Lenox Hill (2020) s01e02 Episode Script

The Barrier

The patient's a 41-year-old
police officer from Tennessee.
She has a big tumor in her neck.
These are risky operations.
No question about it.
You live and die for them.
To me, the ER is like the frontline.
You cannot chose what comes at you here.
I want to work with populations,
who, maybe medicine
has traditionally neglected.
Never know
what you'll get with brain surgery.
Let's roll.
As a surgeon, researcher,
I have to bring my best.
Shit, man. Feel this.
I don't have cancer?
Well, that's what I want to talk to you
a little bit about.
It's a lot of juggling,
being a surgeon and a chair.
We are on the right path.
We're absolutely on the right path.
Growth hurts.
There's the baby.
When do we get to know the sex?
Remember, we're not going to know
until we deliver.
- We're pregnant.
- We are pregnant.
And it's good.
Two, one, okay. Let it out.
Again. One more.
One more. Give me one more.
Push through it!
There you go.
- Much better. Good. Good. Good. Yes!
- And let it out.
So close. We're so close.
Okay, don't push. Don't push.
- Okay, one more push, dear.
- Give me a push.
Look down. Look down!
- Hi.
- Oh!
Happy birthday!
And he's crying.
- Yeah.
- There you go.
- Congratulations.
- Okay.
- What's up?
- Hey, I've I've been thinking
why didn't you call me back, babe?
Um, Kevin, when did you call me?
I called you about four hours ago.
Okay, yeah,
so I was probably working, boo.
Do I want to talk to you
or do I want to do work?
It's hard to know.
You should talk to me,
because you haven't talked to me all day.
Oh. Boo, did you get my email?
Did you make the, um, appointment
for this daycare or no?
Uh, did you read the pamphlet
I sent you, boo?
I did actually read the pamphlet
you sent me.
Huh. Interesting, because in that pamphlet
it would say that
they only give tours to people
who have an enrollment offer.
Would they have spots available
in September?
I just got the pamphlet, boo-boo.
I've been back-to-back busy, boo.
I have to leave every day at 6:00.
That's what that means.
- My homey's
- Hold on, hold on.
And he's like, "No, we gotta go."
And she's like
Which room is that?
- So she be trippin' when he's gone.
- Okay, thank you.
I was like
Oh, you know, Joe told me this sad story.
He said that, uh, he's looking forward
to the day
when he comes to pick up his girl
and she'll be happy to see him.
That's kind of sad.
Call Stephen Fisher.
- Finding
- What? Oh.
It's uh oh.
Speak at the tone. Message canceled.
- Vocera.
- Urgent call, Stephen Fisher.
- Urgent call to
- Stephen Fisher.
Why don't you just call the number?
All right.
Sorry. Did I just hear
the emergency bell go off?
Yeah, it was an accident in room six.
Okay, but then I went out and I was like,
I don't hear it anymore.
So I wasn't sure, so
Yeah, it's fine. We already it's fine.
- Okay.
- Yeah.
She's not having an emergency. Okay.
Sounds good.
Thank you so much.
- Okay.
- Call from
Stephen Fisher.
What, Kevin?
I forget what I was saying, boo.
- Sherese?
- Yes?
Can you update me on Christopher?
- We looked at the images.
- Okay.
- So they look good. They look better.
- Did he get Avastin?
No, he got Cetux.
He's scheduled
for another dose Wednesday
- Oh!
- So I wanted him to get a scan in between.
This is exciting.
This is a clinical trial patient,
so I we we get excited
about clinical trial patients,
because we want to see new
and innovative things work.
He had a particular protein
on the surface of his tumor
and we targeted that with, um, a drug
that we give through an artery.
This is good
if his film was really good.
It looks better.
- Well, even any better.
- I know.
- So how's he doing clinically?
- Clinically he's much better.
That's bizarre, in a good way.
This really should work, right, Sherese?
That would
It seems like it's going faster.
It's reducing quicker than it was
the first time that we went through this.
I'm telling you, the tumor
looks like it's retracting a little bit.
Now, a little bit
is 'a lot a bit' in this disease, okay?
These tumors have a doubling time
of about 17 days.
But, actually,
what I'm most happy about is this.
- You see this storm cloud here?
- Mm-hmm.
That's the edema. That's the edema here.
It's actually completely gone.
- How's the strength on the right side?
- Great.
- Can I see you stand up?
- This is 'cause he's been doing yard work.
- Yeah. Work.
- Okay, good.
What kind of yard work are you doing?
- Well
- We have a new house with no
- It's completely empty yard.
