The Resident (2018) s05e18 Episode Script

1
Previously on The Resident
The leg issue is a little MS flair-up.
Take the pressure off the leg with this.
No, it's a concession to the
disease, and I won't make it.
Look, man, I'm preparing
for my mother's passing,
and when she does, I don't
know what I'm gonna do.
163 anti-psychotic prescriptions
written in your name
at six different clinics.
No, I didn't do this.
The Mafia is often involved
in Medicare fraud.
And we now have mob levels of violence.
Doctors who assist in our investigations
have been murdered.
- I can't believe this.
- Believe it.
26-year-old male found down
at Piedmont Park,
overdosed on olanzapine.
We were able to bring him back,
but found this on him.
It has your name on it, but records show
- you never treated him.
- Because I didn't,
just like the overdose
from a few weeks ago.
This prescription is from the
same pharmacy as the last one.
Think it's a coincidence?
No.
We're just closing.
I'm a doctor at Chastain.
A patient came into our ER,
overdosed from a drug
he got at this pharmacy.
It lists me as the prescriber,
but I didn't write it.
I'm so sorry to hear that,
but I'm not sure how I
can help you, Doctor ?
Hawkins. This isn't the first time.
Do you know who's prescribing these?
I honestly thought they were yours.
I didn't realize patients
were overdosing.
I just fill the prescriptions
that come in.
Phoebe?
If more fraudulent prescriptions
are being written,
more people could get hurt.
Do you have any idea what's going on?
Wait here.
Let me go pull some records.
Who was that?
What are you still doing here?
Was he asking questions?
No. He was nobody.
Just a patient wanting a refill.
His credit card didn't run,
so I'm pulling his records.
- Hello?
- Your pager was off.
Go Team's been activated.
Multi-casualty incident,
Abernathy and Lowry.
Well, I'll have to meet you there.
Hurry. We need you. Now.
- Where were you?
- I'll tell you later.
Two cars were street racing.
One lost control,
crashed into this mini-mart.
Two are critical. One is the driver.
- The other is the store owner.
- All right, let's split up.
I'll take this one.
We've tried everything
to move him, but a metal piece
from the door has pierced his abdomen.
It hurts.
Penetrating abdominal injury.
Moving him could cause more damage.
And he's got an open femur fracture.
- EMTs applied a tourniquet.
- He's still bleeding out.
Let's give him some blood,
but we can't wait any longer.
We got to free him.
Grab the buzz saw.
She's still in refractory V-fib.
I'm gonna get an ultrasound.
You have to save my mother.
The car came through the window,
and she pushed me out of the way.
She has a cardiac contusion.
Her heart's been damaged.
We need to start ECPR
and create a makeshift OR.
Got it.
We're gonna cut this piece of metal
that's lodged in your abdomen, okay?
I'll do it. I got the better angle.
Hold him still.
All right, let's get him out
and send him to Chastain.
Get a backboard over here.
We need a backboard!
Let's create a sterile field.
We're putting her on ECMO.
Can you give us an assist?
You sure about that?
She won't make it to the hospital.
You don't know that.
We just need to support her heart.
Let's continue compressions,
give her amio
- and get her to the ER.
- ECMO will work.
It's been done in the field before.
Yeah, rarely. In this situation,
ECMO could make things worse.
She could die in seconds
or end up brain-dead.
Or she lives.
And then you're looking
at a potential cascade
of complications.
Do it. Please.
I don't like it.
Thought you left.
Hawkins paged me. He wanted me back.
Dr. Austin, what an honor to be
on this night shift with you.
Whatever you need, I am your man.
You just tell me what to do.
Don't do anything stupid.
Which means don't do anything.
Auto versus pedestrian.
Found down in refractory V-fib
with cardiac contusion.
- Mom!
- This is her daughter Alicia.
Hey, let's get her out of here.
Hey, Zach, take her to the waiting room.
We cannulated at the
scene. Briefly achieved ROSC,
but she's still in and out of V-fib.
- Bay 11 is ready.
- Wait, ECPR?
You guys went rogue on this.
Never in my illustrious surgical career
have I seen this done in the field.
