The Resident (2018) s06e03 Episode Script

Experience "The Resident's"
most heart pounding season yet.
Fixing things is my job.
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Previously on The Resident
Billionaire businessman
and first-time candidate is
- the new governor of Georgia.
- Do you want to go get a drink?
I think I better try and
figure out how Chastain is
going to survive without
a third of its budget.
Maybe it's nothing,
but the other day,
I saw him take a pill.
If he is using while he's working,
then that's a problem,
to put it lightly.
You just went through a major surgery.
It's like all these things
that can go wrong
and destroy you,
and there's nothing you
can do about any of it.
I got you my best robe.
It opens in the front,
makes nursing easier.
- Thank you.
- And you forgot your slippers.
You'll be up and walking in no time.
Are you ready?
You don't look ready.
It's still so early. Is it time?
Yes, we have to be there at 6:00 a.m.
The C-section is scheduled for 9:00,
and they need to get you ready.
What are you typing?
Last will and testament?
You're making out a will?
I realized I don't have one.
Everyone needs a will.
There's this website
where you can do it online.
I think it's official.
Padma, look at me.
You are not going to die.
You can't promise me that.
I rushed.
I rushed to get pregnant.
I rushed to find a donor.
I made this huge life-changing decision
without realizing
something so fundamental.
Terrible things can happen
at any moment.
Hey.
You ready to go?
Apparently not.
Holler when you're ready.
Look,
you're about to meet your two babies.
This is the first page
of the first chapter
of the book of the rest of their lives.
- Aren't you excited?
- Yes.
But not all books have happy endings.
If I die today
It's a C-section.
You are not going to die.
I have to know one thing.
If something unexpected
and awful happens today,
will you make sure
they are taken care of?
I will always make sure
they are well taken care of,
but that won't be necessary.
You're their mommy,
and you will be there
to look out for them.
I know it looked bad,
but he could've lost
his entire leg or worse
if we hadn't amputated on site.
BP's steady,
and his respiratory rate seems normal.
Bleeding minimal.
Tourniquet's holding.
You'll take him to the best docs, right?
He's a union brother. He's got
gold-plated health insurance.
We're going to Yates University
Hospital. It's the nearest ER.
- You two need a ride?
- Uh, we're good, thanks.
All right.
Another Go Team job well done.
5:30 a.m.
I'm starving.
Do you know any place that serves
good pancakes at this hour?
Chez Conrad Hawkins whips up
a mean buttermilk blueberry batter.
Mmm, that sounds intriguing.
How's the coffee?
Gunshots.
Let's get out of here!
Hey, buddy, what happened?
Where'd you get shot?
Easy, easy, easy.
Can you tell me your name?
Single gunshot wound to the abdomen.
Pulse is thready and falling.
Bullet to the midsection.
Could've taken out just about anything.
Ambulance won't make it in time.
He's hemorrhaging.
Scoop and run.
It's the only way he lives.
I'll grab my car.
We'll treat him on the way.
Okay, my friend, here we go.
He's decompensating.
I'll call Yates.
Yates Emergency Department.
Triage. This is Nurse Collins.
We have an incoming male, mid-30s,
single GSW to the abdomen.
We need you to prep
a trauma bay and some blood.
Hold, please.
You got to be kidding me.
- You still there?
- Yes.
The ED is full up.
We're diverting patients.
We just sent an amputation
there ten minutes ago.
Yates is the closest ED.
Like I said, we're diverting.
Take him to Chastain.
He's bleeding out.
Tell me they did not just hang up on us.
Unbelievable.
They just assume a gunshot
victim is poor and uninsured.
Which means it would cost them
a mint to try to save him.
Yeah, they know the deal.
One bullet can require
100 health care workers
to fix the damage it causes.
Then we get him to Chastain.
8:00 a.m., omphalocele in OR Four,
9:30, partial nephrectomy
in OR Two and
All righty. I like those
kicks, by the way.
Comfortable, as well as stylish.
And, uh, one more thing
you need to get drug tested.
First I've heard of that.
Yeah, the order came in last night.
All nurses, all doctors on
shift, mandatory drug testing.
Testing center's on the third floor.
Everybody's got to pee in a cup.
See you in OR Four.
It's almost over.
Almost over.
