKLES) DEVON: So it's a no.
Even the former oncologist? He's burnt out.
He's not interested in learning anything new.
H-He doesn't love medicine.
None of them do.
Keep looking.
It's just the first round.
No need to be discouraged.
And the thing is, Dr.
Voss, when I was talking to them, I realized I might not be so different.
Of course you are, Dr.
Pravesh.
I am judging people for not loving medicine enough while trying to cut down on clinical time to go do research.
I think about being in the ER year after year after year, with no outlet for research, and I don't know how we don't drown in the sickness, the sadness, the pressure, the paperwork.
(EXHALES) Half of my med school class isn't doing medicine anymore.
That means something.
Yes, I think it does.
BELL: Hey.
Hell of a day.
Yeah, I heard.
So, how tempted were you to put in the pacer - against the patient's wishes? - More than I'd like to admit.
But there are some rules we can't break.
Do I know I made the right choice? Yeah.
Do I wish I'd made the wrong one? Maybe.
I know my intern thinks so.
I heard Dr.
Daniels has a hard time with the rules.
But maybe the example you set saved his medical career.
To say nothing of your responsibility to your patient.
Yeah, he's a bright kid, that Trevor, but too much confidence and passion, not nearly enough restraint.
He learned something today.
If I'd have saved Wyatt, would he have come back in ten years with an armload of kids, grateful that we didn't listen to him? (EXHALES) And now I realize none of this is why you are here.
Nope.
I got a favor to ask you.
What? But, look, before I even-even spell it out, can I count on you for full confidentiality? Go on.
Something's wrong with me, a-and I'm not quite sure what.
But I think it may be serious.
You want me to examine you? Yeah, I'll clear my schedule tomorrow.
Let's come in early.
And the fact that I'm being tested at all, the results, all under the radar.
So, is that something you can do? (SIGHS) Okay.
Great, thanks.
(DOOR SLIDES OPEN)
- HANNAH: How dare you? - What happened here? CONRAD: If you stepped out of line, then it won't just be Pravesh who comes for you.
Surgery is a dangerous place.
Especially considering your condition.
You mean my dyslexia? CONRAD: Tell me why you aren't a scientist yet.
This is obviously your future.
You just got to go for it.
I would like to start shifting my professional focus to clinical trials.
Have a proposal on my desk by Monday.
("THE WEIGHT" BY THE BAND PLAYING) (PHONE CHIMING) (EXHALES) I pulled into Nazareth No eggs, Daddy, please, no eggs.
I want cereal.
And a banana.
Whoa, whoa, excuse me.
Coming right up.
(PAGER BEEPING) Hey, mister, can you tell me Where a man might find a bed? He just grinned and shook my hand Daddy, did you forget to go to the market again? Take a load off I did.
I am a bad daddy.
No, you're not.
Take a load off, Fanny Let's grab your backpack.
We'll get something great for you takeout on the way to school.
You put the load right on me Ooh-ooh-ooh-ooh I picked up my bag I went looking for a place to hide - (SIGHS) - When I saw Carmen And the devil walking side by side That's another all-nighter.
This has got to stop.
- I know.
- You're wearing yourself out.
I know.
But I don't know how to stop.
I got to go, but my friend can stick around (GRUNTS) Take a load off, Fanny Take a load for free - Take a load off, Fanny - And, and And you put the load right on me You put the load right on me (PHONE CHIMES) - Crazy Chester followed me - And he caught me in the fog (PHONE CHIMES) He said, "I will fix your rack - If you'll take Jack my dog" - I said, "Wait a minute, Chester - You know I'm a peaceful man" - He said, "That's okay, boy (PHONE CHIMES) Won't you feed him when you can?" - Yeah, take a load off, Fanny - Take a load for free Take a load off, Fanny And, and And you put the load right on me Put the load right on me (BIRDS CHIRPING) JANICE: Dude, I lanced this massive abscess, and the pus exploded all over Dr.
Feldman.
- Ah.
- He was pissed.
- Pus-wise, better him than you.
- Definitely.
Trevor, we know you made the highlight reel.
TREVOR: Yeah, yeah.
