Three Rivers s01e01 Episode Script
Place of Life
Hey, kid! Kid! Kid! Kid! - Kid! - Sir? Your slag's dropping on that hydraulic line.
That catches fire, it could blow the roof off this place.
Am I, like, fired, sir? No, just just keep your eyes open.
Watch the area around you.
- Is this your first job? - Yes, sir.
Served three years in the United States Army prior to my apprenticeship training, sir.
You can stop calling me "sir.
" Mahmoud sounds better.
And I rolled the compressor over the paw of my boss's pit bull my first job.
So, in the big picture, you're doing okay.
I appreciate that.
And I promise I won't do anything to your dog, sir.
I don't have a dog.
- And it's Mahmoud, remember? - Yes, sir.
- Supercilious.
- That's correct, Emily.
Auden Drinkwater.
Antediluvian.
"Antediluvian.
" a-n-t e-d-i-l-u - v-i-a-n.
Antediluvian.
- That's correct Auden, nice job.
Auden? Oh, Auden, honey.
It's okay.
It's just nerves.
I had no idea you could donate part of a liver.
That's wild.
It's called a partial hepatectomy.
It's fairly common.
What do they do with the other part? Of the liver.
Well, it regenerates in six to eight weeks.
- Inside your actual body? - Yeah.
- Morning, boys.
- Morning.
Uh, morning, Dr.
Jordan.
Thank you for the book.
It's fascinating.
I was just talking about it with Dr.
Yablonski.
Oh, yes, he was.
The gift that keeps on giving.
Why didn't you give me a book when I started working here? Because you graduated at the top of your med school, Dr.
Lee.
And you got Nurse Wilson's number on your first day, David.
Not bad for a resident.
See you guys at 11:00.
Today's transplant committee meeting.
Try 10:00.
I knew that.
- Miranda warning.
- What's the problem? Well, she showed up in a good mood, but then she started inputting electronic medical records.
Oh, the bane of our existence.
I hear dropping it from the roof works.
Yeah, I love our paperless future.
- Did Lisa find you? - E.
R.
Lisa? That'd be her.
She's looking for you.
- Say what she wants? - I didn't ask, Andy.
Okay, remember: Andy, friend.
Computer, enemy.
- Thank you.
- You're welcome.
I should just buy you a helmet and get it over with.
I was painting our baby's nursery.
Or trying to.
My dear husband has a habit of injuring himself whenever he helps around the house.
Well, at least you'll have a great story to tell your new son.
You can tell the sex just by looking at her? I happen to be a natural telepath.
And the blue paint on your face was a small clue.
You, uh, wanted to see me.
Open a 4-0 prolene for me, will you? You called me down from surgery to assist with a scalp lac? No.
Some guy over there won't talk to anybody but you.
He say who he was? - I didn't ask.
- Okay.
I'm Dr.
Yablonski.
Indeed you are.
- Do we know each other? - No, but I know you.
- My name is Kuol.
- Kuol.
Okay.
How can I help you? I have been diagnosed with HCM.
Hypertrophic cardiomyopathy.
I have been given less than six months to live.
Who gave you that diagnosis? My cardiologist in Omaha.
Prior to that, I was treated in a refugee camp in Ethiopia.
So, your Omaha cardiologist referred you to me? No, sir.
I found you on the world wide web.
This is the best transplant hospital in the united states.
And you are the best transplant doctor here.
And that is why I came here.
I need a heart transplant.
Almost done here.
You feeling okay? I'm just a little dizzy, that's all.
Why don't you take a seat.
Put your head between your legs, take some deep breaths.
You'll be okay.
Usually I'm the one with the weak stomach.
I feel hot.
What's going on? Give me the bag.
- Teri? Teri? - Lisa, what happened? She arrested.
Call a code! Code blue E.
R.
Code blue E.
R.
.
proudly presents - Do we have an IV? - Got a good antecubital.
- Get her on the monitor.
- Somebody tell me what's going on! - Your wife's heart stopped.
Is there any history of heart disease? - No.
What about chest pain, shortness of breath? She complains about her feet.
She can't sleep lying down.
- She's in fib.
- Okay, charge to 200.
- Charging.
- 200.
Everybody off.
Clear.
Still in fib.
Prep for intubation, 7.
0 Draw up 150 of amiodarone.
Clear.
Okay, we got a rhythm.
- That's good, right? - It's better.
- Do we have a pulse? - Faint carotid.
Need a doppler for the fetal heart tones, please.
Good bilateral breath sounds.
You're in, Lisa.
- BP 100/50.
sinus tach 125.
- Get me a tocographic monitor.
- And an ob doctor super-stat.
- Fetal heart rate under 100.
- Is that bad? - It should be higher.
Let's get her upstairs.
Let's go! We're going to take her up to the ICU.
She's stabilized now, but we need to make sure your baby's okay.
But they're both going to be okay, right? They're doing much better than they were a minute ago.
Hang in there, okay? Oh, look at Ryan and his on-the-job training.
I'm only educating myself on what geniuses you surgeons are.
What is this, high school? Just trying to see what our new transplant coordinator knows, Pam.
That's Mr.
Assistant to the transplant coordinator to you.
And, uh bring it on.
Okay.
How many patients are currently waiting for an organ transplant? U.
S.
or worldwide? Ooh, he's good.
- U.
S.
- 103000.
And what are their names? Don't you have some lives to save? Right.
I assume you got the doughnuts for the transplant meeting.
- Doughnuts? - Yeah.
Right.
Yes.
No.
Is is, uh, that part of my job? Well, it is now.
You should go to Oram's.
They're in, uh, Beaver Falls.
And you're going to have to leave now if you want to make it back by 10:00.
get me an extra cinnamon roll, because Andy always eats mine before I get there.
Hey, Pam.
Do I really have to go? Never get between a doctor and his doughnut.
The patient's name is Auden Drinkwater, a 13-year-old male.
Acute upper GI bleeding, no previous history.
No real tenderness, rebound or guarding.
Er docs sent him up for a surgical consult.
Does the name Blake Forstin ring a bell? Mmm, no.
Should it? He chairs our annual fund-raising campaign.
He's a friend of this family.
And he called me personally to make sure they're getting the velvet-glove treatment.
So he's one of those.
I trust that means you know how to handle them.
Yeah, so do I.
Hi, Auden.
I'm Dr.
