Lenox Hill (2020) s01e03 Episode Script


What are you having, a boy?
I just wanted to work
until the very end.
Yeah, you you did.
This is your last night shift!
I'm going to miss you.
Give me a break. Just want to make
the place the best it can be.
That kind of special chemistry
is what allowed us
to be able to compete against
the biggest neurosurgery departments
in the city and in the world.
The tumor looks like it's retracting.
I'm optimistic for what I expect from you.
Can you stop the video for a second?
I think it's worth it for us to do CVS.
We're giving you
a little piece of a bacteria
- Okay.
- To illicit an immune response
in your body.
In the bacteria is a drug
that we hope gets into your brain tumor.
Important thing is you have
a working graft, and it looks good.
You're not gonna have a stroke.
There was no flow.
You can see, it's totally collapsed.
Mitzie had a stroke last night.
One more. You got it. Stay tight.
Take your time. Breathe. Relax
Same thing.
Long arms, straight lines, keep it up.
I didn't grow up saying,
"I really want to be a chairman."
Yeah, I told Don.
It's nice to have it on your card, but
the day-to-day management of this
is a real challenge for me.
I've chosen to take
a kind of an open way
of managing the department.
Some departments, the way it's set up,
you're competing more
with the guy down the hall
than you are competing
with the guy at the other hospital.
Each of the guys has their own careers,
has their own aspirations.
They're all ambitious.
They're all super talented.
But we have to get away
from the mentality of,
"Every case I do is for me."
You have to get gratification
from seeing your partners grow,
from helping young people be successful,
from how you influence
the larger picture of a healthcare system
in a hospital.
That's my job, to shepherd that through.
Today, I want to just talk about
some of the initiatives that are going on
in Staten Island,
Brooklyn, Westchester,
and make sure we're all good
with what's going on.
So Abrams and Cornell are applying
for privileges here.
What kind of surgery do those guys do?
They're going to do all spine
- and brain tumors.
- Where are they gonna do it?
- They're gonna bring 'em here.
- Where?
I don't know. We'll worry about that
when the time comes
We have no rooms, no staff, no equipment.
But that's not a problem
They're taking time away from us
because we're not filling it, by the way.
I'm just concerned
about the fact that we have
a certain dedicated spine staff
and certain people,
and we have a certain workflow,
and then these other guys come in
and need to be accommodated
and then, you know, the staff gets
"We don't have enough trained staff
Specialty staff"
- We have to grow
- "We don't have enough beds."
- We have one eye machine.
- We have to get more equipment.
The whole thing, that's what I'm saying,
as you as you ramp up
and try and fill do more cases,
do more cases, do more cases.
I think, on the other side,
the hospital has to understand,
we need the resources.
So let's get 'em some let's get 'em
See what happens first, then we'll react.
- Yeah.
- But we can't say no, so
Right. Why do you want to go up there?
What are you going to get from that?
Hopefully vascular, brain tumors.
They're gonna try to get involved
with John's clinical trials.
- Send John glioblas.
- Today any emergency
that happens in those hospitals
is going to Westchester Medical Center.
Any elective cases, major case,
is going to Columbia.
We need those cases.
They're part of the health system.
We need to have a relationship with them,
and uh, the best way to do it is
see how it goes.
They're not going to compete with you.
They're-a completely different zip code.
- They compete for resources. That's all.
- Why don't we see what happens first
before we make it a negative?
I'm not making it negative.
It is a negative in some ways.
- It's partial negative
- I don't see any negative.
- Zero.
- Okay.
- Who's in operating today?
- Me.
Me and Mitch.
I'm taking Mitch's resources.
He is, actually.
Next thing.
We have to pick a day for our retreat.
It'll be just the five of us.
John, what week are you at camp?
The 22nd to the 28th?
- Looks like it.
- Because we had said the 20th.
- That was a date that I could do.
- Dude, this is my vacation with my wife.
I don't give up anything.
Then we do another day.
- We could do it August too.
- Going up there.
- Okay.
- Where are you going?
Points unknown.
- And the second time was
- You're out August 12th?
No, not around August.
I'm out three weekends in July.
Think I can do the 29th, potentially.
- 29th?