Your C-section is scheduled
for two hours from now.
Two very short hours.
And then you'll have
two healthy baby boys.
It'll be a miracle.
A C-section is not nothing.
I looked it up, and
it's a tough recovery.
After everything you've
been through already,
this should be cake.
You'll be fine, Padma.
Dr. Pravesh, Dr. Devi, Dr. Austin,
nice to see all of you.
Padma, how are you feeling?
She is a little nervous.
Please, I can speak for myself.
I'm terrified.
Understood.
How about we get you
comfortable on the bed?
This bag weighs a ton.
What do you have in here, gold bricks?
Some incense and crystals
and a comfy robe and a nice book.
We're gonna put some monitors
on your belly so we can
keep track of how your
precious ones are doing, okay?
And I'll put some sage
and jasmine near your bed.
Oh, and the crystals by the window.
Quartz closest to me.
Moonstone by the door.
Dr. Johnson, can you please
tell her she's gonna be okay?
Padma, what specifically
has you so worried? Talk to me.
After the in utero surgery,
I don't see this hospital the same way.
I'm gonna be at your side
every step of the way, okay?
- Okay.
- And
the good news is,
the babies sound great.
Strong hearts, both of them.
We are a go for the C-section
in two hours.
Yes.
It's all good.
Low risk of complications.
I'm gonna check on some patients,
and I'll be back in a little while.
Oh. Okay.
Two hours.
Two hours left.
A doughnut's primary
characteristic is the hole.
If you fill the hole with jelly,
it can't be called a doughnut.
It's 100% still a doughnut,
and you've been wasting
your life not enjoying it.
- I walk a higher path, H.
- We got a gunshot wound,
coming from the scene.
We need a stretcher.
Male, 30s, single GSW to the abdomen.
Let's put him in the new trauma bay.
20 minutes en route
and barely has a carotid.
He's a mess. Any idea what happened?
Found him like this.
He's lucky you did. He doesn't
have much more time.
You get access. I'll intubate.
- On it.
- 16 Gauge IV to right AC.
His carotid's still thready.
How are we doing on blood?
Two units going in
through the pressure bags.
This guy have I.D.?
No wallet. Not responsive at the scene.
- How can I help?
- Give our patient a name.
- Last week's anonymous GSW, we were
- GSW?
Gunshot wound.
We were on D, named him Dandelion,
so we're on the letter E this week.
Oh, uh Maybe Eucalyptus?
Welcome to Chastain, Eucalyptus.
I hope you survive your stay.
BP's low. We need more blood.
Belmont transfuser.
- Maya?
- Getting it.
Bilateral lung sliding, no pneumothorax.
Bullet did not take down a lung.
Midline laparotomy scar.
Might've been shot before.
Often the case.
Let's roll him on my count.
Three, two, one, go.
Exit wounds?
Nothing fresh.
Old scar from the last GSW.
We're good to go on the Belmont.
FAST is grossly positive
in the right upper quadrant.
IVC is completely collapsed.
The bullet definitely took
out something vascular.
BP's steadying.
We gave him a chance,
but he needs an OR now.
I'll bag. Let's move him.
I'll page trauma.
Get Raptor and Leela on board.
The jasmine's a little
pungent.
It's not helping anyway,
so you can toss it out.
Trauma surgery, a GSW.
No, what does that mean?
They need me in OR One.
It's emergency surgery.
Uh, can't they find someone else?
I will be back before
your C-section starts.
Don't worry.
Go. I have a light morning.
I'll stay with her.
I need an OR. Anything you got.
Take him to OR One.
Give me your phone.
I'll handle scheduling.
This is Dr. Voss. Cancel
anything in OR One,
and move nonelective surgeries
to Two and Three.
And call the chief of surgery,
Dr. Sutton,
about rescheduling anything
non-emergent. Keep me posted.
What happened?
I thought you were on
an amputation call.
We were.
Finished, and then heard gunshots.
Found the GSW around the corner.
We brought him here
in the back of Cade's car.
- Say his chances are 50-50.
- Couldn't you have taken him
to Yates University Hospital?
Their ED must've been closer.
Oh, we tried. We sent
the amputation there,
but when we called with
the gunshot ten minutes later,
Yates said they were diverting.
Both know what that means.