Foster.
It's nice to meet you.
Bob Drinkwater.
Nice to meet you, too.
How you feeling? - Okay.
I guess.
- Yeah? Okay.
Let's see.
Okay, well, listen, I'm going to poke around a little bit.
- And you're going to tell me if it hurts anywhere, okay? - Okay.
Have you ever vomited blood before? - No.
- No.
No bloody stool, no problems going to the bathroom? - I know, it's a very gross question.
- No.
He has had an upset stomach and some diarrhea lately, but we just thought it was from the cafeteria food.
Anything else unusual? Not really.
I guess I've been kinda normal.
Okay.
Well, listen, here is our remote control and we have over a thousand channels to choose from.
So you will be highly entertained.
All right? Can we talk outside? So, what do you think? Well, it could be anything from an ulcer to a congenital abnormality.
13-year-olds get ulcers? From what, stress? I mean, he's been pushing himself like crazy with school.
Stress exacerbates ulcers, but doesn't cause them.
I did feel some scar tissue during my exam.
- Has he had any abdominal surgery in the past? - No.
Why? Well, look, I'm going to order a CT, and we're going to see what we're looking at.
- And until then? - Sit tight.
Enjoy those thousand channels.
We're gonna know more soon.
Is it just me, or do we wait on Andy every day? I'm waiting on Ryan.
I sent him to Oram's.
I thought we banned doughnuts from department meetings for health reasons.
Doughnuts make people happy.
Happy is healthy.
It's a verifiable fact.
Will somebody just go and find Andy? - Right here.
- Thank you.
- We can start.
- Okay.
Patient is a 26-year-old female.
Her name is Tere Dawson.
She's 28 weeks pregnant.
She went into ventricular fibrillation in our er.
We defibrillated, we put her on amiodarone.
Ekg showed non-specific ST segment elevations and anterolateral ischemia.
Sorry.
An echo showed dilated cardiomyopathy and an injection fracture of ten to 15 percent.
Exam confirmed congestive heart failure.
Peripartum cardiomyopathy.
And the man in the blue shirt goes to the bonus round.
Very good.
Okay, so, how are you gonna deal with the pregnancy? Well, so far, there's been no signs of fetal distress, and the baby's at 28 weeks, so he's viable.
But I would recommend putting in a vad to get her to term and support heart function.
What about transplant? She'd be one-a status with UNOS, and we'll list her, but she's o-neg, so there's a low probability of getting her a heart soon enough to help.
Right now, I think the vad's the way to go.
- You need to talk to the patient.
- I'm on my way.
Ooh, Oram's.
These guys make the best cinnamon rolls.
Did you see that? - Andy? - Yeah? I got the paperwork for the kid from Africa you admitted.
- Omaha.
- What? He's from Omaha? You may have heard of it.
It's on the subcontinent of Nebraska.
Wherever he's from, I don't have any insurance information on him.
That's because he doesn't have any.
So what do you want to do about it? Well, you're clever.
You'll think of something.
- That's not an answer.
- I love you.
Sorry I'm late.
Oh, you kidding? You saved her.
And the baby.
You could waltz in here in a tutu, and I'd kiss you.
Hey, Teri.
How are you feeling? Alive.
Thank you.
You're welcome.
Let me explain what happened.
You had a severe heart attack this morning.
We ran some tests, and we've discovered a significant problem.
There's a heart condition which can be brought about by pregnancy, called peripartum cardiomyopathy.
Basically, the body's immune system attacks the heart, which leads to swelling, decreased muscle function, and, ultimately, arrhythmia.
That's why you crashed in the E.
R.
Now, combined with your cardiomyopathy, the crash did significant damage to the muscle.
Bottom line, you're going to need a new heart.
- Seriously? - Yes.
We'll get you listed for a transplant right away, but because of your blood type, it may take a couple of months to find you a heart.
And the heart that you have currently won't last that long.
What do we do? We can put in what's called a vad a ventricular assist device.
It's a little pump that helps your heart do its job.
We'll do the surgery, we'll put it in, and that will stabilize you.
Will the baby be okay? In a perfect world, this will take you to term.
But I'll I'll definitely need a new heart someday? Someday soon.
Um, uh, when do we do the surgery? How about now? Babe? What are we waiting for? Okay.
I'm so sorry about your husband.
You are very kind.
I suppose I will need to make funeral arrangements soon.
Oh, we can help with that.
And another thing to consider at this stage is organ donation.
Did you and your husband ever talk about it? No.
We did not.
But I believe it is something Mahmoud would want.
If I have your consent, I can arrange for the donation tonight.
I would like to wait until my daughter arrives to say good-bye.
She would want to do that.
Oh, yes, of course.
Hey, radiology guy.
Tell me the surprise you couldn't tell me over the phone.
Oh, well, some things are just, uh, better in person.
So, real quick, tell me about this Drinkwater kid.
13-year-old male with acute upper-GI bleeding and no previous history.
- Yes.
Found it.
Ready? - Yeah.
Check out this bad boy.
Are those tweezers? That's what I said.
How is it that you have no ring tones? - You're not breaking that, are you? - No.
But you are aware there's a later model, correct? Can I have your attention for a minute? Of course.
The tests show that you're right.
You're a very sick young man.
When did you first get this diagnosed? When I was six, from a U.
N.
doctor at a refugee camp in Ethiopia.
Then, again in Omaha after I came here on the airlift in 2002.
and what kind of care have you been receiving? The church who brought me to the states arranged for the cardiologist in Omaha to treat me.
But he is no Dr.
Andrew Yablonski.
Allegheny state for undergrad.
Board diplomate in cardiothoracic surgery Okay, I get it.
Uh, I'm very flattered.
I'm very flattered.
Here's the deal.
There are a number of highly-qualified doctors who can give you the treatment you need.
But here is my deal, as you say.
My village burned to the ground when I was six years old.
I lived for a year in the desert, eating whatever I could find to stay alive.
Then, in the refugee camps, I saw hundreds of boys like me die.
I have made it this far because I know how to survive, and that is why I came here.
For you.
Because you can save me.
You're not going to let me back out of this one, are you? No, sir, I am not.
I thought as much.
Okay.
I'm gonna be honest with you.
We're gonna face some hurdles getting you the treatment you need, and I can't make any promises, okay? But I will do my best.
Sounds good.
