The Resident (2018) s02e15 Episode Script

Previously on The Resident I am not interested in being in your line of giants.
I am the first of my own line.
An ancestor.
Not your descendant.
His seizures are getting harder to control.
- So what do I do now? - The VNS is the best option available to your son.
It was my responsibility to look after my sisters.
One night I decided to take a quick nap, and when I woke up, the whole house was on fire.
Dr.
Mina Okafor, will you marry me? I know this is a scary diagnosis.
Triple-negative breast cancer is aggressive and difficult to treat.
It's also more common in Nigerian women, and far more often, it's fatal.
Particularly in those who, like you, carry the BRCA gene mutation.
But, Adaku, in this case, we found it early.
After what happened to my mother and my grandmother, I knew this might happen to me.
But A cure is possible with aggressive treatment.
At minimum, you'll need a lumpectomy, chemo and radiation.
But given your family history, I strongly recommend a double mastectomy.
Mm.
I don't want to do that.
It's the only safe option.
- I won't be maimed.
- We have great reconstructive surgery these days.
I'll do surgery to remove the tumor, chemo, radiation, whatever you recommend, but you're not taking my breasts.
I'll let you talk it over with Mina.
You will get through this.
We will get through this.
I'm 28.
I might die even younger than my mother and my grandmother.
They lived in Nigeria, had limited access to health care.
You are an American and will benefit from American medicine.
You have a real chance of beating this if you are aggressive.
I don't want to talk about that.
- But, Adaku - It's my decision, Mina.
I'm going to get you the best breast cancer surgeon I know.
A fellow Nigerian who is experienced with this form of aggressive cancer.
Do you mean who I think you mean? Thank you.
Of course.
It's okay.
Come on.
Was there a ring? Did he get on one knee? Were there witnesses? Yes, a ring.
Yes, one knee.
Smattering of applause from sentimental onlookers.
But you're not wearing a ring.
I haven't made my decision yet.
You love Micah.
You love Conrad.
- You're not getting married.
- True.
He asked me to move in with him, and I freaked out.
Hmm.
More later.
I have to meet my friend Adaku's surgeon.
She's arriving any minute from Nigeria.
All right, see you.
What are you doing here? Dr.
Josephine Okeke is coming to Chastain.
Who told you that? Well, Dr.
Bell organized a welcoming committee, so I jumped at the chance to meet such a legendary surgeon.
I mean, come on, this woman single-handedly transformed the health care landscape in rural Nigeria.
Dr.
Okafor, how do you say, "Welcome to Chastain" - in Yoruba? - Dr.
Okeke is Ibo.
It's a different language.
And don't do that.
You'll only humiliate yourself.
Thank you.
You know her? Mina asked her here to operate on a friend, - a young breast cancer patient.
- She's here because of you? Oh, well then you have to join us for lunch.
I got us a table at The Providence Grill.
I think that's her.
That is definitely her.
Dr.
Okeke, Randolph Bell.
Oh.
Lovely to meet you, Dr.
Bell.
CEO here at Chastain.
- I'm so happy to have the ch - One moment.
Embrace me! Lovely to see you, Mina, dear.
Hello Mother.
What happened to your hair? Good morning.
I'm Dr.
Pravesh.
Milo Trainor, right? - How are you feeling? - Not good, lot to pain.
- Let me take a look.
- Okay.
When did it start? Yesterday, while I was working.
But it didn't get bad until this morning.
- What line of work are you in? - Ethics.
- I'm an ethicist.
- An ethicist? Sounds like you found a job that pays worse than my residency.
Well, technically, I'm unemployed while I finish my dissertation on moral relativism.
Looks like you've been on top of your health.
Only one surgery, appendectomy five years ago.
Any vomiting? - Earlier this morning.
- Uh, lift up your shirt for me.
- Yeah.
- Hundley? Mild hydro in the right kidney.
I'm thinking you have kidney stones, - my philosophizing friend.
- Is that bad? Not typically.