- No trees.
He likes to garden,
so he's been putting in.
- And he's been
- And Yeah.
He's out there
I'm praying my hydrangeas come in well
this year.
I'm really optimistic
for what I expect from you.
And just remember, if this fails,
- we have a lot a lot of good drugs left.
- Yeah.
- Okay.
- Thank you.
Yeah. Bye, guys.
- Okay.
- Thanks, Chris.
Well, I hope I'm right about that.
That was good.
Yeah. Really good.
- That was a good promise.
- I know.
You know?
- I know.
- It's much smaller than the last time.
Will you rub my arm?
Sure I will.
I'll rub your leg.
So her head goes here.
This is the renal artery graft here,
- and I'll be over here.
- Okay.
This screen has to sort of be
where Peter's going to work.
So what I would do is
He has to do the opening, too,
because he wants to make
this combined opening.
I'll start the crani you know, up here.
Just do it
Mitzie arrived to us
after living with this tumor
in her skull base and neck
for about ten years.
At the end of the day,
no one near her was really
willing to operate on her.
It was just too difficult.
Knowing she's a mom to a daughter,
has a family, a son who needs her,
this is the major drive that made me
ultimately decide to take the risk
and try to save her life.
You had some nausea at home,
right, though?
I had the nausea spell after.
- You throw up a little bit?
- A few times.
I think it's probably where the tumor is.
And now it's still pushing on
some of the spots in your brain
that can cause nausea.
I'm just glad you're fine this morning.
You can talk and move your right side.
That's the most important thing.
What should I expect
when I come out of surgery
for the next 24 hours?
What should you expect?
It's possible that you could have
a neurological deficit
from a new blood flow.
It's not a stroke.
Um, we're always concerned about it,
because there's no way for us to tell.
So we end up getting
a lot of scans really quickly.
And nine times out of ten,
there is no stroke.
It's a little unpredictable,
what could happen.
The most important thing is you have
a working graft and it looks good.
You're not going to have a stroke.
The graft will protect you.
I met my husband
a long time ago through a friend of ours.
And I went to medical school with him.
And we reconnected four years ago
and got married.
But there was a time before I met him
that I thought,
"'I'm just going to have
a child on my own."
Now I'm 39 and I'm having my first child.
It's comforting
that now we're living in a time
where women can have children
at an older age.
There was all this family pressure.
I come from a big Latino family.
So all my sisters have
already had their children.
Everybody's been anticipating this,
so it's just a lot of pressure.
My main importance right now
is to have a healthy pregnancy.
And I definitely stressed about it
in the beginning,
given the nature of my work.
It's making me nervous. We good?
125 over 90.
Oh, perfect. Okay.
Pressures have been great
since that last visit.
Oh, good.
So how are you feeling otherwise?
I'm feeling okay. Just tired.
That's normal.
- And Dr. Stephens will be right in.
- Awesome. Thank you.
- You're very welcome.
- Okay.
So, your blood pressure's borderline
again today.
So, I thought like 125 was okay.
- Your 125 is fine, but the 90 is not.
- Ah.
I want you to check
your blood pressure every day.
- I have been, actually. I got a cuff.
- Okay.
- And they've been good.
- Good.
For gestation hypertension
I can just put you off for the rest.
- Yeah.
- It's two more shifts.
They have backup,
so they can find coverage.
- Yeah.
- I'm assuming so.
There's other people who can do it.
- Yeah.
- It's okay.
- Okay?
- I'm sad to leave work, actually.
Yeah, I'm sure. I'm sure.
Okay, let's take a look.
Heartbeat looks great.
Okay, baby looks perfect.
And then, you know,
if you're feeling off at work,
even if you're feeling anxious, shaky,
anything like that, I want you to leave.
- Okay?
- I haven't been.
- And you'll call me.
- Yeah, I mean, I'm used to the busy
The busy environment.
- I I haven't been
- I know.
All right.
I'm still so skeptical,
because my blood pressure's been fine
at home.
- Completely fine.
- I know, but she just said that.
And, all right, like she said, so you had
a really stressful night at work.
I just wanted to work until the very end.
Yeah, you did.
She's coming in right now.
We had to deal with one room,
and he's coming right now.
Who is that for?
Four, but they have it.
Four? Wait, Rachel, what?
I don't feel
like I'm tired because I'm pregnant.
I feel I'm tired because of residency.
Hello. Oh, my God.
I'm not very good
at taking my prenatal vitamins.
I'm like a bad OB patient.
Just tell me what the to-dos are.
- Okay.
- I'm pretty sure I know. Just tell me.
