The Resident (2018) s05e17 Episode Script

- Previously on the Resident - Good morning.
These are - the interns I told you about.
- I'm Zach, - Primary Care.
- Let's get started, shall we? Listen, I'm not a man that you'll 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.
All right, come lie down and grab a mat.
I don't know if I want kids.
At least not right now.
What Padma wants can help us both.
I can give her the egg she so desperately wants so she can have a baby, and at the same time I can freeze some for us.
- What about him? - This guy? Yeah.
He runs marathons, plays the cello and, Oh, Leela, look at that chubby little face.
Aww.
Well, I wish we could meet "Tall & Talented" in person.
Or maybe see an adult photo, not just a baby photo.
Well, then these anonymous sperm donors wouldn't be very anonymous, would they? I just want the father of your child to be as amazing as you.
My sister deserves Grade A sperm.
Thank you for doing this for me.
What, you think I'm doing this for you? No.
I'm only giving you my egg so I can be an auntie.
Well, you're gonna be the best one.
- We should get to Chastain.
- Wait.
What about him? - "The Right Stuff"? - Yeah.
He loves yoga, travel and Basquiat.
No markers for genetic disease.
And he's South Asian.
I think it's a sign.
Okay, well, why don't we email the sperm bank - and try to get a voice sample? - Leel, he is the one, I can feel it.
No, no, you don't need to decide right now.
- Padma, are you sure? - I am.
"The Right Stuff" it is.
Sorry, I know how busy you are.
Not a problem.
Happy to help.
Usually I'm texting you to do something a bit more fun, huh? Yeah.
It's probably just a stomachache, - but Gigi insisted that you check.
- Oh, did she? I told Peter you fix hurt tummies.
- Hey, Peter, remember me? - Your Gigi's dad.
I am.
What's going on, buddy? We were playing super space, Daddy.
Yeah, these two can go all day.
He is the astronaut, she is the alien.
Peter said he didn't want to play, but he always wants to play.
I'm gonna place my hands on your stomach for a second, okay? All right.
Peter's dad is on the way.
Have him meet me in the ER.
Do you like piggyback rides? Yeah, I thought so.
Hop on.
Can I go with you, Daddy? You wait here, my little alien.
I'll come back soon and let you know how Peter's doing.
Kids, we're going on a field trip.
A rite of passage.
When I was a first year, like you, Dr.
Hawkins took me, and now it's your turn.
Our turn for what? Since the start of your intern year, you've learned to become doctors inside these walls, and today you are going outside Chastain to treat one of the most challenging patient populations.
A place you'll tackle complex medical cases that make great doctors.
Dr.
Voss and Dr.
Bell will be joining us, so let's get moving.
Where are we going? Dr.
Pravesh didn't tell you? Let's not spoil the surprise.
Okay.
All right, here we are.
Shall we? We got played.
Oh, my God, old folks? All right, Mr.
Astronaut, can you tell me when it started to hurt? Does the pain move around at all? I'm okay now.
Is my dad coming? Yeah, he's coming.
To take me home? I don't want to go home.
Oh, you're not going home, hon.
You're gonna stay here with us until we can figure out why you're not feeling so great.
- Hey, bud.
- Hey, Daddy.
Are you okay? What's going on? Hey, Spencer.
This is Nurse Hundley.
Spencer works in our IT department.
Nice to meet you.
Peter has a stomachache.
Normally, that's not a reason to be worried.
His temp's a little low.
It could be a sign of infection.
- Oh.
- He seemed fine this morning.
Said that he and Gigi were going to space.
Has he been sick at all in the past few weeks? Had a cold a few days ago, but nothing out of the ordinary.
Any dietary changes this morning? I made him a smoothie, um, as a treat.
Bananas, yogurt, protein powder, juice.
I mean, we shared it.
I feel all right.
He won't tell us more about his pain.
He keeps saying he's fine.
Well, I think because he doesn't want to go home.
- Right? - I'll go home if you stay with me, Daddy.
I'll stay right here, no matter what.
Okay, bud? No matter what.
I'll get us ready to draw labs.