Just painful.
We'll get you on IV fluids and medication for the pain and nausea, and let's hope we can get these stones to pass soon, okay? Josephine Okeke is your mother? Yes, and please keep that to yourself.
I've got to get her in and out of here as fast as humanly possible.
Why? The woman is world-famous.
You call her in to operate on your friend, and you don't want anybody to know you're related? Your flight was good? Oh, it was fine, until Dr.
Michaels from the CDC bribed the flight attendant to switch seats so he could be right next to me.
Oh, he wouldn't stop talking.
He wanted to know all about the hospital I'm building in Gombe 200 beds the biggest in Eastern Nigeria.
Well, I hope you get a chance to tour our state-of-the-art cancer wing while you're here.
Wherever the great Dr.
Randolph Bell leads, I will follow.
Please.
So, the great truth-teller lied.
You said you were an ancestor.
But, Mina, you are a descendent of medical royalty.
My mother is my mother, and yet she is not.
Excuse me.
So, this is Henry, only eight years old, and Henry's epilepsy interrupted his schoolwork, his baseball games, his time with friends.
He suffered from violent seizures daily, until we implanted the QuoVadis vagus nerve stimulator.
And now, Henry's seizures are nearly nonexistent.
He's back to school, he's playing baseball, he's with his friends.
And what was once a pipe dream is now a reality.
- A cure for epilepsy? - Can you imagine? I mean, the potential of this QuoVadis device is unlimited.
All right, hold still for just a second.
So, how's baseball going? I got a triple last week.
Oh, nice.
So tell me, what's going on? Nothing.
Mom's being the worst.
The worst, huh? She thinks I'm having seizures again, - but I'm not.
- Hey, how'd you get that bruise? - Slide into third? - I fell.
At school.
Okay, bud.
Let us talk to your mom for a minute.
Be right back.
What's going on? I thought the VNS would get rid of his seizures.
The best-case scenario was always a reduction in the number and severity.
So far, no VNS device is a cure-all.
And considering how things started for Henry, it's worked really well.
I'll bring in Henry's pediatric neurologist, Dr.
Eckart, and we'll run some tests.
Uh, this sounds like it might take a bit to figure out.
I-I've got to go to work.
I'll check in later.
- Go.
Thank you.
- Yeah.
We just started dating.
Henry's condition is a lot to take in.
Look, Zoey I'm sorry, but we have to ask.
There's a there's a nasty bruise on Henry's arm.
There's no way that Doug would ever No.
Absolutely not.
Okay.
Well, let's see how things go with the EEG.
We'll figure this out.
So this is where you chose to do your residency? I was just at Oxford, and it's like suites at the Hotel Cardova in Positano in comparison to this dump.
Thank you for coming on short notice, Mother.
After four years of cutting me dead, I'm still shocked you called me.
I want the best for Adaku.
That is you.
Well, I'm touched you admit it.
I never denied it.
A decent-sized mass.
- Any sign of distant spread? - No.
But Adaku has multifocal DCIS in the other breast and the BRCA1 gene mutation.
This took her mother at 39 and her grandmother at 38.
Did you set up a gyn-onc consult? Yes, but one step at a time.
We have to deal with the breasts first.
Considering all the factors, she will need a double mastectomy.
I agree, and so does her oncologist, but so far, she's refusing.
Well, have you talked to her about it? Of course.
Ah, that's the problem.
Let me guess you gave her every statistic, but without diplomacy, tact and compassion.
Patients need warmth, Mina.
But it's all right.
I'm here.
- Heart rate, 120.
- How's the pain? Worse.
Lots worse.
You said kidney stones.
What did his UA show? Only a few RBCs but otherwise clean.
Okay, okay.
Abdominal pain is new.
He only had flank pain before.
He's septic.
Five dollars says it's an appendicitis.
Pay up.
He had an appendectomy five years ago.
- He needs a CT, now.
- He's already critical.
I'll give them a call, get him to the front of the line.