No eruptions of bodily fluids, though.
You had that awesome spinal tap.
- Hello.
Beer-gate? Legendary.
- (LAUGHTER) Okay, Pravesh almost cut me, so Sure, but then Hawkins swooped in and took you under his wing.
Please, golden boy.
- "Golden boy".
- I don't think anyone has any strong feelings about me either way.
All right, well, I'd really like to put in a central line.
Hey.
Five-car pileup on Peachtree, multiple injuries headed our way.
All hands on deck.
It's game time.
Dr.
Hawkins, Bay 2.
- On it.
- All right, let's get him to Bay 4.
- Zach, with me.
- Gemma, Bay 9.
Pravesh, Bay 10.
We're gonna need - another set of hands in there.
- Okay, Janice, Trevor, you come with me.
Pravesh! - Give me Trevor.
- Go see what he needs.
CONRAD: Grab the ultrasound.
Right.
Assess her for internal injuries, then we'll deal with the lower-extremity lacerations.
Got it.
Whoa.
- Ma'am, what's wrong? - It's not my stomach.
I'm okay.
But he's not.
I watched him turn his bike and drive right into traffic.
He caused all of this.
There's something definitely wrong with him.
CONRAD: Hey, Zach.
I need you to do a quick FAST exam and suture up some lacs.
Trevor, come with me.
The X-rays showed a fractured rib but fortunately no broken ankle.
You're gonna be fine.
- You're in good hands here.
- Thank you.
You're welcome.
I-I really don't know what happened.
One minute I'm riding my bike, next I'm on the ground and cars are skidding and crashing.
I feel terrible.
Sounds like you might have passed out? You got lucky.
You could've been killed.
Getting lucky is kind of my thing.
Yeah? How's that? I was on a charter boat once, it sunk.
Everyone drowned except me.
- I won the lottery twice.
- TREVOR: Cool.
Maybe you take a look at the numbers I've been playing.
Happy to, Doc.
(CHUCKLES) Wow, you got the odds of the gods on your side.
I have always felt protected in an otherworldly way.
A-And those are just the highlights.
I also got diagnosed with this thing, sarcoid? - Mm-hmm.
- Supposed to be bad, but it's never been a problem.
TREVOR: Sarcoid? What medications are you taking for that? None.
I'm not one to take meds I don't need.
Too many side effects.
- Whoa, whoa.
- Oh, Wyatt.
Wyatt? We need to get him on the monitor now.
- Hey.
- Hey.
Sorry you had to come in on your day off.
It's killing me.
I've got to get my grant proposal done.
- How are you? - Surgery went long.
Don't ask.
Man, it's crazy in here today.
I know.
Hi, Brit.
- (PAGER BEEPING) - This is Dr.
Devi.
She's the surgical consultant I told you about.
Uh, I'm so sorry.
Hi, Brit.
I probably shouldn't have come.
I've had this pain on and off for months.
But I realized I'd lost ten pounds.
Without trying, really, so I'm a little spooked.
I'm probably overreacting, right? LEELA: Let's just start with an exam.
Ow! Right there.
Can you describe your pain for me? Throbbing.
Or maybe stabbing.
Are you having any nausea or vomiting? I thought I was just nervous at first, you know, existential angst, which I am prone to, and it is kind of my occupational wheelhouse.
I'm a cartoonist.
Life's a Joke.
- That's my strip.
- Hmm.
So, yes to the nausea and vomiting? Oh, right, yes.
Krakatoa, east of Java, man.
Just keeps on coming up.
We'll start with a CT scan to take a closer look, and we can admit you to get control over your pain and we'll go from there.
- Okay? - Cool.
DEVON: All right, we'll be back.
It's a large hepatic hemangioma.
That's a good catch, Dr.
Devi.
LEELA: I haven't seen one of these before.
Well, they're more common than you'd think.
They're benign tumors made up of clusters of blood-filled cavities.
And usually they don't cause symptoms.
Well, I'm relieved it's benign.
My patient will be, too.
She's a little kooky.
Sweet, though.
Should I book an OR for us this afternoon? Oh, not so fast.
