The Resident (2018) s05e19 Episode Script

All We Have Is Now

Previously on The Resident So that means we're going - to have to talk about hospice.
- Don't.
Not yet.
Oh, you can have hospice for months.
It's a great service that most people wait too long to use.
I wouldn't mind a kid a lot like you.
You want me to be your sperm donor? Thank you, Emily.
We'll pass this up to the complaint division and discuss the status of the investigation.
How is she? Well, I'll let her tell you herself.
- Hey, Carol.
- Conrad.
Come and meet my hospice nurse.
This is Janaya.
Hello, Dr.
We met years ago, when my father was a patient before he passed.
Darius Purcell.
Yeah, I remember him.
You were in nursing school then.
Now she takes care of dying folk like me.
AJ gets prickly when I use the "D" word.
Austin, I need you to help me review some med dosages and update Carol's charts before I go.
Hey, I'll be right back, Mom.
Anything I can do for you? Oh, I have everything I need.
It's AJ I'm worried about.
He wanted me in hospice, but now he can't seem to face what we both know is ahead.
This is very hard for him, Conrad.
Well, of course it is.
He loves you.
And he has been in the business of saving people for a long time.
I'm a realist.
I have one clear goal.
I want all the time I have left to spend with him.
And no pain.
That's all.
But he can't seem to stop trying to fix what can't be fixed.
I'll talk to him.
Good news, Dr.
Your body's responding well to the hormones.
Your follicles are maturing well.
We should be able to retrieve the eggs within the week.
I can't believe this is all happening.
We hope.
But a first-time course of IVF - only has a 33% success rate.
- Dr.
Devi is correct.
It's important to manage your expectations, Padma.
The path to motherhood is not always an easy one.
I know, I know.
I just - I want this baby so badly.
- It's all I want for you, too.
Once we have the eggs from Dr.
Devi, we can fertilize them and choose the viable embryo to be implanted into you.
Uh, one last question: will your donor sperm arrive - in a test tube or - Oh, no, no, my donor's here, in the hospital.
- He's a, he's a doctor.
- Great.
And he is available to come in during the egg retrieval so we can create embryos as quickly as possible? I hope.
He has a personal situation which makes it a bit complicated.
Yeah, if he's, um, unavailable due to a family emergency, can we can we wait? I'm afraid not.
In that instance, we would have to freeze the eggs.
What's wrong? I haven't been able to reach AJ yet to finalize details.
- What details? - Just little things.
You're blinking.
Too many blinks.
Come on, that's your tell.
AJ hasn't fully committed to be the sperm donor yet.
We just lied to Dr.
Johnson? Okay, calm down.
She's a doctor, not a pujari.
Have a little faith.
The universe - has a way of working things out.
- No.
You need to work this out.
The universe is not paying attention.
Talk to Dr.
Austin today.
Okay? If he's not all in, you need to know.
You're so bossy.
My mother is taking escalating doses of morphine, and we don't even know her kidney function.
You think maybe I should switch to hydromorphone? Uh, that depends.
Are you worried about long-term complications or focused on keeping her comfortable for now? I-I don't think there's any harm in running labs to check her kidney function.
Well, there's no harm, but I think the key is to ask yourself, is there any benefit? Will this bring her more comfort or less? Look, I-I know there's no fix.
I-I know where this is going, I just want to spend as much time with my mother as I can.
There's nothing wrong with that, man.
Of course not, but your mom is worried about you.
More than anything else.
She's worried about how you're taking this.
She told you that? What was that? Mom! Oh, she's seizing.
Let's get her on her side.
- Hospice left you lorazepam, right? - Yeah, yeah, yeah.
It's in the, uh, it's in the medicine cabinet.
Hey, Mom, you're gonna be all right.
So, tell me what happened on your camping trip.
I was heading to the river for a morning dip when I caught my big toe on a root.
I felt a pop in my ankle and I went down.
- And you were barefoot? - Bare everything.
- Oh.
- We're not nudists.
We were earthing.
Reconnecting to Earth's electromagnetic field through bare skin.
Sounds silly, but it works.
Patient is spiking a fever.
That can't be from his ankle.
BP is 83/50.
- Um, okay, uh - And dropping.
- Uh, it's - Dr.
Pravesh? What's the problem? BP is dropping rapidly.
Pravesh is here to take a closer look.
Do you hear that ringing? - He's going down.
- One liter of LR and get that norepi pump next to his bedside.
Let's go.
I think it's best to call the hospice nurse.
Have her come back and take over.