The only person
that needs the sono is.
- I already called.
- Okay, thank you.
She needs to be on insulin.
- I know. I started her.
- Well
I mean. Okay, speak Okay.
Hi. Yes. Hello.
- Hi. Laura?
- No.
- Okay. It's Ellie.
- Yes.
Okay. Thank you.
- Amanda.
- Yes.
I have an appointment
scheduled for my own ultrasound,
which now feels like
extremely inconvenient.
I don't know if I can go to it.
Said, and anesthesia
are ready to go back.
Give me 30 seconds. Is Woo here?
Woo is here.
Okay. No problem.
I'll find somebody who can go.
- Thank you.
- Thanks.
- They're gonna pick it up.
- Tomorrow, yeah. On the side.
Wait, you're not here tomorrow, Forzana?
We're fucked.
It's hot in here. I'm thirsty.
I'll get it. It's probably OB.
I'm like
Hi. It's Amanda.
It started as a migraine, okay?
I used to get migraines all the time.
Um, I couldn't
Uh, I I didn't resist the light.
It was just it was so bad.
Um, and then I fainted.
I fainted on a Saturday.
Then on a Monday, I went to to my doctor
and, um, I said to him,
like, "You have to send me for an MRI,
because I can't really deal with this."
And he sent me for an MRI.
And I came back to his office
and he called me to the back,
because I guess they had
called him already,
that I had a tumor in my brain.
Um, the tumor was about, you know,
this this big.
I got operated.
The year passed, and I was in remission.
And then I got it again.
Tamika. Lucas. Lieutenant.
How are you?
- How are you?
- I'm okay. Thank you.
So who made these shirts?
I made them.
They say my team in the back.
- I know.
- Yeah.
They're so cute.
So, you understand what we're giving.
We're giving you
a little piece of a bacteria.
- Okay.
- To elicit immune response in your body.
In the bacteria is a drug
that we hope gets it
into your brain tumor,
into your glioblastoma.
And the way we want it to target
your glioblastoma is through
a surface antibody, or a targeting
of what we call a honing device.
I gotta talk like police stuff.
Yeah, I know.
It's like a drone,
it's going right into the tumor.
And it's using
the antibody called Cetuximab.
That's the drug
that got Martha Stewart in jail
- for insider trading.
- Oh, yeah. Oh!
You're the eighth patient in the country
to get this treatment.
- Yeah, I know.
- So you're a special girl.
So thank you for your patience
and your courage
and to all you guys
for being so supportive.
Thank you for considering me.
Okay. I need to
They're pushing me aside,
- so I need to
- Okay.
I can't
Every day I see patients that
I feel like
we're making a dent in the disease.
It's just
It's a very challenging disease.
I go to the lab on Wednesday,
and I come back so inspired.
And I have these scientists telling me
great new things.
new viruses, new bacteria, new everything.
But we're making
just incremental progress.
You know, in five decades, we've improved
survival in glioblastoma five months.
So, frankly, I should be devoting
my whole life to research at the bench,
but there are few people like me
that can take it from the bench,
where you have these brilliant scientists
who don't really understand medicine.
And then there are a lot of people that
treat the disease clinically
who don't understand the science.
They're calling me upstairs
to the operating room.
I'll come back
and see you in a little bit, okay?
- Thank you.
- Good luck.
Thank you.
When I was at Penn
as an undergraduate,
there was a guy named Steve Fluharty.
He was
my neuropsychopharmacology professor.
He changed my life.
He piqued an interest in me
that I didn't even know I had,
which is in neuropsychopharmacology.
I started looking at stem cells in cancer,
and I started looking in glioblastoma,
and that's when it took off for me.
It is human's
most aggressive cancer.
You can see by these patients,
they're all so different.
It's a devastating disease.
- Hi. John Boockvar.
- Nice to meet you.
- How are you?
- Good.
So I'll be working with Dr. Langer.
So I run our brain tumor program,
where we take tissue
and we grow it in mice
and then we propagate it.
It's of no cost to you.
It's so we can do some basic
science research on this material.
You have no obligation to do it.
We get the tissue back
in about six months.
And then we have genetic information
from your blood and from the brain.
And that's maybe important
for not just you, but for the next person
- and the next person.
- Absolutely.
I have no financial interest in anything.
I don't get paid a cent
whether you do it or not,
but it is important
for biomedical research.
So the good news is,
we know it's a low-grade tumor.
In this location,
we're going to be aggressive.
Because if we get the whole thing out,
it could be, essentially,
it'd never come back again.