We had a bit of a debate on that.
It was a risk we had to take.
- Maybe.
- Maybe?
Maybe you both should
get on the same page.
BP's dropped to 70/50.
Going up on norepi.
The daughter wants to know
when she can see her mom.
Oh, that's a great idea.
Why don't you bring her in
right now?
Wait, that noise, that can't be good.
Her IVC's collapsing around the cannula.
Bolusing a liter of fluids.
She's hypovolemic.
She's failing ECMO.
This is exactly what I was afraid of.
Go Team didn't follow protocols.
And now we're expected
to work miracles to fix
all the complications ECMO caused.
We lost all pressures.
I'm dropping RPMs.
We're flying blind without
continuous BP monitoring.
This the kid who was driving the car?
Yes. He's broken both legs.
Penetrating abdominal injury.
Likely has a splenic lac as well.
He's losing too much blood.
No, his sats are plummeting.
He's gonna need to be intubated.
Dicey with his hemorrhagic shock.
He could arrest the moment he's induced.
Step aside.
Hey. Ring that Bell.
Make yourself useful, push these meds.
It's okay.
I got this, Boss Voss,
Oh, man, there go my snow
bunnies. They're brand-new.
This is Jayci Lee, our new
nocturnal anesthesiologist.
I'll be here all night
every night from now on.
So, most people don't like
working nights.
Oh, I come alive when the sun goes down.
That's when I come out of my coffin.
Could it be I'm a vampire?
Well, can we, uh, maybe discuss
your thirst for blood
at another time?
Sats coming back up.
BP is stable as well.
Okay, let's get Max to imaging.
I'll see you in the OR later.
Mm, party.
I'll bring the drugs.
Snatched her from Atlanta General.
She's a superstar. Big get.
Yeah. Keep telling yourself that.
Watch and learn. Mr. Zhou?
How is my wife?
We are working to stabilize her
so we can transfer her to the ICU.
Is she going to be okay?
Touch and go at the moment, but she
Your mom sustained serious
injuries to her heart.
Our doctors had to aggressively
treat her in the field,
and there are complications
we're managing right now.
No. No, Mom.
Don't worry. She has a fighting chance.
We left China with nothing,
built a life here.
The store was her idea.
She's beat long odds before.
She will again.
We'll keep you updated.
- Thank you, Doctor.
- Esto es tu culpa.
¿Y como es esto mi culpa?
Where's my son?
My wife got a call
saying that he was here.
Our son was in a car accident.
Excuse me. What's his name?
Uh, Maximo Camacho.
Dad, those are the parents
of the street racer
that did this to Mom.
He is on his way to CT.
He's not staying here.
We have a VIP room
waiting for him at Atlanta General.
What kind of father gives
a child that fast a car?
Your son ran his car into
our store. My mother may die.
Let's all calm down.
I have to go, but Dr. Brooks here
will get you settled
in separate waiting rooms.
Great.
So just, uh, come with me and, uh,
I'll be back with you guys in a second.
Did you hear her?
Maximo hit someone. That girl's mother.
He's hurt and he hurt others.
This is your fault.
Female, 30s, tachy to 140,
found unresponsive
at the bottom of the stairs
- to her apartment.
- Bay 10.
The neighbor who called it in said
she was acting drunk and hysterical.
Let's move her.
Grab her C-spine.
Hawkins, what's your problem?
This is the pharmacist who
filled the fake prescriptions.
On my count. One, two, three.
What are you talking about?
I went to see her a few hours ago.
That's where I was when
you called me for Go Team.
And you confronted her?
Why the hell would you do that?
There was another overdose.
More pills with my name on them.
You realize this could be
blowback from your visit?
Yes. I'm aware.
Phoebe, can you hear me?
She's not waking up,
but her airway is secure.
No rebound tenderness.
How did she seem
when you saw her earlier?
Calm, ready to help.
Someone could have pushed her
down the stairs.
I hear you.
Or the EMT said she was drunk.
Maybe she fell.
Everything's on the table.
Including an accident.
Normal S1 and S2.
FAST is negative. Let's get a tox panel.
Blown pupil.