- I can do the 29th.
30th. Let's do the 29th.
- The 29th, 30th it is?
- It's far away. We should stay close.
All right.
Let's get out of here.
As I get older
this is what motivates me.
Pictures of my wife, my kids, my dad.
It's like a sport.
It's a place to sort of contemplate
what you're about to do,
who you're about to do it on.
It's a moment just to get ready.
You're not swinging the bat yet,
but you're getting ready.
And, you know, this is the part of the day
where I get, as an athlete,
you know,
starting to get mentally focused,
and, in particular,
I don't want to be bothered now. You know?
This is
We're getting laser focused.
Thinking only about the surgery
that I'm about to do.
Scrubs fit.
You know, if they're out
of medium scrubs today,
I'd be annoyed, you know?
These are pictures of my dad.
And I put this picture up here,
because he's holding a you know,
a gasoline saw,
and he was teaching me how to handle it,
and he's a physician, so
I'm reminded of the dangers
of the instruments we're about to wield.
Here he's holding
my daughter Daphne or Ivy.
I can't tell the difference.
This is sort of my my shrine.
My surgical shrine.
I think we're good to go.
Do you feel a contraction?
Do you feel pressure?
Pressure, yes.
I think you're ready to push.
Okay. We're gonna
Deep breath.
And go.
Eight, seven, six. More.
Five, four,
three, two, one. Good job. And breathe.
Good job. What do you think?
I wouldn't count down.
- I think she's going to work really hard.
- Okay.
It's tight.
Okay. So we're gonna rest right now.
Dr. Johnson feels
like the head is too high
and that your contractions will bring
the baby down a little bit more.
That's fine. We're going to rest
and we'll try to push again
in maybe 30 minutes or so.
Okay, I'm gonna start printing.
Thank you, Dr. Johnson.
I haven't seen you in a long time.
- Oh, my God, I need to tell you.
- What?
So I had my evaluation.
Nothing that you said was mentioned.
- Well, that's good.
- He just said, "Everything's going well."
He's like, "Some people say
that you have some aggression,
but I think that's just your personality.
You care about the patients. It's fine."
- That's, like, what you talked about.
- Good.
- But I've been saying that.
- That's some real feedback too
No one's giving us
All they said was "Good resident."
That's what I got.
"Good resident. Team player. These
Lacks sense of urgency sometimes."
- Anyway, I don't know who's back tonight.
- I am.
I'm back tonight. I'm back
this weekend. I'm back next week.
I'm back all week.
Chicken and waffles.
My doctor, Dr. Johnson, texted me,
just being like,
"Hey, can you give me a call?"
And then she was like,
"You know, the test came back positive."
Yeah, that's kinda great
we get to see all of this.
I don't think I'm a crier
so much.
But the day I got that news
Kevin said he's never heard me cry
that hard.
When you hear that something
might be wrong with your your child,
it's, like, devastating. So.
the disease that our child has
is called Noonan syndrome.
Very nice brain.
Which is extremely rare.
Often, there's, like, cardiac defects.
You can have some aspect of deafness.
There can be some learning difficulties.
And short stature.
I should have filmed this for Kevin,
because he loves hearing the heartbeat.
Sorry. Okay.
One more time, please.
Nice. Thank you.
Kevin and I have really decided
to continue the pregnancy no matter what.
What a cutie.
Thank you.
So many pictures. Awesome.
Thank you.
Everyone's going to be so excited.
- Very lucky
- Twelve ounces, which is normal size.
- Okay, good.
- All measurements look good.
They've been
very cautious about telling us
that things can develop later
in childhood, even.
It's a relatively new gene.
Did it look like, um
the heart was taking up
more of the abdominal cavity than normal?
- No.
- No? Okay, I don't know.
- Okay?
- Yep.
- All right.
- Thank you, Dr. Minior.
- You're welcome. Have a great day.
- Thank you.
You know,
there are some things that develop in life
that you can't there's no testing for,
like, schizophrenia,
or autism, and like,
that's just something you, as a parent,
take on the challenge
once a child is born.
And so this is a challenge
that we know we have now,
but I think that every parent will say
that raising children has challenges.
It's actually comforting to hear
the baby's heartbeat the whole time.