I'm gonna step aside for a second, okay? - Can I talk to you? - Yeah, sure.
We're good here, right, hon? Uh he's got separation anxiety.
His mom left us both three months ago.
She hasn't been back, or even called.
New boyfriend, drug problem.
It's a long story.
I'm sorry to hear that.
Now Peter's afraid you might disappear, too? Yes.
He feels safe at Chastain because he knows that I work in the building.
Well, separation anxiety may be behind this.
It can cause stomach trouble.
Do some blood work, run some tests, and then we'll go from there, all right? Dr.
Milner to Emergency.
Dr.
Milner to Emergency.
There he is.
The Brookhaven resident who happens to be - one of my health care heroes.
- Dr.
Kravitz? Yes.
Just be aware he has early mild cognitive impairment.
He remembers people and events from the past perfectly, but his short-term memory's going.
Okay, got it.
- Dr.
Kravitz.
- Kit.
Lovely to see you.
I did a gerontology rotation with Dr.
Kravitz when I was a resident.
He was one of my finest teachers.
This is Dr.
Randolph Bell.
It's an honor.
You're a legend in the field of geriatrics.
You know, your book, Compassionate Care of the Elderly, has been on my shelf for decades.
I-I'm sorry, your name again? Randolph Bell.
Randolph, Randolph, Randolph So do all your friends here wheedle you for free care? Oh, absolutely not.
We won't allow it.
Arthur here is fully retired.
He's earned the right to have others care for him.
Gloria, darling, this is Kit, and this-this is Well, there's no introduction necessary, sweetie.
Everybody knows the famous Dr.
Randolph Bell.
She not only has my heart, she is now my head.
In every way, she takes care of me.
Well, it's mutual.
Well, it was nice of you to come today.
You know, it can be kind of hard to get some of us old coots to get our regular check-ups.
Well, we have an ulterior motive for bringing some of our interns here today.
We're hoping to inspire them to join your field.
This country needs more gerontologists, and even some of the best doctors don't understand the particular needs of senior citizens.
Geriatricians have higher career satisfaction than other medical specialties.
But the pay not what you get in surgery.
Would you consider talking to some of our interns about your career? Let me at 'em.
Do you think we'll still be that in love when we're their age? Why wouldn't we be? Padma, now that you picked a sperm donor, we'll start Leela's daily injections of hormones to encourage her body to produce more eggs - than it does in a usual cycle.
- We're excited.
Me, too.
We'll be monitoring you with blood tests and ultrasounds.
I read about this thing called, uh, - ovarian hyper-something.
- Hyperstim.
Yeah.
Do we need to worry about that? No, not with regular monitoring of my estradiol levels.
If they get too high, we back off, lower the dose.
That question wasn't for me.
But you're right.
This is quite a safe process.
Okay, what can I do to help? For now, nothing.
Not until we start you on meds in a few weeks to prepare for the embryo transfer.
- Okay.
- Okay? Leela, I will walk you through your first injection.
Um, I was thinking maybe I can do it.
You want to stick a needle in me? I just want to be part of this in every way that I can.
- You know.
- Of course.
I would like that, too.
Does our patient have a visitor? He does indeed.
- Gigi! - Hi, Peter.
Ah, good friends are good medicine.
All right, you two, behave.
I'm gonna chat with your dad real quick.
Thought a fun distraction for Peter could be good.
So his labs came back.
White blood cell count was normal, no sign of infection.
Appendicitis, uh seems unlikely.
Maybe it's psychological.
You know, he's been through a lot.
My gut's telling me it's more than anxiety, and I want to run a few more tests.
What's up? Did you fix his tummy, Daddy? It's always his tummy.
What do you mean, "always," sweetheart? It happened before? How often does your tummy hurt, Pete? A whole lot of times.
Why didn't you tell me anything, Pete? - I don't understand.
- I didn't want to stay at home.
I wanted to come here, with you.
I'll never leave you, okay? I'll never leave you.
Do you understand? Daddy, there's something else.
It's weird, but maybe I should tell you.