Blunt trauma victims
car crashes, workplace injuries
tend to be middle class, well-insured.
A private hospital like Yates
is happy to take them
and make a nice little profit.
Yeah, money talks, and penetrating
trauma victims
shootings, stabbings
are usually uninsured.
And get sent to public
hospitals like Chastain,
and we suck up the cost.
That's why we work here.
But a patient like that
can eat up a hospital's resources
and do it fast.
What a mess.
His anatomy is a disaster.
Nothing is where it should be.
Dense adhesions, missing spleen.
This is not this guy's first rodeo.
You think he's been shot before?
100% certain.
Shot, opened and closed.
Maybe even twice.
This dude certainly knows
how to find trouble.
Pressure's dropping fast.
He's exsanguinating.
It's hard to get orientation
with all this scarring.
You got anything?
Damage to the liver, small bowel,
and the branch of the renal artery.
How does one bullet cause
this much damage?
Small caliber, low velocity.
The bullet never exits the body.
It just bounces around,
tearing up the organs.
It's incredibly destructive.
You, sandwich the liver with packs.
Squeeze with both hands
till it stops bleeding.
Okay, resecting the bowel.
Isolating the renal artery.
Jejunal injury is stapled off.
- That should stop him from bleeding out.
- Okay, good.
My packs are not
soaking through anymore.
Great. Let's finish him up.
But we haven't found the bullet yet.
This is just damage control.
We need him to be stable
to give to CT for a pan scan.
There we'll find out
where the bullet is.
- Anybody know this guy's name?
- Eucalyptus.
We're up to E already?
Seems like a few days ago we were on D.
A week ago, to be exact. Dandelion.
Chrysanthemum was the week before that.
Nearly all gunshot wounds.
At this rate, we'll have treated
enough unknown patients
- to get us to Z by New Year's.
- Z Z
Zinnia. I love zinnias.
Did Eucalyptus have a phone on him?
Not that we found.
Anything distinctive? Scars? Tattoos?
Uh, he had a tat of a skull on his arm.
Okay, I'll get a picture.
Um, anything else that
might help me identify him?
Fast food receipt in his shirt
pocket, but he paid in cash.
I'll cross-reference
with social media, reach out
to local shelters, uh,
track down family members,
if possible, to notify them.
If we learn anything more about him,
we'll let you know right away.
Hey, Go Team,
don't forget to chug some water.
Get your bladders nice and full.
- Yeah.
- Words I never wanted
to hear you say to me.
CT scan should come up
in ten minutes for Eucalyptus.
I'll go check on him.
Care to elaborate?
Oh, you know, Chastain is performing
mandatory drug testing
on all doctors today.
Since when does Chastain
drug test their staff?
- Been a minute.
- Three years, at least.
Huh.
Um
How you feeling?
I've been better.
Well, Raptor and Leela
will be here soon.
They're wrapping up in the OR.
Oh, so just half an hour to go.
Uh, no, actually, your C-section
has been pushed back
- by an hour.
- An hour?
Why?
There's a backup in the OR
due to a gunshot victim.
But everything looks good here.
You want to leave.
No, I want to stay with you,
but I have patients
that I have to round.
The Chronicles of Narnia, huh?
It calms me down.
I can't
really focus on anything new right now.
Yeah. Of course.
I'll go check on Leela for you, okay?
Okay.
Okay.
Two lines means positive
for benzodiazepines.
- This is for you, Dr. Sullivan?
- Yeah, for my back.
I've used it before, very effective.
Oxaprozin is not a controlled substance,
but this medication can be
hard on your stomach,
- so don't take too many at once, okay?
- For sure.
Thanks.
Padma's doing good.
Devon said she's reading
Chronicles of Narnia.
The kids book?
Whenever Padma and I were stressed,
we'd read it aloud to each other.
It was like a tranquilizer.
Ah, for me, it was Anne of Green Gables.
I must've read that a hundred times.
- How's Eucalyptus?
- Uh, well, we're about to find out.
Okay, looks like you repaired
everything you could.
No ongoing bleeds.
Let's get him to the ICU,
keep him stable.
Monitor serial hematocrits,
and watch that kidney function.
Once he recovers for 24 hours or so,
we can get that wound vac out of him
and stitch him right back up.