Okay.
- Doctor? - Yes.
- Your phone.
- Right.
My son eats metal? Well, he certainly swallows it.
Looks like one of the sharp objects here is what caused the bleeding, and we're lucky we caught it before it led to an infection.
So, you're telling me there's something to be happy about here? Well, in that we can retrieve the objects safely through surgery, yeah, but there is a psychological element I think we should discuss.
Like what? Okay, well, um, have you noticed any change in behavior recently? Well, he's been moody and distant lately, but my wife and I thought it was just typical teenage stuff.
Can I ask where your wife is? She's in China on business.
She's a partner at a firm downtown.
How often is she gone? A couple of times a month.
- And how does Auden feel about her being gone so much? - Wait.
Wait.
What kind of questions are these? This is none of your business.
Mr.
Drinkwater, there is clearly an underlying reason why your son is engaging in this sort behavior.
Oh, so, it's his mother's fault that our son is swallowing tweezers? - I didn't say that.
- Then what are you saying, doctor? I'm saying that having a chronically absent parent can make a child engage in certain behavior to get noticed.
Ah, and it's your training in surgery that makes you an expert in my son's psychological condition, right? Okay, I think we should have this conversation at another time.
There won't be another time.
Have you seen Dr.
Yablonski? Uh, try the O.
R.
Sally, will you get that, please? - Yes? - Dr.
Yablonski, it's me, Ryan.
Yes.
Yes, I can see that it's you.
What's up? I think I got an offer on a heart for your patient.
Which patient? I believe it's the one you're about to operate on.
Teri Dawson? - Talk to me.
- I got a call from an OPC in Cleveland.
She just listed a donor 52-year-old male, 180 pounds.
Guy ran five miles every morning.
UNOS says it's ours.
- You confirmed it's o-neg? - Yes.
What did the echo show? Normal ventricular function, normal wall thickness.
- What about the jet? - Pilots are on standby.
Come with me.
- What? Is something wrong? - No.
Everything's fine.
We've been offered a heart for Teri.
- You said it'd take months.
- We got lucky.
It's a quality heart, and we can do the transplant tonight, but Teri will need a C-section first.
Will the baby be all right? At 28 weeks, there can be issues in terms of lung development, but our NICU team has had great success in that area.
Well, to be honest with you, Teri's the shot caller with us.
So I have to wait for her to wake up.
The rules state that we either commit to this heart now or we let the next patient on the list take it.
What would you do? We can do the vad.
We're ready to go.
But weighing the risks of the transplant and the C-section versus the odds of getting Teri a good heart I'd vote for the transplant.
It's the best possible option for your wife's long-term survival.
A new heart and a new baby all in the same day, huh? - I didn't see that coming.
- I understand.
I gotta make this call now? One way or the other.
Let's do it.
Let's go for the heart.
- Good, go now.
- I'm going.
You wanted to see me? - Yes, sit down.
- Okay.
What's up? Our fundraiser called.
He just got off the phone with Auden Drinkwater's father.
Don't worry, I calmed him down.
Well, I don't think I was that far out of line, I'm sorry.
I know what that kid is going through.
I know that house.
You know your house.
You know the house you grew up in.
That's right, I do.
And I know that my father was never there.
And I've done things worse than eating metal to get his attention.
Miranda, I won't attempt to minimize the price your family paid for your father's dedication.
I know all about it.
I was here working with him when he built this hospital.
What I am suggesting is, your sensitivity about an absent parent might limit your ability to diagnose this patient.
Well, I hadn't considered that.
Just something to think about.
- Is that it? - Yeah.
Thank you.
Did he talk about us? All the time.
Thanks.
- Oh, Ada.
- Mommy.
They said he was helping a young man, and he fell.
He was always so careful.
I don't understand it.
And then the doctor sent the woman who works with the organ donations.
She said they will go to six different people in need.
He's still breathing.
They say it's the machine doing that for him.
Did you ask if he was in a coma? - No - Because people wake up from comas all the time.
The doctor said that his brain was no longer functioning.
He said daddy would never come back to us.
And then he sent in a woman for his organs? Yes, but Mom, how do you know they did everything they could to save him? Ada, honey, I believe the doctor.
But you were upset.
- Did they pressure you? - No.
I don't remember everything.
Okay, okay, okay.
What do we do? We get a second opinion.
- And no one touches him until then.
- Okay.
Okay? Okay.
No, those are really good.
Next time we're here we're gonna stop at this place on bridge that makes these killer blue cheeseburgers.
Caramelized onions, gooey roquefort, amazing.
Or there's this place on Lorraine with these chili dogs.
The lady puts cinnamon inside the chili.
What's with you doctors? I'm going to have a heart attack just being near you.
At least you'll be in the right place.
Incoming.
- Are you the guys from Three Rivers? - Yes.
Okay, well, we're on hold.
The daughter just arrived, and the family wants to get more tests done.
You had two doctors sign off on brain death, right? Of course.
But the family has a right to request confirmatory tests.
What are the current PA numbers? Pressure's normal.
Wedge is eight.
We can wait a few hours and still be okay.
Well, guess we got time for that burger, after all.
- Uh, call us when you're ready.
- Okay.
- Let's go.
- Is that the daughter? Uh, yeah.
Miss, excuse me.
Miss, miss, may I talk to you? - I am really sorry for your loss.
- What are you doing? - But there are some facts you may want to know.
- Now is not the time.
- There's a pregnant woman in Pittsburgh waiting for a heart, and she could die.
- Ryan! I'm so sorry.
What are you doing? You are way out of line.
She could die, David.
Yes, she could, but this is not how we do it.
Why, because of some rule? Because it's the right thing to do.
It has to be a gift.
- Here's the chart they requested.
- Thank you doctor.
I want to apologize.
- You don't have to.
- No, I do.
I let my own experiences color our conversation.
I really am sorry.
You know, the, uh, the truth of it is, I knew something like this was going to happen With, uh, Susan being gone so much, and, uh, she and I just fighting over it all the time.
So, when you started poking around, I guess i, I got a little defensive.
Maybe it was denial, or, uh Just hoping it wasn't true, you know? After you told me, I tried to bring it up with him.
The eating metal and everything.
He won't even talk to me.
It's like I don't even exist.
I could talk to him, if it's okay with you.
Please.
Anything you can do to make him better.
Absolutely.
