The Resident (2018) s06e05 Episode Script
A River in Egypt
1
Previously on The Resident
MS is such a bastard.
You think you're on a plateau,
and then it just crumbles.
Things are developing all the time, Kit.
But it's always there,
hanging over our heads.
This hospital-wide drug test.
- Did you name my father?
- Of course not.
Would Nic approve of me with Cade?
I just want you to be happy,
so would Nic.
IAN: The twins look perfect.
Healthy weight, strong heartbeat.
I'd say this family can
go home this afternoon.
Ah, you hear that, Padma? We're finally
breaking you guys out of here.
That is music to my ears.
CT is backed up. I'll call over.
One cranberry juice coming up. (SIGHS)
And your discharge papers.
Looks like we can send you home
with a prednisone burst.
(SIGHS) No rest for the weary.
No rest, little reward, and yet
I keep coming back for more.
(SIREN WAILS)
HUNDLEY: What do you have for us?
Raja El Khoury. 38-year-old male,
episode of emesis. Students called EMS.
Sats were low, tachy to 120s.
Let's get him to Bay Eight.
He's improving with oxygen
but still kind of out of it.
What are you doing?
Raja, is it?
Okay, you're in the ER at Chastain.
I'm Dr. Feldman, this is Nurse Hundley.
- We're gonna take care of you.
- I don't care who you are.
I want out of here.
- Just let me get up!
- IRVING: Okay.
Let's get him on a monitor
and a 12-lead EKG.
- HUNDLEY: I'm on it.
- None of the rest of you
touch me. He's the only doctor I'll see.
Seriously? Who are you talking about?
Dr. Hawkins.
(RAJA PANTING)
He saved my life.
(DOOR OPENS)
How old do you think I am?
- Wager a guess.
- I'm sorry,
are you my 8:00 a.m. meeting about
- a research possibility ?
- Sorry, yes.
I'm Marko Zytylny. So, come on,
how old?
All right, all right, all right.
No need to guess.
See this?
My genetic age,
according to this, is 50.
But my real age, in real life,
Yup.
That's impressive, Mr. Zytylny.
No, please, call me Marko.
Since I was a child,
I believed that aging,
infirmity, and death were inevitable,
but that's a fallacy.
Hmm. You see, here at Chastain,
you guys are playing a very expensive
game of Whac-A-Mole.
The patients come to you with,
uh, heart disease in their 50s.
Whack. In their 70s, with cancer. Whack.
In their 80s, with Alzheimer's
Try to whack it, you can't. They die.
But not
if you fix aging.
You get rid of all of that.
- You see, that's my dream.
- Okay.
I am intrigued,
- but how can I help you?
- Dr. Pravesh, I-I've
read your work,
and you think outside the box.
I really believe
What is the scientific question
that you want me to answer?
Isn't that obvious?
How to live forever.
♪
AUSTIN: And I want to thank you
for only doing pee-pee
- while Daddy changes you.
- (CHUCKLES)
(WATCH BEEPS)
Hey, Padma, I got to get going, okay?
(BABY CRYING)
He's probably tired
or hungry
or gassy or he pooped again.
Or maybe he just needs
a little of this.
Twinkle, twinkle ♪
(BEATBOXES)
Twinkle, twinkle. ♪
(BEATBOXES, CHUCKLES)
All right, now, you be a good
little boy for your mama, all right?
And, Padma, if all else fails, remember
you have these womb-inspired
sounds and motions
to remind them of the good old days.
Paddie, I'm gonna get going, all right?
But you haven't had any coffee yet.
Do you want to wait ten minutes?
I'm sorry, I wish I could, but I can't.
Look, I'll try to swing by
between surgeries, okay?
- It's okay. I got this.
- Yes, you do.
Look, you are an amazing mom already.
Just remember, Padma,
if you need anything
I know. I'll call. Okay.
Goodbye ♪
All right.
Good ♪
- (DOOR SLAMS)
- (BABIES CRYING)
RAJA: If I go in the next
couple of minutes,
I might be able to finish my lecture.
I have spent way too much
of my life in this place
with doctors drawing my blood.
- No offense.
- (LAUGHS)
None taken.
I took care of Raja when he was
diagnosed with bone cancer.
Diagnosis you made.
All the other doctors said
- shin splints.
- (LAUGHS)
You were sweating bullets
when you told me.
I was an intern.
I never told someone
they had advanced cancer.
Oh, that takes me back to a time
I never want to revisit.
Managed to stay away from
this building for the last
eight years, till today.
So, what happened?
Well, I was giving my favorite lecture
on Who's Afraid of Virginia Woolf?
when I threw up.
Then I couldn't catch my breath.
My students called 911.
It's good they did.
It actually looks like
you have a bad pneumonia.
You might have aspirated from the vomit,
or you could have a virus
that explains both symptoms.
So, that's all that's wrong?
- As far as we can tell right now.
- So,
maybe I wait here a few more hours
and, uh, I call my fiancée,
- and she takes me home.
- Whoa, hold your horses.
We need to get you on IV antibiotics,
keep you on oxygen,
and get you to the ICU.
Home will have to wait.
Just get me better.
You did it once,
you do it again, okay?
That's the plan.
You know, that's the one
drawback of being an ER doc.
- There's just one?
- One of many. No one
credits me with saving
their life, though I do
all the time, but I send them off,
and they fawn over their internists
who take care of them upstairs.
Do I detect some envy, Dr. Feldman?
It's just frustrating.
Yeah, they get to know you.
You see them day after day.
Why not add another specialty?
Irving Feldman,
- Doctor of Medicine.
- (LAUGHS)
No, thank you. I did my internship.
I remember those interminable rounds,
discussing hyponatremia.
Hey, you don't know what you're missing.
You might actually like
hanging out with the patients.
Can't a man complain
around here without you
always trying to offer
a solution, Hawkins?
When my shift ends in two hours,
I am out
of here. Done.
Gone. Buh-bye.
Buh-bye.
And after my daily push-ups,
I do a quick five-minute
liquid nitrogen bath.
You ever had one?
- Uh, I can't say that I have.
- I highly recommend it.
Soothes the muscles,
reduces inflammation,
lifts the mood.
(PANTING): Damn,
I think I've lost count.
Remarkably, you're at 90.
And my protocols work, Dr. Pravesh.
Just help me study my tests,
then we could all maybe
live forever. 99 100.
(WHOOPS, SIGHS)
(SPECTATORS CHEER AND APPLAUD)
I'm telling you
that death is a scientific problem
we can solve together.
Trust me.
This about does it for our tour
of the hospital today.
I am afraid I'm gonna have to
wrap it up. I have a full day, so
- On one condition.
- What's that?
We round this out
with one set of stairs.
- (LAUGHS)
- Mr. Zytylny
Let's go! Whoo!
(GRUNTING)
- What's going on?
- I don't know.
- I can't, I can't breathe.
- Whoa, whoa, whoa, whoa.
Can I get some help over here?
Reading something good?
Uh, just an email
Ian forwarded me
from a mom thanking him
for saving her baby.
Modest as always.
- Sounds like the Ian we know.
- Hmm.
How is everything with him, in general?
Passed his drug test.
Operating up a storm, so
fine, I guess.
That's a relief.
So is the fact that
I am finally off nights.
As much as I love
my solo dinners with Gigi
You have room for one more tonight?
- Always.
- (CURTAIN PULLS BACK)
Dr. Hawkins, we need you
in Raja's room now.
(MONITORS BEEPING RAPIDLY)
Raja, you're okay. You're
safe. What's going on?
(STRAINED): Good, better, best, bested.
NURSE: He was answering my questions,
and then he stopped making sense.
We need to get his fever down.
One gram of acetaminophen.
Grab a liter of Lactated Ringer's.
Sats are dropping.
I'm going up on his O2.
RAJA: (GRUNTS) Dance like the wind.
- This is more than just pneumonia.
- He's too altered.
- I'm worried about meningitis.
- (SCREAMING)
- It hurts! Stop!
- Photophobia.
Let's check for nuchal rigidity.
We're just gonna move
your head a little bit.
(GROANS) Get off me!
- CADE: His neck is stiff.
