Dr. Death (2021) s02e02 Episode Script

Worth the Risk

I read this piece in "The Times"
about this little girl
who needs a new windpipe.
Name's Hannah Warren.
Her family's working with
this doctor in Europe.
Dr. Paolo Macchiarini.
The focus of my research
is tracheal transplants
with the help of stem cells
by developing biosynthetic tracheas.
So you're basically tricking the body
into thinking the implant's
already a part of you.
Will you be interested in assisting?
Yes. Yes.
I was wondering if
you would be interested
in collaborating on rat
trials to test our tracheas.
- Absolutely.
- Welcome to the team.
So this is the first artificial-trachea
transplant in the U.S.,
and I want Hannah's journey
to be the focus of the piece.
Surgery went well.
I have watched you for a while now.
What you did, it was a miracle.
- Paolo, I shouldn't.
The science doesn't seem sound.
It's not exactly your kind of science.
I will admit I don't get it.
After the operation,
she's healthy and happy
with her donor trachea.




Hannah Warren will be
the youngest patient
ever to receive a biosynthetic
tracheal transplant.
Okay, stop right there.
Let's swap this out to play
over Dr. Macchiarini talking
about the initial diagnosis.
[SIGHS] I think we still
need a little more B-roll
with the parents, but
we are close to locking.
- You okay?
- Yeah, I'm okay.
I was just talking about you.
Uh, Benita.
I called to, um
I called to tell you she, uh
she's gone.
- What?
Hannah's gone.
What what do you mean she's gone?
It was There were complications.
Her her lungs, after all
the time in the hospital,
she just her body couldn't, um
Hannah's gone.
We were with her, and she
just kept getting worse.
We thought maybe she was gonna
that it would pass, but, uh

Mom, your phone.
- Is it work?
- No, it's not work.
What's up with the braids, kiddo?
I haven't seen you
repeat a hairstyle twice,
let alone three times, in a week.
Dad liked my hair this way.
I miss him, too.
But I think you look great.
You ready for school?
What are you doing here?
I wanted to make sure that you're okay.
You're not answering my
phone calls, my texts.
You shouldn't be here.
I know you heard about Hannah.
I just wanted to make sure
that you're okay, Benita.
I thought she was getting better.
- There were complications.
- "Complications.
"Fragile native tissue.
Weakening of the lungs."
I-I read the reports,
Paolo. I know the medicine.
But you told me she was getting better.
She was very sick.
And she was going to die.
I tried.
You think that I'm not upset?
But I won't give up.
I don't have the right to give up.
No, Paolo, don't. I-I can't do this.
Let's just call it what it is, okay?
What is it?
A mistake.
Colleagues, board members,
we are so glad to have you here
for this momentous occasion.
Tomorrow we will perform the
first-ever human transplant
using a bioartificial scaffold.
Our patient is Andemariam Beyene,
a 36-year-old Eritrean PhD
student living in Iceland.
Two years ago, he developed a
malignant tumor in his windpipe.
They have tried radiation
and surgical intervention.
All failed.
So his doctors referred him to us.
As you all know, we only have approval
to perform this procedure
as compassionate use,
a last resort.
We have designed a biosynthetic trachea
tailor-made to Mr. Beyene's anatomy,
down to the last micrometer.
And this truly is the breakthrough
that will launch us
as a global destination
for this kind of medicine.
Ladies and gentlemen,
I present to you the future
of regenerative medicine.
Within weeks, it will grow tissue,
transforming into an
actual, living trachea.