So, you're going to surgery in a couple hours to remove those objects from your stomach.
You know, when I was young, I did all sorts of crazy things to get my parents to notice me.
And it didn't change much, but A lot of things that I did ended up hurting me.
I think you should talk to someone.
'Cause I don't want to see you back here in another six months with the same problem.
Okay? Okay.
I lied.
About throwing up blood.
It's happened before.
It's not what you think.
It's not about my mom or school or anything like that.
Okay.
It's like some itch.
It makes me do it.
- An itch where? - In my brain.
Yeah, hi, I need some additional blood work done on a patient, please.
Name is Auden Drinkwater.
You read the file on my new patient from the Sudan, right? I did, I also read that he is a non-citizen and has no insurance.
Oh, I kind of hoped you'd skip that part.
You brought patients here from South Africa, right? - I did.
- How did you find the money for their treatment? With great effort and trust me, in this economy, those funding sources are bone dry.
He needs a transplant.
I'd really love it if you could tap into that special gift you have of finding money for patients who really need it.
Times are really tough.
I know, but this kid, he's fought tooth and nail to survive this long.
I don't want to be the one who stops him now.
Is that T-pain in your pocket, or are you just happy to see me? Someone's been messing with my ringtone.
Yablonski.
Hey, it's me.
Yeah, we got a hiccup over here.
The donor family's working out some issues.
- What's our time frame? - I don't know.
We're gonna stick around, see how it plays out.
- Andy! - I gotta call you back.
What's up? Teri's crashing! Code blue to ICU room four.
We were just talking, and then she closed her eyes.
- Asystole.
So we have a pulse? - Negative.
- Witnessed arrest? - I was standing right here.
Defibrillate, 200 joules.
Everybody off! Take a seat.
Is everything okay? She's stabilized.
Her heart is weak, but it's still functioning.
Okay, and the baby? I would like to recommend that we go ahead with the c-section right away.
What's wrong? Given everything that Teri's been through today, I just want to ensure the safety of your baby.
You mean Teri might not make it? I'm doing everything in my power to stop that from happening.
But there's something you should know.
Teri went without oxygen for a long time during the last crash.
And this may have affected her brain functioning.
What? So, she's brain dead? No.
But she may have suffered some damage.
None of this would've happened if we'd put in that vad thing.
And I knew, I knew we should've waited for Teri to wake up.
There's no way to know when a heart is going to fail.
We make our best estimates, but beyond that, it's out of our hands.
We were going to paint the nursery and watch the steelers.
It was gonna be a regular day.
Yeah.
Doctor? Do you have a second? Walk with me.
I'm ten minutes late for an HR meeting.
Okay.
Well, I had a talk with Auden Drinkwater.
Have you ever heard of a metabolic deficiency causing pica? I remember something about, uh, iron-deficient patients being compelled to eat sand and dirt.
Yeah, and metal objects, because their brain chemistry tricks them into thinking that ingesting the metal will solve the problem.
He'd already be iron deficient from the GI bleeding.
Which was caused by eating the sharp objects.
So I ordered more blood panels done.
They came back with a zinc deficiency, which is also consistent with pica.
The kid couldn't help himself.
I guess it's not always about family.
Until it is.
- Good catch.
- Thank you.
I'm not really supposed to talk to you.
You expressed how you felt in front of everyone.
Now, I'd like a chance.
This might not be something you're familiar with.
But I've seen my father mistreated because of where he comes from.
He couldn't get a job in the union at first.
When he did, some of the other workers called him "ayatollah.
" then after 9/11, he lost a government contract because he couldn't get a security clearance.
I'm sorry.
So, when I arrived, and the organ donation was already in motion I had heard these stories that if you signed up for donation, the doctors wouldn't try to save you.
The stories are not true.
We weren't even called until everything was done to save your father's life.
- That always comes first.
- I know that now.
Okay.
You must have thought I was insane.
Well, I was afraid that my father's friend might break you in half.
- He seemed quite capable.
- Yeah.
This woman that you spoke of, the pregnant one - Will she get my father's heart? - Yes.
He would want to help her.
- Do what you need to.
- Thank you.
- Ready.
- Yeah.
No, no.
This one's yours.
Go! Probably don't want to drop it.
Okay, we have the heart, people, tense up.
How much time do we have? Cross clamp was two hours ago.
What's up? We may be putting a perfectly good heart into a brain-damaged patient.
You won't know that till she wakes up.
Where's your dad? He went to get me a magazine.
Did he Tell you about the condition you have? That pica thing? Yeah.
You know, I think with the right supplements and some counseling, you're going to be okay.
So it's not totally my fault.
No.
Not at all.
You're going to do plenty of stupid things you'll be responsible for.
This just isn't one of them.
Thanks.
I was kinda starting to feel like a freak.
Listen, I want you to go back to school, and I want you to feel like a freak The way every other 14-year-old does.
Yeah.
I'm going to check on you before I leave.
Get some rest.
What? You should probably take this.
You know, I might get hungry.
Funny.
Get some rest.
She started to stir a couple of minutes ago.
Okay.
Thank you.
Teri, it's Andy.
If you can hear me, squeeze my hand.
Teri.
You're in the hospital.
You're waking up from surgery.
If you can hear what I'm saying, squeeze my hand.
Good.
Good.
You understand what I'm saying? Your baby is doing well.
And, Teri You have a new heart.
You and your baby are going to stay with us here for a couple of weeks.
Now, it's not as fancy as that new nursery you were painting, but we're going to do our best.
I want to show you something.
Okay? Your guys wanted to say hello.
Ready? I love you, baby.
I mean, we we both love you.
Junior here has been talking up a storm.
You just happened to catch him during a little downtime.
Isn't he beautiful? He's got your eyes.
Yeah.
Yeah, he's doing so good.
Aren't ya? Okay.
Okay.
Um, we're, uh I don't know what we're doing now, but He's burrowing and, looking, and there's might be something coming out of something here.
I'm not sure, but, um, God, I wish you were here.
You'd be so much better at this.
But w-we'll be all right.
We'll be all right.
All right.
Hang in there.
Who's my boy? Oh, I love you so much.
Yo, ringtone.
Thanks for sabotaging my phone.
You will soon discover that I have many amazing things to offer.
I need to find you a heart before you sabotage my whole life.
I'm in no rush to leave.
I've been all over the world.