- Raja, what's this?
No, bandage. Don't-don't touch it.
- Is that
- Looks like spinal hardware.
From the surgery for spinal mets.
- But you said his cancer was
- Eight years ago.
Raja, that rod sticking out
of your neck
how long has that been there?
Yeah, I need two milligrams
of IV lorazepam and get me
an intubation kit now.
Tell CT to get ready.
Coming in for a head scan.
You know, I'm still game
to go back to your office.
This is no place to discuss
data. It's pretty loud,
and, well, it's full of sick people.
We're not talking data now.
You nearly passed out, so Dr. Feldman
and I are gonna find out why.
I'm sure Dr. Feldman
has a lot better things to do.
Marko, you said you wanted me
to study you, right?
- Let me study you.
- IRVING: Looks like your EKG is normal.
We're waiting on some lab results,
and we'll see what they tell us.
- Okay.
- All right. Back in a sec.
Thank you.
No way that man is 70.
He has an anti-aging regimen
he thinks is the path to eternal life.
So, what's his secret?
Well
- knock yourself out.
- Whoa.
You know, it's being studied
all over Silicon Valley.
Every tech entrepreneur
wants to figure out
how to live forever,
and I cannot blame them.
I think he collapsed on our stairway
while claiming to have
the answer to eternal life.
He needs to face the truth.
We all age. We all die.
We can't stop it.
But we can try.
I'll see about those labs. You enjoy.
Yeah, thanks.
- (BABIES CRYING)
- (PADMA SHUSHING)
I would love to hold you both,
but that is physically impossible.
You get that, right, guys?
(PHONE RINGING)
(SIGHS)
(SHUSHING)
(LULLABY MUSIC PLAYING)
Okay, please just go
to sleep. You'll feel better.
(BABIES CONTINUE CRYING)
(PHONE CONTINUES RINGING)
Hey. Just checking in.
- How are the little fellas doing?
- Oh, um
Good. Yeah, they're-they're
falling asleep now.
Ah, they like those bassinets,
don't they? I knew that
was a good purchase.
Yeah. Loving them.
(CHUCKLES) Um, listen, I got to go.
Diapers need changing.
But thanks for checking in. Okay, bye.
(PHONE BEEPS)
(PAGER BEEPS, BUZZES)
Wait, I don't understand.
He has hardware sticking out of his neck
and did nothing to get it fixed?
He didn't even mention it
when he was awake,
and now that he's intubated,
I can't ask him about it.
It's not just you he didn't tell.
Looks like he stopped showing up
to his follow-up scans
and appointments five years ago.
They left message after message.
He never even called them back.
We've all seen cases like this.
The patient who ignores
their breast cancer
till it starts bleeding
through their skin.
Mm-hmm. I took care of a man
with squamous cell cancer
on his scalp that he hid
under a hat for years.
When I first told Raja he had cancer,
he wanted to do everything
he could to stay positive.
He didn't want to know his odds.
Nothing negative.
And it worked.
His cancer was cured.
KIT: It's complicated.
Sometimes you need a
dose of denial to have hope.
(MACHINE BEEPS)
(SIGHS) This is even worse
than I thought.
See the debris in the ventricles?
Ventriculitis. No wonder he seized.
Bacteria must have tracked
from his skin,
via the rod, to his brain.
You'll need to make sure his antibiotics
- cross the blood-brain barrier.
- KIT: We'll take him to the OR
to remove the rod, or
antibiotics won't be enough.
Damn it, I already see signs
of hydrocephalus.
I'll have to intervene
on that before anything else.
That's what will kill him.
So we get him back to the ICU.
And I'll place an EVD
in his ventricles at the bedside
to help drain the pus
and relieve the brain swelling.
If that's not enough,
then I'll have to take him
to the OR for an open
craniotomy and a washout.
I told Raja I'd get him out of this.
That he'd be okay.
I'll do everything I can.
- (SHALLOW BREATHING)
- Marko, what's going on?
(STAMMERS) Something's not right.
I can't catch my breath.
My body hurts all over. Ooh
- His lungs are clear.
- And his sats are fine.
He's just breathing
40 times a minute. Marko,
- try to take long, slow breaths.
- Okay. (INHALES DEEPLY)
- (EXHALES FORCEFULLY)
- Let's get a blood gas.
(TABLET CHIMES)
Hold on. His labs just came in.
This explains it.
His lactic acid is sky-high.
(MARKO BREATHES HEAVILY)
- Ischemic bowel or a perf?
- DEVON: Unlikely.
His belly exam is soft,
but his blood pressure is stable.
Infection then,
or alcoholic ketoacidosis.
Alcohol?
And degrade my body's ability
to fight off infection?
Ruin my liver? I do not drink alcohol.
Okay, so no alcohol, but
let's get more fluids running.
Pan-culture, start
broad-spectrum antibiotics
- to be safe.
- And a tox screen. It could be
- an ingestion.
- Hmm.
(MARKO GROANS)
- Marko, are you a diabetic?
- (MARKO SCOFFS)
Alcohol, diabetes.
Are you guys insulting me?
Sorry, but are you on the
diabetes medication metformin?
Well, of course, and
you guys should be, too.
That stuff is a miracle drug.
That miracle drug could be
what's making you so sick.
Metformin can cause a dangerous
build-up of lactic acid.
(STAMMERS) You guys can fix it, right?
We should be able to, but
we're gonna have to admit you
to the ICU and start you on dialysis.
Hey. Your shift's over, right?
Any plans for the day?
Once Jessica's done, definitely.
(SIGHS) Till then, waiting for her,
charting, searching
the call room for bedbugs.
Sounds like a blast.
Well, if you get bored,
you're welcome to join me and
our very mortal patient instead.
Interesting. I would,
but I've already promised
Jessica I'd go rock climbing.
All right, see you.
All right, bye.
BILLIE: Won't know how
bad this ventriculitis is
until I'm in there.
I remember the last time
I saw Raja here.
Nic took care of him.
Threw him a birthday party.
I remember her talking about that.
Threading the catheter.
Conrad
I'll have to put another drain
in the left frontal horn.
He is gonna be a lucky man
if he gets out of this
without any major neurologic deficits.
If he just would've told anyone.
Maybe he was afraid it was the
cancer, and he couldn't face it.
It seems crazy.
But we all cover up things
we don't want to see.
The longer we look away,
the harder it gets to see
what's right before our eyes.
What is on your mind?
Uh, I can't say I'm unfamiliar
with denial.
None of us are.
What have you denied?
Fair amount.
First drain is in.
(MONITOR BEEPING RAPIDLY)
Looks like a massive upper GI bleed.
We'll need central access.
We need norepinephrine,
- and call the blood bank!
- Why is this happening?
Ventriculitis shouldn't cause
a GI hemorrhage.
No, it shouldn't.
- Unless
- What are you thinking?
Rod tore through the skin.
The infection ate away
at the bones in his c-spine
and allowed the rod to come loose.
Could cause any amount of damage
to his muscle, vessels
It could've pushed
through his esophagus,
causing him to bleed.
Which could kill him even faster
than any brain infection.
And then he developed a huge GI bleed,
so we did an upper endoscopy
in the ICU. Take a look.
The rod penetrated the man's esophagus?
It did, which explains why
he vomited initially.
The more we unearth, the more
devastating this becomes.
Question is,
can you operate and save him?
(CHUCKLES) You realize what that surgery
would entail, right?
Man, I'd have to open his neck,
reconstruct his esophagus
with a muscle flap from his pec.
That's if I can remove the rod.
As far as the spine
Billie will take that one with Voss.
It's a Hail Mary, man,
but this is what we do,
isn't it? We take on surgeries
that can't be done,
then convince ourselves
we can accomplish
the impossible.
All right, clearly he can't
give consent himself.
Now, you know him, do you think
he would even agree
to a surgery this dangerous?
I thought I knew him,
but I don't know this guy
who put a Band-Aid over a rod
sticking out of his neck.
- Any family on the way?
- Yeah.
Fiancée. I'll talk to her.
All right, if she gives her consent,
then tell Billie to book us an OR.
(BABIES CRYING)
Get that air out, little guy.
