The Resident (2018) s02e20 Episode Script

If Not Now, When?

Previously on The Resident Dr.
Shaw says that some people have to do this three days a week, - four hours a session? - We're doing a workup to see if your kidney failure's reversible.
And my kidneys will get better.
Right? No reason not to be optimistic.
It's not about being fair.
It's about being honest.
I was a project for you, and now it's finished.
The same issues keep coming up over and over again.
Still a lot we need to talk about.
Tomorrow? My place? I'll swing by before work.
Hey.
Looks like we're finally doing this.
Looks like it.
You first? Oh.
Okay.
Have you ever woke up in the middle of the night and finally realized something you've never understood before? Uh I guess.
I mean, not often, but yeah.
I'm built to keep moving forward.
If there's a mountain, I'll climb it.
If there's a race, I'll run it.
But what I don't do is stay in the same place.
And that's what you think we're doing.
I think I think I want something you don't want.
Movement towards our future.
I'd marry you, Nic.
But I don't ask because you don't even want to live together.
Why are you putting all this pressure on me now? Why is making more of a commitment to me a burden? I am here to help.
That should be a relief.
I have been taking care of everybody around me since I was 13 years old.
I just I learned to take care of myself.
You know what I think? Holding up the world has become your cross.
Okay.
If this is gonna become a litany of what you think are my faults, - I just I can't.
- No.
That's not what's going on.
I'm putting down boundaries.
Can't go forward if we don't have the same level of commitment; and we don't.
You know what this feels like? Emotional blackmail.
I don't move in with you, so you just leave me.
Telling you what I want is emotional blackmail? Yeah, that's what this feels like.
Okay, well, then we see this completely differently.
Yeah, I think we do.
If you're not interested in going forward, for me, it's time to take a step back.
- If that's what you want.
- It's not what I want.
When I go home at night, no matter what's going on in my life, I want you there.
You don't feel the same.
That's the problem.
Conrad.
It's Come on.
At work, we go back to what we always were: friends.
Colleagues.
Sure.
That's a given.
Help! Help! - Are you all right? - I'm okay.
- Help! Help! My wife! My son! - Somebody call 911! Help my wife, my son! Please, my wife, my son! - Help! Help, please! - Okay, go to my son! Go to my son! - He's hurt, he's hurt! Honey! - Please help! Danny! It's okay.
- Honey, just put pressure, please.
- Help me! - Please, I need both hands, okay? - Please help me.
Honey, I love you.
Just try to stay with me.
- Danny, stay with us! - I'll be right there.
- My mom.
- Honey.
Danny! Honey, please, just You got to put pressure.
Keep it.
Keep it.
Danny?! Danny?! Uh, Chastain Base Station.
Go ahead.
On scene with two level-1 traumas.
MVC with significant passenger-side intrusion.
In the process of extricating an adult female and teenage male with critical injuries, including a GSW.
Up.
A level-1 trauma, incoming.
I was really hoping nobody came in with holes in them today.
Move to Japan.
Ten gun deaths a year.
- We get that every month.
- We're just one hospital.
- In one city.
- In one state.
It's completely senseless.
Tokyo Medical Center.
I'll put in a good word.
Hey, I'll take it, bro.
Hawkins, hang on.
Two incoming level-1 traumas.
37-year-old female.
Hypotensive.
Intubated en route for respiratory distress.
GSW to the chest.
All right, Feldman, Okafor, with me and the GSW in Bay Nine.
- What happened? - I saw the shooting.
I was behind them.
- Are you okay? - I'm fine.
Patient two, same accident.
14-year-old male, extricated from the backseat, - open femur fracture.
- Hawkins, Pravesh and Vosh with the femur fracture in Ten.
If you were a witness, they're gonna want to speak with you.
ABCs.
Let's call them out.
I'm Dr.
Pravesh.
Buddy, what's your name? Dan Danny.
- Airway intact.
- Bilateral breath sounds.
Danny, do you know where you are? The hospital.
My mom! She's in good hands.
Pulse is 130.
Blood pressure 100/60.
Let's bolus two liters IV fluids - and send off a type and cross.
- Now his leg.
Checking the pulse.
There's no blood flow to the distal extremity.
Fracture must be compressing his blood supply.
We need to reduce it here and get him into traction.
Danny, on a scale of one to ten, can you tell me your pain level? Zero.