This morning, Peter and I were playing that we were on another planet.
He kept saying that I had two heads.
Yeah, you told me that.
Pretending.
No, he meant it.
He said I really was a space alien.
Peter, does anyone else have two heads? That nurse lady and you, kind of.
Double vision.
How many fingers am I holding up? - What's going on? - This could be neurological.
We need to get him to CT.
So this woman, who is 83, kept chickens.
And she loved her chickens.
She named each one of them.
The-the first day I spent with her, she gave me eggs.
Anyway, she had a problem with worsening anemia.
Fatigue, muscle weakness, intestinal problems.
She started forgetting things and falling.
Now, any ideas what was wrong with her? Likely more than one thing.
Alzheimer's, and possibly cancer? Or a recent stroke.
I'll give you a hint.
The key was the chickens.
People who name their chickens don't eat them.
Exactly.
He's smart.
You-you could be a gerontologist.
I don't get it.
Okay, it's a B12 deficiency, common with age.
Learned that from Dr.
Kravitz's book.
So I'm guessing that the patient was a vegan, because she gave away the eggs.
Bingo.
The woman's vegan diet was a good choice because it reduced her risk of heart disease, Type 2 diabetes, certain cancers.
But she forgot to supplement with B12, which was the source of all of her symptoms.
This is why gerontology is a great profession.
You spend time with patients.
You talk with them, you get to know the whole person, all the while keeping your eye on the big picture.
Which is the key to diagnosis.
Oh! My lady awaits.
And I see that they have put out snacks, and I am peckish.
- Excuse me.
- Thank you, Dr.
Kravitz.
Hi, sweetie.
Hey, maybe gerontology is an aphrodisiac.
This old goat has the prettiest lady in the place, and I have not had a date since high school.
Oh No, no, I'm kidding.
Gloria! Her pulse is thready.
Call 911.
Let's get her to Chastain.
Somebody grab these pills.
To take with us.
We're gonna need to know what she's been taking.
I don't understand.
Are you telling me I fainted? Yes.
And they're going to figure out why.
I was probably just dehydrated.
I didn't ruin your event, did I? No, we were winding down anyway.
You added the drama.
The good news is, your wrist isn't broken.
You just need a splint.
And your EKG and your labs look normal.
So how did you feel right before you passed out? I got dizzy.
A little lightheaded.
A-A drop in blood pressure.
It's not uncommon among women on blood pressure meds.
But she's-she's not on any.
Oh, well, yes, I am, dear.
- You are? - Mm-hmm.
Why didn't you tell me? I did.
Let's start here.
My thought exactly.
Houston to Rocket Nine Niner, do you read me? Copy, Rocket Nine Niner.
Please keep your hands and arms inside the spacecraft.
We are go for liftoff.
Over and out.
Was that for him or for you? A little bit of both.
I'm worried about him.
If Peter's abdominal issues are caused by a neurological one, we could be looking at a bleed.
I don't see one.
No evidence of a stroke, either.
But his ventricles are a little Too little.
His brain is swelling.
Now, if we don't figure out why and the swelling worsens, I'll have to perform a craniectomy to relieve the pressure.
Cutting a six-year-old's head open on an "if.
" Of course not, but if things move south quickly, we have to be ready to move to the OR.
Fine, but let's keep in mind the risks aren't just bleeding and infection.
There could be permanent brain damage.
We need to figure out how to avoid surgery altogether.
Let's start Peter on meds to lower the pressure on his brain immediately, hope they work and move him to ICU.
Yes, that sounds like a plan.
Well, why didn't you tell me you were taking all of these? Oh, I did, dear.
Every time I added a medication.
But you can't be expected to remember all these.
I-I forgot all of them.
Multiple medications, called polypharmacy, is associated with adverse outcomes, particularly as we age.
They interact, causing falls, drug reactions, and can even lead to increased mortality.
It all started with the arthritis.
The ibuprofen wasn't doing anything, so a doctor put me on prednisone.
Well, that gave me heartburn, so he gave me omeprazole.
But then that made me nauseous, so they added ondansetron for my stomach.