Yeah, but what if it's a brain bleed? We know the cancer has spread to her brain, so then that wouldn't be unexpected.
She could be hyponatremic.
She hasn't been taking in enough electrolytes.
- AJ - No, if there's any chance I can get her a few extra weeks, a few extra days, even a few extra hours Any intervention now could cause harm.
Well, I got to try.
As an investigator for the state medical board, my job is to weigh the merits of the case.
And this case is clear.
Emily Benesch was irreparably injured by Dr.
When I reviewed common outcomes for the surgery in question Spinal, neurological, high risk It appears Miss Benesch's outcome is is not at all unusual.
Paralysis is not unusual? I mean, surely you know how ludicrous that sounds.
Did you even speak with Emily? The goal of my investigation is to remain impartial and unbiased.
Right, well, you only took statements from experts provided by the defendant.
You've become emotionally involved in this case, Dr.
It's blinding you to the reality that what happened to this patient, while tragic, is not the fault of her surgeon.
This case is closed.
Bryce came in here with a pulled tendon in his ankle, and has developed fevers, hypotension requiring pressors and increasing agitation.
The broad-spectrum antibiotics haven't really helped with what's going on.
This muscle spasm happened in the past hour, so I checked his electrolytes, and they're all in normal range.
His-his thyroid is normal, too.
Have you been doing any intense exercising lately? I meditate, go for walks.
We've been working through the Kama Sutra.
Sounds like quite a regimen.
Percussive myoedema.
Touch your chin to your chest for me? The stiff neck is new.
Bryce, we're gonna run some tests to check for an infection in your central nervous system.
And we're gonna start with a lumbar puncture, okay? There you go.
Good, good.
Just breathe.
There you go.
- I almost got it.
- Breathe.
I brought kale and apple.
Oh, my God.
What are you doing to him? I'm needle-phobic.
I can't watch.
- Here.
- No, get that away from I feel sick.
He really doesn't like that drink.
It's triggering a physical reaction.
He's afraid of it.
Bryce, we have to test you for rabies.
Just one second, love.
I got you.
I got you, I got you.
I know, I know.
I got you.
Just a little bit.
Just a little bit.
- Mm.
- It's okay.
She's not getting enough calories.
I've tried five other flavors and she wouldn't touch them.
But this one, chocolate raspberry chia, I think this is the one.
Uh, you might want to stick it in the freezer.
She just fell asleep.
She could be tired from the pain meds.
And I know that also affects appetite.
Or her body is requiring less energy.
Less input, less output as she begins to enter a hibernation state.
Austin, I'm not just here for your mother.
I'm here for you, too.
So, if you have any questions How much longer does she have? Could be a week, or a few days.
Her metabolic functions will be telling.
But she'll also give us signs as well.
She may want to open up and start to talk about things she's never discussed before.
She may get a burst of energy.
We call that "planes, trains and automobiles.
" If your mom starts making plans for a trip, that usually means she's ready to go.
I don't know how you do it.
You know, your job seems incredibly hard.
And being a surgeon is easy? I can solve problems with a scalpel.
You know, I can find a cure.
There's always an answer.
But waiting for death to come a-and not trying to do anything to stop it, I don't I don't know how to do that.
All you have to do is follow your mother's lead.
He's positive.
- Bryce has rabies.
- Rabies? But that's so impossibly rare.
The odds of a doctor seeing a rabies patient over the course of their career is one in 325 million.
O-Okay, we know the rabies virus spreads to the brain through the nerve cells, - and once it's there - It multiplies rapidly, causing severe inflammation in the brain and the spine.
It's 99.
9% fatal if it's not treated almost immediately.
Only 11 patients have survived.
Clearly the odds aren't in Bryce's favor, but people have been saved before.
So, now it's all about when Bryce contracted the virus.
Uh - What? - During intake, he told me that he went camping.
No tent, no sleeping bag.
It's some kind of an Earth-love thing.
He could've been bitten by a bat and never noticed.
I wish you told us this sooner.
I didn't think I'm sorry, I screwed up.
Let's find the bite.
The further away from the central nervous system, the longer it takes the virus to reach the brain, okay? Every second counts.
Why is he being tied up? Bryce never hurt anyone.
You're making him feel claustrophobic.
I know it's hard to see him like this, but rabies can cause aggression.
It's safer for everyone, including Bryce.
We're gonna give him lorazepam - to relax him, okay? - Bryce, we're looking for a bite.
It may be so small, like a scratch, something you wouldn't have even noticed.
I don't know.
I don't know, I Bryce, tell me, how do you sleep? What do you mean? With my eyes closed.