You'll feel better.
You have to 'cause I don't
really have a backup plan here.
- Come on.
- (BURPS)
(SIGHS)
Great.
(SIGHS) See? Something's working.
Now you feel
(GASPS)
(SIGHS)
- like crying.
- (BABY CRYING)
- Always crying.
- (PHONE RINGING)
LEELA (OVER PHONE):
Hey, Padma, did you try to call?
Did I?
Baby butt dial. Sorry.
Oh, wait, no, no, since
I have you, how are things?
Aw, I hear the little guys
showing off their lungs.
(SIGHS) Good, good.
Yeah, they are little show-offs,
aren't they?
You know, I was thinking
about you three today
in my wellness yoga.
Sara's not as motivating as you,
but it still feels nice.
Yoga? Nice.
And you know what?
What?
When I was lying in Savasana,
I found myself thinking about your dream
of being a mother, no matter what.
How you didn't let anything stop you.
You wanted it and you made it happen.
(SNIFFLES) All thanks
to you, Leela. I love you.
- Now go save lives.
- (PHONE BEEPS)
Here you go.
Thanks.
- (CHUCKLES) Hi.
- (CHUCKLES)
- Mwah. Hi.
- How was your shift?
The usual.
Fighting the entropy
that is our broken system
- while trying not to get sued.
- Mm.
There was one interesting case,
- and Hundley brought muffins.
- Hmm.
Ready to flee?
I have bad news.
- No. Why?
- I can't.
Nathan called out.
- Oh.
- So I have to stay,
but you should still go
rock climbing without me.
- Yeah.
- Which really is a wise move anyway
since I primarily stay earthbound
and I just watch you,
praying that you don't fall
and shatter every bone in your body.
I never fall. I mean, fall-fall.
Everyone does eventually.
I mean, we're not old,
but we're not young either.
I'm just saying, if you didn't
fall, you wouldn't bounce.
- Ha!
- Just keep in mind
the consequences, okay? And be careful.
Okay. I think I might just stick around.
Really? 'Cause I could be several hours.
There's this case I'm curious about.
Could shed some light on how
to be able to climb rock walls
like a young mountain goat
for years to come.
He told me he wore that bandage to keep
his surgical scar clean.
He wore it the entire time
we were together.
Two years.
You must think I'm so stupid.
No.
Raja's got us all thinking about denial.
Mm-hmm. My own fiancé.
I knew how much he hated
talking about hard things.
I asked him once about his cancer
and whether he still needed
to see doctors regularly,
and he told me no,
he was all better.
What do I know? I believed him.
This isn't your fault.
What matters is what we do next.
Raja can't speak for himself anymore,
and he designated you to make
his medical decisions.
Wow, uh, okay.
- Tell me.
- He's gonna need surgery.
The rod that stabilized his spine
pushed through his esophagus, so
our thoracic surgeon will need to work
with our spine surgeon to remove it.
And if you're successful, he'll be okay?
The surgery's dangerous.
Life-threatening.
And if he lives,
he will not be the same.
There's a chance he might not
be able to eat again or
talk again
or breathe on his own.
And the infection in his brain
might mean that he has trouble
with his thinking
or walking.
I'm so sorry.
Because of a
a-a bandage he-he wouldn't remove?
I'm afraid so.
(CRYING)
He's a brilliant man.
I fell in love with his mind.
I-I'd never met anyone with
a better bookshelf than mine.
But to not eat
or talk
or think
is that living?
Those are all possible consequences,
not guaranteed.
But without the surgery he will die.
Is he awake?
- Can I talk to him?
- No.
He's sedated and intubated.
What can I do to help you
make this decision?
I'd like to see him.
- (MONITORS BEEPING RAPIDLY)
- (GASPING)
Pravesh, your immortal
patient's in trouble.
Get over here.
I need resveratrol.
I have the telomeres of a 50-year-old.
Get him an oxygen mask. He's hypoxic.
And I'll keep him from
pulling out his dialysis line.
- You still here?
- I just can't quit you.
Jessica's in another surgery,
and I want to live forever.
We're just trying
to keep Marko from dying.
His labs came back.
Lactate is coming down.
So, dialysis is clearing the metformin.
But now he can't breathe
and he's febrile. Temp 103.
Which means the metformin toxicity
was actually masking another problem.
And we don't know the extent
of what he was taking.
There could be any number of
drug-drug interactions with this man.
Wait.
The briefcase full of papers
that he keeps talking about.
We have to look through it.
The answer's got to be in there.
Tell me.
Are we headed to the OR?
Abigail's deciding.
She needed a little time.
She's reeling. Raja wore that bandage
for at least two years,
their entire relationship,
and she never looked under it.
I can't imagine being in her position.
Makes me want to ask
everybody everything
even if I'm afraid of the answer.
Me, too.
Please do the surgery.
I know the odds are long, but we'll take
whatever chance.
I think that's the choice
Raja would make.
Just do your best for him, okay?
Of course.
(BABIES CRYING)
DR. PETROSIAN (OVER PHONE):
Ms. Devi? Ms. Devi?
Are you still there?
Wow, I, um,
I forgot I was on hold.
Dr. Petrosian, sorry to bother.
I just I had one question
about the babies.
Of course. Go ahead.
Things were okay at first, but
they won't stop crying, and I mean
all day long.
Something must be wrong.
Babies cry, Padma.
No, but
sometimes I think that
they're gonna pass out
because they're crying so hard
that they're not breathing.
They won't pass out, and if
they do, they'll breathe again.
Just hold them as much as you can.
Lots of skin-to-skin contact.
(BABIES CONTINUE CRYING)
There's two of them.
I can't
I can't hold them both
all day long when they scream.
This is hard, do you understand?
I do. Moms worry, that's normal.
- And crying for babies is also normal.
- (SNIFFLES)
Are you sure I shouldn't
just bring them in for a little while?
No need. Now, do you
want me to transfer you
to our receptionist, confirm
your next appointment?
(BABIES CONTINUE CRYING)
(WATER RUNNING)
Hey.
Getting into anything good?
Uh, an esophageal reconstruction.
It's interesting, complex,
but not good, not by any stretch
of the imagination.
You?
Just a lap chole.
Wish I could stay and watch.
- (WATER TURNS OFF)
- Hey, Devi.
Listen, uh, you talked to your sister?
- Why? What's wrong?
- Nothing.
I was gonna drop by this afternoon
to see if she needed any help, but
I got this case, and I won't be
- done till late.
- I was gonna surprise her after lunch,
but (SIGHS)
I don't want her to think
I don't trust her, you know?
Yeah. I mean, she's got to learn
to fly solo at some point, right?
She wanted this. She chose it.
But did she understand
what she was choosing?
- You're worried?
- Maybe.
A little, but hopeful.
Look, I talked to her,
and she was upbeat,
- on top of it.
- You sure?
Yes.
Great. You know her better than anyone.
(SIGHS) All right.
See you.
Send off another blood gas, okay?
Mm-hmm.
Has he gotten all the
antibiotics we ordered?
The cefepime is going in.
The vanco just finished.
Any other ideas?
Not yet.
Marko's sats are worsening.
Chest images show diffuse ground glass.
- I want to bronch him, but
- He'd have to get intubated.
Please tell me you found
a potential culprit med.
But first, tell me, why
did you stick around?
I'm afraid of death.
You?
Seriously?
You see it all the time.
Every day, somebody dies in our ER.
And when it happens, I walk away.
Another team comes in, cleans
the body, zips up the bag.
One moment, a person is there,
and the next, there's just
dead flesh.
Empty eyes. Heavy limbs.
Absence.
When I almost lost Jessica,
that's when it got personal.
I realized it will happen to us.
Could happen at any time.
And it scares the hell out of me.
Dying.
Jessica dying.
My parents or our family cat dying.
It's inevitable.
Irrational, but there it is.
So, you don't think this guy is nuts?
Oh, obviously.
He's discounted the fact
that a piano could fall on his head.
Accidents can happen, even if you stop
- the ticking clock.
- But stopping the clock
- Slowing it down
- is appealing, I get it.
And reading these papers,
I've learned a few things.