That made my heart flutter, so they gave me metoprolol, and then my legs started to swell, so they gave me furosemide, and that's when I stopped walking very much, and, uh, my blood pressure shot up, so they Should I keep going? practitioner to the ER, please.
Nurse practitioner to the ER.
Double shift? Actually, I'm just starting.
Been having a hard time sleeping.
- Oh, that sucks.
- Yeah, tell me about it.
Oh, um, Leela told me about your mother.
How is she? Sorry, it's it's none of my business.
No, it isn't.
But it's nice of you to ask.
She just moved in with me on Saturday.
It's been good having her close.
And how are you? Well, I'm trying to resist the urge to check my home security camera every five minutes to see how she's doing.
Okay, well, actually, I'm not resisting.
Would you look at this woman? She's out there gardening.
Are those rhododendrons? A little pink for my taste, but she loves them.
I'm leading a meditation at 3:00.
- Join us.
- Maybe I will.
- So, how are you? - Great.
I just injected my sister with hormones so she can donate her eggs to me and I can be a mom.
Hmm! Oh, wear something comfortable.
So they put her on hydrochlorothiazide And that made Gloria feel fatigued.
So they gave her methylphenidate.
Which could have had a negative interaction with the linezolid that she was taking for that cellulitis.
Or the zolpidem or quetiapine, which Gloria was also on.
What are we even doing, Dr.
Pravesh? We're looking into all contraindications.
But she is a sick older lady who needs these drugs.
Like, which do you even stop? We move carefully, removing one by one.
No.
This is over my head and, honestly, kind of boring.
I need to find a surgery to observe.
I thought you were going into primary care.
No.
I want to be a surgeon.
It's exciting, and you fix problems that are actually fixable, not buff up old people until they die.
You don't think people die on the OR table? They do all the time.
Not everything is fixable with a knife.
You get that, right? You can fix things with your brain.
Excuse me, have you met me? I read that surgeons don't actually have the highest IQ, and I thought, there, that's my specialty.
Hmm.
This woman needs us, and Dr.
Kravitz needs her.
So if you're not interested, I say go hunt down Dr.
Austin and see if he'll let you into his OR.
But be aware that he will not consider it for one nanosecond when I tell him you deserted this patient.
Okay, I will stay.
But don't tell him about that IQ thing, either.
I want to go with him.
You can't, honey.
He needs special care in a special part of the hospital.
You mean he's really sick? You fix people.
- You'll fix him, can't you, Daddy? - Spencer.
I'll be right there.
What's happening? His daddy is scared.
You have to save Peter.
I got him.
I got him, I promise.
He seems much worse.
Please tell me you have some news.
We gave him another round of meds to lower the intracranial pressure, but it'll take time if it works.
He was hurting, and I totally missed it.
I get guilt, believe me, but it is not earned here.
Help him.
Please.
We're doing everything we can.
Uh, just I don't want anybody cutting his head open.
Not if we can avoid it.
Understood.
You all right? Now I feel guilty, about how lucky I am not to be in Spencer's shoes.
Peter has to make it through this.
- I know.
- And Gigi, she lost her mother.
She can't lose her best friend.
We have to make sure they both come out of this.
Uh, Dr.
Hawkins! Vomiting means his intracranial pressure must be rising.
I'm a little confused.
- I'm sorry.
- So the metoprolol helped your heart, but it also lowered your blood pressure.
And with all the water pills you were on, plus the stimulants, your heart rate sped and BP lowered, which caused you to lose consciousness.
Other doctors have been telling me that these meds are saving my life, and you're telling me - the opposite? - No, just listen to them, hon.
They want to take you off medications you may not need, and-and keep you on ones that are working.
But we'd like to keep you here to monitor you while we do it.
But it's just for a day, and then, um, you'll go home.
- There's hope for him yet.
- Mm.
Thank you both.
We've given Peter the maximum doses, but he's he's not improving.
Well, time to book an OR.
No, let's just start with a drain before you open his head.
Okay, we can try it.
I'll get an EVD monitor.
- Talk to me.