When I get a contraction,
he speeds up a little bit,
so, yeah, it's kinda soothing.
You don't like those alarms that go off.
Well, I mean, it is hard
I'm actually completely
used to the alarm the alarm sounding.
Because we work in the ER. It's so loud.
And I I You have to get used to it.
That's funny,
because I just walk into our room
with my shoes on, and you wake up.
But the alarm doesn't wake you up.
No, the alarms don't bother me at all.
I'm used to it.
After the baby comes,
he'll steal all the attention.
Mitzie's surgery is, uh
It's complicated.
Unfortunately, not from the bypass itself,
but probably some clot formed somewhere,
blocked one of the arteries
that goes to her left frontal area.
Which is not where the bypass
is being plugged into.
It's in a different vessel.
And she suffered a stroke.
Come on in, Doc.
You okay?
- Doing all right?
- Yes.
- You're gonna get better, okay?
- I know.
Just a bit of a struggle.
So, you there's your face is weak,
but it's gonna get better.
And this hand is pretty good.
Give me a squeeze. Good. Okay.
It'll get better.
You just looked so good last night,
then you had this little setback. But
- Yes.
- Look, the angiogram looks okay.
You're missing one of the vessels,
what's called the middle cerebral artery
is not there, so it must have clotted off.
Uh, you definitely had a small stroke
that's going to affect you temporarily.
I think your your ambidexterity,
the fact that your brain
is probably wired better than mine,
um, is a good thing.
You're going to get much better.
This is all going to get better.
Your face is going to get better.
Your hand's going to get even better.
And it's it's already better
- than it was last night.
- Yeah.
We're just gonna keep you
on the blood pressure medicine
- for the next few days
- Yeah.
And take our time.
But you're going to rehab well.
- You're going to do okay.
- Okay.
All right?
We're probably going to hold off
on the next surgery, though.
Are you going to be there for me?
- I'll be there for you.
- Yeah.
This is you're gonna continue
to get better. And we have your back.
Thank you
You make it easy. Okay?
- All right.
- Thank you, my friend.
Who's the President of the United States?
That is
That is, um I know it.
I won't say nothing.
I won't say nothing.
That is, um
Some people like him.
Some people don't.
You're right.
But we like him, don't we?
Yeah. That is, um
I'm gonna help you out.
First name's Donald.
And last is, um
What's his name?
Everybody sings his name all the time.
- Want me to tell you?
- Yeah.
- Trump.
- Yeah.
- You're gonna be fine.
- I know. Yeah.
This is the paper you need to sign
so that we can go in.
- Okay.
- What you're signing here is
that you understand the procedure.
He was told that he had
nine months to live when he was diagnosed.
But instead he came here,
he got married in the hospital
before surgery.
He enrolled in our
One of my early clinical trials.
Terrific response for three years.
No treatment, had a baby,
bought a white picket fence house.
And then recurred
or had these changes. He's a fighter.
- It's going to be fine.
- You know? He's a fighter.
- Okay.
- We're feeling good.
- We know that he's gonna be fine.
- Yeah.
This is just the killing
of the tumor day. That's all.
That's right.
This I took out,
and then he's had a recurrence
His speech area's here, right?
This is just before enrollment
in the new clinical trial.
He got infusion the day after.
And so he also had radiation here.
- Yes.
- And so this isn't now.
This is now. This is last week.
- That's fantastic.
- Yes.
- So
- So only three weeks apart.
Then we're gonna do another infusion.
What I'm going to look at
is just the the swelling. See.
Yeah, but because of the swelling,
that's why he has so much trouble
expressing himself.
Yeah. Wow. Wow
That's when it came down.
Before and after.
That's really awesome.
Let's get this down even further.
- Chris.
- Yep.
What do you want to listen to?
Grateful Dead?
- Sure.
- Little "Friend of the Devil"?
- Yeah.
- I feel it.
- Let's do it.
- Yeah.
We like to play music for people
before and during.
When you wake up,
it's gonna be all done.
All right. Let's go zap this thing.
And we thread this wire
Very, very thin wire,
inside the needle,
and now we're ready
to have access to the femoral artery.
