The Resident (2018) s05e16 Episode Script

1 - Previously on The Resident - I think we should dig into Dr.
Bosley's patient outcomes and give Ms.
Benesch a fair hearing.
Let's just simmer down.
Just watch and learn how we operate.
I-I think I'm getting a pretty good sense of how you operate.
Are you looking for a financial settlement? No.
I'm looking for accountability.
I did not have to end up like this.
I don't want future patients of Dr.
Bosley to, either.
I want the board to do something.
- Will they? - Honestly, probably not.
But I will do something.
So what's happening in the world? I'm not reading the news.
I'm watching a video of a bulldog failing to eat its kibble.
Okay.
Slow news day.
What's going on with your leg? Oh, I guess it slept in.
Could be an MS flare-up.
I'll email Dr.
Greer, see if she can fit you in today.
Yeah, well, early is better.
I have a 10:00 with Abernathy, the head of the medical board, 'cause I found more complaints against Bosley, the neurosurgeon who paralyzed Emily Benesch.
Do you think you have enough to convince the board to look into Bosley now? I'm not gonna give 'em any choice.
You know, this whole moral crusader thing looks good on you.
It's very super hero-y.
You should see me in spandex.
Well, that's ruined it.
Can I help you? You look familiar, but I can't place you.
Are you gonna harass me every time I have an ER shift? Yes.
You know, please look into your abandonment issues.
You know my father left me at Yankee Stadium and got home with my brother before he realized I was missing.
I'm sorry I triggered you, Irving.
You don't care.
Where's Leela? Sister day with Padma.
Bonding over the gifting of eggs.
Level-1 trauma coming in! Bay 11's ready.
Eliza Brockton.
32-year-old female.
Status post-fall from her sixth-floor apartment building.
BP 120/68, tachy to 100, satting at 98%.
Trauma survey.
Pupils equal and reactive.
Airway's intact.
- Good breath sounds bilaterally.
- Pulse strong.
Vitals stable.
I'll get labs.
I'll do a FAST exam and put in for a chest X-ray.
Eliza, how did you fall from your apartment building? I-I was, um I was hanging a-an orchid on my balcony, and I-I reached too far over the railing and I just lost my balance.
Thank God the entry awning broke my fall.
Well, we're gonna get that chest X-ray and CT scan to check for head trauma.
We'll be back, okay? - Uh, okay.
- All right, hang tight.
You want to get her records and I'll arrange the CT? Yeah.
What is it? Eliza's attempted suicide three times in the past six years.
Let's get a psych consult down here.
Eliza.
Hundley.
My patient eloped from 11.
Call the code.
Excuse me.
Attention, staff.
Code Green.
32-year-old Caucasian female.
Dark hair, blue eyes.
Code Green.
Eliza! Eliza! Wait! Eliza! You all right? I'm fine.
Eliza's stable.
Scans were negative.
BP was borderline, so we placed an A-line.
And Psych is en route.
That was a very brave thing you did, Dr.
Pravesh.
I'm just glad we got to her in time.
Mm-hmm.
We're good.
So I guess the truth is out.
I don't want this anymore.
And I wish you would just mind your own business and let me go.
You know we can't do that.
This is Dr.
Malco.
She's from the psychiatry department.
Hi, Eliza.
I'm guessing you know the drill here.
I'm gonna ask you a few questions.
You have my file.
So you could just read my old answers.
My new answers are all the same.
I'm out of words.
I imagine that must be very difficult for a writer.
To be out of words.
I'm out of everything.
I want you to know, both of your books have informed the way I treat depression.
I'd like to return the favor.
Do you have a gun? We're gonna keep you on a 36-hour hold.
Dear merciful Father, we ask for Your blessings on Daisy.
She needs You.
We're asking that You grant her the patience to help her with her affliction and the freedom from her pain.
And lead her out the shadow of the valley so that we can heal her body and spirit.
Now let's go get you a damn kidney, huh? - Amen.
- Amen.
Ah Aaron, it is good to see you.
Yeah, it's been a minute.
You know we've had our own conversations about pain.
Mm.
How are you and Gigi holding up? Yeah, really well.
Gigi's definitely my greatest achievement so far.
You got that right.
Yeah.