- We're putting in a drain.
It should help relieve the pressure on his brain.
It's a first step.
I don't know how much longer we can put off a craniectomy.
It's my son.
Let's take everything one step at a time.
Right now, we need to sedate and intubate, and to protect his airway.
I have to talk to him first, before you, before you Of course.
Of course.
Hey, bud.
I just want you to know I want you to know that every second that you're asleep, I'm gonna be right here beside you.
Deal? Okay.
Hey, there she is.
So, how'd it go this morning? The hormone shot was fine, but this is not.
Look.
Padma picked a donor, but I did a little bit of digging into this sperm bank.
It's facing three lawsuits from families who claim their donors misrepresented themselves.
In one case, the family alleged that the donor had an undisclosed history of schizophrenia.
In another, a donor covered up a criminal record.
Some claim college degrees when they're really dropouts.
These families were lied to.
Yes.
About the biggest decision they'll ever make.
The genes their kids will share with its father.
Yeah, but, I mean, this is just a few cases out of how many, right? I mean, I had a lot of friends in med school who donated.
They were good guys, they just needed cash; they wanted to help.
Is this your way of saying there are little Devons out there? If it helps, every single one of these donors had to undergo genetic testing.
There is no test to show whether you're a pathological liar, have a mental illness or a criminal record.
- And you're missing the point.
- No, I get it.
Sperm banks are unregulated.
The FDA requires that donors are tested for infectious diseases, but beyond that, nothing.
Their bios aren't even verified.
That may work for some people.
There are amazing kids out there from anonymous donors, but that won't work for me.
- This is my egg.
- Hey, babe You have to accept that this is Padma's choice.
Well, I need to make sure she knows what she's choosing.
We'll talk later, okay? - Are you hot or cold? - Both.
Okay, don't worry, we're gonna help you.
She's in A-fib and hypotensive.
A-fib could be because we took her off metoprolol.
Let me check if her pressure dropped before she slipped into arrhythmia.
I-I was here.
Her BP started to fall first, then her heart rate spiked.
Peritonitis? Gloria, tell me where it hurts.
- Rebound tenderness.
- This has nothing to do with the meds.
She has an acute abdomen and she may need surgery.
Let's get her four of morphine.
Hang pressors and page Bell.
Hey, hang in there, okay? Where to begin? Gloria has three lumbar compression fractures from osteoporosis.
And a hiatal hernia.
All incidental findings.
Consequence of living for eight decades.
So here's today's problem.
Colonic perforation.
No wonder she was in so much pain.
And no idea what caused this? It couldn't have been the fall.
We thought she passed out from too many meds, but something else was going on.
We just don't know what.
Well, what we do know is that without surgery, Gloria won't make it.
You're talking about a surgery that's dangerous at any age, and with Gloria nearly 80 Well, we'll be sure to be very clear with her about what we're facing here.
But I agree with you.
It's the only option.
Okay.
At least she's in the best hands.
Well, I've had success with patients older than her, much sicker.
I really hope she's one of them.
So you think "The Right Stuff" is secretly - some sort of axe murderer? - No.
I'm just saying we can't - really be sure who he is.
- Okay, look, I really appreciate you being protective of me, but there's no guarantees with kids.
I mean, look at us.
What, there's a one-in-a-million chance of having twins? One in 250.
And we are proof that a random genetic accident can be the best gift ever.
Look, I can't give up on being a mother just because there's risks.
I don't want you to.
I just want you to be aware of what those risks are.
Which is why I asked Dr.
Nolan to join us.
What's up, ladies? Show her what you showed me.
Oh.
"Dream Doc"? I don't understand.
- It's him.
- It's me.
You're six-foot five? I do slouch some.
And fluent in French? Yeah.
Je suis Rosetta Stone.
- Trombone prodigy? - I got a standing ovation at my ninth grade recital.
- Just think about it.
- Mm.
Think about what? Surgery? Sounds dangerous.
Yeah, I'm not gonna lie to you.
It is.
But it is the only option.
And without it, you may only have days.
Maybe a week.
I'm sorry.