The blood-brain barrier
is sort of the invisible fence
around the brain.
It's there to protect things from getting
into the brain.
However, if you have something
in the brain that you want to treat,
you can't do it
because you got
this darn blood-brain barrier.
What we're doing,
what I'm studying is how do you overcome
the blood-brain barrier?
How do you get in these good drugs
in high enough dose
that you're going to get effects
that are positive
in brain cancer, in stroke,
in Alzheimer's?
I mean, this is the stuff
that our population has dealt with
and is going to be dealing with
for the next decade.
- All right. Let's do it.
- Okay. Let's subtract, please.
So the blood-brain barrier
should be open now
within two minutes or so.
For about 15 minutes or longer.
- You're injecting how much per?
- That was three CCs.
Three CCs.
These are probably your most important
injections, right now.
Curing cancer one cell at a time.
All right for five.
When I was preparing
my hospital bag, I did little
You know, I'm wearing, like, little things
that mean something to me.
Like, my my wedding earrings, and
And, um,
these Peruvian beads
that I brought back a long time ago.
Just, uh
just important things that
bring good energy, I think.
That's nice.
Yes. It doesn't feel
like it's been 12 hours.
It's actually for
- what we call a cold induction
- Yeah.
Where you're not overdue,
you haven't been really having a lot
of contractions so you don't come in
Already a little bit dilated.
This is a good pace.
- Yeah.
- This is not a long process
by any means right now.
Things still work.
It's it's
It's working, it's working.
It's a marathon, not a sprint.
- Labor delivery.
- That's true.
- I should think about it that way.
- Yeah.
Well, usually,
I meet with Jill once a month,
just to talk about issues
that have to do with our department.
We just
There are a lot of issues to our growth.
My problem is we can really
start going in the wrong direction.
We're gonna do almost 900 cases
here in neurosurgery.
In 2014, we did 250.
- Right.
- So it's like 175%
Some crazy amount
175% growth in four years.
But you know how many
designated ORs we have today? One.
- Same as what we had then.
- Right.
So if we have we need two rooms a day.
We're pretty much doing that now.
It's just moving off
We have one room that's ours,
and then the other room
is wherever we fit you in.
And the problem with that is
the equipment's all over the place,
- the staff gets scattered
- No. I'm on it.
- And I think the other
- I want to understand.
Somebody said no for a reason.
Didn't say no. He just wanted
to know who's paying for this.
Right. The point is what
Who needs what in the hospital,
and what has been shown
that it's growing, we need
Inappropriate, not the right level,
we have to figure it out.
And I don't really
- Can I cut you off for one second?
- Yeah.
The problem is that, yeah,
we're getting the cases done.
We're not getting credit for them.
Because Elle is finding place to put us,
but that's not our scheduled time.
So it's impossible for us
And so if we don't "fill our time"
So I think the time is now
and I'll tell you why.
You're at that really critical point
right now
where everything has grown,
and yet we haven't.
The support hasn't grown at the same pace,
- because you have grown your
- Yes. I couldn't have asked for this
- four years ago.
- Agreed.
But I I think if we don't do it,
at some point, we're just
'Cause I'm looking at the numbers now,
especially things
like US News & World Report,
and Healthgrades,
and all this stuff coming out
No. I'm giving you a hard time.
I am very clear on what I have.
I think I have the best neurosurgery group
in Manhattan, in the city, in the state.
We've actually done that
despite not having the things we need.
Exactly. And I'm very clear on that.
And I think but you had to build it
from the ground up,
so you are you are at that next level.
You've had multiple growing pain areas.
- And now you're at that next level.
- Yeah.
Honestly, I think we should have
two rooms a day.
See how it goes.
Take the risk with me here.
Give me a Front-load me for once.
- Right.
- Okay?
I think that we we we've earned it.
- I agree.
- We really should be looked at critically.
- Thank you.
- You're welcome, Dr. Langer.
Being chairman is, uh,
similar to being a juggler,
except instead of juggling
three tennis balls, it's more like
juggling three knives on a skateboard,
and as you're skateboarding down the road,
someone throws you three new Wiffle balls
and adds some serious headwind.
What's the word?
Where's the exoscope?