Speaking of our past conversations, the last few days, I've been back in the fresh grief of Nic's passing, I-I guess.
I don't Uh, I don't know what set it off.
Ah, well, if it isn't Pastor Aaron, my favorite clergyman.
AJ, my big bad Buddhist, you.
- Hey.
- How are you? How's your mother? She is as well as she can be.
The cancer is progressing.
I'm sorry to hear that.
I-I'll definitely have to go see her.
Well, you see, her palliative care is top-tier, right? But she's gonna need to transition to hospice sooner rather than later, and she is not keen on the idea.
So I was thinking maybe you can help me have that conversation with her when it's time.
I'll be happy to.
Appreciate it, man.
I have a favor of my own to ask you two.
Yeah.
Anything.
Recently, I had a heart stent placed a few months back.
A fit young dude like you? They found some blockage.
Now, the doctor told me that I should be feeling better, but I've been having a lot of chest pain lately.
Ah, say no more.
AJ and I will take a look at you in the ER.
Better safe than sorry.
Let's go now.
Head scans are good.
- Nothing to worry about.
- Great.
But the leg issue is a little MS flare-up.
No biggie.
This will happen from time to time.
Well, I'm glad we checked, then.
We'll put you on a short course of steroids that should improve your symptoms.
In the meantime, take the pressure - off your leg with this.
- Oh.
No.
That is uh, won't be necessary.
It's only for a few days.
The last thing we want is for you to stumble - and hit your head.
- Randolph, - take the cane.
- No, it's It starts with a cane, and then it goes to adult diapers and a chairlift to get up the stairs.
It's a concession to the disease, and I won't make it.
Good Lord, Randolph.
Typical man.
You can dress it as bravery, but it's just vanity.
Okay.
Uh, I'd love to stick around and talk about canes and men, but I have an important meeting to get to.
So, Meghan, thank you.
I remember being at a birthday party when I was four or five years old.
And the birthday girl shrieked with joy when she unwrapped a doll from her parents.
For the first time, I became distinctly aware that it was something that I had never felt.
Is there anything in your daily life that brings relief from the pain and dread? Periodically, when I'm writing.
Are there any moments in your past where you can recall feeling happy? This morning.
When I felt the wind on my face as I fell to what should have been my death.
My reservoir of hope is empty.
Eliza has what we call treatment-resistant depression.
Cognitive behavioral therapy, antidepressants, and ECT have all been ineffective.
So, what do we do? We just keep her here for 34 hours and then just - let her walk out? - We don't have a lot of options.
Sad to say, I have no beds free on the unit.
Don't patients with treatment-resistant depression qualify for off-label deep brain stimulation? I've read some clinical trials on it, and I know Dr.
Sutton has used it on patients with Parkinson's and even OCD.
They do, but there's no guarantee it works.
Well, in one trial, 50% of patients saw some relief from their symptoms.
Do you think Eliza would consider the procedure? All Eliza wants is to exit life.
It'll be challenging to get her to agree to any treatment, much less one that requires holes drilled in her skull and electrodes placed in her brain.
Well, if we do nothing, there is no doubt that she will try - to kill herself again.
- No doubt.
I'll talk to Dr.
Sutton.
See if she can discuss the procedure with Eliza.
Dr.
Sullivan didn't come in? She took the day off.
We got Pravesh back instead.
Who? Good thing we looked into your chest pain.
You have EKG changes and labs consistent with an NSTEMI.
It's a minor heart attack.
What? A minor heart attack? - How is that possible? - Take it easy, Aaron.
All right, we're on it.
We got you.
Taking good care of yourself, right? - Yes.
- All right, well, explain to us how you ended up with a cardiac stent.
Well, this cardiac clinic came to the church leaving flyers.
They were offering heart screenings with no out-of-pocket with Medicaid.
And, uh, now, my congregation relies on outreach, so I wanted to set an example to the flock, so I went.
And what did the screening turn up? Cardiologist said that my my labs and my tests were "borderline" was the word, and that I needed a cath ASAP.
Were you feeling any chest pain? No.
No.
He said that the cath was very important to screen for heart disease.
Silent killer.
Okay, but why did they stent you? Well, during the procedure, my heart was beating out of my chest.