Surgery's not a slam dunk here.
A benign tumor causing pain? Well, surgery on the liver is always high-risk, even in the best hands, and pain can be managed.
Okay, so I tell her we're not operating, and I need a repeat scan in two months.
And that's not the answer, either.
This is not something we can decide here.
You need to talk to your patient and get a sense of her risk tolerance and the seriousness of her symptoms, and then you tell me what path you think makes sense.
All right.
Can you come with? Nope.
She's your patient, you handle it.
Then meet me in OR 3 an, uh, emergent splenectomy.
Uh, 15 minutes.
LEELA: So, you have two options.
If you go with the surgery and it goes well, - your symptoms go away.
- Awesome.
But surgery on the liver is never an easy call to make.
It's an organ with many large blood vessels, which means we could run into significant bleeding.
Oh.
Not awesome.
And that circumstance would require a much larger abdominal surgery with complications and a long recovery.
Are you with me? Uh, sort of.
Uh, you understand, right? I'm not a doctor.
I'm a cartoonist.
Right.
Um Do you take risks? If you do, then we go with the surgery.
Are you cautious? Then we hold off for now, so long as your pain is tolerable.
(SIGHS) I don't know, Dr.
Devi.
Okay, you know what? Look.
It's okay.
Big decision.
Think about it, and I will check in as soon as I'm back from surgery, okay? Okay.
Heart block.
What is that? Because of the sarcoid, your heart's electric circuit isn't working correctly, so your heartbeat slows to a dangerously low rate.
In some cases, it can stop completely.
Which, to state the obvious, is fatal.
This morning, your heartbeat slowed so much that you fainted and you crashed your bike.
AUSTIN: But there is some good news.
Told you guys.
The solution to your problem is safe and simple.
We put in a pacemaker, and your heart goes back to beating normally again.
So you're saying I need a surgery? Yeah, and it's just an outpatient procedure.
No general anesthesia, no operating room.
It's super simple.
TREVOR: Another narrow escape from death.
The Wyatt Barnes legend grows.
- Hey.
- (LAUGHTER) I'd like to admit you for observation, and then we'll schedule the procedure as soon as possible.
Oh, I don't want the pacemaker.
A-Admit me, fine, but, you know, finish fixing me up and (TONGUE CLICKS) send me home.
No, you don't understand.
If we don't put the pacemaker in, you will almost certainly die.
Almost? I'll take those odds.
AUSTIN: We are doctors, advising you on a procedure that will save your life.
Sorry, but it's my body, my decision.
No pacemaker.
No, thanks.
- Hey, we need a cart over here! - Now that you're spending more time on research and clinical trials, we need a new ER doctor.
And I'd like you to do the interviews today.
I would, of course, but I'm only filling in for a few hours today.
And I didn't set aside time for that.
There must be someone else who can help.
There's no one.
And I worked here all night.
I'm sorry.
Here are the candidates.
Dr.
Voss, I have to get my grant proposal in by 6:00 p.
m.
Your proposal will have to wait.
And I don't need to remind you why we're short-staffed in the ER.
Yeah.
I get it.
- (PAGER BEEPING) - Thank you.
I'm counting on you.
Happy to help.
(PHONE CHIMING AND BUZZING) So, our Mr.
Lucky has complete AV block with wide ventricular escape.
He's not gonna live long enough to cash in his third lotto ticket without a pacemaker.
(SIGHS) I mean, you think he wants to die? (PHONE RINGING) Yeah, the guy's super cheerful.
It's bizarre.
Mom, listen, I'm in the middle of Well, is-is the cough getting any better? Did you call the oncologist? Mom, just do it now, please.
Yes, I will see you before I go to the airport.
Tell Carol I'll call her, talk her through some options for her respiratory symptoms.
Appreciate it, man.
Look, I-I wish I could engage.
All right? I-If there were 28 hours in the day, I would gladly wax poetic with the patient about the benefits of a pacemaker, but I do not have the time.
I have way too many patients who would kill for an easy cure.
I got too many, too many obligations.
All right, you get him to see reason, I have no doubt that you will, then I will come back, I'll put in the pacer.