Dr. Macchiarini, I am sorry.
I no longer wish to have the surgery.
We feel it is too risky.
It is completely natural to
have concerns, Mr. Beyene.
The trachea, it's plastic.
How can you be sure it
will work inside my body?
There you misunderstand.
It is not plastic.
The trachea is medical-grade
polymeric nano-composite material.
- If I may.
- Yeah, of course.
Mr. Beyene, you're studying
lava tubes in Iceland.
- Is that right?
- Yes.
I believe the recellularization
process is just like that.
When a volcano erupts,
underground lava rivers create tubes.
When the lava drains, the tubes remain,
but now they're rock solid.
They become a part of the Earth.
And that means they last forever.
That's what your stem cells
will do to the synthetic trachea
to make it last forever
as a part of you.
You're asking my husband to be the first
but offer no guarantee
the procedure will work.
No, we cannot offer guarantees
because it would be
irresponsible to do so.
Nothing is guaranteed in medicine.
Even just a year ago,
your options would have
been much more limited.
You are very lucky to be the first.
Your doctors referred you to us
because the other treatments failed you.
You could have as little
as six months to live.
This is your best chance
to see your son grow up.

I think it's very difficult
to keep an emotional distance,
especially if it is a child.
- Hey.
How you holding up?
I wish I felt numb.
I just feel
Give yourself a break, B.
- You're not on a schedule here.
It's gonna take what it takes.
You know, with Hannah Warren and John
it's just a whole lot of death.
How's Lizzi?
She's really quiet.
I think she's pretending
to be okay for me,
which makes me feel guilty,
which makes me feel worse.
She's just such a daddy's girl.
And that breaks my heart.
At least you still
have a heart to break.
Yeah, the pain reminds us we're alive.
It's awesome.
- Work is good?
- Work is good.
Work is good.
Hey, how's that piece coming along?
Hey, it's not.
a special about the future of medicine.
It's supposed to be hopeful.
And now I don't have a story at all.
- What about him?
- What about him?
Shift the focus to him, you know?
"Dr. Macchiarini, Miracle Man"
a look at the pioneer
of generational medicine.
- Regenerative.
- Exactly.
But then what about Hannah?
She'd still be part of the main story.
Medical breakthroughs are
always paved with setbacks.
It doesn't mean that Macchiarini's work
isn't worth believing in.

Hold on to the hopeful.
If anybody can make it happen, it's you.

- When did the pain start?
Um, off and on for the last few weeks.
I just thought it was
stress or something.
Would you describe the pain
as sharp, dull, or burning?
Sharp, like Aah! [WINCES]
Like someone's stabbing me. Ow.
Let's get a CBC, liver enzymes,
urine test, and a CT of
the abdomen and pelvis,
plus 30 milligrams of
Toradol for the pain.
- So it's my appendix?
- It's not your appendix.
What? No, no, no, no, no.
I have a daughter. She's nine years old.
She just lost her father.
I can't have something wrong with me.
We just need to run some
tests to see what's going on.
Doctor, they're waiting.
Is there anyone you want to call?
Hi, excuse me.
- Hi.
- Hi.
Thank you for coming. I'm sorry.
No, no, I'm glad you called.
- Has the pain subsided?
- No.
I think it's worse, actually.
- What did the doctor say?
- Nothing.
They just ran a bunch of tests,
and no one's told me anything.
I've just been sitting here by myself.
You CT scan shows uterine fibroids.
What? What is that? Is that cancer?
Not at all. They're very common.
- Is it okay if I take a look?
- Yeah.
- Yeah?
- Okay.
- This might hurt a little bit.
- Okay. All right.
- Okay.
- Yeah, I can feel two.
They're about the size of grapefruits.
It sounds much worse than what it is.
Don't worry. They
will have them removed.
So I have to have surgery?
Yeah, but it's a very common procedure.
I'm sure your doctor will
walk you through everything.
You're gonna be fine.
Trust me.