I told you this morning
we're using the exoscope.
- And I told everybody this morning.
- So where is it?
I just like using it.
I hate. My neck is killing me from
No, no. I hear you.
So, I need to talk to you
about that, uh, other issue, so
Let's do that afterwards.
Let's just get the scope in.
Who's going to help us move that in?
Don. He's just getting us a sheet.
And then we're going to get that in.
Do we need to talk about that now?
- Uh, ideally
- Yeah, but
About coverage in the OR today,
you mean?
So so, we had a visiting professor
meeting yesterday, which we obvious
Katie and I couldn't go to.
You guys tell me what you need to do.
The first responsibility to me
is my patients.
- Of course.
- All right?
My second responsibility here is
to your guys' training.
My third responsibility
is some bureaucratic BS
- that can be done any time.
- Yeah.
I care about it, because it's important,
but I really don't give a shit.
- Yeah.
- Honestly.
Right. We'll get this done.
Hopefully, we'll see. The second case
"I give a shit,
but I really don't give a shit."
Living large. Living large.
What we do, baby.
Okay, let's time out.
Okay, everybody, time out.
He's a bartender in Brooklyn.
Old Navy guy. His wife's here.
He had a severe lower-extremity pain
about a year ago.
Had a single-level stenosis.
We decompressed.
We did well for about six months
and recurred.
He has a recurrent. So, human being here.
Everybody, eyes closed. Ten seconds.
Deep breath.
Lot of craziness today, obviously.
Let's focus on the work.
Ten-second time out.
This is, to me,
the most exciting part of my week.
And I usually
after a morning like that,
I try to go home,
digest it, or I sit in my office,
and I write.
I write down ideas. I write manuscripts.
I write grants to say, "Okay, here I have
the smartest people on the planet.
Why are we having trouble
with glioblastoma
or brain cancer or stroke
or neurodegenerative diseases?"
What's interesting is,
um, we have a police officer
who is our eighth patient
in the anginic clinical trial,
Miss Agi. She's getting
her fifth injection tomorrow.
Every time we infuse the bacteria
this mini-cell
20 minutes later,
she's getting a pounding headache
at the site of her tumor.
And it lasts, what?
- 45 minutes to an hour
- 45 minutes, hour, yes.
It, literally and she says,
"I feel like it it's in my tumor."
- Wow.
- That's what she says.
So this was still invasive.
You know what the NTI budget is?
It's about six billion dollars.
Now, that may seem like a lot,
but that's about the cost
of three stealth fighter jets.
To not put
that kind of resource to the cure
of human cancer is just criminal.
But we're all on a mission,
because we've lost so many people.
You know, they become friends,
and they become family.
We've lost family members.
And we're going to lose more people.
So I'm on a mission.
- Hey, Mitch.
- Yes, sir.
The scar is really bad.
I'm just wondering
whether we just leave it there.
Look at that. Holy shit.
What a mess.
Into the spinal fluid.
Give me a drill please.
- Do you have a longer one of these?
- Uh, no.
- Give me some of this bone too.
- I don't have any bone.
There's no bone.
Go ahead. Keep going.
Back Yes.
That's the way to do it.
There's the root.
Ah! I love you now.
If you don't have collaboration,
and you don't have great teams,
and you don't have people
driven to help each other,
everything breaks down.
It's one of the reasons
why healthcare is the way it is.
The doctors are essentially selfish.
They worry about their own issues.
They may see something
and not say something.
All right, Mitch. You're up.
I want to take that out.
Mitch is our spine guru.
Okay. Let's put the screws in, go home.
Mitch is going to be responsible
for the instrumentation
and putting the screws in of the spine
and getting so the spine
We share the work.
This is a lot of work for one person.
Irrigation, please.
We're lucky here.
We have great relationships.
It's not about money.
It's about doing, really,
the best for the patient exclusively.
That's the way we all behave.
That's why I work with Mitch.
I'll come back, guys, okay?
You okay, bud?
Yeah, I'm good.
Whatever you want to. You choose.
You just tell me what you want to do.
Why don't you be with Mitch?
That'll be better. Okay? All right.
I just wanted to show you the scans,
also, bud, okay?
- What's that?