And three, two, one.
It looks arterial.
Tourniquet.
Get two units of blood down here now.
The broken femur must have been helping to tamponade the bleed.
All right, time to figure out why Danny has no pain.
Okay.
Look for other injuries.
Danny, we're gonna turn you over now, okay? One, two, three.
He's been shot, too.
Possible spine injury.
We need to get him to CT now.
Damn it.
Pressure's dropping fast.
The bullet punctured her heart.
- Let's redline her to the OR.
- No, she'd be dead before we get to the third floor.
Emergency thoracotomy, right here, right now.
Okafor, let's get it.
Okay, give us space, people.
Cutting the pericardium, exposing the heart.
There's the bullet hole Put your finger on it! Defect in the left atrium.
Pressure's holding.
Good.
Let's get her to the OR, stat.
Mina, do not move your finger till we get upstairs.
I know that.
I'm sorry transport hasn't come.
It's been a little crazy down here.
Let's check in on the baby.
How you feeling, Mrs.
Davies? Oh, the pain is really bad.
You know, I was gonna go natural, but an epidural's starting to look really golden.
That can be arranged when we get you upstairs.
What is it? Baby's heart rate isn't quite where we'd like it to be.
- Uh, what does that mean? - It means we're going up right now.
Get your bag.
Hundley, call Dr.
Stewart.
She may need an emergency C-section.
- Okay.
- It's all right, honey.
- Don't you worry about this, okay? - All right.
Everything is gonna be fine.
Don't worry.
You know, once the science fair is over, I say we hit up - the Natural History Museum.
- Oh, I'd rather visit the aquarium.
If I lose, I don't want to do anything but sit in the hotel room, eat pizza and sulk.
We can beat this traffic if we go straight and turn later.
Being late is not an option.
Trust me, guys.
I got this.
Okay.
See? Cruising now.
What is this lady doing? If I had just stayed in traffic.
If I if I'd just waited for the turn.
- This isn't your fault.
- Well, whose fault is it? Who shot us? The cops think the shooter was targeting someone else, so it was just the wrong place at the wrong time.
I feel so helpless, you know? Look at me.
I'm sitting here, there's barely a scratch on me, and my My wife and my son might not survive.
They are with our very best, most experienced surgeons right now.
I promise, we will do everything that we can.
Let's get her on the table.
Okafor, keep your finger on the hole in her heart.
Drape the patient.
Betadine prep.
One, two, three.
Have you ever seen a purse string suture performed before, Okafor? Of course.
Do it fast.
I can only keep pressure for so much longer.
It's one of medicine's most rudimentary, yet lifesaving procedures.
Less narration, more action.
Suction.
All right.
Now you take a deep breath.
And hold it and don't you move a muscle.
Okay, three is the magic number, Okafor.
You hear me? One, two, three.
Bravo.
Muy, muy bravo if I say so myself.
All right, let's check.
Is there any other obvious damage? No.
Looks like the bullet made a clean exit without damaging the other organs.
- Good.
- Yeah.
That's probably the only lucky thing to happen to this woman today.
All right, well, you close up, take her to CT, make sure we didn't miss anything.
Dr.
Pravesh is going to assist me.
He asked to scrub in.
We're shorthanded today, so I hope that's okay with you both.
Of course.
It is a good thing you came in when you did.
All right.
Dr.
Pravesh, have you delivered a baby before? Um, nope.
This'll be my first.
Then you are in for a treat.
I've delivered thousands, and, uh, every one is as special as the first.
All right, seconds away.
Ah.
Um how long have you been in the U.
S.
? My entire life.
I was born in Jersey.
Oh.
Well, good for you.
We ready? All right.
Here we go.
Ten blade.
Thank you.
All right, thank you.
Just relax, honey.
You're doing great, beautiful.
Hey, give me fundal pressure.
Little more.
Head.
- Okay.
- The doctors are doing a great job.
- Just relax.
- Get under here.
There we go.
There we go.
Okay.
- She's okay? - Yeah.
Congratulations.
She's perfect.
Oh.
Oh, sweet baby.
Aw.
Lea, honey, we got lucky.
She looks just like you.
Oh, welcome to the world, sweet Fiona.
Yeah.
You have a minute? Uh, yeah.
Any results from Danny's CT? It's happening now.
