Three Rivers s01e05 Episode Script
Alone Together
Alone Together This is Detective Phillip Lombardi, Pittsburg Police Department.
We have a warrant for the arrest of Michael Arriano.
You guys see him coming out the back? Negative.
This is the Pittsburg Police Department.
We have a warrant for the arrest of Michael Arriano.
We got a female Hispanic coming out the back door.
She's running.
Take it down.
Clear.
Clear.
Michael.
You don't want to do this.
It's okay, guys, we got this.
You're going to take my daughter.
No.
I would never do that.
She's not going into foster care.
Now, look I'm about to become a dad, too.
Girl I'm going to marry has got two boys.
It's hard.
Hope I can do it good.
I wish I'd I did better at it.
Don't worry about what you did in the past.
Be the good dad today.
Right this second.
And put the gun down.
You love her that's what you do.
You're a good dad today, Michael.
- See if you can find the mother.
- There you go.
Michael Arriano, you're under arrest on charges of cocaine trafficking.
You have the right to remain silent.
Anything you say can and will be used Phillip! Officer down! Officer down! I need an ambulance to 2417 North Edgemont, apartment 135.
Tell 'em we're going to Three Rivers.
Look! Dr.
Yablonski! Rock and roll computer game.
-My church bought it for me.
- Ah.
I need the key to your hotel room.
- My room in the Med Stay Inn? - I heard those rooms have 42" flat screens.
- I could crank it up in there.
- Oh.
You know, oddly, I find most transplant patients are not big fans of this game.
It's crazy, isn't it? They don't want to spend what could be their last hours on earth playing "Welcome to the Jungle.
" Is there a heart for me yet? Not since you asked me an hour ago.
Please let me have your key.
Kuol, you can't be alone in my room.
Andy the rock gods are in my soul.
Kiss, AC/DC, Motorhead.
Motorhead? You're Sudanese.
What is up with you? It's a final request from a young man with a severe congenital heart condition, that could cause my death at any moment.
Cancel his heart transplant.
Transplant canceled.
You have both hurt me.
deeply.
Son of a bitch.
He took my keys.
Jackson! I know you're in there with her! I see your car parked out front.
Where is he? Get out! Jackson! Come on, honey.
Come on out.
I don't have my gun.
I just want to talk.
I'm calling the cops.
Hey, go ahead, call 'em.
Jackson! Tell me where he is! Your husband is not here.
Yeah, right.
Okay, Jackson, I lied.
I do have my gun.
I need the police now! There's a woman with a gun in my house.
Jackson! I'm going to count to five.
One, two, three, four What was that? Detective Phillip Lombardi.
39-year-old male, sudden acute onset crushing substernal chest pain radiating through his back.
SOB, diaphoresis, pain at ten out of ten.
He's had four of MS and three nitro sprays, ASA given.
- You okay? - Okay, on my count.
One, two, three.
Now down to five over ten in the rig.
BP 110 palp.
Pulse 120.
Pulse ox 95 on ten liters.
- Non re-breathing mask.
- Thank you.
- You can step outside now, Detective.
- Uh, it's okay.
She's, uh, she's my wife.
Nice to meet you.
Okay, Mr.
Lombardi, I'm Lisa Reed.
I'm one of the ER doctors.
Are you having pain? Real bad.
Hey.
- Andy.
- Hey, buddy.
Did Rena call you? Yeah, she's looking out for you.
Don't worry, you're in good hands here, Phil.
Okay.
Lisa's the best.
Okay, BP's 100/50.
Pulse 130, resps 22.
Okay, let's get Mr.
Lombardi ten liters O2.
And then four of MS.
Metoprolol 15 slow, IV push.
Cardiac panel, repeat EKG, and a portable chest X ray.
Okay, is the cath lab standing by? They've got somebody on the table, but they'll be ready by the time we get him up there.
- Bring that X ray machine over here.
- Hold the X ray.
- Is this a STEMI? - Yeah.
Yeah.
Well let's get him up to the cath lab.
Just going to do a quick chest X ray first.
Let's get him up, please.
He's got an acute ST elevation on the interior lateral leads.
It's a heart attack, and time is heart muscle.
Andy, let's just get him upstairs.
I'd rather have all the information.
And I would rather have him alive.
Look, I see ten of these a week.
99 out of 100, it is a heart attack.
Let's roll him, Lisa.
Someone needs to call my fiancée.
Rena.
Call Rebecca.
- Don't worry, I got it.
- Let's have that X ray - machine back over here, please.
- Uh, Maguire said I want that X ray.