(EXHALES) Okay.
Have you, uh you seen this problem before? All the time during the pandemic.
We had a lot of patients who died claiming COVID was made up.
Well, what do we do next? He agreed to a brief admission, so we bring him up to the ICU, start him on isoproterenol to raise his heart rate while I figure out a way to respectfully get him to see reason.
I will watch and learn.
Hey, Brit, have you had some time to review your options? She was here a minute ago.
She should be back soon.
And if you had to change one thing about emergency medicine, what would it be? Well, we're letting money walk out the door.
That's for sure.
Uh, I personally would deploy a-a number of strategies that would be more lucrative for the hospital.
Uh, I mean, you can't fix all the inefficiencies at once, you know? You got to let this, uh, this pig work its way through the-the boa constrictor, so to speak.
So, I created some slides here, uh, with ideas for how to capitalize on low-hanging fruit.
I'll talk you through it.
Uh, shouldn't be more than, uh, an hour.
Or two.
Brit? I've been looking everywhere for you.
Has your abdominal pain gotten worse? You shouldn't be out here.
We should get you back inside.
It's not that, Dr.
Devi.
I had to get some air so I could think.
Okay.
I can't decide about the surgery.
I tell myself, "Go for it".
Then I think it's too dangerous.
What if I bleed to death in the OR and my cat dies alone? Or I go home and die and no one finds me and Tinkerbell eats me.
- You have to take it easy, Brit.
- Sometimes I wake up and she's staring at me like I'm a goldfish.
There's a darkness in her.
I'm indecisive.
Even about things that don't matter.
My cartoons poke fun at people like me.
Brit.
What can I do to help you make this decision? Make it for me? Just be my doctor.
I'll do whatever you say.
(MONITOR BEEPING STEADILY) How am I doing? CONRAD: Your heart rate is dangerously slow.
Meds helped transiently, but they can't fix this, and it's getting worse.
I feel fine.
That's impossible, okay? You have to be tired, light-headed Not really.
I'm hungry.
This place have ice cream? Yes (CHUCKLES) but let's finish talking first.
A pacemaker is a simple device.
It is not dangerous to put in, and it will keep you from falling off your bike in the middle of traffic.
Or dying today.
Which could happen.
It's not gonna happen.
- What are you afraid of, Wyatt? - (SCOFFS) I'm not afraid.
I just don't like the idea of having a foreign object put into my body.
Do you know anyone with type 1 diabetes? Yeah.
My old boss.
Did your boss use an insulin pump? She does, but what you're talking about is putting something in to control my heart.
That's different.
No.
Not really.
Uh, complications from pacemakers are rare.
WYATT: I'm sorry, but I do my own research.
I'm part of this Facebook group.
- Oh, here we go.
- And they just published a list of unsafe products from China.
Know what's on top? Pacemakers.
Now, they're assembled here, but guess where the parts come from.
Yep.
Guy in the group got poisoned by some bad metals.
Those posts aren't truthful, Wyatt.
They are propaganda from unqualified people who have politicized health and medicine.
They either want to sow distrust in science or sell you snake oil.
TREVOR: The real truth, Wyatt? Bad metal is not a thing.
Dr.
Hawkins is who you want giving you advice.
He's an actual expert.
I form my own opinions, okay? - You have yours.
- Okay, this isn't an opinion.
It's fact versus fiction.
- Do you understand? - CONRAD: All right.
We hear you, Wyatt.
Okay? Be back to check on you in a bit.
Thanks, Doc.
He was getting more and more dug in.
- You have to know how to take a step back.
- Okay, but if Wyatt dies, it won't be sarcoid that kills him, it'll be i-irrational fear and misinformation.
And those are difficult conditions to cure.
- I - Some people only accept information that confirms their beliefs.
You have to give them the facts, tell them how important the science is, - but then if you push too hard - I get that, but if we lose what little trust we may have earned.
Even when you're 1,000% right.
- Uh He's gonna - Gentlemen.
So I don't see your patient on my cath lab schedule.
- What happened? No pacemaker? - Uh, not yet.
We were just getting ready to discuss next steps.