And I feel like this is a good place to be.
A place of life.
Today it is.
proudly presents
That catches fire, it could blow the roof off this place.
Am I, like, fired, sir? No, just just keep your eyes open.
Watch the area around you.
- Is this your first job? - Yes, sir.
Served three years in the United States Army prior to my apprenticeship training, sir.
You can stop calling me "sir.
" Mahmoud sounds better.
And I rolled the compressor over the paw of my boss's pit bull my first job.
So, in the big picture, you're doing okay.
I appreciate that.
And I promise I won't do anything to your dog, sir.
I don't have a dog.
- And it's Mahmoud, remember? - Yes, sir.
- Supercilious.
- That's correct, Emily.
Auden Drinkwater.
Antediluvian.
"Antediluvian.
" a-n-t e-d-i-l-u - v-i-a-n.
Antediluvian.
- That's correct Auden, nice job.
Auden? Oh, Auden, honey.
It's okay.
It's just nerves.
I had no idea you could donate part of a liver.
That's wild.
It's called a partial hepatectomy.
It's fairly common.
What do they do with the other part? Of the liver.
Well, it regenerates in six to eight weeks.
- Inside your actual body? - Yeah.
- Morning, boys.
- Morning.
Uh, morning, Dr.
Jordan.
Thank you for the book.
It's fascinating.
I was just talking about it with Dr.
Yablonski.
Oh, yes, he was.
The gift that keeps on giving.
Why didn't you give me a book when I started working here? Because you graduated at the top of your med school, Dr.
Lee.
And you got Nurse Wilson's number on your first day, David.
Not bad for a resident.
See you guys at 11:00.
Today's transplant committee meeting.
Try 10:00.
I knew that.
- Miranda warning.
- What's the problem? Well, she showed up in a good mood, but then she started inputting electronic medical records.
Oh, the bane of our existence.
I hear dropping it from the roof works.
Yeah, I love our paperless future.
- Did Lisa find you? - E.
R.
Lisa? That'd be her.
She's looking for you.
- Say what she wants? - I didn't ask, Andy.
Okay, remember: Andy, friend.
Computer, enemy.
- Thank you.
- You're welcome.
I should just buy you a helmet and get it over with.
I was painting our baby's nursery.
Or trying to.
My dear husband has a habit of injuring himself whenever he helps around the house.
Well, at least you'll have a great story to tell your new son.
You can tell the sex just by looking at her? I happen to be a natural telepath.
And the blue paint on your face was a small clue.
You, uh, wanted to see me.
Open a 4-0 prolene for me, will you? You called me down from surgery to assist with a scalp lac? No.
Some guy over there won't talk to anybody but you.
He say who he was? - I didn't ask.
- Okay.
I'm Dr.
Yablonski.
Indeed you are.
- Do we know each other? - No, but I know you.
- My name is Kuol.
- Kuol.
Okay.
How can I help you? I have been diagnosed with HCM.
Hypertrophic cardiomyopathy.
I have been given less than six months to live.
Who gave you that diagnosis? My cardiologist in Omaha.
Prior to that, I was treated in a refugee camp in Ethiopia.
So, your Omaha cardiologist referred you to me? No, sir.
I found you on the world wide web.
This is the best transplant hospital in the united states.
And you are the best transplant doctor here.
And that is why I came here.
I need a heart transplant.
Almost done here.
You feeling okay? I'm just a little dizzy, that's all.
Why don't you take a seat.
Put your head between your legs, take some deep breaths.
You'll be okay.
Usually I'm the one with the weak stomach.
I feel hot.
What's going on? Give me the bag.
- Teri? Teri? - Lisa, what happened? She arrested.
Call a code! Code blue E.
R.
Code blue E.
R.
.
proudly presents - Do we have an IV? - Got a good antecubital.
- Get her on the monitor.
- Somebody tell me what's going on! - Your wife's heart stopped.
Is there any history of heart disease? - No.
What about chest pain, shortness of breath? She complains about her feet.
She can't sleep lying down.
- She's in fib.
- Okay, charge to 200.
- Charging.
- 200.
Everybody off.
Clear.
Still in fib.
Prep for intubation, 7.
0 Draw up 150 of amiodarone.
Clear.
Okay, we got a rhythm.
- That's good, right? - It's better.
- Do we have a pulse? - Faint carotid.
Need a doppler for the fetal heart tones, please.
Good bilateral breath sounds.
You're in, Lisa.
- BP 100/50.
sinus tach 125.
- Get me a tocographic monitor.
- And an ob doctor super-stat.
- Fetal heart rate under 100.
- Is that bad? - It should be higher.
Let's get her upstairs.
Let's go! We're going to take her up to the ICU.
She's stabilized now, but we need to make sure your baby's okay.
But they're both going to be okay, right? They're doing much better than they were a minute ago.
Hang in there, okay? Oh, look at Ryan and his on-the-job training.
I'm only educating myself on what geniuses you surgeons are.
What is this, high school? Just trying to see what our new transplant coordinator knows, Pam.
That's Mr.
Assistant to the transplant coordinator to you.
And, uh bring it on.
Okay.
How many patients are currently waiting for an organ transplant? U.
S.
or worldwide? Ooh, he's good.
- U.
S.
- 103000.
And what are their names? Don't you have some lives to save? Right.
I assume you got the doughnuts for the transplant meeting.
- Doughnuts? - Yeah.
Right.
Yes.
No.
Is is, uh, that part of my job? Well, it is now.
You should go to Oram's.
They're in, uh, Beaver Falls.
And you're going to have to leave now if you want to make it back by 10:00.
get me an extra cinnamon roll, because Andy always eats mine before I get there.
Hey, Pam.
Do I really have to go? Never get between a doctor and his doughnut.
The patient's name is Auden Drinkwater, a 13-year-old male.
Acute upper GI bleeding, no previous history.
No real tenderness, rebound or guarding.
Er docs sent him up for a surgical consult.
Does the name Blake Forstin ring a bell? Mmm, no.
Should it? He chairs our annual fund-raising campaign.
He's a friend of this family.
And he called me personally to make sure they're getting the velvet-glove treatment.
So he's one of those.
I trust that means you know how to handle them.
Yeah, so do I.
Hi, Auden.
I'm Dr.
Foster.
It's nice to meet you.
Bob Drinkwater.