- I just wanted to show you her scan.
- Okay.
- How's she doing?
Uh, well, sleeping right now.
Just tired. Tired.
This is the area of the stroke right here.
- The dark spot?
- Yeah.
- Yeah.
- But this is an area of just
Area of the surgery.
- Oh, okay.
- The trouble is
this artery is involved with tumor.
What we'll have to do now
is be very careful of this artery
and preserve it.
- That's what we're going to do.
- Absolutely. Absolutely.
- You do it all the time, I'm sure.
- We'll do it.
You guys are very confident.
- All right?
- Cool time.
- Okay, bud.
- Low
- Low fat.
- Yeah.
- Chocolate.
- What? Yeah.
- Milk.
- Milk.
This is chocolate
- chocolate milk.
- Yeah.
What is this?
My phone.
- Who am I?
- My husband.
But what's your husband's name?
His name is Tony.
It's Tony. All right. What are these?
Your keys.
- What is this?
- That's my drink.
- You're doing so good.
- I love you.
Mmm. I love you.
- I bet I love you more.
- We're getting there.
You're getting
We? You're getting there.
I couldn't do it without you.
I can't do it without you.
- Yeah.
- Yeah.
My love.
Really big. There you go. Awesome.
Let's see your tongue.
- Who loves you?
- You.
You got that right.
I had a feeling
- Have they been sitting in here?
- We've been waiting.
Do you have enough oxygen
in here for this?
- We were watching the World Cup.
- Blow out your candles.
Are you one? Are you two?
Are you three?
- Fuck this.
- Happy birthday.
And then scream your name.
- That's really nice.
- What did you wish for?
I wished everyone's happy. How's that?
- All good.
- We're all happy. Today we're happy.
Now forget it.
It's not going to come true.
You're not supposed to say your wish.
Forget it now.
Now we're going to be miserable.
They're tissues.
Read the Post-It.
But did you see
This is
a gift that I got,
and I decided to get it for you.
It's a coloring book.
It's a mindfulness coloring book.
When you're stressed out,
I want you to color.
- What if I color it black?
- Stay in the lines and just color.
What if I color it all black?
This is funny. Look.
- I do, "All bleeding stops eventually."
- " eventually."
And I signed it, so you'll always know.
"Happy birthday to one
of the most colorful guys I know."
- That's good, right? Happy birthday, pal.
- Thank you.
It's funny,
because whenever I look at that wall
of, like, physicians in the past,
that have taken care of patients here,
there's really no people of color
on that wall.
So I think that
there's still so much
in terms of having minorities
who are providing care to patients.
And like
what I'm doing is important,
as hard as it is.
Because I think that, like,
the diversity of experience,
life experience,
definitely affects
the care that you provide to patients.
And, like, we all are needed
in order to provide our patients
with, like with the optimal care.
So it's just interesting.
It takes a lot to go through medicine.
I think a lot of people
enter into the process
From a space of privilege,
myself included.
I recognize that my parents
had financial means
to help support me through undergrad,
through medical school.
And I'm glad
that I was able to kind of do that.
Hey, guys.
- Coopy!
- That's how it works.
Happy birthday.
How you guys doing?
- Hi, Molly.
- Hi, Dad.
- How was your trip?
- It was good.
Happy birthday to you too.
I'm very sweaty.
It's okay. Yeah, you kind of are.
- Hi.
- Happy birthday, honey.
- Love you.
- Love you too.
And of all things
Honey, I cooked for you tonight.
Can't you see the table? It's all set out.
You've got a big spread.
For your birthday.
- I'd like to get Vietnam or Thai.
- It's your birthday.
- Vietnam it is.
- Do what you want to do.
- I'm going to go pick out something.
- Okay.
- This is, uh
- You don't look a day over 20.
- Hello.
- Hi.
- Anybody here?
- Yeah.
Hi, baby.
How are you?
I'm glad you made it. Hi, Mommy.
How are you feeling?
Good, it seems like
the epidural is making me
it isn't having an effect
on the left side,
- so it's giving me pain.
- It's giving you pain?
Okay, but the baby is okay?
The baby is fine, I mean
Could your blood pressure
be high, suddenly?
No, it's good.