One of the reasons why I told him
he should come here
is because I knew we had not only
sophisticated guys like John with us,
but just kick-ass monitoring.
And having a guy like John with me
makes both of us because we can
You know, you talk
and we make these hard decisions.
Because what happens today could have
implications for quite some time for you.
Okay. All right.
We'll do a good job, okay?
Okay, buddy. Good to see you.
I'll see you later.
Hey, Ben, it's Dad. Just calling to see
See how you're doing. Love you.
Call me when you get a chance
this afternoon.
Love you, bud. Bye.
Okay. I have to do an angiogram
that morning it looks like.
Just tell Alex I need to get
an early start on Friday, if possible.
I used to just get so stressed.
Because I was just worried about being
I wanted to be a good dad.
There's just so much, um
you know, emotional energy
that goes into doing this well.
And then, actually having
a piece of yourself
that you can share
with your wife and your kids.
It's there,
but because of the intensity of this
I'm just a person who looks inwardly
and, like, "I'm not doing enough."
And, look, I love what I do.
It's not a sacrifice.
When you're doing what you feel like
you're cut out to do, it's great.
You have to accept the fact
that you give up something
to get something, I suppose.
Ah. There's plenty of room in here.
Whoever set the room,
this actually really looks good.
- I'm very impressed.
- Good.
Darwin, you want to step in here
and get this screen hooked up
so Sherese can see?
Keep his head Stop.
Let me have the head.
That's how you want the head.
Is to be horizontal, okay?
You can do nothing surgically
if you're not comfortable.
If you're leaning over
and you're not in a good position,
you're never gonna be able to operate
or do anything.
That's right in the center of it, right?
So the tumor is here.
I like to prep my own patients
because it's the last time
you see the patient uncovered.
It's a valuable time.
I know you love this.
Okay, so Kevin's 28.
He works at a restaurant in Brooklyn.
His mom and sister are here.
They're from Detroit.
Uh, he presented with a seizure
to King's County.
Uh, they found a tumor that's right here.
You see that?
But, uh, with JB here, we're going to be
aggressive and take the whole tumor out.
Either way,
because his prognosis will be best
as removing all this if we can,
which I think
we oughta be able to do, okay?
All right, ten second time out.
Deep breath. Eyes closed.
Let's get our eyes on the work.
Let's do a good job for this guy.
Where's the blood gonna go?
- It's gonna come this way by gravity.
- Yeah.
You pull it tight okay?
Little things
make your surgery perfect, okay?
Do you have another one of these
or just one?
I'm not getting a good contact.
This is that electrode
we're putting on the surface of the brain,
and he's watching electrical activity.
How about here?
- No, not there.
- How about now?
It's gonna be tumor there.
We're gonna be fine.
You shouldn't hit anything.
Yeah. All right. We're good.
- All right. I need 3D glasses, please.
- Something like this.
No, look, how there's tumor right here.
All this has to go.
All of it.
- Want to come on the inside here?
- Yeah.
- Want to preserve this vein
- Exactly.
Well, I think that's a tumor vein,
but it's the vein on top of it.
- Right there.
- Scissor.
- You see it?
- Yeah, I see it.
- Right there.
- That's it. That's all tumor.
It's all tumor.
It's gotta go.
It's behind our motor strip.
This is what we call
supramarginal resection
from low-grade gliomas.
It's like the first offer
you get on your house
when you put it on the market.
It's probably your best offer.
You get one chance to cure this disease
in a low-grade glioma.
That's gorgeous.
- It's gorgeous.
- Come here.
There's the tumor.
Pretty cool, right?
For whatever reason, this is hard.
The tumors just grow infiltratively
into the adjacent brain.
And that's why it's
Gliomas are essentially incurable.
Here's the surface
where the patient had a previous biopsy.
And all the tumor's underneath.
Now we're going to send some for frozen.
We're going to grow
a large chunk of this in mice.
Do some experiments on it.
Yeah, divide that one in half.
That was awesome.
That's how we do it, baby.
It's perfect. It's a perfect operation.
- That was great.
- We saved the veins.
See how we preserved the vein?
He's still going to wake up weak,
but he's going to get better with time.
Another tumor,
defeated by the crew, baby!
David, great job.
You too, brother.
Always clean your shoes.
Families don't want to see
blood on your shoes.
Come, come, come.
- Leave everything there.
- Okay.
We got it all out. We did what's called
a supramaximal resection.
Meaning we took out the tumor
and then some.
- And that
- Okay.
You know, remains to be seen.
So, look, this is what I study.
This is what keeps me up at night.