Nice to meet you, too.
How you feeling? - Okay.
I guess.
- Yeah? Okay.
Let's see.
Okay, well, listen, I'm going to poke around a little bit.
- And you're going to tell me if it hurts anywhere, okay? - Okay.
Have you ever vomited blood before? - No.
- No.
No bloody stool, no problems going to the bathroom? - I know, it's a very gross question.
- No.
He has had an upset stomach and some diarrhea lately, but we just thought it was from the cafeteria food.
Anything else unusual? Not really.
I guess I've been kinda normal.
Okay.
Well, listen, here is our remote control and we have over a thousand channels to choose from.
So you will be highly entertained.
All right? Can we talk outside? So, what do you think? Well, it could be anything from an ulcer to a congenital abnormality.
13-year-olds get ulcers? From what, stress? I mean, he's been pushing himself like crazy with school.
Stress exacerbates ulcers, but doesn't cause them.
I did feel some scar tissue during my exam.
- Has he had any abdominal surgery in the past? - No.
Why? Well, look, I'm going to order a CT, and we're going to see what we're looking at.
- And until then? - Sit tight.
Enjoy those thousand channels.
We're gonna know more soon.
Is it just me, or do we wait on Andy every day? I'm waiting on Ryan.
I sent him to Oram's.
I thought we banned doughnuts from department meetings for health reasons.
Doughnuts make people happy.
Happy is healthy.
It's a verifiable fact.
Will somebody just go and find Andy? - Right here.
- Thank you.
- We can start.
- Okay.
Patient is a 26-year-old female.
Her name is Tere Dawson.
She's 28 weeks pregnant.
She went into ventricular fibrillation in our er.
We defibrillated, we put her on amiodarone.
Ekg showed non-specific ST segment elevations and anterolateral ischemia.
Sorry.
An echo showed dilated cardiomyopathy and an injection fracture of ten to 15 percent.
Exam confirmed congestive heart failure.
Peripartum cardiomyopathy.
And the man in the blue shirt goes to the bonus round.
Very good.
Okay, so, how are you gonna deal with the pregnancy? Well, so far, there's been no signs of fetal distress, and the baby's at 28 weeks, so he's viable.
But I would recommend putting in a vad to get her to term and support heart function.
What about transplant? She'd be one-a status with UNOS, and we'll list her, but she's o-neg, so there's a low probability of getting her a heart soon enough to help.
Right now, I think the vad's the way to go.
- You need to talk to the patient.
- I'm on my way.
Ooh, Oram's.
These guys make the best cinnamon rolls.
Did you see that? - Andy? - Yeah? I got the paperwork for the kid from Africa you admitted.
- Omaha.
- What? He's from Omaha? You may have heard of it.
It's on the subcontinent of Nebraska.
Wherever he's from, I don't have any insurance information on him.
That's because he doesn't have any.
So what do you want to do about it? Well, you're clever.
You'll think of something.
- That's not an answer.
- I love you.
Sorry I'm late.
Oh, you kidding? You saved her.
And the baby.
You could waltz in here in a tutu, and I'd kiss you.
Hey, Teri.
How are you feeling? Alive.
Thank you.
You're welcome.
Let me explain what happened.
You had a severe heart attack this morning.
We ran some tests, and we've discovered a significant problem.
There's a heart condition which can be brought about by pregnancy, called peripartum cardiomyopathy.
Basically, the body's immune system attacks the heart, which leads to swelling, decreased muscle function, and, ultimately, arrhythmia.
That's why you crashed in the E.
R.
Now, combined with your cardiomyopathy, the crash did significant damage to the muscle.
Bottom line, you're going to need a new heart.
- Seriously? - Yes.
We'll get you listed for a transplant right away, but because of your blood type, it may take a couple of months to find you a heart.
And the heart that you have currently won't last that long.
What do we do? We can put in what's called a vad a ventricular assist device.
It's a little pump that helps your heart do its job.
We'll do the surgery, we'll put it in, and that will stabilize you.
Will the baby be okay? In a perfect world, this will take you to term.
But I'll I'll definitely need a new heart someday? Someday soon.
Um, uh, when do we do the surgery? How about now? Babe? What are we waiting for? Okay.
I'm so sorry about your husband.
You are very kind.
I suppose I will need to make funeral arrangements soon.
Oh, we can help with that.
And another thing to consider at this stage is organ donation.
Did you and your husband ever talk about it? No.
We did not.
But I believe it is something Mahmoud would want.
If I have your consent, I can arrange for the donation tonight.
I would like to wait until my daughter arrives to say good-bye.
She would want to do that.
Oh, yes, of course.
Hey, radiology guy.
Tell me the surprise you couldn't tell me over the phone.
Oh, well, some things are just, uh, better in person.
So, real quick, tell me about this Drinkwater kid.
13-year-old male with acute upper-GI bleeding and no previous history.
- Yes.
Found it.
Ready? - Yeah.
Check out this bad boy.
Are those tweezers? That's what I said.
How is it that you have no ring tones? - You're not breaking that, are you? - No.
But you are aware there's a later model, correct? Can I have your attention for a minute? Of course.
The tests show that you're right.
You're a very sick young man.
When did you first get this diagnosed? When I was six, from a U.
N.
doctor at a refugee camp in Ethiopia.
Then, again in Omaha after I came here on the airlift in 2002.
and what kind of care have you been receiving? The church who brought me to the states arranged for the cardiologist in Omaha to treat me.
But he is no Dr.
Andrew Yablonski.
Allegheny state for undergrad.
Board diplomate in cardiothoracic surgery Okay, I get it.
Uh, I'm very flattered.
I'm very flattered.
Here's the deal.
There are a number of highly-qualified doctors who can give you the treatment you need.
But here is my deal, as you say.
My village burned to the ground when I was six years old.
I lived for a year in the desert, eating whatever I could find to stay alive.
Then, in the refugee camps, I saw hundreds of boys like me die.
I have made it this far because I know how to survive, and that is why I came here.
For you.
Because you can save me.
You're not going to let me back out of this one, are you? No, sir, I am not.
I thought as much.
Okay.
I'm gonna be honest with you.
We're gonna face some hurdles getting you the treatment you need, and I can't make any promises, okay? But I will do my best.
Sounds good.
Okay.
- Doctor? - Yes.
- Your phone.
- Right.