The guy actually believes in luck.
As in, he's too lucky to die.
He did tell us he's always felt protected in an "otherworldly" way.
An argument could be made that he doesn't have the capacity to make medical decisions for himself.
Well, if he's making his decision based on otherworldly information, you may be right.
I'll call Dr.
Malco in the psych department.
Let's hope this works.
Wyatt's running out of time.
Wyatt, why don't you tell me in your own words what's going on with your health right now? It's pretty simple.
I've never liked hospitals, but I came here because of a bike accident.
They escalated the whole thing by threatening to put in a pacemaker.
Do you know how many people get a pacemaker? They're slapping them into everybody these days.
Why don't you trust your doctors? I make up my own mind.
And, look, I'm not crazy.
You know, agreeing to have doctors I just met implant something into my body is what's crazy.
We just need to make sure that you understand the consequences of the decision you're making here.
I've been listening to those two all day.
Of course I understand.
And there's something you need to understand about me.
And what is that? You're not gonna change my mind.
And if I do die, I don't want anyone going wild and pounding on my chest, okay? Write that down in your little notepad.
We all have to die someday.
And I am not going out like that.
- Dr.
Bell? - Yeah.
- Do you have a second? - Mm-hmm.
(EXHALES) Please tell me this gets easier.
Is this about making a life-or-death decision - for a person you just met? - Yes.
It should never be easy.
This is the job.
It's not irrational for a patient to think we know more and should decide for them.
What if I can't figure out what's the best way to go? You will, because you have to.
That's what your patient needs.
So go with your gut, Dr.
Devi, informed by your experience and your schooling.
- Okay? - Okay.
PADMA: Dr.
Voss.
Tell me what you need.
I'm here to help.
Well, I'm realizing that all our doctors are in danger of burnout.
The stress at times can be unrelenting.
Maybe your program can help.
I would love that.
I offer yoga sessions, meditation, sleep counseling and positive affirmations.
Plus, fresh-baked resiliency cookies.
Gluten-free.
I think I could make everybody ten percent happier, at least.
I would invest in ten percent happier.
When can you start? Shall we start now? (LAUGHS): Yes.
Sign me up.
- Come sit down.
- Oh.
Just five minutes.
- Lie down, put your feet up.
- Oh, wait, I can't.
I'd be (LAUGHING): All right.
Okay.
(CLEARS THROAT) Close your eyes.
And now just take a deep, cleansing breath.
(PAGER BEEPING) Ooh, sorry.
- Later.
I promise.
- Okay.
(LAUGHS SOFTLY) (SPEAKING SPANISH) - Do you speak Spanish? - (CHUCKLES) No.
I don't think there's room in my head for any more words I'm supposed to understand.
Do you mind turning it down? I promise to keep this simple.
(TV TURNS OFF) Based on the size of your hemangioma and your symptoms, if it were me, I would go with the surgery.
(EXHALES) Surgery it is.
When? Well, we can operate later today.
But I would like to take you through the consent.
There are risks.
Bleeding, infection, damage to your liver.
It's possible but unlikely that we'll have trouble getting you off the ventilator.
And as with any surgery, there is a risk of death.
Have you done this operation often? Uh, no, I haven't, but the senior surgeon I work with has, and he'll be there.
(EXHALES) Pen.
All right.
BRIT: Thank you.
(PEN SCRATCHING) He's clear and consistent.
I don't find him to be influenced by untreated depression, and he's not suicidal.
His choice isn't one that I would make for myself or someone I love, but it's one he has a right to make.
What do you make of his belief that he's cosmically protected? Hearing celestial voices is one thing, but it's human nature to search for explanations for our experiences.
Just describing them in ways that are fantastical doesn't signify a lack of capacity.
Um, I'm sorry, it makes no sense.
I mean, look how young he is, and he even requested a DNR? Which is a sign that he's-he's clear and coherent.
Look, lack of capacity is a high bar, and Wyatt doesn't reach it.
I'm sorry.
- You have to respect his wishes.
- All right, thank you, Leslie.
Uh Is that really it? If he's determined to have capacity, we can't force him to be treated.