- Yes?
- Yes, it's good.
The baby is positioned
to be born, his head?
Joaquim doesn't want to come out.
Joaquim doesn't want to come out.
He likes it in there.
He's not really cooperating.
But it's very high up, right.
It hasn't gone down
for anything, I don't know.
Are they waiting for a natural birth?
Yes, they want it to be done normally.
Why not?
Natural birth is better.
My mom just wants me
to be sectioned.
- Oh, yes.
- Why? Why?
It's easier,
the baby boy won't suffer.
But the baby is fine, he isn't suffering.
I know. If it doesn't
work out and you have to force it,
the problems begin.
No, but you have to give it a chance,
it's only been
a little more than 12 hours.
Oh, no, please.
She told me 24 to 36 hours.
No. Relax.
The dogs can't wait.
I don't care about the dogs!
We can leave early.
After she has it, we can leave.
- Huh?
- After she has the baby, we can leave.
You're just being nosy.
Oh, my God.
I don't think Dad can watch the birth.
Aye yai yai.
We'll see.
You can't labor by yourself, dear.
You can't labor by yourself.
You want to do it without medicine?
So your partner has to wake up.
It's going to be a while.
Which is fine.
But if you, um, wanted to do it
unmedicated, which we completely support,
um, we're going to have to come up
with some sort of plan.
Laying down
usually doesn't work for 12 hours.
- I don't want to lay down.
- You don't want to lay down.
Exactly. Okay.
So, she's getting you a ball.
We'll have you get on the ball.
Let's have you stand.
You can get back massages.
- Where's your pain usually? In front?
- It's more like on my back.
Perfect. That's why I said
your partner has to wake up.
He has to rub your back.
Hey, good morning. I'm Dr. Little.
So, um, she wants to do it
without medicine. Right?
But it's going to be hard for her
to do it by herself.
So let's get you on the ball,
and another trick
that people do sometimes,
if you are able to stand,
some people lift this bed all the way up,
then they put their hands
on the bed like this,
and they go like this
through the contraction too.
- Okay?
- Okay.
All right. You you got this.
African-American patients,
having someone that
they can connect with and feel safe,
who is also providing them
with quality medical care,
which is always my goal
- Do you wanna walk?
- If you're trying to do on the ball
and move around a lot,
if you find it's very annoying
Do you wanna walk?
So she only gotta eat ice?
African-American women
die at a much greater rate in labor,
have much more high
maternal morbidity and mortality.
Not saying that only black physicians
are able to give
excellent care to these patients,
but I think that,
as a minority, entering those spaces,
it can be something
that we're very attuned to,
potentially can recognize,
like, institutional problems
that may be contributing
to these higher rates.
I think that's an expertise I want
to bring to whatever ward I work in,
whatever hospital system I work in.
Okay, so this is your time to practice.
Giving her a little bit of massage
back here during the contraction.
This is a 12 to 24, 48-hour deal, yo.
Everything is okay.
Hi. Thank you.
This is in my way.
I'm just like
I'm gonna set my alarm clock.
Set it for ten minutes.
Are you having pain, my daughter?
- What?
- Are you having pain?
- Yes.
- It's coming down now.
It's not coming down.
It's going to be a C-section.
- Are they going to do it?
- I think so.
Kiddo, you're letting it go for too long.
Baby wanted some attention.
- Yeah.
- Yeah.
- He doesn't like this side.
- Well
He actually never has. Even at home
What happens? He kicks more on this side?
Is he decelling or anything?
I mean, just a little bit, yes.
But it could just be
the baby rotating too.
Okay. Want to lay back
on your left side for now
- to get a little more comfortable?
- Is that a good side for him?
Maybe, like, sitting up all the way.
- I'm going to have you sit up.
- We can do that.
- Yeah.
- We can do that.
The dips are getting deeper with each
contraction, but the head's not
Although if you wanted
to give him longer, we can.
I just think the baby needs a break
from the Pitocin for a little bit,
because we are seeing
some dips with the contractions.
I feel the safest thing to do
at this point is a C-section.
I think you're gonna end up
with a C-section no matter what.
Yeah, I I wanna do what's right
for myself and the baby.