My son eats metal? Well, he certainly swallows it.
Looks like one of the sharp objects here is what caused the bleeding, and we're lucky we caught it before it led to an infection.
So, you're telling me there's something to be happy about here? Well, in that we can retrieve the objects safely through surgery, yeah, but there is a psychological element I think we should discuss.
Like what? Okay, well, um, have you noticed any change in behavior recently? Well, he's been moody and distant lately, but my wife and I thought it was just typical teenage stuff.
Can I ask where your wife is? She's in China on business.
She's a partner at a firm downtown.
How often is she gone? A couple of times a month.
- And how does Auden feel about her being gone so much? - Wait.
Wait.
What kind of questions are these? This is none of your business.
Mr.
Drinkwater, there is clearly an underlying reason why your son is engaging in this sort behavior.
Oh, so, it's his mother's fault that our son is swallowing tweezers? - I didn't say that.
- Then what are you saying, doctor? I'm saying that having a chronically absent parent can make a child engage in certain behavior to get noticed.
Ah, and it's your training in surgery that makes you an expert in my son's psychological condition, right? Okay, I think we should have this conversation at another time.
There won't be another time.
Have you seen Dr.
Yablonski? Uh, try the O.
R.
Sally, will you get that, please? - Yes? - Dr.
Yablonski, it's me, Ryan.
Yes.
Yes, I can see that it's you.
What's up? I think I got an offer on a heart for your patient.
Which patient? I believe it's the one you're about to operate on.
Teri Dawson? - Talk to me.
- I got a call from an OPC in Cleveland.
She just listed a donor 52-year-old male, 180 pounds.
Guy ran five miles every morning.
UNOS says it's ours.
- You confirmed it's o-neg? - Yes.
What did the echo show? Normal ventricular function, normal wall thickness.
- What about the jet? - Pilots are on standby.
Come with me.
- What? Is something wrong? - No.
Everything's fine.
We've been offered a heart for Teri.
- You said it'd take months.
- We got lucky.
It's a quality heart, and we can do the transplant tonight, but Teri will need a C-section first.
Will the baby be all right? At 28 weeks, there can be issues in terms of lung development, but our NICU team has had great success in that area.
Well, to be honest with you, Teri's the shot caller with us.
So I have to wait for her to wake up.
The rules state that we either commit to this heart now or we let the next patient on the list take it.
What would you do? We can do the vad.
We're ready to go.
But weighing the risks of the transplant and the C-section versus the odds of getting Teri a good heart I'd vote for the transplant.
It's the best possible option for your wife's long-term survival.
A new heart and a new baby all in the same day, huh? - I didn't see that coming.
- I understand.
I gotta make this call now? One way or the other.
Let's do it.
Let's go for the heart.
- Good, go now.
- I'm going.
You wanted to see me? - Yes, sit down.
- Okay.
What's up? Our fundraiser called.
He just got off the phone with Auden Drinkwater's father.
Don't worry, I calmed him down.
Well, I don't think I was that far out of line, I'm sorry.
I know what that kid is going through.
I know that house.
You know your house.
You know the house you grew up in.
That's right, I do.
And I know that my father was never there.
And I've done things worse than eating metal to get his attention.
Miranda, I won't attempt to minimize the price your family paid for your father's dedication.
I know all about it.
I was here working with him when he built this hospital.
What I am suggesting is, your sensitivity about an absent parent might limit your ability to diagnose this patient.
Well, I hadn't considered that.
Just something to think about.
- Is that it? - Yeah.
Thank you.
Did he talk about us? All the time.
Thanks.
- Oh, Ada.
- Mommy.
They said he was helping a young man, and he fell.
He was always so careful.
I don't understand it.
And then the doctor sent the woman who works with the organ donations.
She said they will go to six different people in need.
He's still breathing.
They say it's the machine doing that for him.
Did you ask if he was in a coma? - No - Because people wake up from comas all the time.
The doctor said that his brain was no longer functioning.
He said daddy would never come back to us.
And then he sent in a woman for his organs? Yes, but Mom, how do you know they did everything they could to save him? Ada, honey, I believe the doctor.
But you were upset.
- Did they pressure you? - No.
I don't remember everything.
Okay, okay, okay.
What do we do? We get a second opinion.
- And no one touches him until then.
- Okay.
Okay? Okay.
No, those are really good.
Next time we're here we're gonna stop at this place on bridge that makes these killer blue cheeseburgers.
Caramelized onions, gooey roquefort, amazing.
Or there's this place on Lorraine with these chili dogs.
The lady puts cinnamon inside the chili.
What's with you doctors? I'm going to have a heart attack just being near you.
At least you'll be in the right place.
Incoming.
- Are you the guys from Three Rivers? - Yes.
Okay, well, we're on hold.
The daughter just arrived, and the family wants to get more tests done.
You had two doctors sign off on brain death, right? Of course.
But the family has a right to request confirmatory tests.
What are the current PA numbers? Pressure's normal.
Wedge is eight.
We can wait a few hours and still be okay.
Well, guess we got time for that burger, after all.
- Uh, call us when you're ready.
- Okay.
- Let's go.
- Is that the daughter? Uh, yeah.
Miss, excuse me.
Miss, miss, may I talk to you? - I am really sorry for your loss.
- What are you doing? - But there are some facts you may want to know.
- Now is not the time.
- There's a pregnant woman in Pittsburgh waiting for a heart, and she could die.
- Ryan! I'm so sorry.
What are you doing? You are way out of line.
She could die, David.
Yes, she could, but this is not how we do it.
Why, because of some rule? Because it's the right thing to do.
It has to be a gift.
- Here's the chart they requested.
- Thank you doctor.
I want to apologize.
- You don't have to.
- No, I do.
I let my own experiences color our conversation.
I really am sorry.
You know, the, uh, the truth of it is, I knew something like this was going to happen With, uh, Susan being gone so much, and, uh, she and I just fighting over it all the time.
So, when you started poking around, I guess i, I got a little defensive.
Maybe it was denial, or, uh Just hoping it wasn't true, you know? After you told me, I tried to bring it up with him.
The eating metal and everything.
He won't even talk to me.
It's like I don't even exist.
I could talk to him, if it's okay with you.
Please.
Anything you can do to make him better.
Absolutely.
So, you're going to surgery in a couple hours to remove those objects from your stomach.