I know I know the biology
of this disease as much as one can know,
and I'll treat it the way I would want
my family member to be treated.
Right. Right.
There's some controversy
about best treatments,
and we are still understanding
what is the best treatment,
but given his age
and the extent of resection,
I expect good survival from him.
You're gonna ask me exactly
how many years he has left to live,
I can't give you that.
Kevin, you're all done, brother!
- Sorry.
- It's all right.
- This went really well. A little too well.
- Strong guy.
Everything went great!
I think we're good.
All right.
- Good job.
- Good job.
John Fehling, Senior.
I'm a lieutenant in the NYPD.
My uncle passed away in 9/11.
I said the "P" names,
and then I said my uncle's name at last.
And my uncle, Pedro Francisco Checo.
Tio Frankie, we miss you, we love you,
you'll never be forgotten.
We will miss you and get to heaven.
I wanted to be a civil engineer, you know?
I was in Hartford University,
and I got into John J
because I wanted to be a cop.
When he passed away.
Thank you.
- I'm so proud of you.
- You're welcome, mom.
Today's two.
And then next week is our max dose
at eight times ten to the ninth.
Yeah, you know,
your body got introduced to it last week,
and you did well.
Now we're sort of doubling,
and then we're going
up to eight times ten to the ninth.
So it's a lot of bacterial particles.
We took the same pieces of bacteria
and we put them in mice.
We cured some of the mice of cancer.
The problem is
you can experiment a little bit more
Take a little more risks in mice
than you can in humans.
You see how carefully
we're titrating up her dose
from one to two to eight.
If I get to eight too quickly
and she dies,
the FDA will shut down the trial,
you know?
And so we're very, very cautious.
The courage that a patient like that has
to be the first or the eighth patient
in the nation to do something,
it's incredible.
It's almost it's almost unfathomable
the trust that she has in the team,
and just say, "Hey,
I'm going to take this risk."
We can just order it. Okay.
Borderline but not terrible.
Not positive.
- Hi.
- Let me say hi to the baby.
Hi, boo-boo. Hi.
- I know, I'm like too big.
- Your blood pressure good?
- Don't scratch.
- Uh, borderline.
I know. I don't want those stretch marks.
- Don't scratch. Just rub.
- Just rub. Okay. Okay.
Yes, I'm a little bit swollen.
- Yeah, my rings
- What about your feet?
- My feet are, too. They are swollen.
- Try and take it easy.
Yeah, everything is swollen,
but later it'll go away.
- It's momentary.
- Now I'll go eat and it'll go away.
We're having ham and cheese.
And my mom is like ridiculous.
She washed all the clothes,
- she's putting everything away.
- She's nesting?
She's nesting for me.
I'd rather be here than be at home.
I know that's gonna happen
after I have the baby.
I'm just going to want
to come back to work.
So why is the last day today?
My husband's like, "That's it."
Yesterday I was breaking down boxes
and taking them downstairs.
He's like,
"Can you stop what you're doing?" Like
- I just can't sit on the couch.
- I know.
I heard you're not feeling well.
I think I've seen you before, haven't I?
- Yeah.
- Your face looks so familiar.
Why does it look familiar?
What's going on today?
- Chest hurt.
- Your chest hurts?
Okay, what were you doing when it started?
- What?
- It hurts.
- What hurts?
- My chest.
- You having a boy?
- Mm-hmm.
- Mm-hmm.
- How'd you know that?
I'm a mother.
- You're what?
- I'm a mother.
- You're a mother?
- Mm-hmm.
- Oh, so you know.
- Mm-hmm.
- How many children do you have?
- Just one.
- How old?
- Eleven.
- He or
- She.
She. Where is she?
At my sister's.
- In New York?
- Brooklyn.
In Brooklyn.
What's your daughter's name?
- Jamia.
- Jamia.
- Yeah.
- That's pretty.
How often do you see her?
I don't.
- You don't see her?
- No.
How come?
I don't know.
But she's with your sister.
How long has she been
with your sister for?
Two years.
- Okay.
- I miss my baby.
I think about her every day.
She's an honor roll student.
Is she?
Mm-hmm. Gifted and talented,
and she's on student council.
She's very intelligent.
- Are you allowed to see her?
- Mm-mmm.
How come?
Me and my sister don't get along.
- And you're not doing any drugs right now?
- Mm-mmm.
I'm a good girl.
- Yeah?
- Mm-hmm.
All right.
Trust me, my life,
I should be doing drugs.
But I'm not.
All right.
I'm just really hungry.
I haven't eaten in two days.
All right. Well,
how about we bring you some food?
How about that?