How's his dad? I mean, second-guessing every moment that happened before, everything that he could have done differently to avoid it.
Yeah, imagine.
Could've been me.
Nic? What do you mean? I was upset after this morning, so I pulled over.
They passed in front of me and then it happened.
Should've been me.
Wow.
I'm so glad you're okay.
- It's awful.
- Anyway, um you had something to tell me? I wish it could wait, but Jessie.
Her kidneys aren't getting any better, Nic.
So we keep her on dialysis for a while.
They will never recover.
She's been off dialysis for two days; she's still anuric.
Her B.
U.
N.
and creatinine levels are climbing, as well as her potassium.
Have you told her? No.
I knew you'd want to be there.
Well, let's tell her together.
Nic told me they're visiting from Tennessee.
They were on their way to Danny's science fair.
I hope the scan shows us something we can fix.
The bullet entered the spinal canal at L2-L3.
Explains his loss of feeling at the waist.
Now it's here, at L5-S1.
The bullet is migrating.
Could cause permanent damage if we don't take it out.
There's a traumatic liver laceration from the accident.
That I can fix.
Good.
The question is: Will this poor boy ever walk again? So so my kidneys will never work again? Are you sure? The drug trial did irreversible damage.
You have to stay on dialysis.
Okay.
Okay.
For how long? The rest of your life, Jess.
No.
What? That's That's not possible.
H-How will I, how will I ever get a job or go back to school? There's no way.
That's no life at all.
Come on, there's got to be another option.
There is one.
A kidney transplant.
But for now, you're not eligible to be listed through Chastain.
They're not gonna put you on the transplant list directly from rehab.
You just have to be sober for at least six months.
And once those six months are up, we can start the process.
Just go, please.
Just go.
Jess.
Just leave me alone, okay? Jess.
I'm so sorry.
We're gonna figure it out.
You know, in six months, if she gets on a transplant list there's still a three-to five-year wait.
Not if I'm a match.
You'd donate a kidney? Of course I would.
She's my sister.
Okay.
Just keep in mind, if she relapses, the drugs could damage her new kidney.
Well, I choose to believe that this is a wake-up call, and she won't relapse ever again.
Something to keep in mind: Why are you first in the donor line? Sacrificed so much for Jessie.
Maybe your dad steps up this time.
We can't even count on Kyle for a birthday card.
A kidney transplant? Not a chance.
Nic, I know we have new boundaries, but I am here for you.
Thank you.
You nervous? I am, actually.
It's rare for me.
But one slip of the hand, and that poor boy will never walk again.
I like his chances in your hands.
How many bullets have you cut out of healthy young men? Too many to count.
- You? - Same.
My daughter Amelia did a science fair.
Some silliness with plants and chlorophyll.
Placed dead last.
I was still a proud mum.
Fond memories because we were lucky enough to make it to the fair.
A bullet from a random shooting, nothing to do with us, out of nowhere, didn't rip through our bodies and send us to an OR.
They were in the wrong place at the wrong time.
Very unlucky.
Luckily, he's with us now.
Beautiful, huh? Nothing better in the world.
Thank you, Dr.
Pravesh.
For everything.
My pleasure.
Just checking in on you guys.
Hey.
Dr.
Stewart? Dr.
Stewart, hey.
Glad I caught you.
I was just in the Davies' room, and I noticed some blood in Lea's catheter.
Yeah.
She just had major abdominal surgery.
Some bleeding's normal.
Yeah, I-I get that.
But would you mind checking on her, just to be sure? I appreciate your concern, Dr.
Pravesh.
I have delivered thousands of babies, and I have seen every postpartum problem there is.
So leave my patients to me.
Hmm? Okay, almost done.
Now for the really scary part of the surgery.
- Are you ready? - As I'll ever be.
And and done.
Spine's all yours.
Okay.
Help me get access for an anterior approach to the spine.
Another first.
- It's psychosomatic.
- No way.
You're putting yourself in the place of the patient's mother.
It's very human of you, but, Kit, in here, you're a doctor and a damn good one.
So just channel your normal bravado, pull yourself together, and fix this kid's spine so he can walk again.
Right.
Sorry.
There you go.
She's so cute.
How long until she speaks? Hey.
She got to learn how to hold her head up first.
- Where's Mommy? - Right here.
Say hi to your amazing mama.
Hey, darling.
When are you gonna come home, Mommy? Soon.
