A Gifted Man s01e09 Episode Script

In Case of Abnormal Rhythm

Gina, you have done it again.
- And that's just the East Coast.
- Mm.
Michael Holt invents a new instrument, everyone wants to get their hands on it.
Hmm, bet you say that to all your neurosurgeons.
Only the one who keeps me in Armani.
You going to fly home to DC tonight? I'll be back in two months.
You have time for dinner? Already made a reservation at Per Se.
Swing by and get you at 8:00? See you then.
Shall I cancel your lunch? Hate to spoil your appetite for tonight.
Not possible.
This will.
The Clinica called three times.
Said you're late for your shift.
Tell them I'm on my way.
Hold on, Romeo.
You have a last-minute consult in Exam Two.
- Rachel Lewis.
- New patient? You treated her mother Eileen for a slipped disc three years ago.
She sent you Yankee tickets to thank you.
Yes.
Sat front row behind first base.
I caught a pop fly.
Oh, yeah.
Of course you did.
What's up with her daughter? She passed out right in the middle of her bridesmaids' brunch.
It was terrifying.
Mom, it wasn't that big a deal.
I'm getting married Sunday.
Take a deep breath.
She's a little wound up.
Rachel is trying to play this down for you, but when she stood up to give a toast.
she crashed to the floor.
I was just a little dizzy, that's all.
She has also had a headache for three days straight.
But it's gone today.
I'm fine.
This headache where was the pain? Everywhere.
Felt like my head was being crushed in a vise.
Any double vision or nausea? No.
Any weakness in the limbs - or numbness? - Nothing.
See, Mom, it's not a brain tumor.
It could be any number of conditions that could be causing these symptoms, starting with the stress of your wedding.
So will you still run some tests? Yeah, let's do an MRI, Ugh.
some labs and, uh, try to take a breath, relax.
Your wedding should be fun.
Mine was.
Tavo, will you give Mrs.
Pence one of our starter diabetes kits and extra syringes till she has time to get to the pharmacy? Will do.
Where's Holt? We got more than a dozen patients waiting here.
Autumn, any word from Dr.
Holt? - I've called him three times.
- Try again.
- Here you are.
- Thanks.
That's quite a shiner.
How come you don't have any lollipops? Uh here.
These are better.
Raisins? They're good for you.
Raisins suck.
Okay.
Can I help you? Hi.
I teach first grade down the block, and I was just wondering if I could see somebody real quick.
- What's the problem? - I don't know.
I just feel cruddy.
Well, you're in luck.
We treat "cruddy" here.
Just fill this out, and we'll be with you as soon as we can.
MRI's clear, labs are normal, and EKG looks good.
Then why did she faint? What about the headaches? Uh, fainting's probably from just not getting enough to eat.
Headache is probably just tension.
Let me give you a prescription for Naproxen to get you through your honeymoon.
Now, get out of here and go get married.
Mom? Eileen, you all right? I'm fine.
Whew! I guess all this is harder on me than I thought.
Seeing your father with his child bride Rita, get me a nurse! I can't catch my breath.
What's wrong with her? Her pulse is thready and her heart's racing.
What do you need? Get me a crash cart! Grab a pillow.
Hang on, Eileen.
Season 01 Episode 09 December 2, 2011 - Is it a heart attack? - No.
Her heart rate's up to 180.
It's what we call atrial fibrillation.
What on Earth is that? It's when your heart beats abnormally.
The electrical impulses at the top of your heart are out of sync with the ones at the bottom.
That sounds serious.
It can be.
We need to admit you to Manhattan Memorial right away to start you on a blood thinner.
I can't go to the hospital.
We have her dress fitting this afternoon.
You need an echocardiogram first to make sure there's no underlying cardiac damage - causing the arrhythmia.
- So she could've had it - for a while without knowing? - Possibly.
A-fib is more common the older you get.
What causes it? Heart disease, stress, even alcohol.
Well, we know it's not alcohol.
My mom's been sober for 15 years.
Right, Mom? Eileen? Have you had a drink today? Um, I may have had a few sips of a mimosa at brunch.
You what? They gave me one with champagne by accident.