Who knew Dairy Queen
could help you live forever?
- Hmm?
- Okay, now you lost me.
DQ.
It's all over the notes
for his protocols.
DQ isn't Dairy Queen.
It's a combination of two meds
that help your body
get rid of old cells.
I want to get rid of
my old cells. What's in it?
Well
It looks like the Q is quercetin,
another antioxidant found in plants.
All right, cross that
one off, and the D?
Dasatinib, that's chemo.
Marko's been taking chemo? He is nuts.
But wait, if he's taking dasatinib,
then he has a compromised immune system.
And we have a whole new differential.
Marko.
- Hey, Marko.
- (GROANS)
Do you take the chemo drug dasatinib?
Yeah, yeah, I take it every day.
Great vessels mobilized.
Spinal rod visualized.
Damage is extensive.
Manipulation could cause injury
to the spinal cord.
That's why you two are here, Kit.
Hold retraction steady.
I'll begin working on the hardware.
(DOOR OPENS)
It was finally quiet in the unit.
I wanted to see how you
were doing with all of this.
Raja was my biggest win of intern year.
We saved his life. Now
he'll never be the same again,
if he even gets out of this OR.
And it was all avoidable.
I can't pretend to know
what was going on in his head,
but I can imagine.
Tell me.
The cancer was a trauma.
He wanted to leave it behind,
believe he was all better.
Couldn't tolerate knowing if he wasn't.
Okay, yeah, but
look at the consequences.
I looked away many times with my dad.
For years, there were signs
that something was wrong,
that he was altered,
but I'd excuse it.
I'd say it was pressure
or stress or fatigue.
But then, I realized,
the next time I looked away,
he could OD and die.
So, you started
watching him like a hawk.
Yeah.
But this last time, I was wrong.
He wasn't using,
the drug test proved it.
And I (SIGHS) I overreacted.
It happens to everyone
who loves an addict.
Nic had the same issue
with her sister, her father.
She spent her whole life
trying to save them.
In Al-Anon, they say let go.
Let them take the consequences.
Mm-hmm.
But, sometimes, those
consequences are death.
How can a family
not try to prevent that?
I think that whatever happens with Ian,
it is out of your control.
He's a grown man.
Maybe the same thing is true with Raja.
Once he left the hospital,
it was out of your control.
You did everything you could, Conrad.
Thank you.
(MONITORS BEEPING RAPIDLY)
CHU: BP's spiking. Heart rate's slowing.
AUSTIN: He could be herniating.
Check his pupils.
Pupils unequal.
The EVD. Nothing's coming out.
- Must be an obstruction.
- The ventriculitis.
The pus must've clotted off the drain.
- I'll have to relieve the pressure.
- Tell me what you need.
Craniotome to me.
(MONITORS BEEPING RAPIDLY)
He's going into V-fib.
I feel a pulse, but it's thready.
- (MONITOR ALARMS BEEPING)
- He's coding.
Almost done.
- I'll start compressions.
- Get the pads on him.
Clear!
Well, I was taking chemo,
but in-in such low doses
to clear dead cells,
you know, to extend my life,
not to threaten it. (CHUCKLES)
- It was a perfect storm.
- DEVON: Your strict diet
and exercise left you dehydrated,
which allowed
for the metformin to build up
- in your bloodstream.
- That damaged your kidneys
and caused the lactic
acidosis, and that's
what made you so short of breath
when doing push-ups.
And once your kidneys were injured,
they couldn't metabolize
the chemo fast enough,
so it accumulated, and you
couldn't fight infection.
Which is how you got this pneumonia.
(SIGHS) But-but I'll be okay, right?
It'll take some time, but with
a full course of treatment,
you should be okay.
But you should know, Marko, that
this could've easily killed you.
(SIGHS) Well
I guess we know what this means, right?
No one lives forever.
(SCOFFS) No.
No, I meant that I should not
be doing this by myself.
I totally messed this up.
I should be doing this
under a doctor's supervision,
- and now I have two.
- Yes, but
No, no, no, no. You guys
looked at the science, right?
You saw my protocols, the regimen,
you looked at the underlying data,
you had to, in order to see what I took
- to see what happened to me, right?
- We did, but.
So, please, Doc, help me
study how to slow down aging.
A clinical trial.
I will completely fund it.
I would have to think
about that some more.
MARKO: I understand.
What if anti-aging
wasn't the only research
I was willing to fund?
I mean, you must have other
studies that need money, right?
Doc, I
I don't want to just live forever.
I want my life to have meaning.
- Me, too.
- IRVING: Eh.
I just want to live forever.
(CHUCKLES)
- (GASPS) Hey, you.
- Hey, you.
I thought you would've gone home by now.
Yeah, I would've thought so,
too, but there was this case
I have to tell you about it.
I actually wanted to stay
and help solve it.
I've never heard you say that before.
I know. I even followed
him up to the ICU
and saved his life,
if I do say so myself.
He might even remember my name.
It's possible.
Well, how serious is this?
Are you considering becoming
some kind of internist?
Earlier today, I wondered (SIGHS)
but I like my life as it is.
- I just want more of it.
- (CHUCKLES)
How about another
hundred years with you?
Okay, that sounds great.
(CHUCKLES)
I'll explain it all on the drive home.
Ooh, stop for some DQ
- on the way?
- Mm-hmm. Sure.
I have a craving.
(CHUCKLES)
(DOOR OPENS)
I'm so sorry.
I'll never get used to this.
That's one of the many ways
that you are special.
Dr. Voss.
You look awfully happy.
Get this, my patient from today
may be writing us a check
with a whole lot
of zeroes to fund some new research.
I like the sound of that.
What's the story?
His name is Marko Zytylny, and
he first came to me with a pitch
about longevity
and anti-aging science
Oh, Devon, please don't go
selling our reputation
to some zillionaire with
delusions of immortality.
I'm not, and it-it's not all
snake oil and chemical peels.
Besides, if we didn't
explore the fringes,
we never would've
discovered antibiotics,
evolution, or handwashing.
Anyway, Marko is willing
to fund more than one area
of our research. Dr. Voss, we're talking
cancer, MS,
we name it.
Well, now that does sound interesting.
What do we have to do to make this real?
(JAZZ PLAYING)
(PAN CLATTERS)
Hello, beautiful.
(LAUGHS) I didn't think
you were coming home
- until tomorrow.
- Well, it was either
one flight tomorrow
or two flights today.
I just couldn't wait to see you.
Wow.
That smells good.
(BOTH LAUGH)
You look great.
Well, I feel great. There's no pain.
No flare-ups. It's just like
I'm a new man.
And so ready to get back to you
- and my OR. Okay, so
- (CHUCKLES)
just tell me every
little thing I missed.
Oh, Devon and I are hot on the trail
of a major research grant.
You are such a rock star.
It's good news, but it
doesn't solve the fact
that the governor's cutting our funding.
Well, it's lucky I'm in fighting shape.
You do look healthy.
You'd tell me
if you weren't, right? If
if there's something I should ask?
Not at all. I'm good.
I-I really am.
Where is this coming from?
Rough case.
I know what will make me smile.
Showing you photos
of the exquisite venue
I booked for us, where,
in a few short weeks,
I will marry the man of my dreams.
Can I get an invitation?
(LAUGHS)
I am so unbelievably happy you're home.
(BOTH LAUGH)
So, I was thinking we should try
that new Brazilian restaurant.
Sure.
Hey, are you sure you're
okay not having kids?
- Um, what?
- Look at this.
They're little miracles.
How can I deny you that?
Are we seriously doing this right now?
I just don't want you to resent me.
Well, are you changing your mind?
No.
I don't know.
- (SCOFFS)
- (CAR ALARM CHIRPS)
I always thought I'd be a father,
but helping out for two weeks
with those newborns
and Padma while she recovered?
It wasn't all roses.
I mean, it was sort of a reality check.
I mean, it's nice, you know,
being the auntie and uncle.
Those babies are cute and all,
but you know what else is so cute?
Hmm?
The patio at that Brazilian
restaurant. (LAUGHS)
Come on.
(KNOCKS ON DOOR)
Hey.