VNS is functional.
And Henry's EEG looks good.
No seizures since he's been here.
Oh, thank God.
But how do you explain the falls? I trip, that's all.
They weren't seizures, I swear.
Let's keep him here for the day for observation, just to be safe.
Everything okay? My boss.
Big presentation today.
Promised I'd be there.
I am pretty sure he'll fire me if I miss another day, but I can't leave Henry.
The hospital can provide a sitter until you come back.
Yeah, and Conrad and I can check on him as much as possible.
I'll be fine, Mom.
Go, Zoey.
We got this.
Okay.
What the? Hope you haven't spent that fiver, because that would be an appendix right there.
That's impossible.
Dr.
Kays did an appendectomy on Milo five years ago.
Well, someone screwed up.
Because that's an inflamed appendix.
We need to get him to surgery now - before it ruptures.
- Good idea.
Thank you so much for coming to see me.
Oh, I was so happy to get my daughter's call.
It's the first time she's ever asked for my help, which means you must be very special.
Now, as you know, Mina is, um, a woman of few words.
And I'm sure you love her for it, but I am just the opposite.
I love to have a good chat.
And unlike most surgeons, I talk to my patients.
I want to know what is uppermost in your mind.
I'm terrified.
Of course you are.
It's only natural.
I watched this happen to my mom.
I saw how she suffered and I saw how she died.
A tragedy, for her and for you.
Every daughter needs her mother, and you were robbed of her love and her support.
A crushing loss.
Daughters need their mother, don't they, Mina? I want to have a child soon.
And I want to nurse my baby.
And then, if necessary, I'll have the double mastectomy.
And I wish your mother were here to see this baby of yours, don't you? Yes.
I miss her so much.
The last time I saw her was right after her surgery.
And the scars were awful and she died a week later.
The doctor maimed her and it did no good.
Because it was too late, Adaku.
But I'm younger.
I have time.
And what good would it do your future baby for you to leave her early the way your mom left you? You saw a part of your mother's womanhood destroyed and still she lost her life.
But that doesn't have to be your story.
Adaku.
We have to act immediately, and you have to trust me to give you the best chance to live, for you and your future family.
Schedule the surgery, Mina.
I have a lot to teach you if you'd ever listen.
- I listened, and - You're welcome.
Hey, buddy.
Taking a break from all those tests? Dr.
Eckart said I could for a little while.
- I'm sick of being in the hospital.
- I know.
I can sit with Henry for a little while.
Thanks.
Purple, that's my favorite.
- Mine too.
- Yeah? Well, you look like you're feeling a bit better.
How are things at home, Henry? Are you and Conrad gonna get married? That's a good question.
- I don't know.
- Don't you love him? Yeah.
Yeah, I do.
Very much.
- But - I thought maybe he'd marry my mom.
But now she has Doug.
I wish Conrad was my dad.
Buddy, that's another bruise since this morning.
How did you get that? - I don't know.
- It's okay.
Don't worry.
We'll figure it out.
I heard there was an issue with our VNS poster child, Henry Barnett.
Has he been admitted? Yeah.
Uh he was brought in with a possible seizure, a minor seizure.
We are getting ready to take our stock public.
- I'm well aware.
- The VNS is being featured at the Innovation Summit tomorrow.
If any issue comes up, I want it handled.
Quietly.
Obviously, our first concern is the child's welfare.
B-But we will be as discrete as possible.
You paged me? My patient is still hypotensive.
Are you sure that you got out all the infection during surgery? Yeah, well, he perforated, so it took me an extra 20 minutes to lavage his abdominal cavity, all because you caught this so late.
A ruptured appendix, Pravesh.
It's kindergarten stuff, the janitor could've caught it.
- Yeah, but his record said - Do not give me your excuses.
The patient could've died.
In Nigeria, it is not uncommon that the first time a woman is seen in a clinic, she already has stage IV breast cancer.
I have seen tumors the size of tangerines.