It's no big deal.
Have you had anything else to drink in the past few days? Mom, please tell him no.
It's been going on for a couple of weeks.
It started with a glass of port before bed, and it just got worse.
Well, that certainly could cause the A-fib.
Drinking after so many years of being sober can bring on an attack.
How could you? You sat on that bench in Central Park when I was 13 and promised me you'd never touch another drop of alcohol.
Sweetheart, I'm sorry.
Can you take this thing out of me, please? Eileen, you're in no shape to Please! I've screwed up.
I need to talk to my daughter.
You walk out of here right now and you could die.
Honestly, I'm feeling much better.
The fluttering is gone.
Check my heart.
- Well? - Yes, your heart rate's fine.
But A-fib can come and go.
This puts you at risk for a heart attack or a stroke.
You need to be in a hospital on a Heparin drip to thin your blood.
I'm leaving.
And you can't stop me.
You're right, Eileen.
I can't tie you down, hold you here.
If you want to do something that stupid, there's nothing I can do about it.
Isn't there anything you could give me, please? I just want to see my daughter in her dress.
Yeah, I could give you a shot of Enoxaparin.
It's not my first choice 'cause it doesn't work as fast as Heparin, but if you insist on leaving, that's the best I can do.
I insist.
So, as soon as you've talked to Rachel, you're going directly to Dr.
Eastman.
He's a cardiologist at Manhattan Memorial right next door.
I've called him and he is expecting you.
You have my word.
Thank you, Dr.
Holt.
You're welcome.
You have a wonderful boss.
Let me guess, someone's leaving against medical advice.
From now on, all family members stay in the reception area.
Sorry to keep you waiting.
We're a little understaffed today.
One of our docs is in Philly playing with his band, and the other one is well, don't get me started on him.
Yeah, what about him? Other than having an ego the size of Wyoming? He's, uh, an hour and a half late.
Anyway, what's going on with you? You don't look so hot.
I have a sore throat, maybe a fever.
I thought it was allergies, but my principal made me come in.
Yeah, you do feel a little warm.
Anything else going on? No.
I'm sure I just picked up something from my kids.
My school is one great big petri dish.
Well, it's probably a viral pharyngitis.
But I'd like to do a rapid strep test just to be sure.
How long will that take? Just a few minutes.
All right, open up and say aah.
Aah.
There we go, all done.
Those for your students? Yeah, we're having a fall festival in class tomorrow.
You have school on Saturday? Tomorrow's Tuesday.
No, tomorrow is Saturday.
Today is Friday.
Oh, you're right.
What am I thinking? All right, I am going to run this test, and I'll be right back.
Would you mind calling my boyfriend, Hank? I've been trying him all morning, but he's not at work.
Maybe there's something wrong with my phone.
Sure.
Can you write down his number for me.
That's strange.
I can't remember the number.
Well, well, well.
Dr.
Punctuality.
- Nice to see you too, Sunshine.
- Hold on.
Dr.
Sykora wants all her employees to clock in now.
Her employees? She wants to keep track of how many hours everyone's working.
Really? All right, now all together, let's breathe in forgiveness.
Deep breath.
And on the exhale, let's focus that breath and let's send love to yourself and to someone you care about.
Brother Mike.
Come on in, join us.
Surely you must have some forgiveness work to do.
Surely you must be joking.
Oh, Dr.
Holt, fashionably late for work? Even though you only work here ten hours a week.
I had a patient in rapid A-fib.
So what's the deal with Anton's little séance across the hall? You know, I brought him in to do carpentry.
It's part of our new meditation program.
We're also going to offer nutritional classes, yoga.
No leeches? I hear they're making a comeback.
Oh, taking a stand against wellness.
I practice evidence-based medicine.
Then you must've read the randomized trial on the effects of Tai Chi on fibromyalgia in the New England Journal of Medicine.
Well, the study wasn't double-blind.
A dozen things could account for the correlation.
Just because we don't know the exact mechanism, doesn't mean there isn't one.
Or is that too much uncertainty for you? So your social worker says I'm on the clock.