♪
♪
(CRYING)
Previously on The Resident
MS is such a bastard.
You think you're on a plateau,
and then it just crumbles.
Things are developing all the time, Kit.
But it's always there,
hanging over our heads.
This hospital-wide drug test.
- Did you name my father?
- Of course not.
Would Nic approve of me with Cade?
I just want you to be happy,
so would Nic.
IAN: The twins look perfect.
Healthy weight, strong heartbeat.
I'd say this family can
go home this afternoon.
Ah, you hear that, Padma? We're finally
breaking you guys out of here.
That is music to my ears.
CT is backed up. I'll call over.
One cranberry juice coming up. (SIGHS)
And your discharge papers.
Looks like we can send you home
with a prednisone burst.
(SIGHS) No rest for the weary.
No rest, little reward, and yet
I keep coming back for more.
(SIREN WAILS)
HUNDLEY: What do you have for us?
Raja El Khoury. 38-year-old male,
episode of emesis. Students called EMS.
Sats were low, tachy to 120s.
Let's get him to Bay Eight.
He's improving with oxygen
but still kind of out of it.
What are you doing?
Raja, is it?
Okay, you're in the ER at Chastain.
I'm Dr. Feldman, this is Nurse Hundley.
- We're gonna take care of you.
- I don't care who you are.
I want out of here.
- Just let me get up!
- IRVING: Okay.
Let's get him on a monitor
and a 12-lead EKG.
- HUNDLEY: I'm on it.
- None of the rest of you
touch me. He's the only doctor I'll see.
Seriously? Who are you talking about?
Dr. Hawkins.
(RAJA PANTING)
He saved my life.
(DOOR OPENS)
How old do you think I am?
- Wager a guess.
- I'm sorry,
are you my 8:00 a.m. meeting about
- a research possibility ?
- Sorry, yes.
I'm Marko Zytylny. So, come on,
how old?
All right, all right, all right.
No need to guess.
See this?
My genetic age,
according to this, is 50.
But my real age, in real life,
Yup.
That's impressive, Mr. Zytylny.
No, please, call me Marko.
Since I was a child,
I believed that aging,
infirmity, and death were inevitable,
but that's a fallacy.
Hmm. You see, here at Chastain,
you guys are playing a very expensive
game of Whac-A-Mole.
The patients come to you with,
uh, heart disease in their 50s.
Whack. In their 70s, with cancer. Whack.
In their 80s, with Alzheimer's
Try to whack it, you can't. They die.
But not
if you fix aging.
You get rid of all of that.
- You see, that's my dream.
- Okay.
I am intrigued,
- but how can I help you?
- Dr. Pravesh, I-I've
read your work,
and you think outside the box.
I really believe
What is the scientific question
that you want me to answer?
Isn't that obvious?
How to live forever.
♪
AUSTIN: And I want to thank you
for only doing pee-pee
- while Daddy changes you.
- (CHUCKLES)
(WATCH BEEPS)
Hey, Padma, I got to get going, okay?
(BABY CRYING)
He's probably tired
or hungry
or gassy or he pooped again.
Or maybe he just needs
a little of this.
Twinkle, twinkle ♪
(BEATBOXES)
Twinkle, twinkle. ♪
(BEATBOXES, CHUCKLES)
All right, now, you be a good
little boy for your mama, all right?
And, Padma, if all else fails, remember
you have these womb-inspired
sounds and motions
to remind them of the good old days.
Paddie, I'm gonna get going, all right?
But you haven't had any coffee yet.
Do you want to wait ten minutes?
I'm sorry, I wish I could, but I can't.
Look, I'll try to swing by
between surgeries, okay?
- It's okay. I got this.
- Yes, you do.
Look, you are an amazing mom already.
Just remember, Padma,
if you need anything
I know. I'll call. Okay.
Goodbye ♪
All right.
Good ♪
- (DOOR SLAMS)
- (BABIES CRYING)
RAJA: If I go in the next
couple of minutes,
I might be able to finish my lecture.
I have spent way too much
of my life in this place
with doctors drawing my blood.
- No offense.
- (LAUGHS)
None taken.
I took care of Raja when he was
diagnosed with bone cancer.
Diagnosis you made.
All the other doctors said
- shin splints.
- (LAUGHS)
You were sweating bullets
when you told me.
I was an intern.
I never told someone
they had advanced cancer.
Oh, that takes me back to a time
I never want to revisit.
Managed to stay away from
this building for the last
eight years, till today.
So, what happened?
Well, I was giving my favorite lecture
on Who's Afraid of Virginia Woolf?
when I threw up.
Then I couldn't catch my breath.
My students called 911.
It's good they did.
It actually looks like
you have a bad pneumonia.
You might have aspirated from the vomit,
or you could have a virus
that explains both symptoms.
So, that's all that's wrong?
- As far as we can tell right now.
- So,
maybe I wait here a few more hours
and, uh, I call my fiancée,
- and she takes me home.
- Whoa, hold your horses.
We need to get you on IV antibiotics,
keep you on oxygen,
and get you to the ICU.
Home will have to wait.
Just get me better.
You did it once,
you do it again, okay?
That's the plan.
You know, that's the one
drawback of being an ER doc.
- There's just one?
- One of many. No one
credits me with saving
their life, though I do
all the time, but I send them off,
and they fawn over their internists
who take care of them upstairs.
Do I detect some envy, Dr. Feldman?
It's just frustrating.
Yeah, they get to know you.
You see them day after day.
Why not add another specialty?
Irving Feldman,
- Doctor of Medicine.
- (LAUGHS)
No, thank you. I did my internship.
I remember those interminable rounds,
discussing hyponatremia.
Hey, you don't know what you're missing.
You might actually like
hanging out with the patients.
Can't a man complain
around here without you
always trying to offer
a solution, Hawkins?
When my shift ends in two hours,
I am out
of here. Done.
Gone. Buh-bye.
Buh-bye.
And after my daily push-ups,
I do a quick five-minute
liquid nitrogen bath.
You ever had one?
- Uh, I can't say that I have.
- I highly recommend it.
Soothes the muscles,
reduces inflammation,
lifts the mood.
(PANTING): Damn,
I think I've lost count.
Remarkably, you're at 90.
And my protocols work, Dr. Pravesh.
Just help me study my tests,
then we could all maybe
live forever. 99 100.
(WHOOPS, SIGHS)
(SPECTATORS CHEER AND APPLAUD)
I'm telling you
that death is a scientific problem
we can solve together.
Trust me.
This about does it for our tour
of the hospital today.
I am afraid I'm gonna have to
wrap it up. I have a full day, so
- On one condition.
- What's that?
We round this out
with one set of stairs.
- (LAUGHS)
- Mr. Zytylny
Let's go! Whoo!
(GRUNTING)
- What's going on?
- I don't know.
- I can't, I can't breathe.
- Whoa, whoa, whoa, whoa.
Can I get some help over here?
Reading something good?
Uh, just an email
Ian forwarded me
from a mom thanking him
for saving her baby.
Modest as always.
- Sounds like the Ian we know.
- Hmm.
How is everything with him, in general?
Passed his drug test.
Operating up a storm, so
fine, I guess.
That's a relief.
So is the fact that
I am finally off nights.
As much as I love
my solo dinners with Gigi
You have room for one more tonight?
- Always.
- (CURTAIN PULLS BACK)
Dr. Hawkins, we need you
in Raja's room now.
(MONITORS BEEPING RAPIDLY)
Raja, you're okay. You're
safe. What's going on?
(STRAINED): Good, better, best, bested.
NURSE: He was answering my questions,
and then he stopped making sense.
We need to get his fever down.
One gram of acetaminophen.
Grab a liter of Lactated Ringer's.
Sats are dropping.
I'm going up on his O2.
RAJA: (GRUNTS) Dance like the wind.
- This is more than just pneumonia.
- He's too altered.
- I'm worried about meningitis.
- (SCREAMING)
- It hurts! Stop!
- Photophobia.
Let's check for nuchal rigidity.
We're just gonna move
your head a little bit.
(GROANS) Get off me!
- CADE: His neck is stiff.
- Raja, what's this?