She could have
an intracranial hemorrhage.
Page Billie and Leela.
Let's get her to CT now.
Intracranial pressures rising fast.
Must've been a really bad fall.
We have to drill now.
How's our pharmacist doing?
Brain bleed is worse than we thought.
I hear your prehospital ECMO
on the mom got complicated.
Dr. Austin is handling it.
The pharmacist's labs came back.
Blood alcohol was negative.
She wasn't drunk when I saw her, so
still could be a suicide attempt
or maybe she slipped.
Or again, she was pushed.
Could someone have seen you
at the pharmacy?
No. We were alone.
She left me to find some records,
was taking forever,
I got your call, left.
Why did you go without telling me?
- I need your permission?
- You need my help.
Prescription drug scams
are favored by the mob.
They kill people who threaten
their revenue stream.
That's why we handed this
over to the FBI.
I can't have my name on bottles
of drugs that kill people.
That pharmacist knew something.
Maybe everything. And if
someone saw you with her
All right, you made your point.
If it turns out that I caused
this, will I feel guilty? Yes.
Can I undo it? No.
So now we have to save her.
And contact the FBI in the morning.
Hi, Carol.
Sorry to keep you waiting.
Thank you for making the time.
I feel like I've been such a bother
to everyone for so long.
- Mom
- No. No, you have been no trouble at all.
So, AJ tells me that you're
having some issues with pain.
What's going on?
My bad days are getting worse.
My good days are, too.
She's having pain
across her chest, and it-it's
wrapping around her back.
Sometimes, when I move,
the pain is so sharp
I feel like I can't breathe.
It started a couple of days ago.
Before that, I was doing so well.
Yeah. Yeah, she was.
Last week, she made the most
exquisite seafood paella.
And I beat him in chess.
- Indeed you did.
- Or you let me win.
No, not at all, Mom.
That was a legit thrashing.
I played the King's Indian,
and she overwhelmed my bishop pawn.
Well done.
So, are the pain meds helping?
Some.
But they make me sleepy and confused.
Pravesh.
We have to find out
what the cause of this is.
Maybe there's something we can do.
I-I knew the cancer
was advancing, but
Wow.
I'm so sorry, AJ.
No wonder she's in so much pain.
The cancer has progressed
to her chest walls
and her brain.
An intercostal nerve block
could help her with the pain.
All right, let's get it done tonight.
And I'll take her home.
You understand the prognosis
Yes, I understand
the prognosis, Pravesh!
I'm a doctor!
Do you want me to talk to her with you?
No.
This is on me.
Look, I'm sorry, man.
So, it's something called a nerve block.
It's a minimally invasive procedure
that treats the source of the pain.
So you should feel relief right away.
If I can just go back
to where I was before this.
What?
Um
Well, the scans show that
the cancer is progressing.
And it's-it's now in your brain
and in the bones on your chest,
which is why it-it hurts
so much to breathe.
But the, um, the-the met in your brain
is what's of most concern.
How long?
Son.
- Son, tell me.
- Uh
Maybe a couple of months.
Okay.
Next steps.
We knew this was coming.
Okay, um
Well, I-I'm going to have
to ask some questions
just to make sure
you get everything you need.
Um, what would you say are
your most important goals now?
Leaving here.
Staying home.
With you.
Okay.
And what are your biggest fears?
I don't want to spend any
more time in a hospital.
Okay.
So that means we're gonna
have to talk about hospice.
Don't.
Not yet.
The word scares me.
That's for the
That's just for the very end.
No, no, Mom, it's-it's not. It's not.
No, you can have hospice for months.
It's a great service that most
people wait too long to use.
You know, hospice nurses are better
at managing pain than most doctors.
Okay, we'll-we'll get you equipment
to make you more comfortable,
and there will be a visiting
nurse to check on you.
And I promise you, you will never
have to set foot in this hospital again.
Pupils are equal, round and reactive.
Heart sounds normal.
Brain bleed was evacuated
without complication.
She should wake up any time now.
We'll ask her what happened.
Any luck with her family?
We haven't been able to reach them.
Hey.
Hello, there.
Phoebe, how do you feel?