You know, when I was young, I did all sorts of crazy things to get my parents to notice me.
And it didn't change much, but A lot of things that I did ended up hurting me.
I think you should talk to someone.
'Cause I don't want to see you back here in another six months with the same problem.
Okay? Okay.
I lied.
About throwing up blood.
It's happened before.
It's not what you think.
It's not about my mom or school or anything like that.
Okay.
It's like some itch.
It makes me do it.
- An itch where? - In my brain.
Yeah, hi, I need some additional blood work done on a patient, please.
Name is Auden Drinkwater.
You read the file on my new patient from the Sudan, right? I did, I also read that he is a non-citizen and has no insurance.
Oh, I kind of hoped you'd skip that part.
You brought patients here from South Africa, right? - I did.
- How did you find the money for their treatment? With great effort and trust me, in this economy, those funding sources are bone dry.
He needs a transplant.
I'd really love it if you could tap into that special gift you have of finding money for patients who really need it.
Times are really tough.
I know, but this kid, he's fought tooth and nail to survive this long.
I don't want to be the one who stops him now.
Is that T-pain in your pocket, or are you just happy to see me? Someone's been messing with my ringtone.
Yablonski.
Hey, it's me.
Yeah, we got a hiccup over here.
The donor family's working out some issues.
- What's our time frame? - I don't know.
We're gonna stick around, see how it plays out.
- Andy! - I gotta call you back.
What's up? Teri's crashing! Code blue to ICU room four.
We were just talking, and then she closed her eyes.
- Asystole.
So we have a pulse? - Negative.
- Witnessed arrest? - I was standing right here.
Defibrillate, 200 joules.
Everybody off! Take a seat.
Is everything okay? She's stabilized.
Her heart is weak, but it's still functioning.
Okay, and the baby? I would like to recommend that we go ahead with the c-section right away.
What's wrong? Given everything that Teri's been through today, I just want to ensure the safety of your baby.
You mean Teri might not make it? I'm doing everything in my power to stop that from happening.
But there's something you should know.
Teri went without oxygen for a long time during the last crash.
And this may have affected her brain functioning.
What? So, she's brain dead? No.
But she may have suffered some damage.
None of this would've happened if we'd put in that vad thing.
And I knew, I knew we should've waited for Teri to wake up.
There's no way to know when a heart is going to fail.
We make our best estimates, but beyond that, it's out of our hands.
We were going to paint the nursery and watch the steelers.
It was gonna be a regular day.
Yeah.
Doctor? Do you have a second? Walk with me.
I'm ten minutes late for an HR meeting.
Okay.
Well, I had a talk with Auden Drinkwater.
Have you ever heard of a metabolic deficiency causing pica? I remember something about, uh, iron-deficient patients being compelled to eat sand and dirt.
Yeah, and metal objects, because their brain chemistry tricks them into thinking that ingesting the metal will solve the problem.
He'd already be iron deficient from the GI bleeding.
Which was caused by eating the sharp objects.
So I ordered more blood panels done.
They came back with a zinc deficiency, which is also consistent with pica.
The kid couldn't help himself.
I guess it's not always about family.
Until it is.
- Good catch.
- Thank you.
I'm not really supposed to talk to you.
You expressed how you felt in front of everyone.
Now, I'd like a chance.
This might not be something you're familiar with.
But I've seen my father mistreated because of where he comes from.
He couldn't get a job in the union at first.
When he did, some of the other workers called him "ayatollah.
" then after 9/11, he lost a government contract because he couldn't get a security clearance.
I'm sorry.
So, when I arrived, and the organ donation was already in motion I had heard these stories that if you signed up for donation, the doctors wouldn't try to save you.
The stories are not true.
We weren't even called until everything was done to save your father's life.
- That always comes first.
- I know that now.
Okay.
You must have thought I was insane.
Well, I was afraid that my father's friend might break you in half.
- He seemed quite capable.
- Yeah.
This woman that you spoke of, the pregnant one - Will she get my father's heart? - Yes.
He would want to help her.
- Do what you need to.
- Thank you.
- Ready.
- Yeah.
No, no.
This one's yours.
Go! Probably don't want to drop it.
Okay, we have the heart, people, tense up.
How much time do we have? Cross clamp was two hours ago.
What's up? We may be putting a perfectly good heart into a brain-damaged patient.
You won't know that till she wakes up.
Where's your dad? He went to get me a magazine.
Did he Tell you about the condition you have? That pica thing? Yeah.
You know, I think with the right supplements and some counseling, you're going to be okay.
So it's not totally my fault.
No.
Not at all.
You're going to do plenty of stupid things you'll be responsible for.
This just isn't one of them.
Thanks.
I was kinda starting to feel like a freak.
Listen, I want you to go back to school, and I want you to feel like a freak The way every other 14-year-old does.
Yeah.
I'm going to check on you before I leave.
Get some rest.
What? You should probably take this.
You know, I might get hungry.
Funny.
Get some rest.
She started to stir a couple of minutes ago.
Okay.
Thank you.
Teri, it's Andy.
If you can hear me, squeeze my hand.
Teri.
You're in the hospital.
You're waking up from surgery.
If you can hear what I'm saying, squeeze my hand.
Good.
Good.
You understand what I'm saying? Your baby is doing well.
And, Teri You have a new heart.
You and your baby are going to stay with us here for a couple of weeks.
Now, it's not as fancy as that new nursery you were painting, but we're going to do our best.
I want to show you something.
Okay? Your guys wanted to say hello.
Ready? I love you, baby.
I mean, we we both love you.
Junior here has been talking up a storm.
You just happened to catch him during a little downtime.
Isn't he beautiful? He's got your eyes.
Yeah.
Yeah, he's doing so good.
Aren't ya? Okay.
Okay.
Um, we're, uh I don't know what we're doing now, but He's burrowing and, looking, and there's might be something coming out of something here.
I'm not sure, but, um, God, I wish you were here.
You'd be so much better at this.
But w-we'll be all right.
We'll be all right.
All right.
Hang in there.
Who's my boy? Oh, I love you so much.
Yo, ringtone.
Thanks for sabotaging my phone.
You will soon discover that I have many amazing things to offer.
I need to find you a heart before you sabotage my whole life.
I'm in no rush to leave.
I've been all over the world.
And I feel like this is a good place to be.
A place of life.
Today it is.
proudly presents