Hey, bud.
How are you, man?
Are you doing okay?
You sure?
You seem a little off.
Is everything okay with Mom?
It's all going to work out.
It's your first year.
I think you just have to
This is the way the world is.
I know you think
you're the master of the universe,
but it's competitive.
And you're going to do fine, but this is
There's a lot at stake
in everything you do. And that's why,
if I give you a hard time a little bit
about some of that stuff at school,
it's because I know what the potential
for the pitfalls of this are.
Well, don't keep it under your hat.
You should talk to me.
Okay? I've actually been through
some stuff before.
All right, I'll check in with you later.
Love you.
All right.
I'm late, I'm late
for a very important date.
Hi, Phyllis.
How was your night?
You want to go home?
Maybe that would be a good idea.
I think it would be a good idea.
And can you tell me a little bit
what's going on in there?
I took off one of the plates.
And growing up from under it was a cancer.
And I can tell
There was just this purplish
And so I took pieces and sent it upstairs
and I looked myself at it.
- Okay.
- It's a little unusual,
but it's all out.
Everything's been unusual with me.
The question will be is
if there's no other sites,
what do we do with this site
that's already gotten radiation?
And that's a question for the oncologist
and my radiation doctors as well.
So my take is do nothing.
It's not worth it.
It's not worth it.
I'm gonna get myself a nice pill,
so whenever that moment happens
happily, I'll say good night.
That's my plan.
And I told my husband,
if he wants one too,
I'll give him one too,
if he thinks he'll miss me too much.
We're going to talk about in the office
when you come back.
- All right.
- Okay?
Saul is home with you?
- Yes.
- Okay.
He'll be happy I'm home.
Yeah, I'm happy you're going home.
All right, thank you.
- I'll see you next week, okay?
- Okeydokey.
You know, each of us have to
think about what we would want.
I'll never forget my dad.
When he had cancer,
he was very explicit about
what he would do if he lost consciousness.
So at the end of the road,
when all the doctors said
his case was terminal
he said, "Don't unplug me.
Just give me six months
in case I make a miraculous recovery."
I can come home early tomorrow and help
from the lab.
I have four kids, right? So every time
If you have cancer
and you get chemotherapy,
you can't be around children.
So he couldn't be around my kids.
He actually succumbed to not the disease,
but the treatment that he had gotten
for his disease.
And that shouldn't happen.
Everyone else good?
I don't know. I got two big cases,
and I'm not exactly sure what time.
My experience with my dad
changed me forever.
- He's doing pretty well, huh?
- I think he looks great.
Again, thank you so much.
No problem. Let me see your head.
That looks great.
And he had something else to say.
What else did you want to say?
Uh, I think you just saved my life.
- You look awesome.
- Thank you so much.
- You really look great.
- I appreciate it.
- He's not going to even need you.
- He's not going to need me.
And that And guess what.
Isn't that the best thing
you could say to me?
- Yeah, absolutely. See you soon, okay?
- Thank you.
- All right.
- Thank you, Dr. Langer.
You're not going to need me.
I know, John. I'm just I'm so happy.
It's it's better than I could've
I know. Yeah.
I've never been so happy
my child doesn't need me.
Kevin actually he moved to California.
So we're doing a little bit
of long distance right now.
So he's coming every other Friday,
so we have this whole process.
- Okay. Okay.
- Yeah.
Should I stay here, or over there?
Well, this is the ultrasound,
so where do you want to be?
Okay, my my pride and joy right now
is that no one can tell I'm pregnant.
You don't know gender or anything.
I'm trying not to know.
- Oh, good for you.
- We have debate within the household.
- Actually, no, it's cool.
- Oh, wow!
All right.
Your baby's in a perfect position
for the nuchal translucency.
Little big I feel like big
Oh, look at that little heartbeat.
Got a little heartbeat.
Nice and strong.
- Oh, moving.
- Hold still, baby.
It's awesome that you don't want to know.
I feel like there's not
that many genuine surprises in life.
- Right.
- And I feel like
when I'm in those deliveries
where the parents don't know the sex,
- it's like even more joy than normal.
- Yeah.
That's amazing.
Did you meet in California?
- No.
- We actually meet at the club.
That's why
you can't predict life like that.
And then he didn't know
what he was getting into
- by dating someone who was in medicine.
- I did not.
She did not tell me.
Oh, look at that. That looks good.
Can you stop the video
for a second, or no?
I was just going to say something, but
Generally speaking,
eventually it's going to be your decision.
So, if you look here,
it's the fetus, this is the profile.