And the pain, I mean, it's very severe, but once they put in the stent, I had relief.
You know, I'm a little achy and tired here and there, but for the most part, I'm-I'm thankful.
Chest pain usually comes before cardiac catheterization, not after.
Excuse me, I need to take this.
I hate to do this to you, brother, but we need to get you in our cath lab right away.
And I promise you, you won't feel any pain with these hands.
All right? We got you, man.
Hey, Billie.
- You got a sec? - What's up? So, I have a young woman in the ER, she's banged up pretty bad from two failed suicide attempts today.
Yeah, I heard Superman flew in and saved her.
Her name is Eliza Brockton.
She's very smart, wily.
She's a memoirist who wrote two best sellers about depression.
Sure, yeah, I read the first one, The Lure of the Void.
Right.
So, I think she's a good candidate for DBS.
Well, DBS is still experimental for depression.
Does she meet the inclusion criteria? Yes.
No improvement from CBT, SSRIs, or ECT.
Okay.
- I'll talk to her.
- Thanks.
It's Trevor.
I've been trying to reach him for weeks.
Take it.
No, take it, and let him know that we miss him.
Trevor, I'm so glad you finally called.
- Are you okay? - Uh, yeah, yeah.
I'm sorry it took so long to get back to you.
Just - dealing with a lot of stuff.
- Of course.
I can only imagine a horrible revelation like Yeah.
We don't have to, um Look, there's some there's some stuff I want to tell you in person.
Okay.
Sure.
Just know, I've been worried about you.
All of us here have.
And I'm not sure if you're aware of this, but you're in danger of losing your residency.
Yeah, I know.
Uh, look, can we meet up tomorrow? I'll fill you in.
Yeah, sure.
That works.
Cool.
Thanks, Billie.
Phones in your locker while you're at the warehouse.
Yeah, yeah, sorry.
My bad.
- You know that.
- Yeah.
What's with the limp? You okay, Randolph? Oh, I'm-I'm doing great.
Thanks for your concern.
I want to talk to you about Bosley.
I don't get it.
What is your beef with Dr.
Bosley? - Is this personal? - I've never met the man.
I told you last week, Dr.
Elkins was looking - into the Emily Benesch case.
- Well, you know She didn't.
These are five more complaints against Bosley for catastrophic outcomes that the board didn't look into either.
Look I-I'm just not familiar with the details of these old complaints off the top of my head, but I can tell you that, if we made the decision not to investigate, we had good reasons.
See, I can't imagine what those could possibly be.
Randolph, you're a good man, and I like you.
You can be a very valuable member of the medical board.
That's what I'm trying to be.
Well, typically, new members tend to stay on the sidelines for a period to see how things work before going full Norma Rae, you know what I mean? I'll see you at the board meeting this afternoon.
All right, Aaron, I found the stent, and I also found the cause of your heart attack.
Unfortunately, they're one and the same.
Uh, what does that mean? The stent your doctors placed is actually blocking one of the other arteries in your heart.
That's why you were feeling so much pain.
AJ, the rest of his vessels are pristine.
Cholesterol's low, no family history And it looks like the stent was placed in the location of a coronary artery dissection.
Are we thinking the same thing? Yeah.
It sickens me to say this, but you never should have had a cath in the first place.
Worse, the cardiologist tore blood vessels when he put it in, which is why the procedure was so painful.
I should prepare to see my maker.
No need to pack your bags.
You will get to your next great achievement.
Aaron, what was the name of your cardiologist? Eliza, this is Dr.
Billie Sutton, and she is a neurosurgeon, and I've asked her to come here and talk to you.
Hi, Eliza.
I've seen that expression on your face too many times.
You have a plan to fix me, but I am unfixable.
I don't want to go through this again.
I-I get that.
And, truth be told, my plan might not work.
The success rate of deep brain stimulation for depression is about 50%.
That is a broad definition of success, from modest improvement to complete absence of symptoms.
Deep brain stimulation? A small conductor, an electrode, is permanently placed in a specific region of the brain.
The conductor carries a low-level impulse from a battery to the area of the brain that regulates mood.
What could possibly go wrong? In very rare circumstances, a hemorrhage can occur.
Wh-Which would conceivably turn me into a can of peas.