Wait, hold on, I thought you were the renegade.
I heard you drilled into a guy's head and you're not even a surgeon.
But you're gonna sit here and let this man die? If the guy would've said, "Whatever you do, don't drill into my head", I wouldn't have.
It's pretty simple.
You can't do what the patient doesn't want.
Okay, this is what we're gonna do.
I did a deep dive into temporary pacers.
Wyatt passes out, we get the pads on him, shock him if we need to, slip it in - at his bedside.
- Hey.
(WYATT SHOUTING) CONRAD: Let's get him some O2.
I'm nauseous.
My stomach hurts.
What's going on? Gut ischemia from poor perfusion.
Your heart rate's too low.
Let's get him some pain meds.
Page Bell.
- Okay.
- (PANTING) (CRYING SOFTLY) BELL: Okay.
Yeah, he's-he's calmer now with the pain meds on board.
It's highly likely he has dying bowel, but he's not a viable candidate for surgery.
Unless we get him to agree to a pacer.
And, yeah, if you do, tell me, and I'll take him to the OR.
As of now, all the complications from his untreated heart condition are fixable, - but I don't know for how long.
- (PAGER BEEPING) He's refusing all intervention.
Is there anything else I can do for you? I wish there were.
Okay, just just hear me out.
All right, you know the Dax Cowart case, right? He wanted to die after suffering catastrophic burns.
He was in pain, terribly disfigured, went blind.
And he was ruled to have capacity, too, but his doctors disregarded his wishes and saved his life.
Mm-hmm.
Yeah, he had a career, he had a family, I mean, he lived until he was 71.
Wyatt can have the same thing.
Dax Cowart became a lawyer and built a career on fighting for patients' rights.
He used his own case to show what the doctors did, what you want to do to Wyatt, was a betrayal of those rights.
It's not a betrayal of his rights.
Hey, I'm as frustrated as you are.
As doctors, our purpose is to help.
And you got that part right.
But Wyatt needs to want to be helped.
No, until he's dead, I'm not giving up.
Then neither am I.
(WASHING HANDS) (DOOR OPENS) BELL: Sorry I'm late.
Had a rough consult with Conrad's patient.
The exact opposite of Brit.
He doesn't trust Conrad, for all the wrong reasons.
And here I am tied up in knots over a patient who trusts me too much.
You made the best decision you could with the information you have.
(WATER RUNNING) You have a very unusual career path.
What brought you from oncology to emergency medicine? So much suffering and death.
The patients call you weeping at all hours of the day and night.
I-I was worn out from the stress.
Those days ruined me.
And now? Just off a shift, look at me I'm still fresh.
Well, it must have been a challenge to go back to residency and learn all the ER procedures.
Hmm, I'm not one for new techniques.
I pretty much slept through that residency.
- It was no big deal.
- I see.
(MONITOR BEEPING STEADILY) WYATT: I told you, Doc.
If God wants me to live, I'll live.
He'll reach His hand down to me.
He's always been so good to me.
TREVOR: Is this about luck now, Wyatt? Or God? He can't save you right now.
We can.
Leave me alone, Doc.
No.
Wyatt - Trevor.
- You just, you got to listen to what I'm Trevor.
Trevor, take a walk now.
He's young.
But he cares deeply.
And I respect your faith in God's will.
I'm in His hands now.
And you always have been, right? How do you know He is not using us to save you? You think he wasn't sitting beside Rune Elmqvist in Sweden half a century ago when he invented the pacemaker? He is sending you one lifeline after another.
Hey.
I'll ask Him.
Wyatt? Wyatt.
(LAUGHS) (RAGGED BREATHING) BELL: Yeah, the liver is exposed.
LEELA: Ready to begin the enucleation.
BELL: Remember, the beauty of this technique is that we, we work along existing planes to pop the mass out and we leave the liver intact.
That's how we avoid massive bleeding.
And note the vessels extending into the liver.
Divide and ligate.
Be careful.
LEELA: Ugh, I have a tiny bleeder.
Cautery.
And another one.
Okay, suction.
Okay, that's arterial.
Clamp.
JESSICA: Dr.