And the area behind the neck,
it's the skin fold.
It's this area we measure
and the larger the measurement,
the likelihood
of an abnormality is higher.
Also, there's a slightly increased risk
for birth defects.
Not that I can see one.
That's why we may have a fetal echo.
At this point, I would say
CVS makes more sense,
because we can get you the results
- within a few weeks.
- Mm-hmm.
An amnio means that you wait
for at least another month to do it.
some patients may decide
that they don't want
Yeah, I didn't know
So basically what he's saying is
It's a little bit thicker
than it should be.
- Thicker
- But it's on the borderline of being
It's not like if it was four or five,
they'd be like, "This is done."
Like, this is 100% abnormal pregnancy.
But like, it's just a little bit
over the border,
but more
than they're willing to be like
Some people would definitely not do
a diagnostic test
and, like, have a high percentage
of having a normal pregnancy
but I think it's worth it
for us to do CVS.
And CVS is?
Chorionic villus sampling.
It's really kind of sampling the placenta.
Looking at the fetal genes
and the placenta.
- So they take a needle and they go in
- In my belly.
I don't know. I've never seen a CVS.
I've actually only seen amnios.
- You've never done it before.
- No.
- Oh. Is that something you should do?
- Yeah, but I do.
It sounds like I'm very busy,
but are you okay? Are you okay?
I'm all right. I'll be all right.
- Come here.
- Okay.
I think it's going to be fine.
I don't think you need to change
your flight, actually. I really don't.
Actually, the more I think about it,
I don't need someone here.
I'm just going to get a resident to come.
I'll get a fourth-year.
- Okay, I'm going to talk to you later.
- All right.
This is not how you leave.
You can't go this way.
I'll talk to you later.
What Oh
Go that way.
Oh, this is
I'll see you up here
before you leave, okay?
- All right.
- See ya. I love you too.
I was running around
like a chicken with my head cut off
between cases.
I sent the lady down for a CAT scan.
No one could see the CAT scan
for literally an hour.
I don't mean to be shrill,
and I do get emotional, admittedly,
and I apologize for that,
but in general,
it's when things get really bad.
I just want to be a voice of reason.
I want to make this
the best damn place in the world.
And I believe that IT is
a huge component of that.
So, I'm about to start a big case.
I have got to focus on this,
but I can't tell you how much I appreciate
you guys reaching out.
I need to do this for myself
and my patient and my team.
Okay? All right, guys, loving you.
Thanks so much.
Okay. Bye.
All right, ready? Sorry about that.
We'll try not to cut her hair.
I think he's going to do
something like this.
And then he's going to come behind the ear
and like that.
You can feel it. That's the tumor.
- Yeah?
- Feel it?
We have to be able
to get to the middle circle.
This will be good.
How is everybody today?
It's a big one, guys.
I don't have
I don't have a signal on the screen.
He's coming down.
I see him. Give me one second, please.
Love it!
I fucking love the exoscope!
That move is so hard
with a microscope, dude.
That's like when you hit
that three-pointer.
The reason
why she's getting the bypass is that
there's a large blood vessel passing
through the tumor.
If we just take the tumor out
with the blood vessel,
we think she would have a stroke
based on the testing.
We want to put a bypass in first
to bypass the tumor
so that we can remove the vessel
along with the tumor specimen.
I'm gonna cut a little bit more,
you think?
That's just perfect.
You couldn't have asked
for a better match.
It's a good graft.
That's really nice, dude.
That's varsity.
Somebody just walk down
and tell the family
I'll be out to talk to them in a half
an hour, but everything's going very well.
And John has his final exams.
He has finals?
The week I'm due.
- So if it happens, it happens, but
- Don't feel bad.
Actually, if it happens a week before,
then he can take the finals a week later.
Um, yeah, I know. No control.
I'm starting to feel
the weight of my, uh my work
on my body and my mind.
Give me one minute.
I'm going to have to bring a chair
to see these people.
My legs are my legs are tired, Jennifer.
Put them up.
What if I just get pushed
over to the other side?
I'm pushing myself, actually.
This this past week was pretty tough.
So, Mr. Munn, what's going on?
You were just here 24 hours ago.
Yeah, so I'm having the same issue again.
Just like a swollen throat.
- Yeah.
- Like my tongue is sore.
Um, I've not done any drugs
or eat anything different.
So I don't know what's happening.
So when's the last time
you did the crystal meth?
- Three days ago.
- Three days ago.
- I don't do that.
- Okay. Okay.
That's okay. I'm just asking.
- She has a bed.
- Okay.
- I told her everything that's going on.