He means back, side, - stomach? - Side.
- Okay.
- Let's go.
All right, here.
There's some puncture marks.
We need to get as much HRIG as possible into this infected area beneath the bite.
Bryce, we're gonna give you a series of injections.
A vaccine and some immunoglobulins.
We're gonna repeat them every 12 hours.
You're gonna get pretty sore.
Those needles are huge.
And if he's already sick, - then why are you giving him a vaccine? - Janice.
We're trying to stop the virus from spreading to his nervous system.
If we can slow the progress of the virus, then we have a chance at treating him.
That'll work? You'll cure him? If he got here in time.
Oh, God.
No, I-I I can't I can't handle this.
I I can't watch him get worse and worse.
Oh, my God.
The board lied.
Promised the patient a fair investigation.
Instead, case closed, no further review.
So I did more investigating myself.
And the names of the same five doctors, including Bosley, come up again and again.
These are career bad apples with multiple complaints of the worst kind.
You remember that surgeon they called Dr.
Death? Of course.
He maimed and killed patients in Texas.
His colleagues knew it.
They took it to the state board and the state board did nothing.
But he got caught.
When someone leaked the story to the press.
There you are.
I've been texting you nonstop.
I know.
I got your 5,000 messages.
Don't worry, I didn't call AJ.
I heard about his mom and I'm respecting their privacy.
Okay, so next steps? We call Dr.
Johnson and we tell her we're freezing the eggs.
I'm not willing to give up on this cycle of IVF just yet.
It's not giving up.
A lot of people freeze their eggs.
They do it because the timing of making a baby is just not right.
Last week, I went to the farmers' market and I got bagels.
Okay? They were fresh out of the oven, perfect.
But I didn't think I'd be able to eat them all in time before they went stale, so I froze them.
And guess what happened the next day? You microwaved one and ate it? It wasn't the same.
Padma, that is a ridiculous metaphor, and you cannot expect a donor to just fall into your lap.
It is really hard for me to talk to you when you get like this.
- Get like what? - Overly Logical Leela.
Trust the universe.
No freezing.
He snapped the restraint.
Push two of lorazepam and five of haloperidol.
On it.
We're treating him too late, aren't we? I hope not.
This virus is a terrible way to die.
What are you doing on your feet? Dust inflames my sinuses.
I thought I told you last night.
You need a haircut.
Well, you also called me Dad, so I figured I would let it ride.
And come on, you really should get back in bed, Mom, come on.
Okay? Come on.
Janaya said your peach tree was blooming.
I'd like to see it.
We'll get you in the wheelchair and we'll move you to the window.
No, son.
Hear my words.
I feel good.
I want to go outside.
We'll make it a field trip.
All right, let's do it.
So far, I've identified two major hurdles in rabies protocols.
We have antiviral effectiveness and neuroprotection.
So once the virus enters his spinal cord or the brain, the antivirals are ineffective.
The meds can't pass through the blood-brain barrier.
- Patient dies.
- So, what if we made - the barrier more porous? - How? Something I learned in clinical trials.
Some brain cancer studies show that mannitol can actually poke holes in the barrier - so that the chemo can get in.
- Yeah, poke enough holes in the blood-brain barrier and the antivirals can seep through.
That's an incredible long shot.
And it doesn't explain how we preserve the nervous system long enough for it to work.
So we need to figure out a way to cool him down without heavy sedation.
What if we lower his temperature from the inside out? We place an IV cooling probe in a blood vessel.
Warm him from the outside with blankets and meds for shivering.
So we take the existing rabies protocol and tweak it just a bit.
I mean, it could work.
I mean, it has never been done before.
This is completely hypothetical.
And the minute Bryce was bitten, hypothetical became his only chance.
- Thanks for coming.
- Flattered you remembered me.
You wrote that "Dr.
Reality Star" piece.
I framed it.
That's kind of you, since it was, uh, shall we say, a balanced profile? Well, I appreciated your honesty.
- That's why I called you.
- Look, we've sniffed around the medical board's incompetence many times before, but without any proof, we never get anywhere.
I have case files.
And patients that all are willing to talk.
And I thought if you published their stories The board is appointed by the governor, approved by the state senate.
You understand that, by doing this, you'll be rocking a very big boat.
Oh, yeah, it's an ocean liner.
You know, all doctors benefit from the shield the white coat provides.
And I have, too.
Malpractice breaks our oath to do no harm, but it also destroys the public trust in even the best doctors.
And the-the bad ones are few.
But they need to be weeded out.
And the guard dogs need to be reminded of who they're meant to protect.