Bell? Here's the clamp.
LEELA: Are you okay? BELL: Uh, no.
LEELA: Jessica, I'll take it.
BELL: Uh, Dr.
Devi, I have to leave.
LEELA: What? BELL: I-I'll find someone to cover as soon as possible.
Uh, as soon as possible.
LEELA: Dr.
Bell.
JESSICA: You can do this.
LEELA: I've got the mass on the last vascular pedicle.
Any word from Bell? JESSICA: Nothing yet.
You'll probably get this sucker out of here before anyone comes.
(MONITOR BEEPING RAPIDLY) CHU: Pressure's drifting down, Dr.
Devi.
LEELA: She's losing blood.
Let's get some blood products in her.
JESSICA: Tell me what you need.
Lap pads and suction.
I'm operating underwater here.
If I can't find the source for the bleeding, I can't fix it.
CHU: Two units are in, and I activated massive transfusion protocol.
We're maxed on norepi.
LEELA: Found it.
CHU: You've got to get control.
She won't tolerate this blood loss much longer.
LEELA: I need to remove the portion of the liver the vessel is feeding.
Prepare for a hepatectomy.
JESSICA: That's a serious change in plans.
We should call Dr.
Bell first.
LEELA: No time.
Clamp, now.
Chu, give her 1:1:1 resuscitation to keep up.
- Jessica, do not stop that suction.
- JESSICA: Got it.
LEELA: Got it.
CHU: We've got a stable pressure.
- (CHUCKLES) - CHU: Strong work, Dr.
Devi.
(LEELA SIGHS) JESSICA: You did it.
- (CHUCKLES) - LEELA: Let's get her closed up and off this table.
What do you think the evidence is behind cookies for stress relief? - NOLAN: Anecdotal but robust.
- I'm really feeling - the chocolate chip.
- HUNDLEY: Dr.
Austin? Of all people.
Do raptors do yoga? I'm only here because my CEO told me I had to be here.
But I won't be here for long.
I have to round on the post-ops again before I fly to Manhattan tonight - for talk shows tomorrow.
- DEVON: Well, I'm stiff, my back is in knots.
I've been in interviews all day, looking for an actual doctor who likes actual doctoring.
PADMA: Welcome, health care heroes.
Uh, listen, I am not a man that you will find in Child's Pose.
So I'm just gonna be on my way to AJ, I happen to know from personal experience that you could really benefit from a little extra flexibility.
- (LAUGHTER) - All right, come lie down and grab a mat.
- Close your eyes.
- (GRUNTING) Let the world fade away and just relax.
- (PAGER BEEPS) - It's the ER.
(PAGERS BEEPING) Oh, that's my next interview.
Med-surg floor.
My mother's having another complication.
- (BEEPING STOPS) - I mean, I feel so blissed out right now.
I feel like I'm back to zero.
I feel great.
You know, after this is all done, I think that you and I should go to this great little vegan place that I know about in Inman Park.
It-It's wonderful.
It's the best tempeh à la King you will ever have.
You're cute.
Not a chance.
(SIGHS) - That's a, that's a no, then? - (PAGER BEEPS) Okay, Wyatt Barnes' heart rate is in the 20s.
He has gut ischemia, his kidneys are failing.
Without a pacer, he's dying.
We're running out of time, and he's waiting for the hand of God to reach down - and-and save him from - First of all, back up.
You're in my personal space.
And you have intern coffee breath, which I do not like.
Okay, look, look, look, with all due respect, Dr.
Hawkins seems to have lost his edge, it's gonna cost a young dude his life.
Can you please just put in a pacer, please? - I have one right here, come on.
- Put that away.
You are a green recruit questioning the general on the field.
W-Wait, hold up.
If someone came into this hospital after slitting their wrists or-or taking pills, we'd save them, right? Wyatt Barnes is doing the same thing.
This is not a suicide.
This is a man with capacity refusing intervention.
That's a right we cannot abridge.
His recalcitrance is not jeopardizing anyone else's health.
- He's only hurting himself.
- Okay, but he is hurting himself Trevor, stop.
Now you go back to your patient's room.
You watch Dr.