Where am I?
You're at the hospital. At Chastain.
You had a fall.
Do you remember what happened?
You.
Yes, I remember.
I have to
Phoebe?
She's in respiratory distress.
Her chest imaging was clear.
This looks like Kussmaul respirations.
We need to get a blood gas
and get her on oxygen.
No. Where am I?
She's altered. Let's intubate.
We need a crash cart!
- She hasn't regained consciousness since?
- No.
Not since she went into distress.
She was altered and confused.
Her blood gas shows
a severe metabolic acidosis
that she couldn't compensate for.
Well, her images just came in.
X-ray shows bilateral
infiltrates. That's new.
That could be ARDS.
Or pulmonary edema from heart failure.
This is more than just
trauma from the fall.
Something else is going on.
Well, her head CT looks good.
She hasn't rebled.
I mean, this isn't centrally driven.
Nor a post-op complication.
All right, we'll send out more labs,
check lactate and ketones, get an echo.
Let's figure out why she's
getting worse and save her.
They said he was doing
twice the speed limit.
Drag racing in the middle
of a busy city.
What the hell was he thinking?
What would his parents expect
him to do with a Porsche?
Oh, the usual. Pick up
milk at the market,
help out with carpool.
Oh.
Open fracture of the right femur,
and bilateral comminuted
tib/fib fractures.
I'll have to rod the femur,
ex-fix the rest.
So, grade IV splenic lac as expected.
I will do a splenectomy and penetrating
foreign body removal.
All right, let's go.
You know, we can call another
surgeon to operate with me.
Meaning?
You've had a massive
surgery earlier today,
and now another
in the middle of the night.
It would be a long day for anyone.
The steroids are working,
the MS is under control.
- I haven't even needed the cane.
- Randolph,
I love you, but you can be
a stubborn old so-and-so.
I am allowed to worry, and
notice when you're exhausted
and holding yourself upright on a desk.
Yeah Okay.
Yeah, am I sore? Yeah.
But if I need relief, I'll tell you.
All right. Eileen's labs are all
trending in the right direction.
She didn't have any other injuries.
Just the cardiac contusion.
She still needs ECMO support,
we don't know
when she's gonna wake up,
but overall, I'm hopeful.
Can we tell her family?
They could use some good news.
- Let's get her up to the ICU first.
- Okay,
let's prep for transfer, people.
This is no small feat.
Get her on the portable monitor.
Disconnect the vent.
Start bagging.
Put the ECMO machine on the bed.
Watch the cannulas, hon.
Put pressure now! Stop the bleeding.
Starting compressions.
You tore her artery.
I didn't mean to.
Hundley, page Austin.
We have to recannulate here,
then get her to surgery
so we can repair the artery.
- What the hell were you thinking?
- Well, I was
Wrong. You weren't thinking.
No, sir. I mean, uh, yes, sir.
Uh, Dr. Austin,
that other stretcher doesn't
seem to be slowing down.
Your finger in her femoral
artery is the only thing
keeping her alive. Figure it out.
- Heads up! Move, move, move.
- On your right!
- That was
- The bare minimum.
Now, listen, I have no time
for the stupidity
for which you are prone,
so from here on out,
you do not talk, you do not move
and you do not breathe
- unless I give you express permission.
- Yes, sir.
I'll step it up.
That was not me giving you permission.
Have wanted it this way ♪
Thank you.
I do believe I'm feeling
stronger every day ♪
Who put that there?
Borrowed it from
the ophthalmic surgeons.
They rarely work nights.
Your throne, Dr. Bell.
The time has come ♪
For both of us to live on the run ♪
Oh, yeah, oh, yeah ♪
Everyone comfortable?
I do believe I'm feeling
stronger every day. ♪
This doesn't make sense.
Phoebe's osmolar gap is decreasing
while her anion gap is increasing.
But her lactate is normal.
Along with most of her other labs.
But she's starting
to go into renal failure.
We're running out of time.
Whatever is making Phoebe worse
is literally undetectable.
What if it's because
you can't actually see it?
Is there a Wood's lamp here?
No, but we can use my phone,
some tape and blue and purple markers.