Got a patient for me, boss? I've got a lady with the flu, a kid with pinkeye, but, uh, first I'd like you to take a look at a school teacher.
Julia.
Chief complaint, sore throat, temp of 101.
Here strep test just came back negative.
Sounds like viral pharyngitis.
What's the big deal? She's confused.
Did you talk to my boyfriend? Our social worker is trying to reach him.
Julia, this is Dr.
Holt.
I'd like him to examine you.
Dr.
Wyoming.
Excuse me? It's nothing.
Hi.
Does that bother you? Yes.
Hurts.
Look up at the ceiling.
I can't.
It's okay.
Excuse me, folks.
I got through to your boyfriend's office, but they said he's out today on a rock climbing trip.
Oh, that's right, he was going to the Catskills.
Or maybe it was Bear Mountain.
I'm not sure.
Confusion, fever, photophobia, neck rigidity.
It's meningitis.
Or encephalitis.
Either way, she's going to need a spinal tap.
I'll have Rita send someone over to pick up the spinal fluid and run it back to my office.
Autumn, we should start an isolation protocol in case it is meningitis.
I'll call her school and tell them they may have been exposed, too.
- Anyone else need to be notified? - Department of Health.
We may need prophylactic antibiotics for everyone at school or here who's come in contact with Julia.
We got to get her out of there! So what does it feel like to be a second grader? It's cool.
Julia, you shouldn't be out here.
Oh, Miss G's not bothering us.
She used to teach my son last year.
Why did I come out here? Come on, Julia.
What's happening to me? Let's just get you back to your room.
I need my boyfriend.
I need to call Hank.
I can't remember why I'm here.
Until we know what's wrong with Julia, nobody comes in, nobody leaves.
Excuse me.
Listen, everyone.
Sorry, I'm sorry.
I know that you have all been here for, like, two hours, but we just can't let anyone leave until we get the results of the meningitis test.
That really sucks.
Hey, deep breaths, friend.
Keep it cool.
Come here.
Kate, I made calls to Catskill Park, Bear Mountain, Adirondack Park, and all of them said there's no way we can track down Julia's boyfriend.
Call the state police.
Tell them he may have been exposed to meningitis and we need to pick him up before he infects others.
How's Julia? Still altered.
Otherwise no change.
Does she remember where Hank was rock climbing? Yeah, Connecticut, Massachusetts, New Hampshire, Pennsylvania or Maine.
That narrows it down.
It's Rita.
Any news? Good news.
Julia's spinal tap is negative for meningitis and encephalitis.
Really? Okay, read me the results.
Two white cells, four red cells.
Gram stain negative.
You read both pages? After six years with you, Michael, and 20 as an RN, I think I know how to read a lab report.
Okay.
Excuse me.
I'm Rachel Lewis.
I was here earlier today with my mother, Eileen.
Oh, yes, she left to go find you.
She found me.
She came to my dress fitting and we had a big fight.
I said a bunch of things I didn't mean, and now she's not picking up her cell.
Did she say she was going anywhere else? Dr.
Holt made her promise to go see Dr.
Eastman, a cardiologist next door.
Thank you.
Come back for meditation next week.
Bye, Mrs.
Lopez.
Bye, sweetheart.
You're welcome.
Thank you all so much.
I'm so sorry.
Thank you for your patience.
Have a nice weekend, guys.
Thank you.
So, we've ruled out infectious meningitis and encephalitis.
What else is causing Julia's altered mental state? Maybe we should get Anton and meditate on it.
Don't quit neurology for stand-up just yet.
Have you found Hank yet? Not yet.
Is there anyone else that we can call? A friend, family member? No, just Hank.
What are you scratching? I don't know.
You mind if I take a look? Oh.
Those scabs look infected.
How long have you had them? A little while.
I got some bug bites.
Julia, have you ever been camping with Hank? Just once.
A few weeks ago.
Maybe a month ago.
I'm not sure.
Did you sleep in a tent? No, under the stars.
We saw a meteor shower.
It was beautiful.
There were a lot of bugs.
Yeah, I bet.
We'll be right back.
Those bugs could have infected her with any number of vector-borne illnesses.
We should test her for Lyme disease.