And the reason they come so late is because of social pressures? Lack of education? Oh, no, no.
No access to health care or screenings.
Not until I started my clinic.
I mean, it was a battle from the beginning, but change is never easy.
You push, you nudge and if necessary, you fight.
You're such an inspiration.
We need more doctors like you here at Chastain.
Oh, no, my dear.
I have no interest.
I'll stay in Nigeria, my home.
We have too few doctors there and that is why it's such a shame that Mina came here.
Well, we're awfully glad that she did.
Indeed we are.
Dr.
Okafor, have you ever thought about going back to Nigeria to help your mother with her work? - No.
- You see having a successful parent is difficult for children.
They have to chart their own course.
That is not the issue.
I believe I know what Mina is referring to.
You see, my daughter was a med student in Lagos and she was a good student.
She showed promise.
And then something happened that caused her to leave her family, her home, her country, and never come back.
It was a family matter seldom spoken about that caused us all the greatest pain.
So the clinics in Gombe - how many - I take it you have not discussed this with your colleagues.
Mother.
This lunch is about you, not me.
I think you'll be kind enough to respect my privacy.
Excuse me.
This has been lovely but I have to get back.
- No, Mina.
- No.
Thank you so much, Dr.
Bell.
Few things are as rewarding - as spending time with colleagues.
- My pleasure, Dr.
Okeke.
Oh, please call me Josephine.
Thank you again.
I thought you had to get back.
Obviously, we need to talk in private.
- How dare you.
- How dare I? You walk out of a luncheon to honor me and embarrass me in front of your colleagues, but you embarrassed yourself more because they respect me.
You are worthy of respect, as a doctor.
Oh, but I'm not worthy of respect as a mother? Oh, I know what's behind this attitude.
I know it all too well.
You blame me.
You blame me for the fire.
I blame myself, and our problems long predate that tragedy.
Oh, I know.
I work too long.
I work too late.
I should've been home.
I am a bad mother.
That is why your sisters died.
That is what you think.
Do not presume to know my mind.
We can find common ground in the OR.
There is no reason to bring our personal lives and the past - into my workplace.
- Oh, please.
If there is any chance of this coming up again, our relationship, both professional and personal, is over.
Is that clear? Your sisters adored me.
They adored me.
We were inseparable, but you you never liked me.
Never.
He's still hypotensive.
IVC looks good.
Increase his norepinephrine.
Let's hope he responds.
I need his full history to figure out what's going on, and I don't trust that chart.
Should we call his emergency contact? See what his brother - could tell us? - Please.
Brent Trainor.
There's the number.
Hello? We called the patient's cell phone? Or he has his brother's phone.
Who does that? Wait, you said his name was Brent, right? Yeah.
Hold on, here.
Mina and I have never been in the OR together.
Strange, isn't it? Residents beg to scrub in with me on a daily basis.
Well, then this must be a great moment for both of you then, right? I am praying for the best outcome for Adaku, our patient.
We'll be using electrocautery.
Set up the Bovie, please.
I prefer to use radio frequency instruments for maximum precision.
Cautery is what I used for a crowned princess.
Good enough for royalty, good enough for your friend.
Bovie.
You have incredible hand dexterity, Dr.
Okeke.
The field is practically bloodless.
Well, I've been working on my technique for decades.
It minimizes post-op complication and reduces patient recovery time.
Here we go.
What do you got? No! No! - Let's play again.
- Yeah.
All right.
I can tell you're scared of something, but I don't know exactly what.
Will you help me understand? I'm fine.
I think you might've had another episode since you've been here.
If that's it, you don't have to be afraid to tell me.
I'm on your side no matter what.
Don't tell my mom, okay? She wants what's best for you.
She's on your side, too, you know that.
Yeah.
It's not that.
My dad left when I got sick the first time.
My mom really likes Doug, but if I get sick again, I think he'll probably leave, too.
She's lonely.
She needs him.
Doug and your mom they're new.