Y-You always say how e-easy choices are your favorite.
I wish I could offer you more time to make this decision.
But the sooner you operate, the better my chances are? Well, then, I'm ready.
Arthur, I'm sure everybody over at Brookhaven is worried.
You think maybe you could go call them - and fill them in? - Oh, of course.
Any-Anything, darling.
Yes, Brookhaven.
Update, update Brookhaven.
Update Brookhaven.
I can't leave him.
- He needs me.
- Oh, I I get it.
You have got to be better than you have ever been.
Neither one of us have children.
Not even siblings.
It's just the two of us.
He has no one else.
I have no one else.
Do you know what it's like to find the love of your life this late in the game? Actually, I do.
And when the day comes, and he forgets my name, I won't even care.
I'll fill in that blank, 'cause he'll still love me.
And I'll love him.
To the end.
Just don't let it be today.
Okay.
His intracranial pressure is still rising, and we're not sure of the cause.
The MRI didn't show any tumors or blood clots in his brain.
So what does this mean? That the drain wasn't enough.
Mr.
Shafer, we have no choice but to proceed with the craniectomy to relieve the pressure in Peter's brain.
My God.
I can't believe this is happening.
There must be something else you can do.
If we wait any longer, he's at risk of brain damage.
Treat him like he's your child.
Would you agree to this if it was Gigi? Spencer, give us a minute to review.
- Tell me there's another option.
- There isn't.
What he just said in there won't help Peter.
Keeping your objectivity will.
You have to.
I'm sorry to interrupt, but the preschool's been trying to get in touch.
Gigi needs you.
Do what you have to do to reduce the swelling.
Hey.
She's been like this since Peter left this morning.
She won't eat or talk.
- Thank you.
- Yeah.
What is that? A space helmet for Peter.
If he goes into space, he can't die.
Is he gonna die, like Mommy? I'm fighting for Peter.
- I'm scared.
- I know.
That's okay.
I knew he was sick when he didn't want to eat my sandwich.
We trade.
He always eats my sandwich.
When his mommy left, his daddy started making his lunch with roast beef.
After he ate it all, his tummy started hurting.
Did he eat your sandwich this morning? No, Daddy.
Craniotome to me.
I've done this a hundred times, but rarely on a child.
You're more than qualified.
Watch for bleeding, be gentle.
When I pass through bone, I stop.
Now, let's get started.
Wait! I think Peter has urea cycle disorder.
It's a genetic enzyme deficiency that makes it hard for people to break down protein.
Whenever Spencer packs his son roast beef, he trades it away because it makes his stomach hurt.
I think sharing his dad's protein shake this morning gave him more protein than he could process, and his body was already under stress from his recent cold.
Talk about a zebra.
Urea cycle is extremely rare.
But it would explain all the symptoms.
Let's get him back to the ICU, start him on dialysis, clear the ammonia.
Yeah, but do we have that kind of time? The odds you're right are vanishingly small, and if you're wrong, this boy's brain continues to swell, which will cause him permanent damage.
We need to operate now.
A craniectomy is a gamble, too.
At the rate the swelling is worsening, best-case scenario, what, it buys Peter days? It doesn't fix the problem.
That is true.
So let's do both.
Dialysis right here.
We can watch his ICP.
If it doesn't drop, I'm ready to start a crani immediately.
I'll be right here when you wake up.
Okay, this is as far as you can go.
I love you.
I love you more.
Okay.
Wire, please.
Dilator.
All right, we're almost there.
All right, catheter in.
If you're right, the pressure should trend down once the proteins are filtered out.
Yeah, well, it's not gonna happen immediately.
If that number doesn't come down soon, I start.
Whether I want to or not.
We're working through some unexpected adhesions.
Did Gloria mention anything about prior surgeries? None.
Any sign of the perforation? Running the bowel now.
There's no sign of widespread ischemia.
- Oh, there it is.
- Can you repair it? Well, the surrounding bowel is thickened with extensive lymphadenopathy.
It sounds like whatever's going on caused significant inflammation.
I should be able to repair the perf, but, you know, this didn't happen overnight.