Hold on.
Lower thoracic spine. Look.
Bullet is lodged in the bone
right next to the cord.
That's dangerously close.
We have to remove it.
If we don't and he moves
- the wrong way, then
- He's paralyzed,
which might happen anyway,
regardless of what we do.
Add neurosurgeon to the list of doctors
keeping Eucalyptus alive.
When you open him back up, page me.
I'll come running.
I think something triggered
this drug test.
They suspect someone's using?
That would be my thought.
Well, who do you think it is?
What are we, living in a police state?
They'll chip us next.
Kidding. I know you're
just doing your job.
And doing it very nicely, by the way.
You wanted to talk? What's up?
Can you close the door?
This hospital-wide drug test.
Did you go to Kit and suggest she do it?
Yes. Yes, I did.
What did you tell her?
I just said there was a possibility
someone in the hospital
was taking drugs while on shift.
Did you name my father?
Of course not. I didn't even
say it was a doctor.
I talked to you about Ian in confidence.
And I didn't break that confidence.
My conversation with Kit
was completely anonymous.
I can't believe that you did this.
We can't have a drug-addicted surgeon
operating on our patients.
I had an intuition, Conrad.
It was a feeling, that's all.
And if he's clean, fine.
If not, that's a violation
of the Hippocratic Oath.
"Do no harm".
This does a lot of harm,
to me and my family.
Did you think about that?
If he's using,
it's a dangerous situation
for everyone here,
including your dad.
So, yes, I did think about your family.
If it was your father,
would you have dealt with it
by going to Dr. Voss?
Okay.
I hear you. I guess I would've
talked to him first.
Which is exactly what I was going to do,
but you took it out of my hands.
I don't need you to save me
or the members of my family.
You should've let me handle it.
If your father was about to operate
on a vulnerable child in your care,
would you be comfortable
with him doing it high?
And if that child suffered
irreparable harm
how would you live with it?
I have heard you.
Now, have you heard me?
Eucalyptus is in the ICU. I have to go.
Status update?
He's getting harder to ventilate.
Pressure is reading artificially high.
Let's increase the PEEP to 16
and set the driving
pressure alarm to 60.
- How's his urine output?
- Not good.
He needs more fluids and more blood.
Uh, let's prep his neck
for another line.
The bullet destroyed his kidney,
so if he wants to survive
the next 48 hours,
he'll need dialysis pretty
much around the clock.
Page renal, Juliet.
You'll have to give up
your other patients today.
You're on Eucalyptus watch
- for the rest of your shift.
- Yes, Dr. Sullivan.
You're putting him on
a "one nurse to one patient" ratio?
We're short on nurses to begin with.
He needs real-time monitoring.
And dialysis as well?
Do we even have a machine available?
We do, but it's our last one.
Look, I will try to manage his care
and keep costs low, but if we
don't throw everything at him
right now, he dies.
Of course.
Do what you have to do,
and-and thank you.
Hey.
Sorry it took so long.
Devon's been an angel,
but I am glad you're back.
How we doing?
Vitals are good. We're having
some small contractions.
Maybe I don't need a caesarean.
I can give birth naturally.
I'm afraid that's not in the cards.
Cervix is still only at one centimeter,
and these contractions aren't
coming at regular intervals,
so I'm fairly certain
they're Braxton Hicks.
It's a false labor, Padma.
But the good news is,
our OR schedule has opened up,
so your C-section is back on the board.
Oh, thank God.
I'm gonna go get ready.
Someone will bring you down very soon.
- Okay.
- Those twins will be here any minute now.
You ready?
- Yeah.
- Okay.
What's going on?
His pressure was soft,
but it just tanked.
Look at his abdomen.
Damn it.
Dialysis isn't working?
No, he doesn't have enough blood
to make it through the circuit.
It's pooling in his abdomen.
Let's pause dialysis
and return what we can.
Get two more units of blood up now.
I'm having trouble again
with the ventilation.
Got bloody secretions from the ET tube.
Looks like he's bleeding
around the line. Guy's a mess.
We can get him back
to normal. Let's get two
- of FFP, some platelets, and
- Dr. Sullivan,
the wound vac.
Canister's full. The blood's
backing up into his abdomen.
His internal bleeding is out of control.