Still figuring things out.
It's not your fault your dad left.
You know that? I miss him.
But I also know he misses you and he loves you, too.
Sometimes people just have a hard time showing it.
Especially dads.
So you're falling down, okay? What happens next? I don't know.
It just happens all of a sudden, then I wake up on the floor.
It's not like my other seizures.
Okay, when did it start? - Last week.
- How many times? Four, maybe.
Yes! Finally get a win over you.
Come on.
Come on, come on, come on, come on, come on, come on.
No! How is Dr.
Okeke doing? Fine surgeon.
Truly gifted.
Problematic human.
I don't know what you're talking about.
- I found her utterly charming.
- That's because she flattered you.
Common technique amongst charming people.
I hate charming people.
Their main goal is to make you like them.
They're narcissists, and once you see through them, the charm disappears, they cut you and then they move on to the next conquest.
That was a mouthful.
Is this about what happened at lunch? - Partly.
- Retract.
Suction.
Not like that! Good God, what have they taught you in America? What is it? What? - You'll need the scalpel to - When I ask! I did not expect that.
So I called Milo's emergency contact and I finally got his medical information.
He has rheumatoid arthritis.
That doesn't explain any of the complications.
Well, we inadvertently stopped his steroids, which left his body without the stress response it needed to fight the infection.
Why wasn't rheumatoid arthritis noted in his medical records? Well, let's ask Milo.
Okay.
Milo Trainor? - Dr.
Devon Pravesh.
- Nice to meet you.
Thank you so much for coming down.
We're so glad that we found you.
Dr.
Feldman, this is our patient's identical twin brother, the real Milo.
We've been looking at his records all day because Brent told us that he was him.
Brent? Hey, Brent.
You okay? You stole my insurance card, man.
Not cool.
I always wanted a twin.
Oof, two Irvings? Terrifying idea.
My mom would be happy.
I'm sorry.
Brent has so much student debt and no health insurance.
I'm sure it seemed like a good idea at the time.
You almost died, my philosophical friend.
Rule number one if you want to stay alive: don't lie to your doctor.
Hey, girl.
Hey.
The surgery went well.
The reconstructive surgeon and then Dr.
Osder will be in tomorrow to talk about next steps.
I feel like less of a woman.
You're a warrior, Adaku.
And from now on, you have the scars of a warrior.
Thank you.
And thank you for bringing your mother here.
She was wonderful.
She did an excellent job.
I can attest to that.
Her skills will make your recovery far easier and the outcome better.
You're awake.
Oh, Mina, why didn't you page me? I am so grateful that you came all this way to help me.
Oh don't mention it.
It was my pleasure, and you did great.
You realize what Brent did is insurance fraud.
If you don't report it, you could lose your license.
- What'll happen to Brent? - Worst case, the insurance company presses charges.
He pays the fines and a whopper of a bill.
I don't think he'll get jail time.
But he'll be ruined.
In debt for years to come.
- Yep.
- Dr.
Pravesh.
You said there was a billing error with, uh, Milo Trainor? You called me up here from billing.
It's your lucky day.
I'm here.
Nadine, do you ever believe sometimes, especially when someone is starting out, they shouldn't be saddled with enormous debt? Hmm.
Above my pay grade.
But everyone deserves a break sometimes, right? - Can we agree to that? - If I believed that, I'd be sipping a caramel latte outside on a bench right now.
Well, then, here is five dollars.
Go get yourself that caramel latte.
Well, what about the billing error? It turns out it was a false alarm.
A glitch in the medical record system.
I can fix it myself.
Sorry you came all the way here.
Enjoy that coffee.
We are so grateful for your visit.
I wish I had more time to get to know you.
I-I also I want you to know how much we admire and treasure your daughter.
She inherited all your skill.
She's a rising star who will one day outshine us all.
Speak for yourself, Dr.
Bell.
Hiding out? From whom? Everybody.
I told you I was adopted, right? I never met my birth parents.