And West Nile.
She scratched herself so much, it's hard to even tell what bit her.
Could be an animal bite.
I know what you're thinking, Michael.
Hello? Do me a favor and call my assistant.
Tell her to run a new infectious panel on Julia's cerebral spinal fluid.
Lyme disease, West Nile, and throw in rabies, too.
Rabies? They were sleeping outside the tent.
She could've been bitten by a bat.
If Julia has rabies and she's already symptomatic - Then she's going to die.
- Just call Rita.
You know, you don't need to tell me what I'm thinking.
Alaska, that boy who lived above Jiggy's auto shop, bitten by the rabid dog.
I know.
There was nothing you could do for him, and that tore you up.
I am not ready to plan her funeral yet.
Michael, if it comes to that, please don't let her die alone.
When the car hit me and the driver just drove off, the kids whose ball I chased, they were too scared to come over.
And I just laid there alone and died.
I wouldn't wish that on anyone.
We are trying to find her boyfriend, okay? Rita, you can't have the test results back.
Kate just called you.
It's Eileen Lewis.
She and her daughter had another big fight, then Eileen went to an AA meeting, and her right side went limp.
Someone from the meeting just brought her in.
She's got a blood clot in her brain.
The Enoxaparin didn't work fast enough.
Do you want an MRI? Yeah, and prep her for surgery and call Victor Lantz.
I'm on my way.
Look, I gotta Where are you going? I got an emergency back at my office.
Right now this is your office.
I can't do anything for Julia until I know what we're treating.
I'll call you as soon as I get her test results.
Where's the clot? Middle cerebral artery.
I hear you treated with Enoxaparin.
That's why we can't use TPA to bust the clot.
She'll bleed out.
My daughter? Rachel's on her way.
Rita called her.
I have to see her.
You have to get into surgery now.
Wait.
I ruined everything.
I just want to tell her I'm sorry.
Eileen, you don't have time.
I have to get that clot out or you could die.
Now get her in there now.
All right, Victor, how's Eileen's heart rate? It's fine, but she's still in A-fib.
All right, I'm nearing the occlusion.
Once the catheter's in place, I'll Roto-Rooter the clot and have her dancing at her daughter's wedding.
Where's my mother?! In surgery.
She had a stroke.
Oh, God! Oh, my God! Dr.
Holt is removing the clot.
He's done hundreds of these procedures.
Why don't you have a seat and try to relax? Come on, Eileen, let me in there.
You find the little bastard? Hit it.
Ah Got him in my sights.
And now the main event.
Ready for the penumbra.
I love my job.
Shouldn't he be done by now? Oh, the procedure takes time.
As soon as Dr.
Holt is finished, he'll let us know.
Chocolate? I find it's a trusted friend in times like these.
Thanks.
I'm threading the wire through the middle cerebral artery.
All right, I'm at the clot.
Start the aspiration.
Engaging the penumbra separator.
I'm breaking the clot into little pieces.
Then I'll suck 'em out.
I think I got it.
Let's give her another dose of contrast.
Let's see how good I am.
Hey, blood flow has been restored.
And that is a beautiful thing.
I'll start to wake her up.
Victor, talk to me.
BP's dropping, heart rate's rising.
Did you tear the vessel? No.
I need more contrast! Must be in the brain stem.
She must've thrown a second clot.
Give me back the guide wire.
Come on, let's go.
Are you at the second clot yet? No, I'm just ready to image the posterior circulation now.
BP's still dropping.
I'll start pressors to get her pressure up.
There it is.
Second clot's in her basilar artery.
She's stroking out her brain stem.
That's why her BP's falling.
We are in big trouble.
- Not once I get the sucker.
- Hurry up.
Her fluids are running wide open.
Hanging norepinephrine.
I know the waiting's tough.
You know what I did when my mom showed up at my fitting? I told her not to come to dinner tonight, that a drunk didn't deserve to meet my fiancé's parents.
What kind of a daughter says that? One who's pushed too far on the wrong day.
Now she's in there alone.
That may be the last thing I ever say to her.
When your mother had her disk operated on a few years ago, I got to know her pretty well.
You know what she talked about? You.