Well, like I said, that outcome is very rare, and I'm very good at this.
And here's the part you might like Can't imagine what that would be.
Well, first we have to scan your brain.
Then, I give you a tour of the organ that's not only the source of your literary success, but the thing that wants you dead.
I'll pull some strings to get you out - of the ER while you wait.
- Mm.
We'll be back.
Aaron is stable, but I can't undo the injury his heart has sustained.
Once a blood vessel's been torn, it can tear again.
And an acute clot could form, cause him more heart attacks.
His cardiac function has decreased to only a third of what it should be.
- In time, it could improve.
- It's all wrong, and the worst part is, the procedure was entirely unnecessary.
Look, I got a quick errand I got to run.
I'll be back as fast as I can.
I'll hold the pastor in the ER, keep an eye on him.
- Yeah, man.
- I'll update you.
This is the cerebrum where consciousness, emotion, perception, and memory are all integrated.
Like any other part of the body, pathways of connections can be too strong or too weak, and when they are weak, we try to augment them with medications, you know, SSRIs, ECT - But those didn't work.
- Which is why we get to try something more intense.
We would place electrodes here and here.
Like a pacemaker for the brain instead of the heart.
The electrodes stimulate Brodmann area 25, which is like the interstate highway of nerve connections, or white matter, and it's sitting right on top of a huge serotonin depot.
It's like drilling for a well of happiness.
If you like that image.
Reminds me of those flimsy claws at arcades that kids dump their money into and try to grab a prize, but they never get one.
Well, DBS has much higher odds of success than those claws.
Define success.
We banish the hell in your head but keep the heavenly talent.
I won't wake up and be someone else, will I? Everyone facing DBS asks that question.
Surely not everybody.
Look, they say in Alcoholics Anonymous, if you sober up a horse thief, all you have is a sober horse thief.
You will remain you, but a happy you.
You're describing a stranger.
You know, I really appreciate you making time for me on such short notice, Dr.
Pellington.
Well, I'm glad we could make it work, Mr.
Austin.
Now, as you know, we took a picture of your heart a few minutes ago, I sure am glad we did.
It revealed some extra beats.
Now, we have a fancy term for that.
It's called premature ventricular contractions, but the important thing is, it may have shown a blockage in your arteries that feed blood to your heart, and that's the first step to a heart attack.
Whoa, a heart attack.
C-Can I take a look at that? - Oh, sure, sure.
- Thanks.
You are one lucky man because we can do a cardiac cath.
That's a procedure where we can get a better view of those arteries, and if there is blockages, which I suspect there will be, we can open 'em right up.
Any questions? Yeah, just one.
Did you go into medicine intending to become a fraud? Excuse me? I'm a cardiothoracic surgeon at Chastain Park Memorial, and you and I both know that my EKG is normal.
There is no medical reason to take me to cath, just like there wasn't for Pastor Aaron either.
- I could point to hundreds - Pastor Aaron is in our ICU right now as a result of the botched stent you put in when you dissected his LAD during an unnecessary cath.
So, not only are you greedy, you are incompetent at best.
I don't know what the hell you think you're getting at, but everything I did is legal.
Legal? Really? You know, that's a pretty low bar for a doctor.
I'll tell you what, Pellington, if my friend takes a turn for the worse, you will find yourself on the losing end of a lawsuit with me as the expert witness.
Aaron.
How you doing? I was just working on next week's sermon.
You know, today's been all about me, and earlier you mentioned about being pulled back in the pain of your wife's death, before we got interrupted.
And it will continue to be all about you.
Numbers look good.
Any chest pain? Ah, nothing significant.
You and I are in the "you" business.
You let me do my job.
This resurgence of grief, have you had any big recent changes in your life? Crazy work stuff the past week.
Have you been stepping out with any women since Nic's death? Eh one.
Nothing serious.
Potentially others.
- They all come with complications.
- Yeah.
Yeah, and I'm sure that you had those complications with Nic.
Yeah, but the baggage was mostly mine.
You know, my experience with counseling widowers is that guilt and loyalty can toss you back into the original grief.
Maybe.
Hey.
If it's this woman, or if it's that woman, you deserve your next great romantic achievement.