It could be something else.
Don't worry, we'll go fast.
Three Rivers 1x05 Alone Together sync, corrections Okay, let's get you upstairs.
I'll check the X ray.
Andy, don't let me die.
I'm going to dance at your wedding, pal.
Yeah, Maguire's looking for him in the cath lab.
Get him up there fast.
Go, go, go.
We'll get the X rays back in about five minutes, and they'll check for blockage in the cath lab.
How you doin'? I've been a lot better.
I can imagine.
I called Rebecca.
She's on her way.
Okay, good.
Phillip finally found somebody.
I didn't think it was ever going to happen for him.
Did you get my text yesterday about the-the couples counseling? The guy I found, he's supposed to be - he's supposed to be great.
- Yeah.
Um let me think about it.
Of course.
I'm going to go wait for Rebecca out front.
Okay.
Good.
Good morning, Mr.
Boyle.
Look the United Colors of Benetton ad for doctors.
I vomited.
Profusely.
Oh, projectile.
Yes, you did.
On the floor.
Thank you.
You know, we gave you - bags for that.
- I like to be different.
Anybody can throw up in the bags.
This is why none of the nurses want to take care of you anymore.
I've noticed your unending concern for nurses.
If I wore a brassiere, would you pay as much attention to me? Dr.
Lee, would you check the size of Mr.
Boyle's liver? When Dr.
William Foster did this, it didn't hurt.
When my father was treating you you weren't as sick as you are now.
Or maybe your father touched me like I was a human being, and not a ball of pizza dough.
I don't feel liver, but he has ascites.
Oh.
Ugh You threw up here, too.
Yes.
I did.
What now, Dr.
Lee? I'm going to go clean up.
Can you hold out your hands, please? The flapping is asterixis.
It's a sign of advanced liver disease.
You notice that your skin is almost the same color as mine? Do I have to take this? Mr.
Boyle, your liver function is deteriorating rapidly.
Your clotting factors are critically low.
Serum ammonia level is doubled.
I'm sorry.
Handsome Dr.
Lee, what happens as your serum ammonia level rises? As your serum ammonia levels rise, you go unconscious.
You'll fall into aoma, and And within hours die.
My name is Falo Matafi.
I'm the organ procurement coordinator here at the hospital.
You understand your husband is now brain dead.
I learned that on my honeymoon in Puerto Rico.
That's a joke.
Good.
Um Your husband signed his donor card.
Most of his organs were damaged in the accident, but his liver, it seems, can be used to help someone in need.
Where do I sign my consent? Now you have to listen to me.
You know all that, um BS about if you love something set it free? Well, I was lying in our waterbed thinking about all that, and it hit me.
You know, even if you left me cold and you went off with that tramp I mean, that's what she is, Jackson.
I'm sorry, but I saw her shoe collection.
I was thinking even if I couldn't have you well, I'd still wish that you were alive somewhere in this world.
Be free, my love.
I just got a match on a liver for Mr.
Boyle donor is Jackson White.
Mr.
Boyle's going home? Oh, yes! There is a God in Heaven.
Get me the paperwork on it.
Let's see if we should accept it.
Oh, just sayes so he'll go home.
I don't mind treating Mr.
Boyle.
I would rather stick a pencil in my eye.
He's a theater professor.
He's just a little dramatic.
Tell them we accept.
- Miranda.
- Yep? You're going to make the procurement run.
Whoo.
All right.
Let's see.
New York, Chicago West Virginia.
The land of coal mining.
And the first federal prison for women in the United States.
Have you had sex ever? You better behave.
They're going to lock you up.
I know.
All right, guys, let's go.
Not you.
You are going to stay and do Mr.
Boyle's pre-op.
And I am being punished because? You have done lots of procurements.
I think it's time you start treating patients who are not brain-dead.
It's got a whole different feel to it.
Let's get moving.
Mr.
Boyle's critical.
Here's Lombardi's X-ray.
Take a look.
What do you think? Widened mediastinum? Absolutely.
It's not good.
I mean, it could be an aortic aneurysm.
He might be bleeding internally.
They're about to give him anticlotting medication.
We have to stop them.
Tim.
Yeah.
Don't anticoagulate him.
Oh, it's too late.
Already have.
How much anticoagulant did you give him? Full dose just about a balloon in.
Why? What did you see? A widened mediastinum on the chest X-ray.
He has an MI on the EKG.
His aorta could be dissecting and cutting off the flow to his left pulmonary, causinm to bleedbe internally.
and cutting off We need to fluoroscope him.