Nice.
- Here's tape.
- Place it over the light.
Two more.
And there's our makeshift black light.
Used it once at an escape room.
An escape room, huh?
Let's give it a try.
Turn off the lights.
Moment of truth.
There, around her mouth.
Fluorescein.
Some more around her fingers,
which means if she consumed
something, we'd expect to see
Fluorescent urine.
We can confirm what this is at the lab.
Yeah, but there's no doubt,
she was poisoned.
You were right.
Someone tried to kill her.
Intramedullary rod in place.
Ligating the splenic artery
and vein near the hilum.
Not good. Max is desatting fast
and becoming hypotensive.
- It's not a bowel perf.
- No torn vessels here.
Pressures dropping fast.
What do you got, Dr. Lee?
It's auto-PEEP. Air is
trapped inside his lungs,
- compressing his heart.
- And the vent's not letting it out.
- So you'll change the settings?
- It won't be enough.
His cardiac output is dropping.
I'll disconnect the vent
- and readjust the setting.
- He won't be breathing
- or getting any air.
- It's dangerous and unorthodox.
Yeah, it might work if you move fast.
We can help by, uh, pushing down
on his chest and getting out
some of the air.
All right, team.
Disconnecting the vent.
Okay, push.
Lowering respiratory rate
and tidal volume.
Increasing I: E ratio.
And boom, we're done.
He's stabilizing.
That's a brilliant save.
He's coming around to me. Inevitable.
There's another surgery. Dr. Lee,
you're the only anesthesiology
attending on call.
I'll get a CRNA to cover here.
All right Go ahead. They need you.
Of course they do.
Hey, thanks for the assist.
Yeah. Who was the klutz?
- My money's on the med student.
- Intern, actually.
Huh, and you might need a new career.
You know, comments like that
can cause long-term damage.
Toughen up, snowflake, or you'll
never get through residency.
I'm gonna scrub in.
Keep an eye on this one.
Good save. Uh
I guess I'll get scrubbed in, too.
You will do nothing of the sort.
You had one job and you blew it!
Get out of my sight, now.
No, in fact
I want you to go to the waiting room,
and you explain to this woman's family
why she's even in the OR.
And you give them every last detail.
Any news on our son?
Uh, he's still in the OR.
Our-our surgeons are doing their
best to repair his injuries,
but his leg is shattered
in multiple places.
W-Will he walk again?
Please, he's only 17.
Teenage boys are stupid,
but don't let him be crippled for life.
At least he has a life.
My family may not be so lucky.
Let's go somewhere else.
So they don't have to face us? No.
Look at us.
See our pain.
How's my mother?
There's been an accident with Eileen.
What do you mean?
What accident?
Uh, she was getting better,
and now there's a hole in her artery.
It was my fault.
I tripped on the cannula,
it tore and she's in surgery.
I am really sorry.
Please, go ahead, yell at me.
I deserve it. I feel just terrible.
The fault is ours.
I bought him that car.
It should have been me
who got hurt at the store.
Mom wanted me to work the register.
I refused.
We started fighting.
I said something awful.
Turned to go.
Mom pushed me out of the way
right when the car
It was Max's birthday.
Miranda warned me.
I begged you not to buy that stupid car.
I-I grew up poor.
I wanted him to have
everything I never had.
We came from Colombia two decades ago.
I-I know how hard it is to build
a life from the ground up.
When this is over,
and, God willing, everyone is okay,
we'll help rebuild yours.
Thank you.
But I'll believe it when I see it.
You'll feel a tiny pinch.
Is that the numbing medicine?
That's right.
I'm at the inferior aspect of the rib.
Ready for contrast and phenol.
How long will it last?
Several months.
But if this pain recurs,
we can discuss next steps.
It'll be enough.
Uh, listen, um
my mother and I want to thank you
for the exceptional care
that you have provided.
You've been nothing short of remarkable.
You've helped with some
really tough decisions
and you have shown me the power
of compassionate comfort care,
and-and I just want you
to know that it means a lot.
It makes all the difference
in the world.
And I know my mother will
hold all of you in her heart
with the time that she has left.
It's Eileen.