No, bandage. Don't-don't touch it.
- Is that
- Looks like spinal hardware.
From the surgery for spinal mets.
- But you said his cancer was
- Eight years ago.
Raja, that rod sticking out
of your neck
how long has that been there?
Yeah, I need two milligrams
of IV lorazepam and get me
an intubation kit now.
Tell CT to get ready.
Coming in for a head scan.
You know, I'm still game
to go back to your office.
This is no place to discuss
data. It's pretty loud,
and, well, it's full of sick people.
We're not talking data now.
You nearly passed out, so Dr. Feldman
and I are gonna find out why.
I'm sure Dr. Feldman
has a lot better things to do.
Marko, you said you wanted me
to study you, right?
- Let me study you.
- IRVING: Looks like your EKG is normal.
We're waiting on some lab results,
and we'll see what they tell us.
- Okay.
- All right. Back in a sec.
Thank you.
No way that man is 70.
He has an anti-aging regimen
he thinks is the path to eternal life.
So, what's his secret?
Well
- knock yourself out.
- Whoa.
You know, it's being studied
all over Silicon Valley.
Every tech entrepreneur
wants to figure out
how to live forever,
and I cannot blame them.
I think he collapsed on our stairway
while claiming to have
the answer to eternal life.
He needs to face the truth.
We all age. We all die.
We can't stop it.
But we can try.
I'll see about those labs. You enjoy.
Yeah, thanks.
- (BABIES CRYING)
- (PADMA SHUSHING)
I would love to hold you both,
but that is physically impossible.
You get that, right, guys?
(PHONE RINGING)
(SIGHS)
(SHUSHING)
(LULLABY MUSIC PLAYING)
Okay, please just go
to sleep. You'll feel better.
(BABIES CONTINUE CRYING)
(PHONE CONTINUES RINGING)
Hey. Just checking in.
- How are the little fellas doing?
- Oh, um
Good. Yeah, they're-they're
falling asleep now.
Ah, they like those bassinets,
don't they? I knew that
was a good purchase.
Yeah. Loving them.
(CHUCKLES) Um, listen, I got to go.
Diapers need changing.
But thanks for checking in. Okay, bye.
(PHONE BEEPS)
(PAGER BEEPS, BUZZES)
Wait, I don't understand.
He has hardware sticking out of his neck
and did nothing to get it fixed?
He didn't even mention it
when he was awake,
and now that he's intubated,
I can't ask him about it.
It's not just you he didn't tell.
Looks like he stopped showing up
to his follow-up scans
and appointments five years ago.
They left message after message.
He never even called them back.
We've all seen cases like this.
The patient who ignores
their breast cancer
till it starts bleeding
through their skin.
Mm-hmm. I took care of a man
with squamous cell cancer
on his scalp that he hid
under a hat for years.
When I first told Raja he had cancer,
he wanted to do everything
he could to stay positive.
He didn't want to know his odds.
Nothing negative.
And it worked.
His cancer was cured.
KIT: It's complicated.
Sometimes you need a
dose of denial to have hope.
(MACHINE BEEPS)
(SIGHS) This is even worse
than I thought.
See the debris in the ventricles?
Ventriculitis. No wonder he seized.
Bacteria must have tracked
from his skin,
via the rod, to his brain.
You'll need to make sure his antibiotics
- cross the blood-brain barrier.
- KIT: We'll take him to the OR
to remove the rod, or
antibiotics won't be enough.
Damn it, I already see signs
of hydrocephalus.
I'll have to intervene
on that before anything else.
That's what will kill him.
So we get him back to the ICU.
And I'll place an EVD
in his ventricles at the bedside
to help drain the pus
and relieve the brain swelling.
If that's not enough,
then I'll have to take him
to the OR for an open
craniotomy and a washout.
I told Raja I'd get him out of this.
That he'd be okay.
I'll do everything I can.
- (SHALLOW BREATHING)
- Marko, what's going on?
(STAMMERS) Something's not right.
I can't catch my breath.
My body hurts all over. Ooh
- His lungs are clear.
- And his sats are fine.
He's just breathing
40 times a minute. Marko,
- try to take long, slow breaths.
- Okay. (INHALES DEEPLY)
- (EXHALES FORCEFULLY)
- Let's get a blood gas.
(TABLET CHIMES)
Hold on. His labs just came in.
This explains it.
His lactic acid is sky-high.
(MARKO BREATHES HEAVILY)
- Ischemic bowel or a perf?
- DEVON: Unlikely.
His belly exam is soft,
but his blood pressure is stable.
Infection then,
or alcoholic ketoacidosis.
Alcohol?
And degrade my body's ability
to fight off infection?
Ruin my liver? I do not drink alcohol.
Okay, so no alcohol, but
let's get more fluids running.
Pan-culture, start
broad-spectrum antibiotics
- to be safe.
- And a tox screen. It could be
- an ingestion.
- Hmm.
(MARKO GROANS)
- Marko, are you a diabetic?
- (MARKO SCOFFS)
Alcohol, diabetes.
Are you guys insulting me?
Sorry, but are you on the
diabetes medication metformin?
Well, of course, and
you guys should be, too.
That stuff is a miracle drug.
That miracle drug could be
what's making you so sick.
Metformin can cause a dangerous
build-up of lactic acid.
(STAMMERS) You guys can fix it, right?
We should be able to, but
we're gonna have to admit you
to the ICU and start you on dialysis.
Hey. Your shift's over, right?
Any plans for the day?
Once Jessica's done, definitely.
(SIGHS) Till then, waiting for her,
charting, searching
the call room for bedbugs.
Sounds like a blast.
Well, if you get bored,
you're welcome to join me and
our very mortal patient instead.
Interesting. I would,
but I've already promised
Jessica I'd go rock climbing.
All right, see you.
All right, bye.
BILLIE: Won't know how
bad this ventriculitis is
until I'm in there.
I remember the last time
I saw Raja here.
Nic took care of him.
Threw him a birthday party.
I remember her talking about that.
Threading the catheter.
Conrad
I'll have to put another drain
in the left frontal horn.
He is gonna be a lucky man
if he gets out of this
without any major neurologic deficits.
If he just would've told anyone.
Maybe he was afraid it was the
cancer, and he couldn't face it.
It seems crazy.
But we all cover up things
we don't want to see.
The longer we look away,
the harder it gets to see
what's right before our eyes.
What is on your mind?
Uh, I can't say I'm unfamiliar
with denial.
None of us are.
What have you denied?
Fair amount.
First drain is in.
(MONITOR BEEPING RAPIDLY)
Looks like a massive upper GI bleed.
We'll need central access.
We need norepinephrine,
- and call the blood bank!
- Why is this happening?
Ventriculitis shouldn't cause
a GI hemorrhage.
No, it shouldn't.
- Unless
- What are you thinking?
Rod tore through the skin.
The infection ate away
at the bones in his c-spine
and allowed the rod to come loose.
Could cause any amount of damage
to his muscle, vessels
It could've pushed
through his esophagus,
causing him to bleed.
Which could kill him even faster
than any brain infection.
And then he developed a huge GI bleed,
so we did an upper endoscopy
in the ICU. Take a look.
The rod penetrated the man's esophagus?
It did, which explains why
he vomited initially.
The more we unearth, the more
devastating this becomes.
Question is,
can you operate and save him?
(CHUCKLES) You realize what that surgery
would entail, right?
Man, I'd have to open his neck,
reconstruct his esophagus
with a muscle flap from his pec.
That's if I can remove the rod.
As far as the spine
Billie will take that one with Voss.
It's a Hail Mary, man,
but this is what we do,
isn't it? We take on surgeries
that can't be done,
then convince ourselves
we can accomplish
the impossible.
All right, clearly he can't
give consent himself.
Now, you know him, do you think
he would even agree
to a surgery this dangerous?
I thought I knew him,
but I don't know this guy
who put a Band-Aid over a rod
sticking out of his neck.
- Any family on the way?
- Yeah.
Fiancée. I'll talk to her.
All right, if she gives her consent,
then tell Billie to book us an OR.
(BABIES CRYING)
Get that air out, little guy.