He's got you working late already?
I'm preparing.
It's something doctors do.
- You should try it.
- Noted.
I'll sleep when I'm published.
Why don't you like him?
I don't really like anybody.
That's true.
Still, so few surgeons want to
operate on the throat at all,
and he throws in stem-cell regeneration.
Aren't you interested in his work?
Yes, yes, I find it all very
You're an ass.
Look at this.
He has to identify the surgical
planes bordering the trachea,
avoid tumor dissemination,
all without exposing the larynx,
the thyroid, the esophagus.
Say what you want.
Dr. Macchiarini's got some balls.
I guess that's what it takes,
huh some nice big balls?
Sorry, I didn't mean to offend you.
Yes, I have tiny balls.
You know, a good surgeon
knows when not to cut.
Fuck that. I'm tired of being
on the verge of something.
Too afraid to make the cut
this is groundbreaking work.
I'm getting in.
Just watch your back.
I always do.


Dr. Svensson.
Dr. Macchiarini? Uh
Oh, the trials seem to
be proceeding nicely.
Uh, yes.
Um, we're on schedule.
Any exciting conclusions so far?
Well, nothing you know,
nothing really determinable yet.
Of course, I won't be
able to truly discern
any results until
Yeah, until you completed
the trials, of course.
As you can imagine,
I'm I'm very anxious
to see any results
positive or otherwise.
Well, on the test rats that
have received synthetic tracheas,
so far none have responded negatively.
Well, that that is excellent.
But as you said, we're
still gathering data.
the purpose of this trial
is to witness objective
results, of course.
Of course, of course.
May I ask, is there
anything in particular
- that is concerning you?
- Oh, no, not at all.
I have complete faith
in your research, Doctor,
as well as my own.
I'll just leave you to your work.

- Thank you.
- Yeah, no problem.
Oh, thank you, thank you, thank you.
Oh, my God, please.
Wow, I wish I had that effect on you.
48 hours without caffeine?
Who am I today?
I spelled your name for them.
- You're feeling better?
- Mm-hmm.
I am. Like two grapefruits lighter.
Thank you, really.
we've both been through a lot
of loss the past few months.
And I know I wasn't
dying in there, but I
I was really scared, and it
It just
it put things in perspective for me.
Us together, it could cost
me my job, my reputation,
but I think this thing we
have, it's worth the risk.
For me, too.

You've heard the criticism
that you're really taking a
chance with these patients.
What do you say to that?
I was raised to believe that if you
if have even one chance,
you need to take it,
because either that patient will die,
or we try to do something,
even if it's new.
As a doctor and and
as a human being, I
I ask myself, are we allowed to say no?
I don't think we are.
And when you got that call later
- that that she had passed
- Mm.
It had to be devastating for you.
I couldn't stop thinking
did I make the right decision?
Did I do everything to save her?
There are so many patients
all around the world
who need this procedure.
We should really try to achieve this
for all of them,
because even in the face of failure,
we should keep hope alive.

Great job today, guys.
Dr. Macchiarini, do
you mind staying behind
for a few minutes to
go over the schedule?
Good night.

Of course.
Well, I have some
follow-up questions for you
that are gonna happen
- Really?
- Behind closed doors, yeah.
I'm so sorry you had to go through this.
It's okay.
It's just gonna be a scar.
One day we will live in a world
where we won't have to cut
people open to fix them.
You'll see.
Do you ever have any doubts?
Of course I do.
- Really?
- Mm-hmm.
'Cause you seem so sure of all of it.
Even the things that could go wrong,
that have gone wrong
you just keep moving forward.
I think a lot about the
ones who came before me.
Like Thomas Starzl
he started the first liver transplants.
- His first patients died.
- Hmm.
Or Christiaan Barnard
he performed the first heart transplant.
People threw rocks at him.
- Everybody thought he was crazy.
I'm sure people looked
at him the same way
that you're looking at me right now.

When Hannah died, I did lose faith.
But these doctors, they
they believed, they
worked, they persevered
until they found their way.
Being the one to try something new,
no matter the personal cost,
is vital to move medicine forward.
It's vital.
And I believe that the
work that we're doing
is going to save many lives.
I believe it will, too.

Hi, my love. I'm here,
missing you in Barcelona.
The lemon trees are ready for you.
Oh, there is a sushi
roll with my name on it.
- Benita?
- Hmm? Oh, yeah, lunch.
- You ready?
- Sorry. Yeah.