And if I did, it probably wouldn't be pretty.
Every time I see her I think it's gonna be different.
My dad died years ago, so when I lost my sisters I lost the only family I had left.
My mother is not my mother.
Not really.
So you came here, you built your own family at Chastain.
Look, we will always appreciate you.
Always.
- You have an update for me? - The good news is, I haven't been able to detect any seizure activity.
So the VNS is working.
It seems so.
The bad news is we still don't know what's causing these reported drop attacks.
Even though the tests haven't revealed any abnormal activity, I'd still like to keep him here overnight.
We need answers.
Well, if he's not having seizures, there's no medical reason to keep him in the hospital.
Thank you.
Dr.
Bell, just a second No, I share your concerns, so stay in touch with the mother, - and we'll bring him back if we need to.
- Dr.
Bell Just set a follow-up appointment for later, but discharge him.
Call me if anything comes up, even if it's the middle of the night.
- Even if it seems like nothing.
- I will, I promise.
Look at him.
He's so happy to be going home.
Conrad, you keep helping us over and over, And I think maybe I've been overreacting to every little thing.
But you always take me seriously.
What happened? Excuse me.
Henry? Henry? Lost his pulse.
Call the code team, I'm starting compressions.
Oh, my God! Oh, my God, baby.
Baby.
Baby He's back.
He's back.
- What happened? - Don't worry.
I'm gonna take care of you.
Hold on, buddy.
I'm gonna put you on the gurney.
What happened? There was a code? His heart stopped.
But it started again.
I'm not sure what's going on.
Okay, here we go.
- Get him in.
- Let's hang some fluids.
Cardiac arrest it makes no sense.
This one is gonna help us keep track of your breathing.
And these guys are gonna monitor your heart.
Ah.
You all right? - Yeah.
- All right.
Two more, ready? Smoke over fire.
One, two, three.
- Good? - Uh, yeah.
All right.
I heard.
What's going on? His heart stopped.
Is it the seizures? We don't think so.
We're still learning things.
I paged cardio and neuro.
- Okay.
- It's okay.
Okay, he's safe now.
- Henry! - Zoey, Zoey Okay.
Just stay back with us.
- Henry! - He's down again.
He's going directly into asystole.
His heart stopped.
Come on.
Come on.
Come on.
What in God's name is happening? It's the VNS.
That controls his seizures.
It has nothing to do with this.
His heart is stopping.
The vagus nerve also slows heart rate.
The VNS must be overstimulating it.
The VNS is set to send impulses every Three minutes.
Every three minutes, it sends a 30-second pulse.
The VNS is stopping his heart every time it fires.
So his heart is gonna stop again? Yes, if we don't turn off the VNS.
We can't stop it without the programming wand or the magnet.
- Do you have it, Zoey? - Uh, not here.
I-It's at home.
There's a wand in the ER.
Go, now.
Keep up with the compressions, and Ambu when he goes down again.
Devon.
The programming wand for the VNS where is it? Supply cabinet.
- It's not here.
- Damn it.
Eckart has one.
He left for the day.
Call him and get him back here.
It would be in his office across the street.
Tell him I'll meet him there! Hey! Mom I don't want to die.
No.
No, you're not gonna die, baby.
No, it's gonna be okay.
Just like the last time.
We've got ten seconds.
- Prepare the Ambu bag.
- You're doing great, my brave, brave boy.
We have you.
He's down again.
Starting compressions.
Save him, please.
You have to save him! - I'm here.
- Eckart is six minutes out.
Too long.
Please, God.
Please.
Please.
We should switch.
- I got it.
- We may be at this a while.
Why isn't Conrad back? I'm sure he'll be back any second.
Not Henry, no.
Keep going.
Come on.
Hurry.
I got it, I got it.
Baby At least we did it.
You saw what just happened.
Yeah, a QuoVadis device failed in this child.
It stopped his heart.
- It nearly killed him.
- I was there.
Chastain cannot continue to be in business with this company.