It's been going on for years.
Bowel inflammation is extremely painful.
Her daily steroids must have been masking it.
See the big picture.
Dr.
Kravitz told me in geriatrics you always gotta keep your eye on the big picture.
What if the arthritis and the bowel inflammation are all part of the same disease process? It's possible.
If the side effects of her medications were actually symptoms of the underlying issue.
We've been looking at this all wrong.
Let's get back to Gloria's prescriptions and see if we can't get her some answers when she wakes up.
It just keeps rising.
Can we dialyze faster? Any faster and his neurons could shear from diffusion.
Just give it a minute.
Conrad, this is the brain.
A minute can be the difference between life and death.
Just give me one more minute.
We don't have good choices here.
- Billie, we're on the same side.
- But this is my OR.
- It dropped.
- Wait, Dr.
Sutton.
That number's still dangerously high.
It worked.
You ready to close? Sure am.
Focus on that still space between our inhale and our exhale.
Please remember to silence your devices before we begin the class.
- I seem to have gotten turned around.
- Okay.
My wife is in surgery.
Can you direct me to the waiting room? Uh, here, let me show you.
The cavalry has arrived.
77-year-old woman with a bowel perf.
Pressure started tanking.
At first I thought it was peritonitis, then I saw her neck.
I need ultrasound now.
Any idea why she might be in tamponade? No idea what the underlying issue is.
Right now, we just need to get her off the table.
Start another epi and bolus a liter.
There's fluid around her heart.
We need to prep her for pericardiocentesis.
Okay, I'll finish up so I can assist.
All right, but if she doesn't stabilize, Bell, I'm gonna have to crack her chest open.
Oh, God, let's hope not.
Oh, man, I can't wait to tell 'em.
Hey, we figured it out.
Gloria's medications didn't cause her problems, but they masked an underlying one: Whipple's disease.
That's what caused her arthritis, weight loss, fatigue.
And steroids that her doctors first thought was arthritis only made it worse.
She told us that they increased her dose, leading to the perf.
Now all Gloria needs is an antibiotic.
We can take her off of - almost everything else.
- She didn't make it.
- I'm sorry.
- What? She She developed cardiac tamponade, which was probably the final complication of her undiagnosed Whipple.
And Austin was working to place a pericardial drain when she coded.
We did five rounds of CPR.
More than I should have on a woman her age.
It was a tough one.
Now, if she'd been treated properly, or if she'd gotten to us sooner, maybe we could have done something to turn it around.
But today it was just far too late.
Dr.
Kravitz Kit is his friend, so I will call her to tell him.
Even if we had diagnosed her sooner, Gloria's disease began years ago.
There's nothing we could have done.
Gloria wasn't just another fragile old lady.
She was strong, in love.
She deserved more time.
But every doctor looked at her like just another lost cause.
No one cared enough to see that by just treating her symptoms, they were actually making her worse.
No one saw the bigger picture until you did.
Reconsider going into gerontology, Zach.
You may have a gift.
I am so sorry.
I'm so sorry.
Look what I made you.
Wow! Hey.
So we'll continue dialysis until we lower his ammonia levels, but with some attention and lifestyle modifications we can manage this.
You will need to look out for any signs that his ammonia levels are up.
Sluggishness, nausea, vomiting.
Avoid extreme temps.
Keep him hydrated and on a low-protein diet.
No more roast beef sandwiches.
He'll do great.
I can't thank you enough.
Well, we did have help.
How would you two like a surprise? What is it, Daddy? What is it? Wow! It's beautiful.
Nolan as a sperm donor? Our Nolan? - Yep.
- Ooh.
- That put the fear of God in me.
- Yeah, I bet.
But the eggs are gonna be retrieved in about two weeks, which means I need a volunteer, fast.
Someone I trust, someone I care about.
What are you gonna do? Actually, um, I had a crazy idea.
You and I are good friends, now that we aren't lovers, and I wouldn't mind a kid a lot like you.
You could do worse.
So what if I did have a kid just like you? You want me to be your sperm donor?