Soon.
You go ahead and be a good little girl for your grandma, okay? You okay? Something hurt? - Yeah, my stomach.
- Okay.
Hey, Rachel, Daddy's gonna call you back, okay, sweetie? - Okay.
- Love you.
Here.
Hey, hey.
Whoa, whoa.
Careful.
- Let me take her.
- Okay.
- Here, I'll take her.
- Okay.
- You got her? - I got her.
Okay.
What's the matter? I don't know.
Lea, you okay? Lea.
Liam still hasn't opened his eyes.
- Excuse me, my wife needs - I think something is wrong.
I-It's very common.
Just try and relax.
- Excuse me.
Can someone come - I'll be there in a minute.
Oh, alarm in 4210.
Mrs.
Hobbes' IV bag is probably empty.
Uh, Mrs.
Henderson in 4233.
I'm guessing the O2 monitor just slipped off her finger again.
Hey, my wife in 4238 Oh, one sec.
Maternity.
No, you need pediatrics for that.
I'll transfer you.
Sorry, what room? 4238.
Lea Davies.
Can a doctor come check on her? She's really weak, and now her belly is hurting.
Well, she had the baby a few hours ago.
It sounds about right.
No, no, no, no, no.
It's more than that.
Now, she wasn't like this with our first child.
- Was your first a C-section? - No, but It's normal.
Trust me.
She just needs some sleep.
I'm telling you, something's wrong.
Now, if you can't come, can someone else? Maternity.
Give me five minutes.
What's the patient's last name? Nurse Fallon to NICU.
Nurse Fallon to NICU.
Chastain has been incredible.
Everyone swooped in to help our family.
Nurse Nevin was there when the accident happened.
Glad I could help.
Your operation went perfectly.
Not a hitch in the giddyup.
Not many people survive a bullet to the heart.
- But where's Danny? - He just got out of surgery.
We were able to repair his liver laceration and remove the bullet from his spinal cord.
His spinal cord? Is he okay? We'll know more tomorrow.
Dr.
Pravesh, how can I help you? Hey, just checking in on Lea Davies in room 4238.
I just got an anxious call from her husband.
Right, uh - Right.
Crap.
- When was the last time you checked on her? I don't know.
I'm sorry.
We're short-staffed.
Seems like everyone is having their baby.
Well, it doesn't seem that busy anymore.
Why is it so difficult to look in on Ms.
Davies? I need to make sure that she gets proper care.
She's getting the same attention as everyone else.
Respectfully, it seems to me that she is not.
- Hey.
- Thank God, Dr.
Pravesh.
So glad you're here.
Lea keeps saying her stomach hurts.
How are you feeling, Mrs.
Davies? Her pressure's a little low, but in the range of normal, especially after a C-section.
We'll be right back.
That much blood in the catheter is not normal.
Dr.
Stewart, we have Dr.
Pravesh on the line.
- He says it's urgent.
- Talk fast, please.
I have a planned C-section starting two hours late.
You recall I mentioned seeing blood in Lea Davies' Foley catheter.
It is worse.
Significantly.
- What's her BP like? - 92/55.
She seems altered, barely conscious, even when being spoken to.
She is in a lot of pain.
All right, fine.
Go ahead and send off a CMP, - CBC and coags.
- No.
Lea needs a CT.
Nurse Fallon to NICU.
Tell me you are not that guy.
What are you implying? That you haven't listened to me or to her husband, and you are not taking this case as seriously as you should.
I treat all of my patients the same.
I believe what I see; and in the ER, I have seen you do way more based on less information for patients that look like you.
That is an offensive That is a ridiculous accusation.
Fine, all right.
If it'll make you feel better, go ahead.
Get a CT.
I'll check in as soon as I get out of surgery, if that's all right, Dr.
Pravesh.
He ordered the CT and labs.
I need you to put a rush on it.
A rush.
Do you understand? Yes.
Hey, where are Lea's CT results? It hasn't been done yet.
I've been trying.
I swear.
They keep saying they're backed up, and I don't have the authority to override Unbelievable.
Well, why didn't you just call me? The ER has a clear set of protocols.
Don't you? Where's your standard of care? Dr.
Pravesh! My wife needs help now! So cold.
I need blankets.
- I'm so cold.
- Okay.
Okay.
- Page Dr.
Stewart.
- He's in a delivery.