You mind if I record this? I'm counting on it.
You have a green thumb.
Well, I have a well-paid landscaper.
You've got your career, your beautiful home, your well-paid landscaper.
Is that all you need? Well, if-if you're inquiring about my dating life, I-I assure you, it's-it's quite robust.
Dating is fine.
But you have to open yourself up to love.
What about a family? Bah.
Don't you worry about me, Mom.
- Mm.
- I'm gonna be okay.
I want you to be more than okay.
You know what we need? A trip to Butter Bean Beach in Savannah.
We haven't been in so long.
Yeah, I don't think we can manage that, Mom.
I've turned a corner, AJ.
We'll bring home a pile of shells.
Come on, baby.
Let's go.
Mom, you You okay? Need some water? Can you get me back inside? Yes, yes, yes, yes.
Crazy, huh? I heard you did the intake.
More like blew the intake.
I'm trying to convince myself that it wasn't what will kill him because no matter what, too many days had passed since the bite, and he came in too late.
All right.
Temperature probe is set.
We're gonna start cooling you down now, okay? In order to protect your airway we're gonna intubate you with a breathing tube.
And you'll enter a light hibernation state.
You'll feel drowsy and your breathing and heart rates will fall.
Like a bear.
Love bears.
Yeah, like a bear.
But we need to keep you awake as long as possible.
So, Dr.
Bonner is gonna sit with you, and she's gonna perform serial neurochecks.
Basically, that just means she's gonna talk to you and keep you awake.
All right? Listen, we-we were just outside, right? - She-she was lucid, she was happy - Remember what I said.
At the very end, patients can rally and have their best day in a long time.
Your mother is dying.
Maybe today, maybe tomorrow or the next day.
We don't know when.
She is accepting, no longer fighting.
That is a huge win.
Now, Dr.
Austin, it's your turn.
What-what should I do? Don't burden her with your grief.
Honor all that she is and has been.
Say any words left unsaid.
The last thing they lose is their hearing, so talk to her, if you wish.
Hey, Ma.
You know, I don't know if I've ever said thank you enough.
Everything that I have become is because of you.
I think all this time I've been afraid of losing you.
But these last couple of days, you have shown me that I can never lose you.
And you will not lose me.
'Cause I will be here by your side.
I'm not gonna leave you.
We've done all this and it looks like Bryce is gonna die anyway.
Should we have already quit? You're tired.
You haven't slept in days.
Come here.
How's Padma? Depressed about AJ.
Feeling the loss of this chance.
But she'll understand the story is just beginning.
She'll come around to freezing the eggs.
What if I offered to be the sperm donor? You can't be serious.
Why not? Doesn't it solve everyone's problems? Wouldn't it help us, too, in the end? No, Devon.
My egg and your sperm would make our baby.
We couldn't give that baby away.
Well, I agree it would be complicated, but hear me out.
We would be the-the fun uncle and auntie.
Everybody wins, especially the kid.
You're tired.
I'm going to have to believe that because this is - a truly awful idea.
- Why? Because I couldn't handle that.
And I'm utterly astonished that you can.
It puts my sister between us in a bizarre way.
It affects my relationship with her profoundly, and with the kid, and with you and me.
Can't you just discuss it with her? No.
I don't want to talk about any of this at all.
You like music? You have a favorite band? Whoa, whoa, whoa, whoa.
Stay with me.
Uh, how about I try to guess what it is? Grateful Dead? Okay, um, how about Phish? You seem like a Phish guy.
Oxygen is dropping.
The vent's starting to take over.
Page Pravesh and Hawkins.
Let them know he's got signs of papilledema.
Increased pressure in the brain.
I think we need neuro right away.
Good call.
Not very many doctors would have caught it off of such a subtle finding.
Can you give him the extraventricular drain? We can, but there's a limit to how much CSF fluid he can lose.
If the pressure shoots up too high, too fast I'm not sure I'll be able to stop it.
This patient is young, otherwise healthy.
He's got good brain plasticity.
No signs of herniation.
So you're saying we risk the EVD.
I am.
We push ten milligrams of ketamine and midazolam to drop his temperature by two more degrees.
Okay, let's do it.
Mom? Devon.
What? He's getting better.
His antibody titers are rising.
His body's fighting this infection.
His intracranial pressure is in normal range.
This is amazing.
We won't know what deficits he'll have until we bring him out of the hypothermic state, but these are really good signs.
Okay, uh, we start slow.
We raise his core body temperature up half a degree at a time until he regains consciousness.