Take a good look at his aorta.
See if this is an aneurysm or a heart attack.
BP's heading south.
We need to move, people.
Crank up the dopamine drip, hold the beta-blockers.
And guys good call on the X-ray.
Injecting dye.
There it is.
Look at that aneurysm.
His aorta is shredding.
I got to operate before it blows completely.
Man has a ton of anticoagulants in him, Andy.
If you operate now, he will bleed out in minutes.
If we don't operate he's a dead man.
This is Phillip's fiancée, Rebecca.
How is he? He's not having a heart attack.
The main artery that goes through his heart is quickly weakening, and it's leaking blood into his chest.
Well, how bad is it? If we don't operate, the artery will burst, and he'll die.
- Oh, my God.
- So, can you fix it? Not right away.
When he came in, he was given anticloting medicine because we assumed he was having a heart attack.
If I operate now, he'll bleed to death.
Are you telling me that Phillip's going to die? He loves my kids.
We were going to get married.
- No, Rebecca - No, Rebecca, Rebecca, listen to me.
We're giving him clotting factors to help his blood coagulate, but they need time to work.
Once his clotting levels come up a little, I'm going to try a very new procedure.
It's called an endovascular stengraft.
Instead of opening his chest, we go in through an artery, and we fix the aneurysm from the inside.
There's much less bleeding, and it just might work.
Have you done this before? No.
But I've studied it, and I've assisted on several.
Okay.
Sit tight.
Mr.
Boyle.
Good news.
There is a matching liver for you.
I sent Dr.
Foster out now to procure it.
I think this is the first time I've ever seen you speechless.
I wasn't prepared To live a long life? Actually, yes.
Your serum ammonia level is now up to 834.
But if you can hang in there, we can make this work.
Dr.
Lee is going to do your pre-op work.
Uh, I'd rather a resident not oversee my care.
Well, let me assure you, I am qualified to perform You will assure me of nothing.
Mr.
Boyle, this is a teaching hospital.
I don't want Yo-Yo Ma here working on me without supervision.
Residents are always supervised.
And, believe it or not, I run the transplant unit, not you.
Look, if I'm making Mr.
Boyle uncomfortable, I do not have - to do this.
- No, no.
I think the two of you will be good for each other.
Get going on that pre-op work.
Keep an eye on his serum ammonia level, and I will check back in with you soon.
And good luck to you both.
Uh, Wheeling County General has no landing pad, so we have to land on the high school football field.
Welcome to West Virginia, ladies and gentlemen.
Hey, I'm from Indiana.
Don't underestimate the heartland.
We'll impress you.
One minute, okay? Then we need to take him into surgery.
Hey, baby.
They they tell me I might not make it.
Phillip, you listen to me.
You are loved too much to go away from me now.
The boys need you.
You are so so beautiful.
Now you have to stay alive, so you can keep telling me that.
I hate how every moment of my life, I spent doing something stupid instead of being with you.
The kids.
Uh-uh.
We are going to have a lifetime together, baby.
We have to go.
Okay.
I'm going to see you soon.
I love you.
Okay? Oh, Dr.
Lee.
Your hands are so soft.
Your blood pressure's falling.
That's part of your liver failing.
And your accent is almost perfect.
I was born in Detroit, Mr.
Boyle.
Take a deep breath.
You know I'm American.
If you're just trying to get under my beautiful yellow skin, it's not going to work.
Don't challenge me, young man.
You do your worst I can take it.
Let's see.
You wear $700 Barker Black loafers on a resident's salary.
You drive an SLK300 Mercedes.
I can see the parking lot from my window.
You were born of privilege.
And my guess without a cashmere cardigan and a soy latte, you would start to cry.
I have to do a rectal exam.
Roll onto your side, Mr.
Boyle.
Are you going to buy me flowers afterwards? You know, I noticed there are no flowers in your room.
Maybe, if you were a nicer guy, you might have some friends who would send you some.
Are you going to tell me about life and friends now? No.
That is not my intention.
Life is watching your lover of 15 years die of AIDS in a hospital room that you can't get into because you are not so-called immediate family.
I know firsthand about life, Dr.
Lee, so don't you dare tell me why I don't have flowers in my room! We can't get out of here? All the exits are locked.
Oh, my God.
We come all the way to West Virginia for a critical transplant, and nobody thinks to unlock these gates? I'm impressed.
Shouldn't they have sent an ambulance - to pick us up? - Hey, come on.
We can climb the fence.
No.
B-b-bad idea.
Dumb.