- Mm.
- Come on, come on

No, I hear you. The
information is great.
But I'm going to need
another source on it
to confirm her account.
Sure. Could you email that to me?
Wow, that sounds good.
- [WHISPERING] It's Lizzi. Okay.
- [WHISPERING] I'll miss you.
Yeah. Sure.
It's okay with me.
If it's okay with Aubrey's
mom, you can sleep over.
Okay. I love you, too. Bye.
- Did you say "sleep over"?
- Yeah.
Maybe I could change my flight.
Oh, I didn't know that was an option.

- What?
- The Stones are sexier.
- No, no, no.
- That's it.
How can you even compare them?
I've always thought this, and
I'm not going to apologize.
"Blackbird," um
- "Martha My Dear,"
"While My Guitar Gently
Weeps," "Rocky Raccoon."
Okay, now we're listing songs?
- Yeah.
- "Satisfaction"
- Oh.
- "Gimme Shelter,"
- "Sympathy for the Devil."
- No.
No, we can't have this conversation.
This is terrible. Now
I have to leave you.
- Are you gonna leave me?
- I'm gonna leave you.
Are you gonna leave me for The Beatles?
- This is a very, very
- They're almost
- All of them are dead, almost.
- Important distinction.
Italian "Vogue," nice touch.
- For Lizzi.
- Ah.
Hey, Lizzi? My friend Paolo is here.
- Your "friend"?
- My friend.

"Cacio" means "cheese,"
and "pepe" means "pepper."
So it's like Italian mac and cheese.
And pepper, you know, "pepe."
It's delicious, right?
What do you think, kiddo?
I don't like it.

Your mom tells me that
you play the violin.
- She does, yeah.
- Yeah?
She practices every day.
Sometimes I don't even
have to ask her to practice.
Oh, wow. That's impressive.
It's impressive,
'cause I used to play the
piano when I was your age,
- but I hated to practice.
Well, maybe we can play together.
You you play the violin,
and I play the piano.
We make a concert for your mom.

Did you hear what happened
when Johann Sebastian Bach
dropped his violin?
It Baroque.
It Ba-roque.
Ba-roque, that's funny.
- Can I go to my room?
- Lizzi, come on, please.
- No, it's okay.
But, Lizzi
I know that you're feeling
a thousand things right now,
all at once.
And I'm ready to wait
for as long as it takes
for you to figure out
how you feel about me.
But I'll make you a deal.
If you let me show you
how much I care about your mom,
I promise you I will never make you eat
my cacio e pepe again.


Good night.
- She'll get there.
It takes time.

It's really good.
But you got it, right, Baroque?
- I got Baroque.
- Okay.
Yeah, it's a cute joke.

Hey, three more pages, then
jammies and lights out, okay?

- I love you.
- I love you, too.
Good night.
Hey, Mom?

I like his accent.

What? Are you kidding me? You cooked.
Get out of here.
I have bad news.
Our trip to Barcelona No!
- I have to cancel.
- Oh.
Uh, there's there's a new patient
I need to meet in Moscow.
I was so looking forward to
finally seeing your place.
I know, my love, and I'm so sorry,
but if she agrees to surgery,
this could launch funding
for the entire lab.
No, I-I get it, I get it.
I just, um
have to figure out what to
tell Kim and everybody else,
'cause I already took time off.
And I have Laura coming
to stay with Lizzi and
Why don't you come with me?
- To Russia?
- To Moscow.
I can show you off in Moscow.
I don't know. [CHUCKLES]
Oh, come on, Benita, I
want to spend time with you
without having to hide please.
We have to wait until the special airs
before we tell anybody anything.
I'm sure our secret
will be safe in Russia.
Please come with me.
- Please, come with me.
- Okay.
I mean, who
who am I to say no to
the great Dr. Macchiarini.

Accessing the cricoid ring.