I heard all about the clerkship you had that summer, how hard it was to get, how well you did in law school and how much she liked your boyfriend.
My fiancé Brad.
She told me how proud she was that you managed to avoid all the stupid mistakes she made in life.
That she wasn't gonna take credit for how well you turned out, but that sometimes, when you weren't aware of it, she'd look at you and you just took her breath away.
Oh BP's 63/40 and still dropping.
Penumbra again.
She's bradying down.
She's gonna code.
I'm getting close.
I lost her pulse.
Start compressions! Push an amp of epi.
Still flatlining.
Give her atropine! Come on, you little son of a bitch.
Still no rhythm.
I'm there, but I can't engage the clot.
Come on.
Come on.
LANTZ Still no heartbeat! Got it! Removing the clot Okay, brain stem has good flow again.
Pulse is back.
It's weak, but it's back.
Start her on a Heparin drip, no bolus, titrate up the norepinephrine.
Nice work.
Dr.
Holt! Rachel, your mom did great.
What? Sulla, take Ms.
Lewis to her mother's room.
Mother.
Michael She's gonna be okay.
Eileen is, but Julia.
It's rabies? Oh, I'm sorry, Michael.
Shall I call Dr.
Sykora and let her know? Just tell her I'm on my way.
Is that what they're wearing to Per Se days or are we skipping dinner altogether? Gina, I can't do tonight.
Next time, I promise, as soon as you get back.
But Julia has rabies? Her test was positive.
So we can treat her symptoms, but She's not gonna make it.
She may only have a couple hours.
Excuse me.
I think my girlfriend's here.
- Someone called me.
- You're Hank.
Yeah, I'm Dr.
Sykora.
This is Dr.
Holt.
Hi.
Where is she? I'll take you back.
She's right here.
You coming? In a minute.
I'm gonna make a call.
Hank.
Jules, honey, are you okay? - I didn't know where you were.
- I know.
We were about to get up to Bear Mountain, and I just had the feeling something was wrong.
And when we got back into cell range, I had 15 missed messages.
Thank you for finding him.
Honey, look at you.
You can't kiss her.
Why, what's the matter? One of my messages said it might meningitis.
Is that what she has? We thought so at first, but But what? Unfortunately, Julia has tested positive for the rabies virus.
Rabies? How? We think she might have been bitten by a bat when you went camping last month.
- A bat? - You're joking, right? I don't know how much you know about rabies Well, she has to get shots in the stomach, right? Only if exposure is suspected before the patient becomes symptomatic.
We're gonna have to get you started on prophylactic shots right away.
Okay, what about Julia? Once the patient becomes symptomatic, the chances of survival are extremely small.
Are you saying I'm gonna die? I'm sorry, Julia.
No, this isn't happening.
What, you-you can't, you can't treat her? I mean, they treat AIDS, they treat cancer! We can make sure she doesn't suffer.
You're gonna have to do better than that! Hank, it's not her fault.
No, baby, it's my fault.
Look, I made you go camping.
You didn't want to go.
You did it for me.
Hank, I'm scared.
I don't want to die Honey, honey.
Dr.
Sykora, can I talk to you for a moment? So, I just got off the phone with a virologist who says there's an experimental protocol for treating rabies.
- And? - It was first used on a 15-year-old girl in Wisconsin who was already symptomatic and she survived.
And it's worked five other times since.
Okay.
And how many times has it failed? If you've got another option, I'm all ears.
You understand, this procedure is experimental.
There are no guarantees.
- Then we won't do it.
- Hank, we don't have a choice.
What do you have to do? Essentially, we put you into a coma to protect your brain and let the rabies run its course.
Julia, you have to decide now.
Victor, it's Michael.
Yeah, I'm coming in with a rabies patient.
Yes, rabies.
We have to put her into a coma as fast as we can.
I'll tell you when I get there.
- Ambulance is on its way.
- Okay.
Julia, are you allergic to any medications? Any prior difficulty with general anesthesia? - No.
- What about a health care proxy? Do you have someone to make medical decisions for you if you can't? It's usually a family member or spouse.
Hank's the only one.