We're doctors.
We don't climb.
Listen, I can't.
If I sprain my wrist, cut my hand, who's going to procure the liver? You've got to be kidding me.
They should turn off in a few minutes.
After you.
David, what the hell happened with Mr.
Boyle? I didn't say anything that out of line.
As a doctor, you have got to be above this.
He was making racial remarks.
I don't care.
The earth is shifting under this man's feet.
One minute, he's dying, the next minute, hope's being dangled in front of him.
He gets a big fat flaming pass.
So I'm just supposed to put up with it? Yes.
If you want to be an average doctor, just put up with it.
And what does that mean? David, you have the potential to be a great doctor.
You're smart as hell, you've got good instincts, and you work hard.
But one of the most important things about being a great physician is loving the unlovable.
So you want me to love Mr.
Boyle? Hello.
Hi.
I'm Dr.
Yorn.
I'm head of surgery here.
I'm Dr.
Foster.
Dr.
Patel.
Hi.
Ryan Abbott, Assistant Transplant Coordinator.
Why wasn't an ambulance sent for us? I'm sorry.
Uh, why are you here? Uh, we're the organ procurement team from Three Rivers, Pittsburgh.
We're here for a liver from Jackson White.
Uh, that liver was assigned to my patient, Alan Lang, here at Wheeling General.
I was about to do the procurement myself.
No, no.
No.
I got a call from the OPC, Falo Matafi.
Me, too.
He works here.
Okay.
All right, all right.
Listen, it was There was just a huge mistake.
I'm sorry you had to come all this way.
Um, we have a a very big problem here.
I don't have a problem.
That liver is mine, and as soon as I procure it, it's going in my patient.
Okay.
Listen, you get UNOS on the phone right now.
- All right.
- Hey, don't procure that liver until we get this straightened out.
UNOS thinks one of the OPCs screwed up.
They're figuring it out now.
What? Wait, wait.
What are you doing? If Yorn procures that liver, it will go in his patient within minutes, and UNOS will never order it removed.
Well, we can't physically stop him from operating.
Why not? Oh, no.
No, no.
He's a very big guy, Miranda.
And this isn't our hospital.
He has friends here.
And security guards.
Dr.
Yorn?! Just hear me out.
You are not authorized to be in here.
UNOS is figuring this out as we speak.
It's Jackson White.
He's procuring the liver.
Jackson White's body is beginning to shut down.
I am obligated to move quickly here.
Okay, okay, okay, listen to me, listen to me.
My patient, Mr.
Boyle, may not make it through the night.
And I'm sure you're gonna tell me he's a great guy.
In good conscience, I can't say that, but that's not the point.
I am procuring the liver.
Ryan, get UNOS on the phone right now.
Yeah.
No.
No.
Get out of the way, or I'll call security.
Call security, and somebody remove them - now, please.
- We have a Code Gray, in scrub room two.
I repeat No, no, no.
No.
No.
No.
Get off me! - Oh! - Oh, my God.
Oh, my God.
Whoa.
Okay, okay, it's no big deal, no big deal.
- That looks really bad.
- You know what? Can we not make it a bigger deal than it is? It was an accident.
Let me just Just Here.
Just, come on.
Shh, shh, shh, shh.
- Oh.
- Put some pressure on it.
That's a bleeder.
She broke my nose.
- It was an accident.
- I can feel - the bone move.
- It was a pure accident.
- It was an accident.
It was - Get them off the premises now! Where are you taking us? Miranda, apologize to him! Listen, I'm sorry.
What do you want from me? Here you go.
Thank you.
Sure.
Andy makes such a mess.
I don't even know what Phillip's mess looks like.
He still makes sure everything is neat before I come over.
No wonder you want to marry him.
I want the chance to know his mess.
I want to know everything about him.
You guys are lucky.
You have a history.
You grew up together.
Yeah, that makes it harder.
I know you guys are separated, but I see the way you look at him.
That doesn't mean we're supposed to be together.
Phillip chased me for almost a year.
I don't know what the hell I was thinking, because I could have had that year with him.
Something like this happens, priorities get clear really quickly.
Rebecca, it's not that simple.
Yeah, it is.
You love him, Rena.
He wants things that I can't give him.
If it were all over tomorrow, would you spend your last day with him? You broke his nose?! Are you kidding me?! It was an accident.
Listen they're gonna try to procure the liver before we have an answer.
What did the OPC say? Nothing.
Nothing.
They threw us out before we had a chance to talk to him.
So, you have no ETA? At this point, we may not even get it.