You'll feel better.
You have to 'cause I don't
really have a backup plan here.
- Come on.
- (BURPS)
(SIGHS)
Great.
(SIGHS) See? Something's working.
Now you feel
(GASPS)
(SIGHS)
- like crying.
- (BABY CRYING)
- Always crying.
- (PHONE RINGING)
LEELA (OVER PHONE):
Hey, Padma, did you try to call?
Did I?
Baby butt dial. Sorry.
Oh, wait, no, no, since
I have you, how are things?
Aw, I hear the little guys
showing off their lungs.
(SIGHS) Good, good.
Yeah, they are little show-offs,
aren't they?
You know, I was thinking
about you three today
in my wellness yoga.
Sara's not as motivating as you,
but it still feels nice.
Yoga? Nice.
And you know what?
What?
When I was lying in Savasana,
I found myself thinking about your dream
of being a mother, no matter what.
How you didn't let anything stop you.
You wanted it and you made it happen.
(SNIFFLES) All thanks
to you, Leela. I love you.
- Now go save lives.
- (PHONE BEEPS)
Here you go.
Thanks.
- (CHUCKLES) Hi.
- (CHUCKLES)
- Mwah. Hi.
- How was your shift?
The usual.
Fighting the entropy
that is our broken system
- while trying not to get sued.
- Mm.
There was one interesting case,
- and Hundley brought muffins.
- Hmm.
Ready to flee?
I have bad news.
- No. Why?
- I can't.
Nathan called out.
- Oh.
- So I have to stay,
but you should still go
rock climbing without me.
- Yeah.
- Which really is a wise move anyway
since I primarily stay earthbound
and I just watch you,
praying that you don't fall
and shatter every bone in your body.
I never fall. I mean, fall-fall.
Everyone does eventually.
I mean, we're not old,
but we're not young either.
I'm just saying, if you didn't
fall, you wouldn't bounce.
- Ha!
- Just keep in mind
the consequences, okay? And be careful.
Okay. I think I might just stick around.
Really? 'Cause I could be several hours.
There's this case I'm curious about.
Could shed some light on how
to be able to climb rock walls
like a young mountain goat
for years to come.
He told me he wore that bandage to keep
his surgical scar clean.
He wore it the entire time
we were together.
Two years.
You must think I'm so stupid.
No.
Raja's got us all thinking about denial.
Mm-hmm. My own fiancé.
I knew how much he hated
talking about hard things.
I asked him once about his cancer
and whether he still needed
to see doctors regularly,
and he told me no,
he was all better.
What do I know? I believed him.
This isn't your fault.
What matters is what we do next.
Raja can't speak for himself anymore,
and he designated you to make
his medical decisions.
Wow, uh, okay.
- Tell me.
- He's gonna need surgery.
The rod that stabilized his spine
pushed through his esophagus, so
our thoracic surgeon will need to work
with our spine surgeon to remove it.
And if you're successful, he'll be okay?
The surgery's dangerous.
Life-threatening.
And if he lives,
he will not be the same.
There's a chance he might not
be able to eat again or
talk again
or breathe on his own.
And the infection in his brain
might mean that he has trouble
with his thinking
or walking.
I'm so sorry.
Because of a
a-a bandage he-he wouldn't remove?
I'm afraid so.
(CRYING)
He's a brilliant man.
I fell in love with his mind.
I-I'd never met anyone with
a better bookshelf than mine.
But to not eat
or talk
or think
is that living?
Those are all possible consequences,
not guaranteed.
But without the surgery he will die.
Is he awake?
- Can I talk to him?
- No.
He's sedated and intubated.
What can I do to help you
make this decision?
I'd like to see him.
- (MONITORS BEEPING RAPIDLY)
- (GASPING)
Pravesh, your immortal
patient's in trouble.
Get over here.
I need resveratrol.
I have the telomeres of a 50-year-old.
Get him an oxygen mask. He's hypoxic.
And I'll keep him from
pulling out his dialysis line.
- You still here?
- I just can't quit you.
Jessica's in another surgery,
and I want to live forever.
We're just trying
to keep Marko from dying.
His labs came back.
Lactate is coming down.
So, dialysis is clearing the metformin.
But now he can't breathe
and he's febrile. Temp 103.
Which means the metformin toxicity
was actually masking another problem.
And we don't know the extent
of what he was taking.
There could be any number of
drug-drug interactions with this man.
Wait.
The briefcase full of papers
that he keeps talking about.
We have to look through it.
The answer's got to be in there.
Tell me.
Are we headed to the OR?
Abigail's deciding.
She needed a little time.
She's reeling. Raja wore that bandage
for at least two years,
their entire relationship,
and she never looked under it.
I can't imagine being in her position.
Makes me want to ask
everybody everything
even if I'm afraid of the answer.
Me, too.
Please do the surgery.
I know the odds are long, but we'll take
whatever chance.
I think that's the choice
Raja would make.
Just do your best for him, okay?
Of course.
(BABIES CRYING)
DR. PETROSIAN (OVER PHONE):
Ms. Devi? Ms. Devi?
Are you still there?
Wow, I, um,
I forgot I was on hold.
Dr. Petrosian, sorry to bother.
I just I had one question
about the babies.
Of course. Go ahead.
Things were okay at first, but
they won't stop crying, and I mean
all day long.
Something must be wrong.
Babies cry, Padma.
No, but
sometimes I think that
they're gonna pass out
because they're crying so hard
that they're not breathing.
They won't pass out, and if
they do, they'll breathe again.
Just hold them as much as you can.
Lots of skin-to-skin contact.
(BABIES CONTINUE CRYING)
There's two of them.
I can't
I can't hold them both
all day long when they scream.
This is hard, do you understand?
I do. Moms worry, that's normal.
- And crying for babies is also normal.
- (SNIFFLES)
Are you sure I shouldn't
just bring them in for a little while?
No need. Now, do you
want me to transfer you
to our receptionist, confirm
your next appointment?
(BABIES CONTINUE CRYING)
(WATER RUNNING)
Hey.
Getting into anything good?
Uh, an esophageal reconstruction.
It's interesting, complex,
but not good, not by any stretch
of the imagination.
You?
Just a lap chole.
Wish I could stay and watch.
- (WATER TURNS OFF)
- Hey, Devi.
Listen, uh, you talked to your sister?
- Why? What's wrong?
- Nothing.
I was gonna drop by this afternoon
to see if she needed any help, but
I got this case, and I won't be
- done till late.
- I was gonna surprise her after lunch,
but (SIGHS)
I don't want her to think
I don't trust her, you know?
Yeah. I mean, she's got to learn
to fly solo at some point, right?
She wanted this. She chose it.
But did she understand
what she was choosing?
- You're worried?
- Maybe.
A little, but hopeful.
Look, I talked to her,
and she was upbeat,
- on top of it.
- You sure?
Yes.
Great. You know her better than anyone.
(SIGHS) All right.
See you.
Send off another blood gas, okay?
Mm-hmm.
Has he gotten all the
antibiotics we ordered?
The cefepime is going in.
The vanco just finished.
Any other ideas?
Not yet.
Marko's sats are worsening.
Chest images show diffuse ground glass.
- I want to bronch him, but
- He'd have to get intubated.
Please tell me you found
a potential culprit med.
But first, tell me, why
did you stick around?
I'm afraid of death.
You?
Seriously?
You see it all the time.
Every day, somebody dies in our ER.
And when it happens, I walk away.
Another team comes in, cleans
the body, zips up the bag.
One moment, a person is there,
and the next, there's just
dead flesh.
Empty eyes. Heavy limbs.
Absence.
When I almost lost Jessica,
that's when it got personal.
I realized it will happen to us.
Could happen at any time.
And it scares the hell out of me.
Dying.
Jessica dying.
My parents or our family cat dying.
It's inevitable.
Irrational, but there it is.
So, you don't think this guy is nuts?
Oh, obviously.
He's discounted the fact
that a piano could fall on his head.
Accidents can happen, even if you stop
- the ticking clock.
- But stopping the clock
- Slowing it down
- is appealing, I get it.
And reading these papers,
I've learned a few things.