Patient's in V tach! I need a crash cart! He's pulseless.
Now in V fib.
We need to shock.
Get the pads on.
Charging.
And clear.
Now.
Still in V fib.
Get me a bolus of amio and shock again.
Charging.
Clear.
And shock.
- He has a pulse.
- Sinus rhythm.
But if this happens again, he is not When it happens again, he won't survive it.
Let's get him to the ICU.
I'll page AJ.
- Hey, what's going on? - I got him out of V fib, but Hey.
Right here, I got you, brother.
His left ventricle is barely contracting.
Down to about 15%.
He couldn't tolerate the refractory arrhythmia.
We can't fix his coronary arteries with more stents.
They're too damaged.
I'm gonna have to take a vessel from his chest and go around it.
From an unnecessary cath to open-heart surgery.
His systolic's dropping to the 60s.
I need more pressure than that - to do surgery.
- I'm maxed out on pressors.
We're gonna have to put him on ECMO.
Wh-What's going on, fellas? AJ needs to perform bypass surgery, so we're gonna put you on a machine that will take over for your heart, so your heart can survive the procedure, okay? If God wants me at His table right now, I have faith in Him.
Have faith in me.
I'm gonna do my best to make you late for that dinner.
You hear me? I am glad to see that you agreed to the DBS.
Of course, you'll be under psychiatric care for some time after the surgery, but have you thought about what kind of support you're gonna need when you get back into your life? Well, if this works, I'll be happy, right? So I won't need anything.
I started reading your first book.
Hmm.
Enjoy it while you can.
And that description of the conversation that you had with your therapist after your first suicide attempt About falling in love with my depression.
Yeah.
It's hard to conceive of that.
Well, for most people, it's impossible, which is why this is all so futile.
- Are you okay? - Yeah.
Yeah, I'm just, I'm just tired.
This is so weird.
- Eliza? - Hmm? Yeah.
Hey.
My God, she pulled out her A-line! I need another set of hands in here! Eliza, I'm not letting you go.
Please give us a chance.
Okay, so, remember, stay calm, avoid an accusatory tone.
But just share your truth.
Yeah.
Okay.
I'm nervous, but I can do that.
I wouldn't put you in front of these people if I didn't think you could reach them.
Okay.
Okay.
All right.
Here we go.
I'm gonna move that chair.
Just the top of the table.
Okay.
Uh Who is this woman, Dr.
Bell? You didn't mention that you were bringing a guest this morning.
This is Emily Benesch.
She's gonna tell us her story, and we are going to listen.
The last time I walked on my own two feet, it was into Dr.
Bosley's practice.
The man I was engaged to marry left me after I was paralyzed.
I can't turn over in bed, reach a book on the shelf, get out of my house, into a car, through a store without pain and struggle.
And why? Because no one stopped a man who should never have been operating to begin with.
You sit in here and review his explanations.
Accidents happen, but again and again? Who else will end up like me? Would you send your wife to him? Your son? Your father? Then why a stranger? I know that a very high percentage of doctors are-are competent and good people.
And the few who ruin people's lives, they're are repeat offenders.
Like Dr.
Bosley.
If a hundred good doctors do nothing about one bad one, then we've got 101 bad doctors.
You owe it to yourselves.
You owe it to me.
Thank you, Emily.
We'll pass this up to the complaint division and discuss the status of the investigation on a weekly basis.
Thank you.
The ECMO's giving his heart some relief, but this is as strong as he's gonna get.
If I don't operate now, there might not be - any heart muscle left to save.
- Yeah, it's time.
Let's hope he's strong enough to survive.
All right, the first graft is complete.
This LAD is gonna be a little tougher.
4.
0 Prolene to me.
Suturing over the dissection.
You're using both internal mammary arteries for grafts.
Is there a risk of recurring heart disease? Oh, good question, Chu.
Not in a man who doesn't actually have heart disease.
Both anastomoses complete.
Removing the clamp.
Let me know when you're ready.
I am in position.
Let's hit the reset button on the good pastor's new and improved heart.
Starting with five joules.
Going up to ten.
Take it to 20.
Come on.
I'm placing the electrode.
Now, there are no pain receptors in the brain, so this won't hurt.
That's ironic.
Advancing the electrode.