He needs the OR.
Page AJ.
Tell him we're coming in hot.
Again.
In. Out.
In. Out. You're gonna see
your babies soon just focus on that.
My baby boys.
Hold up, guys.
I am so sorry, but I'm afraid
the twins are gonna have to stay
in there a little longer.
- What?
- Why?
We got bumped out of the OR.
Another emergency.
Something to do with the GSW again.
Eucalyptus.
OR One.
What?
I'm so sorry. I have to go,
but I will be back, okay?
Wh-When?
Soon.
Soon?
Go. We can handle this.
We'll take care of it.
I will let you know the second
we're back on the schedule.
Hey, don't worry,
I will not leave you again.
What do you mean "delayed"?
I've been waiting months for a new hip.
I'm so sorry, Mr. Garret,
but unexpected emergencies
can have a ripple effect
on scheduled surgeries.
- Will it even be today?
- You will get your new hip,
I promise, but we have to give
life-threatening cases priority.
No. Cancel it.
We need that room five minutes ago.
We're shifting things around.
I'm sorry. We're doing
the best that we
Wait, Dr. Sutton.
I've got to scrub in on the GSW.
The bullet is lodged in his spine.
Dr. Miller says his myomectomy
needs to go.
Everything that can push is pushing.
We've got no choice.
How'd we get this low on AB negative?
We were low to start, then
the GSW went through 50 units.
50?
Call scheduling, see if they can
bump the coronary bypass
- in OR Three.
- Bump a bypass?
That'll free up four units, minimum.
This is Kay down in blood bank.
I need to bump a bypass.
I'm worried about Padma.
Same here, but she'll be okay.
Flights get delayed, you
still make your destination.
Eventually.
After sitting at O'Hare
for ten miserable hours,
and sometimes they say,
"Get a hotel room",
- but then all the hotels are booked.
- Jessica.
All right.
Removing the wound vac.
Damn, that's a lot of blood.
All right, set up extra
suction. Laps to me.
And massive transfusion protocol, now.
Where's he bleeding from this time?
Like I said, the bullet went everywhere.
We have to approach this systematically.
Okay, you lead, I'll follow.
Okay, repack every quadrant,
and then remove them
clockwise until we find it.
Okay.
You're doing great.
I was really hoping to never
have to see this room again.
Honestly, same here.
Devon.
Something's happening.
Oh, it hurts under my belly a lot.
Dr. Johnson!
Oh, God!
I've got you. It's gonna be okay.
- What's happening?
- Fetal heart rates are dropping.
She has lower left abdominal pain.
She's bleeding from her uterus.
- An abruption?
- Yes.
Placenta's detached
from the uterine wall.
She needs an OR right away, but,
Devon, there's none available.
I'll make one available.
Hey, we need an OR right away.
I'm sorry, Devon. Every
room's booked solid.
Padma is having an abruption.
If we don't get
those babies out now, they die,
maybe she does, too.
Cancel the appendectomy in OR Two.
Prep it for a C-section.
Thank you.
Cancel OR Two.
Need for C-section.
Oh, God!
It hurts!
We're almost there, okay?
She's going into shock.
Padma, I'm here. I got you.
Ten blade.
Give me fundal pressure.
Baby number one is out.
Reach.
Baby number two.
Okay, now, Padma, she's bleeding
heavily from the abruption.
Get me four units of blood to catch up.
We're out of AB negative.
In the entire hospital?
Yes, it was used up
from the gunshot wound.
Oh, my God.
Let's try uncrossmatched blood.
Okay, but we need it now.
Add TXA, more oxytocin.
I need help. Page trauma now.
I need four units of
uncrossmatched right now.
Two units are all we have left.
OB is paging trauma to OR Two.
Padma's had an abruption.
- An abruption?
- She's bleeding out.
- She could die.
- Go.
I'll finish here and join
you as soon as I can.
- What can I do?
- Help me keep this son of a bitch alive.
It's not his fault he got shot.
Are you certain of that?
Because I'm not.
His pressures are tanking.
All right, it's coming from the liver.
We need to do a hepatectomy
to control the bleeding.
Clamps to Dr. Sutton.
Padma.
- Two units of uncrossmatched.
- That's it?
It's all they had.
Have you found the source?