Frank, how's the morning treating you? How dare you go to the press? You've had it in for other doctors from the moment you set foot on our board.
Not true.
I love doctors.
Good doctors.
You think I can't get a story out to counter the one you leaked? You want to start a media war, be my guest.
And we'll be asking the governor to relieve you of your position.
Enjoy your little victory while it lasts.
No, it's our little victory, Frank.
Bad doctors will now be brought to justice.
That's what we all wanted, right? That's the job.
What's this? An apology.
I've had time to think.
Freezing is the right option.
It's also the only option.
Apology accepted.
I would have loved to find another donor.
A doctor or a nurse, or just a nice guy hanging around.
You're so lucky to have found Devon.
You have no idea, Leela.
I know he's not perfect, but but he's gonna make a great father one day.
And you'll never have to wonder about who's gonna be part of your baby.
If you ever decide to have a family, that is.
You'll find a new donor.
Someone great.
When the time is right.
And he's back.
Welcome back, buddy.
Welcome back.
I'm Kimberly Gund - Shh! - Joined now by Dr.
Randolph Bell, Chastain Memorial surgeon and now former member - of Georgia's State Medical Board.
- Thank you for having me.
There's quite a scandal unfolding.
Lack of oversight.
Doctors who should lose their licenses are still practicing.
The Board doing nothing to protect the patients - they are tasked to protect.
- Oh, it doesn't end there.
The governor and politicians all over Georgia, who are supposed to make sure that the Board does its work, are bought and paid for by every single entity that stands to lose in a malpractice suit.
And there are many.
Hospitals, doctors, insurance companies; the list is long.
- And it is full of deep pockets.
- Finally! The medical industrial complex gives more money than any other single donor, including the NRA.
It just has to stop.
I understand only 2% of all malpractice cases are ever reviewed by the State Medical Board.
Break down for us, if you will, how everyday citizens are supposed to get the attention - of the Board.
- Well, that's at the very - heart of this, isn't it? Because most people don't know that the State Medical Board is there to protect patients.
Who knew? He just called out the whole Medical Board.
He just called out the freaking governor.
That's my man.
You're tracking much better, Bryce.
And you have some intentional movement in all four of your limbs.
And it may not seem like it yet, but that is monumental.
The virus did a number on your nervous system, but you just beat one of the most fatal diseases - on the planet, man.
- Yes, you did.
And you're a young guy with a young brain with the ability to rewire itself.
I spoke to the rehab facility.
They're gonna roll out the red carpet for you, Bryce.
You're a medical celebrity.
You know, people are saying you ought to have a whole wing dedicated to this success story.
The Hawkins-Pravesh Rabies Treatment Facility.
You mean the Pravesh-Hawkins Facility.
Ha-ha, I like hers better.
But honestly, if I never see another rabies patient again it'll be too soon.
Excuse me a sec, guys.
I'm so proud of you.
It was a team effort.
So, uh - are things weird between us? - Not weird.
And we don't even have to discuss it because Padma agreed to freezing the eggs.
I thought you said her biological clock was ticking.
What can I say? She hit snooze.
You know my sister.
Devon, did you really want to father my sister's child? No, I-I I don't know, I just I don't know, I just want to help in any way I can.
I have to get to surgery.
Congrats again on your patient.
- Look at that.
- Italian.
Gigi's favorite.
And she insisted it was your favorite, too.
Of course.
Come on in.
- Hey.
- This is for you, Dr.
I'm sorry about your mommy.
Oh, thank you, Double-G.
Oh, I really appreciate it.
All right, you guys come on in.
Oh, these flowers are so nice.
Thank you.
Everyone at Chastain misses you.
I feel that.
I'm not ready to come back yet.
You know, I I'm used to checking on her.
You know, listening for her voice, for her every move.
Now it's just silent.
And I'm all alone.
I could lend you Gigi.
Daddy! Daddy needs a break.
I'll pick you up in say, what, about a week? What do you say, Uncle AJ? Yeah? - Are you nervous? - Why would I be nervous? Because it's hatch day.
Time to find out if you're a good chicken.
I didn't expect to see you here.
I'm so sorry about your mother.
Me, too.
How are you? Grieving.
It's gonna take some time, right? But it's time that a woman women going through IVF cannot afford to waste.
So, Padma, if it's not too late, I would like to be your sperm donor.
And you didn't think the universe would come through.
Yes! But there is a condition.
Now that I'm alone in the world, I realize I-I don't like being alone.
So if we're going to do this, I don't want to just be a donor.
I've got to help you raise this kid.
I want to be a father.

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