But we're not married.
Jules, let's get married.
Hank I knew you were the one for me the first moment I saw you.
Standing in Trader Joe's, with your little canvas bag.
But I'm sick.
I don't care, okay? I love you.
Please, Julia, will you marry me? Yes.
But stand up.
You're embarrassing me.
Wish you could make it official down at City Hall, guys, but we got to move.
Right.
Come on.
I can help you.
Not now, Anton.
No, no, I'm talking about marrying them.
What, are you eavesdropping? The walls here are paper thin.
I thought you'd want to know, I'm a legally ordained minister.
Of course you are.
I got my license on the Internet.
Married a couple of friends of mine in a yurt upstate.
I'm your guy.
We don't have time.
I can marry them on the way over.
I mean, three minutes max.
Michael, don't make her face this alone.
All right, get in.
- Are you serious? - Just get in! Hey, Doc, nobody rides in the back but you and the girl.
Not the hippie guy and not the boyfriend.
It's not her boyfriend, it's her husband.
At least he will be in three minutes.
Let's go.
Wait, wait.
Take this.
Anton, let's go.
You ready? Julia.
Tonight we go to that place of eternity.
This is the wedding night.
A never ending union of lover and beloved.
We whisper gentle secrets to each other.
And the child of the universe takes its first breath.
Without love, all worship is a burden.
All dancing is a chore.
All music is mere noise.
Do you, Hank, take this woman, Julia, from this day forward to have and to hold, for better or for worse, for richer or for poorer, to love and to cherish as long as you both may live? I do.
Do you, Julia, take this man, Hank, from this day forward for better or for worse, for richer or for poorer, to love and to cherish as long as you both may live? - I do.
- By the powers vested in me by the State of New York, I now pronounce you husband and wife.
You can kiss her, friend.
On the cheek.
- Give me some room.
- What are you doing? Starting dopamine to get her pressure up.
- How much longer? - Five minutes.
She's lost her pulse.
Need some help back here.
Stay with us, Jules.
Bag her.
Come on, baby.
Push an amp of epi.
If you're going to be here, start bagging.
Jules Got a rhythm.
Damn it, it's a V tach.
Clear.
Jules, I love you, baby.
Please don't leave me.
- I love you.
- Damn it, lost her pulse.
Bag her.
Push another amp of epi.
Come on Honey.
Honey.
Time of death, 9:12 p.
m.
Bye, Julia.
My beautiful wife.
Her needs a moment with his wife.
But it flew away from her reach And the bullets catch in her teeth Life goes on, it gets so heavy The wheel breaks the butterfly Every tear a waterfall In the night, the stormy night She'll close her eyes In the night, the stormy night Away she'd fly And dream of para-para, paradise Para-para, paradise Para-para, paradise Ooh-ooh-ooh, ooh-ooh-ooh She dreamed of para-para, paradise Para-para, paradise Para-para, paradise Whoo-ooh-ooh, ooh-ooh.
Michael.
Welcome back.
I should've never have left.
Rachel? She's out getting a cup of coffee.
Rita's gonna get her to tell her you're awake.
I had the strangest sensation in there like I was leaving my body.
And I saw that bright light, like a tunnel.
But then I heard Rachel's voice calling me back.
And then I woke up in the recovery room.
Well, you didn't have a heartbeat for almost a minute in there.
It's what we call a "near death experience.
" I know how it sounds.
Believe me, I'm not big in all that afterlife stuff either.
But it felt so real.
It can be explained medically.
Are you sure? Like all paranormal experiences can.
- Go on.
I can't wait to hear.
- Anoxia; lack of blood flow to the brain, causes hallucinations.
Does that apply to me? Even extreme physical trauma can cause the body to go into REM sleep, which triggers increased brain activity.
But you're not sleeping, Michael.
Even the tunnel phenomenon can be explained by the way the retina reacts to oxygen deprivation.
Or maybe she and her daughter still have unfinished business.
Dr.
Holt? Let's just be happy you're here now.
Mom? Rachel! Mom.
Come here, sweetheart.
I was so worried.
It's fine.
Anna? Season 01 Episode 09 December 2, 2011