- You want me to do it?
- I can walk over there.
- Okay, I can walk with you.
My sister
My sister's asking where the will is.
Why are you watching me
go down the stairs?
- Be careful.
- Do you think I'm going to fall?
Look at this!
You guys are so amazing.
Thank you so much, guys.
Eat, eat.
I'll eat.
I made a flan. I was like,
there's a potluck going on.
That's right. You made something.
It's like my grandmother's recipe.
It's really good.
It has to be flipped over
or else it's not flanned.
This is your last night shift.
I'm going to miss you.
I know. I'm going to miss all of you.
You'll have to send the photos to me.
Oh, boy.
Aw! Everybody's on here. Everybody.
The nurses. The techs.
You guys, this is honestly
the best place to work.
It's by far. It gets number one.
I mean, the people here are just
so amazing.
I'm really going to miss you guys
at nights.
I might come back before.
I don't know if I can make it.
Let me know. Let me know.
Four months is too long.
- Thank you, everyone.
- You're welcome.
You're welcome. Bye.
Go see what it looks like up there.
I'm scared to look.
Oh, boy.
Fuck me. What in God?
Look, it's not bleeding.
There's no flow.
Give me a scissor, please.
The stenosis is fine.
It was flowing fine for five minutes.
Now it's got no flow, though,
coming from the proximal side.
- There it goes.
- There it goes.
There it goes. There it goes.
Whatever clot was there
just opened up completely.
Right here.
This narrowing.
Get the exoscope on it.
Give me the pickups with the teeth,
the blue ones
and a brand new 15-blade scalpel.
Doesn't look right.
Doesn't look right.
Look at it up here, Pete. There's no flow.
You can see, it's just totally collapsed.
It's not bleeding all the way through
is what I'm saying.
You need more flow
for this thing to dilate up.
The only way to prove it
is an angiogram
and show the ACOM fills the MCA.
Let's do an angiogram.
It'll explain why it's not working.
That's why no one else does this stuff.
It's hard.
It's challenging.
She's going to do okay.
We'll get this tumor out.
She'll be all right.
Just going to stroke her in the process.
Oh, boy.
The graft worked for about five minutes,
and then it started slowing down.
And I think she may have collateral.
Because the graft is absolutely perfect.
- Yeah.
- Yeah.
That I could accept.
The brain's smarter than we are.
Yeah. That's, the human body.
Let's hope she doesn't have a stroke.
So there was some other source
that was competing against
the graft, basically.
Essentially, her right side
is filling the blood vessels to the brain
the normal way,
and actually through the face,
the right to the left side is feeding
these same external carotid branches
that we thought were isolated
and she couldn't tolerate losing.
There's no better way to study her
than we did.
And if it's my mom or my sister,
I would've done the same thing.
We'll go ahead with the tumor resection
next week.
I'm starving.
Things went well.
And, in fact, in a strange way,
unexpectedly, things went
better than we anticipated.
Because we have reserve redundancy
in the blood flow to her brain
that we didn't realize existed before.
And I think that,
it's likely that her brain will be safe
throughout this entire process,
- but I'll let Dr. Langer explain that.
- That's awesome.
There's no way that Dr. Constantino
could have gone in next week
and done this tumor resection
without knowing.
And now even though it's
a 12-hour exercise
and it takes our technical thing
even though the graft isn't working,
we do know that she's safe and that
- he can safely take that tumor out.
- Yeah.
Well, you guys had a long, hard day, man.
We both, everybody appreciates
everything you've done.
- And you guys rock.
- Yeah.
- It's an art for what you guys do
- Y'all are famous in Tennessee.
One thing for sure,
- everybody in Tennessee knows you.
- I didn't have anything else to do today.
Yeah. I know you didn't.
She did a lot of background
on Constantino, and it led to you.
And seeing the positivity
between the both you guys,
and seeing how you managed, it means a lot
to people like us.
- Good.
- You know?
- All right, man.
- Get you some rest, man.
Let's hope she's okay.
Yes, let's hope she's okay.
- Okay.
- Tomorrow's another day.
So Mitzie had a stroke last night.
And I came in to see her at about
I was at dinner, and they called me
that she wasn't moving her right arm
and her
She was having trouble with speech.
I came and saw her and we're we're trying
to wean off pressers.
She'd been doing great in the afternoon.
But, you know, obviously, it's, um
very, very unfortunate.
And, um
complications are not
things that I take lightly,
and certainly in the vascular world,
it happens, but this was, um
just hard to take.
You have to think of yourself
as an arrow,
and that you you work
on sharpening your tip.
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