60 millimeters.
78 millimeters.
We're at the target region.
Dr.
Malco? Pass it over to me.
For what it's worth, I feel no different.
I maybe feel worse, even.
Perhaps because now my head is screwed into a metal frame.
We haven't turned it on yet, Eliza.
- That's what I'm about to do.
- Oh.
Two volts.
Eliza, rate your mood on a scale of zero to ten.
Unchanged.
Zero.
Adjusting to four volts.
And now? Nothing.
Six volts.
Eliza, how about now? Eliza, are you okay? I'm - I'm - Eliza, if we - went too far we can turn it back down.
- No.
No.
Don't-don't-don't turn it back down.
Don't-don't Don't do anything.
Tell us how you feel, Eliza.
I feel calm? Everything everything seems brighter.
Is? Could this be Could this be happiness? Well, against all odds, Aaron's alive with plenty more sermons to give.
Yeah, well, it's a flawed victory.
His heart is permanently damaged, and he'll spend the rest of his life exhausted.
All because of unnecessary tests and useless procedures that were detrimental to his health.
You know, I talked to Bell, now that he's on the medical board.
Ah, let me guess.
The system is so broken, Pellington won't face any ramifications.
Bingo.
There's literally nothing we can do.
Maybe not, but there is always karma.
So we'd like to think.
Like the beating of life in my veins I know there's gonna be Some brighter days I know there's Gonna be some brighter days I swear that love will find You in your pain Ooh I feel it in me like The beating of life in my veins I know there's gonna be Some brighter days I know there's gonna be - Are you okay? - Yeah, yeah, Nic has just Nic has just been on my mind.
And and what we do, just watching people slide to the very edge while we fight to save them.
Yeah.
Yeah, like we're surrounded by loss.
Past, present, the future.
Ours, other people's.
Look, man, I'm preparing for my mother's passing.
And when she does, I I don't know what I'm gonna do.
I know I'll never know another like her.
No.
There are some holes you just can't fill.
Yeah.
I know there's gonna be some brighter Days.
Go ahead, ask.
How are you feeling? Good.
Weird.
Um, hopeful.
Scared.
Bionic.
I feel like I'm at one of those all-you-can-eat buffet restaurants, only it's for emotions.
Sounds dizzying, but an improvement.
Dr.
Malco has a few options for psychiatric treatment centers, and they all accept your insurance, and they're gonna take you right away.
You'll come back and see me in two weeks, and I'll adjust your stim level if necessary.
Okay.
Uh, thank you for not letting me go.
Of course.
Days like this, I love being a doctor.
Best job in the world.
Bell.
Bell, Bell, Bell.
You know, I thought I had the deepest, highest-octane reservoir of ego, but, brother, your vanity makes mine blush.
Randolph, you are my friend, but it's a good thing you don't have cancer because you are not a good enough friend for me to shave off this.
I mean, this is like a silken - masterpiece up here.
- That it is, it is.
So What do you say? Okay, I will take this walking stick, but not because I'm old or infirm, but because it's really cool.
- Thanks, guys.
- You got it.
Well, you look good.
You okay? I am.
I'm good.
So, what's going on? Okay, first I'm not sure I want to be a doctor.
I went into it for the wrong reasons.
Why did you go into it? I wanted to be the person I thought you'd love enough to wish you'd kept me.
Now I realize you were a child.
That's why you couldn't keep me.
I know we both suffered.
Right now it feels like being a doctor won't give me what it gives you.
The good news is, being an M.
D.
opens up a lot of opportunities.
Yeah.
I got a job in research and development at a biotech start-up.
Drug chemistry, my sweet spot.
But I'm gonna do it, you know, by the rules.
Try to make a difference.
I don't know.
We'll see what happens.
I'm happy for you, Trevor.
And I'm very proud.
Yeah, since Porter, since giving you away, I It had been inconceivable to me that I could ever feel maternal towards anyone.
I never wanted kids.
But you forced me to meet you, and what had been inconceivable happened.
Something opened up in me.
No, these last couple of weeks, when I didn't know where you were, what you were doing I was beside myself with worry.
Which I suspect means I was feeling a little bit like a real mother.
You are my son.
Nothing can ever change that.
And I love you.