I see severe infection,
most likely caused
by the excessive radiation
treatments on the patient.
The cartilage is necrotic.
If the tumor hadn't killed him,
it would have been only a matter of time
before he succumbed to infection.


Starting resection.
The biosynthetic trachea will fit
perfectly in the resected area.





Okay, switch the oxygen input.

Any leaks in the trachea will
produce bubbles in the saline.

Pulse ox?
Holding steady.

No signs of leaking.
Oxygen holding, 98%.
It's working.
Congratulations, Doctor.
Okay, let's close him up.
- Doctor?
BP's dropping.
- He's bleeding.
- Vitals are weakening.
No, it can't be. The implant is working.
Where is this blood coming from?
- Doctor?
The left carotid's most likely ruptured.
No, I didn't touch it.
I wasn't even near it.
You said there was radiation damage.
Losing OX.
It must have weakened the vascular wall.
- Doctor.
- Blood pressure is dropping.
Doctor, we need to do something.
- Doctor?
- Losing oxygen.
I can fix this.
He needs to be stabilized.
- Suction?
- Blood pressure is dropping.

Found it. Cautery.

- BP is on the rise.
He's stable.
Sutures for Dr. Macchiarini.
You should close him.

All right, my love, this way.
I was texting with Lizzi about
setting up our Skype call.
And she specifically
asked for you to jump on.
- Oh, she did?
- Yeah.
You charmed her, you big charmer.
Pardon me.
Uh, compliments of the
gentleman at the bar.

Thank you.
To you, to me, and to
ice buckets, always.
[CHUCKLES] Cheers.
So who is our benefactor this evening?
- I shouldn't say.
- Paolo, come on.
I protect sources for a living.
He's a Russian oligarch, very connected.
No, don't look.
There is a network of
high-profile patients,
celebrities, clergy, presidents
that are treated in secret,
that I treat in secret.
Because of who they are,
I have to keep our arrangement quiet.
Presidents, like U.S. presidents?
Paolo Macchiarini, surgeon to the stars?
- Okay.
I Somebody's got to do it, right?
- Shh, they're coming.
Yulia, this is Benita Alexander.
- Paolo, good to see you.
- It's nice to meet you.
[CHUCKLES] If you're trying
to impress me, Doctor,
it's it's working.
Yulia, my dear, for you, only the best.
Uh, Paolo tells me you're a dancer.
- The best in Russia.
I met Andrej not long
after I joined the Bolshoi.
I saw her perform in "Swan Lake."
She was magnificent.
I was only part of the corps
de ballet, not the soloist.
Still, I could not
take my eyes off of her.
While I was on tour in
London a few years ago,
I was involved in a
horrible car accident.
It's a miracle she's even alive.
My windpipe was broken. My
Everything was broken.
And it left me with
this hole in my neck.
I'm so sorry.
The past is a lighthouse, not a port.
[CHUCKLES] I found Dr. Macchiarini.
Up until now, we have implanted
only patients for compassionate use,
those who otherwise would die.
But you have shown me
that quality of life
is nearly as important as life itself.
So this is an elective surgery?
- Yeah.
- Mm.
A part of me
hopes it will allow me to
dance again, but, mostly
we have a two-year-old son, Sasha.
I want to play with him [CHUCKLES]
Sing him a lullaby.
And you're the perfect candidate.
You're young, healthy,
no other medical issues that
would complicate matters.
You you're ready.
Mm. I really don't want to go to Sweden.
I wish you were set up
to operate in Russia.
Then I have great news for you.
Our colleague, Dr. Lasbrey,
is setting up facilities
in Krasnodar as we speak.
Your procedure will launch
our work here in Russia, Yulia.
You will have your operation here.
- To Dr. Paolo Macchiarini
- Ah.
Our rock-star surgeon.
- You okay?
- Mm-hmm.
- Yeah?
- Yeah, I'm okay.