Mom.
I love you,
and I'm sorry for everything.
I shouldn't have fought with you,
I should have been the one
No. You are the light of my life.
I'm happy you're okay.
Darling, we were so scared.
We thought we might lose you.
How long will she need this machine?
Well, that depends
on how her heart heals.
But we're already seeing improvement.
And the store?
- Damaged.
- Oh
But we will rebuild.
It'll be even better.
This time, can we get
the shaved-ice machines?
Dr. Austin, please, I just
wanted to apologize again
Have I mentioned that
you are quite possibly
the least promising intern
to ever sully the halls of Chastain?
- Don't say that. I really want to be better.
- Don't interrupt me.
Now, I happen to know there
have been far worse interns
who have gone on to become fine doctors.
You owned up to your mistake.
That's a rare, almost extinct virtue,
and for that, I will not
kick you to the curb yet.
Thank you, oh, thank you.
Does this mean, uh,
could it be that you'll
let me back in your OR?
I promise not to do anything stupid.
Yeah, well, don't make
promises you can't keep,
and I won't, either.
So the answer is maybe.
We were able to repair
your lacerated spleen
and your broken legs.
In a few weeks,
you should be able to start
working on getting on your feet again.
Thank you.
Do you remember what happened?
I drove too fast.
I lost control.
On a city street, putting
other lives in jeopardy.
I'm ashamed.
Is that what you needed to hear?
We will need to hear
a lot more than that.
You won't be driving
anything again for a long time.
But I-I'm ashamed, too.
For putting you behind
the wheel of that car.
We love you.
Always.
But you and I both share
a responsibility for this.
And we'll be helping the family
that you harmed to rebuild.
Both of us.
Octahedral and needle-shaped crystals
in the urine, characteristic of
poisoning with ethylene glycol.
Commonly found in antifreeze,
it has an additive
that fluoresces under UV light.
It's a perfect murder weapon.
Odorless, colorless, sweet,
masks as alcohol.
- Someone made her drink it.
- She tried to get away
Yeah, and she fell down the stairs.
There is an antidote.
We can save her with fomepizole.
And we have proof for
an attempted homicide.
Let's get security to guard
her room immediately.
It's room 3350.
Hey.
What are you doing?
He disconnected the vent and
turned off the heart monitor.
No pulse. She's not breathing.
- I'll start bagging.
- Call a code now!
Starting compressions.
Code Blue, room 3350.
Code Blue, room 3350.
She was gone by the time we got there.
She wasn't breathing.
And her heart had stopped.
We tried
But we couldn't bring her back.
I caused this.
You didn't.
She wasn't killed 'cause you
walked in asking questions.
She was being blackmailed.
Forced to not check prescriptions.
So, Phoebe agreed to wear a wire for us.
Someone must have found out.
The Mafia always takes retribution.
That's why they killed her.
This is even bigger than we feared.
We got a good look at the killer.
And he got a good look at you.
You'll have to make a decision.
Are you gonna leave Chastain?
I don't want to.
We don't want to lose you,
but if you're in danger
"We"?
Chastain.
All of us.
We got into it a bit today.
Yes, we did.
Friends again?
Always.
I love working with colleagues
who have strong opinions.
Me, too.
To a point.
Ditto.
You made a questionable call
in the field; I did, too.
From this point forward,
we have each other's backs.
Whatever comes of this,
we fight this together.
I want to thank you for
agreeing to hospice, Mom.
I think you're going to like it.
And this here is Janaya Purcell.
She's your hospice nurse,
and I think you're going
to like her, too.
Lovely to meet you, Janaya.
Call me Carol.
Let me help you with that.
So, your son had me set up
everything for your return.
- Mm.
- And
this is your new bed.
The head and foot both go up and down,
and there is a railing on one side
that you can use to help
you get out of bed.
But it's out here? Not a bedroom?
Yes, your son wants to have you near,
and it's closer
to the bathroom and kitchen.
I put it by the window to the garden
- so you can watch the birds.
- Ah.
And this is your chair.
One button and it tips up
so you can get up.
It's really a beautiful home.
Yes, I'm very happy here.