Hawkins and you do what he says.
Stop second-guessing him.
You might learn something.
(MONITOR BEEPING STEADILY) Please let me save you, Wyatt.
I have everything we need.
You just say the word.
Think of all the beautiful things you'll never be able to experience again.
I don't know what happens when you die, but I bet you don't get to kiss a woman and know you want to be with her for the rest of your life.
Don't you want to wake up on the first day of fall? Eat a peach? (LAUGHS) Laugh your ass off with your best friends? You don't have to give up any of that.
Think of how lucky that makes you.
(LAUGHS SOFTLY) Is he still saying no? (EXHALES) Do it.
Please.
What are we here for, anyway, huh? To watch people we could save just just die? I was here to save him.
Now we're just here to make sure he doesn't die alone.
(SNIFFLES) (FLATLINING) He's your first death.
Yeah.
Not how I imagined it would go down.
You pictured a different kind of heroism, blood spattered all over your white coat.
(EXHALES) Do you ever get used to it? It never gets easier.
It just It just gets different.
But today was no small accomplishment.
Dr.
Daniels.
We allowed him to live and die according to his principles, and because of that, we managed to keep ours.
Look, again, I'm-I'm sorry about what happened in there.
Well, I'm relieved you're okay.
No, I-I'll be fine, it's just It's a pinched nerve and little bit of vertigo that came on suddenly.
I think, you know, I-I overreacted, but in the moment, I-I thought if I stayed in the OR, you'd have two patients to deal with, so Well, then, you did the right thing.
So did you.
This time.
But, to be honest, it could have gone either way.
- Hi.
- So? Did you find anything else horrible inside me? I'm vaguely optimistic because I have a familiar sense of existential dread, and I'm pretty sure that can't be removed surgically.
The surgery went great.
You're going to be fine.
Thanks to Dr.
Devi.
There was a complication during surgery.
We had to remove a small piece of your liver.
But it will grow back.
And the hemangioma is gone for good.
Thank you.
I mean, really, thank you.
And you made the right decision for me, too.
Can I call you next time I'm buying a new car? - (LAUGHS) - Or don't know what to do when I get in a fight with my mom? I actually am a triple board-certified mother vanquisher.
(CHUCKLES) DEVON: So it's a no.
Even the former oncologist? He's burnt out.
He's not interested in learning anything new.
H-He doesn't love medicine.
None of them do.
Keep looking.
It's just the first round.
No need to be discouraged.
And the thing is, Dr.
Voss, when I was talking to them, I realized I might not be so different.
Of course you are, Dr.
Pravesh.
I am judging people for not loving medicine enough while trying to cut down on clinical time to go do research.
I think about being in the ER year after year after year, with no outlet for research, and I don't know how we don't drown in the sickness, the sadness, the pressure, the paperwork.
(EXHALES) Half of my med school class isn't doing medicine anymore.
That means something.
Yes, I think it does.
BELL: Hey.
Hell of a day.
Yeah, I heard.
So, how tempted were you to put in the pacer - against the patient's wishes? - More than I'd like to admit.
But there are some rules we can't break.
Do I know I made the right choice? Yeah.
Do I wish I'd made the wrong one? Maybe.
I know my intern thinks so.
I heard Dr.
Daniels has a hard time with the rules.
But maybe the example you set saved his medical career.
To say nothing of your responsibility to your patient.
Yeah, he's a bright kid, that Trevor, but too much confidence and passion, not nearly enough restraint.
He learned something today.
If I'd have saved Wyatt, would he have come back in ten years with an armload of kids, grateful that we didn't listen to him? (EXHALES) And now I realize none of this is why you are here.
Nope.
I got a favor to ask you.
What? But, look, before I even-even spell it out, can I count on you for full confidentiality? Go on.
Something's wrong with me, a-and I'm not quite sure what.
But I think it may be serious.
You want me to examine you? Yeah, I'll clear my schedule tomorrow.
Let's come in early.
And the fact that I'm being tested at all, the results, all under the radar.
So, is that something you can do? (SIGHS) Okay.
Great, thanks.
(DOOR SLIDES OPEN)