Who knew Dairy Queen
could help you live forever?
- Hmm?
- Okay, now you lost me.
DQ.
It's all over the notes
for his protocols.
DQ isn't Dairy Queen.
It's a combination of two meds
that help your body
get rid of old cells.
I want to get rid of
my old cells. What's in it?
Well
It looks like the Q is quercetin,
another antioxidant found in plants.
All right, cross that
one off, and the D?
Dasatinib, that's chemo.
Marko's been taking chemo? He is nuts.
But wait, if he's taking dasatinib,
then he has a compromised immune system.
And we have a whole new differential.
Marko.
- Hey, Marko.
- (GROANS)
Do you take the chemo drug dasatinib?
Yeah, yeah, I take it every day.
Great vessels mobilized.
Spinal rod visualized.
Damage is extensive.
Manipulation could cause injury
to the spinal cord.
That's why you two are here, Kit.
Hold retraction steady.
I'll begin working on the hardware.
(DOOR OPENS)
It was finally quiet in the unit.
I wanted to see how you
were doing with all of this.
Raja was my biggest win of intern year.
We saved his life. Now
he'll never be the same again,
if he even gets out of this OR.
And it was all avoidable.
I can't pretend to know
what was going on in his head,
but I can imagine.
Tell me.
The cancer was a trauma.
He wanted to leave it behind,
believe he was all better.
Couldn't tolerate knowing if he wasn't.
Okay, yeah, but
look at the consequences.
I looked away many times with my dad.
For years, there were signs
that something was wrong,
that he was altered,
but I'd excuse it.
I'd say it was pressure
or stress or fatigue.
But then, I realized,
the next time I looked away,
he could OD and die.
So, you started
watching him like a hawk.
Yeah.
But this last time, I was wrong.
He wasn't using,
the drug test proved it.
And I (SIGHS) I overreacted.
It happens to everyone
who loves an addict.
Nic had the same issue
with her sister, her father.
She spent her whole life
trying to save them.
In Al-Anon, they say let go.
Let them take the consequences.
Mm-hmm.
But, sometimes, those
consequences are death.
How can a family
not try to prevent that?
I think that whatever happens with Ian,
it is out of your control.
He's a grown man.
Maybe the same thing is true with Raja.
Once he left the hospital,
it was out of your control.
You did everything you could, Conrad.
Thank you.
(MONITORS BEEPING RAPIDLY)
CHU: BP's spiking. Heart rate's slowing.
AUSTIN: He could be herniating.
Check his pupils.
Pupils unequal.
The EVD. Nothing's coming out.
- Must be an obstruction.
- The ventriculitis.
The pus must've clotted off the drain.
- I'll have to relieve the pressure.
- Tell me what you need.
Craniotome to me.
(MONITORS BEEPING RAPIDLY)
He's going into V-fib.
I feel a pulse, but it's thready.
- (MONITOR ALARMS BEEPING)
- He's coding.
Almost done.
- I'll start compressions.
- Get the pads on him.
Clear!
Well, I was taking chemo,
but in-in such low doses
to clear dead cells,
you know, to extend my life,
not to threaten it. (CHUCKLES)
- It was a perfect storm.
- DEVON: Your strict diet
and exercise left you dehydrated,
which allowed
for the metformin to build up
- in your bloodstream.
- That damaged your kidneys
and caused the lactic
acidosis, and that's
what made you so short of breath
when doing push-ups.
And once your kidneys were injured,
they couldn't metabolize
the chemo fast enough,
so it accumulated, and you
couldn't fight infection.
Which is how you got this pneumonia.
(SIGHS) But-but I'll be okay, right?
It'll take some time, but with
a full course of treatment,
you should be okay.
But you should know, Marko, that
this could've easily killed you.
(SIGHS) Well
I guess we know what this means, right?
No one lives forever.
(SCOFFS) No.
No, I meant that I should not
be doing this by myself.
I totally messed this up.
I should be doing this
under a doctor's supervision,
- and now I have two.
- Yes, but
No, no, no, no. You guys
looked at the science, right?
You saw my protocols, the regimen,
you looked at the underlying data,
you had to, in order to see what I took
- to see what happened to me, right?
- We did, but.
So, please, Doc, help me
study how to slow down aging.
A clinical trial.
I will completely fund it.
I would have to think
about that some more.
MARKO: I understand.
What if anti-aging
wasn't the only research
I was willing to fund?
I mean, you must have other
studies that need money, right?
Doc, I
I don't want to just live forever.
I want my life to have meaning.
- Me, too.
- IRVING: Eh.
I just want to live forever.
(CHUCKLES)
- (GASPS) Hey, you.
- Hey, you.
I thought you would've gone home by now.
Yeah, I would've thought so,
too, but there was this case
I have to tell you about it.
I actually wanted to stay
and help solve it.
I've never heard you say that before.
I know. I even followed
him up to the ICU
and saved his life,
if I do say so myself.
He might even remember my name.
It's possible.
Well, how serious is this?
Are you considering becoming
some kind of internist?
Earlier today, I wondered (SIGHS)
but I like my life as it is.
- I just want more of it.
- (CHUCKLES)
How about another
hundred years with you?
Okay, that sounds great.
(CHUCKLES)
I'll explain it all on the drive home.
Ooh, stop for some DQ
- on the way?
- Mm-hmm. Sure.
I have a craving.
(CHUCKLES)
(DOOR OPENS)
I'm so sorry.
I'll never get used to this.
That's one of the many ways
that you are special.
Dr. Voss.
You look awfully happy.
Get this, my patient from today
may be writing us a check
with a whole lot
of zeroes to fund some new research.
I like the sound of that.
What's the story?
His name is Marko Zytylny, and
he first came to me with a pitch
about longevity
and anti-aging science
Oh, Devon, please don't go
selling our reputation
to some zillionaire with
delusions of immortality.
I'm not, and it-it's not all
snake oil and chemical peels.
Besides, if we didn't
explore the fringes,
we never would've
discovered antibiotics,
evolution, or handwashing.
Anyway, Marko is willing
to fund more than one area
of our research. Dr. Voss, we're talking
cancer, MS,
we name it.
Well, now that does sound interesting.
What do we have to do to make this real?
(JAZZ PLAYING)
(PAN CLATTERS)
Hello, beautiful.
(LAUGHS) I didn't think
you were coming home
- until tomorrow.
- Well, it was either
one flight tomorrow
or two flights today.
I just couldn't wait to see you.
Wow.
That smells good.
(BOTH LAUGH)
You look great.
Well, I feel great. There's no pain.
No flare-ups. It's just like
I'm a new man.
And so ready to get back to you
- and my OR. Okay, so
- (CHUCKLES)
just tell me every
little thing I missed.
Oh, Devon and I are hot on the trail
of a major research grant.
You are such a rock star.
It's good news, but it
doesn't solve the fact
that the governor's cutting our funding.
Well, it's lucky I'm in fighting shape.
You do look healthy.
You'd tell me
if you weren't, right? If
if there's something I should ask?
Not at all. I'm good.
I-I really am.
Where is this coming from?
Rough case.
I know what will make me smile.
Showing you photos
of the exquisite venue
I booked for us, where,
in a few short weeks,
I will marry the man of my dreams.
Can I get an invitation?
(LAUGHS)
I am so unbelievably happy you're home.
(BOTH LAUGH)
So, I was thinking we should try
that new Brazilian restaurant.
Sure.
Hey, are you sure you're
okay not having kids?
- Um, what?
- Look at this.
They're little miracles.
How can I deny you that?
Are we seriously doing this right now?
I just don't want you to resent me.
Well, are you changing your mind?
No.
I don't know.
- (SCOFFS)
- (CAR ALARM CHIRPS)
I always thought I'd be a father,
but helping out for two weeks
with those newborns
and Padma while she recovered?
It wasn't all roses.
I mean, it was sort of a reality check.
I mean, it's nice, you know,
being the auntie and uncle.
Those babies are cute and all,
but you know what else is so cute?
Hmm?
The patio at that Brazilian
restaurant. (LAUGHS)
Come on.
(KNOCKS ON DOOR)
Hey.
♪
♪
(CRYING)