I don't want to
Whatever's healthier for us.
I think it's the right thing to do.
You're hiding?
- Yep.
- How's the speech?
- It's not too bad
- Yeah
But this hurts. I feel it on this side.
You know, when you get frustrated,
put on the music and sing.
- I know. Do doing that, yeah.
- Yeah.
You know the words?
That's it.
- Keep pushing through it.
- Yeah.
Because I know you understand,
and I know you hear it.
So today when you go home,
don't be worried about this.
If it gets worse
or you start seeing weakness
- on the right side
- Yeah.
Facial drooping, right side
you can't move as well, right leg
Yeah, it's a little
- It's gonna be a little bit weaker.
- Mm-hmm.
We may need to bump your steroids
a little bit.
- Mm-hmm.
- And that's normal.
So, keep practicing. You can be
a little frustrated. That's okay.
- No BLT tonight.
- No.
- No bending, lifting, or twisting.
- Okay. Yeah, I'll just hang out.
Okay, tomorrow,
don't pick up your daughter either.
Mm-hmm. My mom's around too.
- Good.
- So, yeah, so.
- That was good, what you just said.
- Yeah, good. Thanks.
Of course.
- Okay, thank you.
- Okay, thank you.
Good afternoon.
May I have your attention, please?
We will be conducting a test
on the building. Fire alarm test.
Oh, God.
- I hate when that happens.
- Think of it as a birthday alarm.
Everybody on is coming.
Thank you.
Raise your upper body. I got you.
One, two, three.
- How you doing? Are you all right?
- I'm good.
They'll get you one in here.
Okay. Anything?
No. We have no drug allergies.
We're doing a primary caesarian section
after a failed induction
that was performed for PIA.
She's in supine position.
Her SCDs are on and functioning.
She got Ancef.
All right.
We're gonna be out soon.
Lots of pressure.
Oh, my gosh. He's got so much dark hair.
No, just get it. It's fine. I'm fine.
There you go. Perfect.
- Clamps.
- Oh!
Hi, baby.
Happy birthday!
All right.
He is perfect.
What a relief.
- Thank you.
- You're very welcome.
And then one more thing. Sorry.
He's sticking his tongue out.
He's beautiful.
Beautiful, thank you.
- Did you kiss him yet?
- No, I
He's not been brought close enough.
- Here, let me take him.
- I don't know how to hold babies.
- He's adorable!
- He is.
- I got him.
- You got him?
Hey, mama.
- Happy birthday. He's very cute.
- Is he?
- He's adorable.
- Did you see all his hair?
He's such a little man. He's
- That was rough.
- It was rough, but I'm so happy.
I don't care about all the hours
we just spent.
I'm still shaking.
Board meeting.
Oh, my God.
Shut the door for a sec?
Mitch. You feel like you're okay?
I mean, I do have a realistic
You know, there's
a realistic reason to be anxious, right?
We're here for you.
The radiologist there looked over
an MRI I had done
for some neck pain two years ago.
It was there?
The node was there, the tumor was there.
It's just, the randomness
of this is truly incredible.
You might have a hard time
getting this out.
Mitch has just been diagnosed
with having neck cancer.
Yeah, it's You have a
You have a cage there
That's what I'm saying.
But if you can take this stuff out,
the rest you can get out
through the chest.
But this stuff here
It just is absolutely incredibly humbling
to have a colleague, a friend,
get a diagnosis like that
that is so close to home.
I'm saying, you can get this out
We're gonna help him.
He can beat this.
Baby, hi.
It's Nonna.
It's Nonna, it's Nonna, yes.
Nonna and Pappo.
- I'll take them.
- Sharps.
Yeah. It's hard to hold him with this.
- Yeah.
- He smells so good.
All right.
- Enjoy.
- Thank you.
By the way, I'm Emily.
I'm the transition nurse.
- I'm gonna be helping with the baby.
- Okay.
I'm gonna take vitals
in another half hour.
So, how long can I hold him like this?
Just it feels really comfortable.
He's good.
Yeah. That's the best place to be.
- Okay.
- All right.
I'll eventually try to get him
on to nurse when you're ready.
- Okay.
- Okay?
- Ready?
- I think he's ready.
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