This ballet was first performed in 1871.
You know
Are you okay?
- Hey. Hey, hey, hey, my love.
- Hey, are you okay?
I'm sorry. I don't think I can
No, no, no, we'll go home.
No, we'll go. I text you.
No, she's I'll text you, okay?
- Let's go.
- Are you sure? Should I
Yes. Yeah, yeah.

You're getting worse.
You should have let me
take you to the hospital.
No, I just want to lie down.
- You're burning up.
- Mm. I feel sick.
Let me check something.
The surgical site is infected.
What? There's no way.
That was months ago.
- It's got to be healed by now.
- No, it's not.

So so what, antibiotics or something?
No, it's too late for that.
You're in sepsis. I need
to debride your wound.
Otherwise, you will go into shock.
"Debride"? What does that mean?
- You're gonna be okay.
Do you trust me?



"Two months after transplantation,
the patient is asymptomatic,
breathes normally, and is tumor free.
These results are evidence
that a successful
organ-regeneration strategy
has been accomplished."
[LAUGHS] "And the procedure's
success provides proof
of the viability of this approach."
To Dr. Macchiarini, who
dared to make the cut.
To Andemariam Beyene,
who bravely risked his life for science.
And last but not least,
to The motherfucking "Lancet"
for publishing our research article.
- Cheers!
- Skol, Anders.
Nathan, tack.
So published in "The Lancet"
you're halfway to a Nobel.
This is shit.
You'd think they would have
sprung for better bubbly.
Then feel free to steal someone else's.
- Fantastic.
- Cheers.
I'm surprised to see you here,
knowing how you feel
about Dr. Macchiarini.
Well, free champagne
is free champagne
- or whatever this is.
- Of course.
You must all be on cloud nine.
I'm excited, of course,
though I also have the feeling of
What do you call it?
Impostor's syndrome.
You're running Macchiarini's rat trials.
Which are still in progress.
Macchiarini included
my name in the byline,
but I have yet to submit my results.
Welcome to the world of
scientific publishing.
As I recall someone once saying,
"Competition fuels progress."

- Okay.
- Here we go.
Watch out for the chair.
[LAUGHING] Yeah, but
I can't watch anything.
- Okay, you can open your eyes.
- No.
You said you wanted
to start playing again.
- We can do a duet.
- Wow.
Yeah, we can do a duet.
This is incredible. Thank you.
- Careful with your stitches.
- Aw.
Love, come here.
Thank you so much. [SMOOCHES]
Wow, this is so cool.
But first, I have to
remember how to play.
- Oh, let me get my phone.
- This is so cool.
Thank you.
"NOCTURNE OP. 9, NO. 2"]


Knowing I'll be missing ♪
Christmas Eve in my hometown ♪
- Thank you.
- Mm.
Are you okay?
Yeah. Christmas, family
holidays, you know?
It makes you sad?
Not really, not this year.
We feel like a family.
You read my mind.
Wait. Hold on.
What what is going on?
This feels like collusion.

Through dreams and just pretending ♪
I'm there, and I'll be spending ♪
Christmas Eve in my hometown ♪
What do you say, Mom?
What do you say?
In my hometown ♪

- Hey, come in.
- Hello.
Hi. Please come in.
Mr. Beyene sent it.
- It's nice, isn't it?
- Yeah.
I wish our work always ended like that.
Thank you for sharing that with me.
Sometimes it's nice to
be reminded why we
So you, too?
Oh, you know, nothing big
just girlfriends, children,
probably a few years off my life.
Well, maybe we can
build something together
that will make it all worthwhile.
I think we can.
The funding for our transplant
research is about to run out.
I'm sure "The Lancet" article
garnered some attention.
Yes, we can capitalize on that
momentum to secure a new grant,
which will lead to more surgeries
and to more money.
Around and around.
Until we can expand
The goal is six operations
within the next three months.
You can produce that many
custom tracheas in that time?
Yes, it can be done.
But we need more patients.
Then let's find more patients.

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