Uh, not yet. She had an abruption.
I treated her for atony.
I'm looking for the laceration.
Now she's bleeding uncontrollably.
These two units won't last long.
Leela.
You've done this a hundred times.
Here's what we're gonna do.
Get better exposure. Laps, suction.
- Retractors to me.
- Ring forceps here.
Tear at the uterine artery with
an extension of a hysterotomy.
It's in a tough spot.
Rotate more superiorly.
- This is as much as I can give.
- You're gonna have to give me more.
- I can't find the tear.
- Okay, if this doesn't work
- It will work.
- Her pressure's tanking again.
- She's on two pressors.
- Leela, she's gonna code.
More suction. I know where I am.
I've isolated the vessel.
Adding a third pressor.
Get the crash cart.
Wait, hang on, hang on.
Almost there, almost there.
I've tied off the bleed. We're good.
Partial hepatectomy complete.
Bleeding's stopped.
Pressures stabilizing.
All right, 2-0 silk suture to me.
AJ.
Go to Padma.
I'll try to remove the bullet.
Thank you.
I need access to dissect
down to the spine.
Okay, retract.
Hey.
- How's Padma?
- She's okay.
She's stable. We stopped the bleeding.
Leela did it. She's a boss.
Of course she was.
The babies are in the NICU
if you want to go see them.
Two healthy boys. Congratulations.
Would you like to hold them?
Padma's baby boys are doing well.
Strong hearts,
no sign of any adverse effects
- from the abruption.
- Oh, that's welcome news.
And Padma?
Last I heard, on her way to ICU.
Extubated and stable.
That what you wanted to see me about?
Oh, no.
You tested positive for benzodiazepines.
That's not possible.
Actually, it is possible.
I've been taking oxaprozin
for my back pain.
I took two yesterday.
Can make you test positive for benzos.
It's happened before.
I should've said something
before the test.
My mistake.
Okay. Makes sense.
- All right.
- Oh, but, Dr. Sullivan,
I'm sorry, but I can't have you operate
with a positive test result.
It's against hospital rules.
You'll have to stop taking
the oxaprozin,
let it clear your system,
and then get tested again in a week.
Okay, sure.
Okay, I'll make sure
the test administrator
puts you on the schedule.
Should be clear by then, no problem.
She looks good.
I'm gonna try to wake her up.
Padma?
Padma?
It's Dr. Sullivan.
How you feeling?
Where are the babies?
They're fine. They're in the NICU.
Crying, just like babies do.
Strong and healthy.
There was a serious complication.
You'll likely have a long recovery,
but you're okay now.
Call me if you need anything.
Got a sec?
There's something I have to tell you.
I don't want you to get upset.
I've tested positive for benzos.
No, it's not what you think.
I've been taking oxaprozin for my back.
It causes a false positive.
Didn't you realize
the oxaprozin would do that?
I should've.
I didn't.
Kit's asked me to stop taking them.
I'll test again in a week.
I should be clear by then.
Okay.
It's no worries, Dad.
Just wanted you to know.
Any idea when we can transfer
him out of the hospital?
A week, maybe longer.
We'll have a hard time placing him
in a long-term care facility.
The bullet transected his spinal cord.
Eucalyptus will never walk again.
Poor guy.
And we don't even know
if he has health insurance.
Health insurance?
We don't even know his name.
Winston came up empty.
One bullet caused so much mayhem.
For our patient and for our hospital.
One damn bullet.
We good?
My father tested positive.
He has an excuse.
Said he's been taking
pain meds for his back.
Is that possible?
It's possible.
But
We don't have to talk about it.
We don't have to talk about anything.
Come home with me.
I need to be alone.
Do some thinking.
Tomorrow?
Sure thing.
Whatever you need.
- See you tomorrow.
- See you tomorrow.
Good work today.
Got a male, teenager,
single GSW to the chest.
No exit wounds. BP crashing,
no breath sounds to the right.
- Does he have a name?
- Unconscious at scene, no I.D.
We're on F.
How about Fuchsia?
Welcome to Chastain, Fuchsia.
All right, let's get you
to Trauma Bay Nine.
- Call respiratory.
- And set up for a chest tube.
Call blood bank.
Experience "The Resident's"
most heart pounding season yet,
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