I don't care! Get him here now! We need Dr.
Stewart in 4238.
- What's going on?! - I'm trying to find out.
Blood pressure's 78/43.
- Get the ultrasound.
- Her labs just came back.
Hematocrit is down to 18.
She's gonna be okay, right? - Right? - Hang two units of blood.
Doctor, help her.
What is going on? - Free fluid everywhere.
- She's bleeding internally.
And she's hypotensive.
We got to get her to the OR stat.
- Don't leave me.
- I'm not.
I'm not, baby.
- I'm scared.
- No.
You're gonna be okay.
Everything is gonna be okay.
All right.
I'll take it from here.
- I'm not leaving her.
- I want to be with her, too.
Hey.
- Lea.
Lea! - Don't leave, please! I want to, I want to be with her.
You can't this time.
I'll be there.
through downtown Atlanta, extending down into the central business district.
There are isolated storms Ten blade.
Call Trauma! Massive transfusion protocol.
Now.
Suction, Pravesh! We need to find the source.
- God.
- Give me more! Ugh.
More! She's bleeding internally.
I can't find the source.
- Step aside.
- Laps.
Suction.
And get the cell saver.
I want to keep her pressures up.
A big vessel must have cut loose to cause this much bleeding.
- How long ago was the C-section? - Six hours.
What? What the hell happened?! Lea Davies wasn't a priority.
I found the bleeder.
Tear in her bladder.
Right angle and a stitch to me.
Ask yourself would this have happened if Lea wasn't black? Not now, Pravesh.
Then when? This happens far too often to women of every color.
But it's four times more likely to happen to black women.
That's a fact.
Mr.
Davies, I'm Dr.
Austin.
I'm the surgeon who was called into the operating room to help the team taking care of your wife.
Lea suffered internal bleeding during the C-section.
The bleeding was catastrophic, and her heart stopped in the OR.
I'm very sorry to tell you that, despite our best efforts, your wife has died.
Let me see my wife.
I want to be with her.
All right, I've got to get to work, but there is food in the fridge.
And listen, it's not all bad news, Jessie.
I got you into the weekday morning dialysis.
At least you'll have weekends off.
Thanks, Nic.
Listen, we didn't talk about this yesterday, but I'm gonna make sure you get a kidney when that six months is up.
I haven't been tested yet, but with any luck, I can be your donor.
You'd do that for me? What do you think? Thank you.
I love you.
I love you, too.
Hey, hey.
Hey, big guy.
How you doing? How's Mom? She's doing great.
Danny has something to show you.
Ready? All right.
Wiggle the toe I touch.
Ah.
Excellent job, my man.
Now, I know, in this situation, an apology is not enough.
But from the heart of this hospital, I'm here to offer one.
Your pain can't even be imagined, and I I want you to know that everyone here at Chastain is we're just devastated.
Your wife suffered what we refer to as a "never event," something that should never happen.
I can't tell you how sorry we are.
Apologies are routine now because they help prevent lawsuits.
Most people who receive them don't take legal action.
He's not gonna get away with dodging the consequences this time.
- Oh, I know.
I'm as upset as you are.
- Not a chance.
I saw it.
I lived it.
I'll never forget it.
Same day we save a mother and son who by all rights should not have survived, a young healthy woman dies.
A tear in her bladder was fixable, and wouldn't have killed her if she hadn't been ignored.
And you'd better believe I'm gonna identify whether it was a series of system failures that led to this catastrophe More than that was involved, Dr.
Bell.
I know what you're thinking.
But I've known Dr.
Stewart and Nurse Colby for years.
I've never seen either of them treat a patient differently because of race.
People can have unconscious bias.
You're absolutely right.
This can't happen again.
I have some ideas to safeguard every mother that comes into this hospital.
I'm listening.
After yesterday's tragic event, we are gonna create a review board to examine every maternal death or near death in this hospital over the past few years.
We're gonna pinpoint the problems, and we're gonna implement a new standard of care immediately.
And these protocols will include comprehensive checklists, maternal crash carts, simulated training drills.
We need communication and teamwork to prevent all forms of bias, racial or otherwise.
We need to ensure that every person is heard.
The United States is the most dangerous country in the developed world to give birth in.
There's no excuse for that.
I know.
I know.
I know.
I know.
Look at you.
Look at you.
Daddy's got it.