Mr.
Boyle's liver is on the verge of shutting down completely.
Look, I hate to say this, but if Mr.
Boyle's too sick to transplant, then I shouldn't be fighting for this liver.
If UNOS says the liver is ours, I will make a decision then.
Yup, got it.
Okay, bye.
Okay, I'm inserting the catheter through his femoral artery.
Hopefully we can fix this aneurysm from the inside.
There it is.
There's the aneurysm.
I've got to get my catheter past it.
- BP's dropping.
- We're losing a lot of blood.
Let's get another unit of packed cells into him quickly, please.
I'm seeing a run of PVCs.
That's 'cause the catheter's near the aortic valve.
It's irritating the heart.
Lots more PVCs.
Okay, let's ease out for a second.
Let his heart get a constant rhythm so that I can try again to get this stent back in.
Up his amiodarone drip.
Upping drip.
BP is still dropping.
We should stop.
No, we can't stop.
I'm gonna try again slowly.
More PVCs.
I'm almost there.
You should back off.
He could go into cardiac arrest.
Run of V tachs.
Andy, he's in trouble.
Okay, I got it.
I got it.
The graft's in place.
Deploying now.
Let's inject some dye to check for leaks.
Injecting.
Look at that.
The stent has sealed the inside of the artery.
No leaks.
Looks great, guys.
Let's get out of there.
You awake? Hey, how you feeling? I'm dying.
Rudy Boyle, do not give up.
I put my faith in Dr.
Foster, and he died.
Why am I any better? Let me tell you something.
Dr.
Foster was just a man, true, but he built this center, and he taught me to do what he did.
He's still healing you, so you don't give up.
I miss him.
terribly.
So do I.
Oh.
Oh, my.
You loved him.
He was a great doctor.
He was a great man.
Hi.
So, we've got him back in his room.
It's still touch-and-go, but I'm gonna stay with him for a while and make sure the stent holds.
Is he gonna be all right? I'm not gonna know for a couple of hours.
Can I see him? Andy, Lombardi's crashing.
They're moving him back to the OR.
BP hit the skids 60 palp.
Pulse is up to 140.
Graft must have started leaking.
Pam, get me ten units packed cells and meet us at the OR, super stat.
BP's 50/30.
Pulse is up to 150.
He's crashing.
Let me see the post-op X ray, please.
Left hemothorax.
He's bleeding into his chest again.
Prepare for endovascular entry? No.
This time we need to crack the chest.
Prep for thoracotomy.
- He could bleed out.
- We don't have a choice.
Pump in the saline, and give me four units of packed cells on the rapid infuser right away.
- Let's go, people.
- Right away, Doctor.
BP's 40/30.
Pulse is 160.
- Scalpel.
- Scalpel.
Okay, bone saw.
Okay, rib spreader.
Here it is.
Oh, my God.
His chest is full of blood.
Lap pads keep 'em coming.
Faster, more.
More, faster.
Lots, lots, lots, lots.
I can't see the aneurysm.
BP's 40, systolic pulse is 165.
Pam, suction, please.
I see it, I see it, there it is, there it is.
The distal end of the endoluminal graft.
We've got to stop this bleeding fast.
Okay, give me a 40 nylon on a swedge.
I'm gonna do a running stitch.
- All right.
- Need some more suction.
- Suction.
- We're not getting blood into him fast enough.
BP is dropping.
I'm going to reinforce the suture with fibrin glue.
BP is still dropping.
What's going on? Falo Matafi.
I'm the OPC.
This is all my mistake.
Three Rivers was the primary recipient and Wheeling was the backup.
You both accepted the offer, and I I confirmed both by mistake.
I'm sorry.
You tell UNOS about this? UNOS called.
Your guy's MELD score doubles mine, so they said the liver's yours.
We're prepping him for procurement now.
All right, let's do it.
- Come on.
- Dr.
Foster.
What? I am a dynamic eligible bachelor in my dating prime.
My nose is going to have to be fixed perfectly, and you will be receiving the bill.
Won't help.
Hey, Ryan, get that chopper ready.
Hey.
So the aneurysm was repaired.
He's stable, and we're watching him in the ICU.
You can go and see him now.
Wow.
Great.
You know, the Talmud says if you save one life, you save the world.
Well, tonight you saved the lives of one man, a woman, and two children.
Thank you thank you.
You're welcome.
Mr.
Boyle, you're in the operating room.
- You're going to get your new liver.
- You loved him.
You loved Dr.
Foster.
Everybody loved Dr.
Foster.
No, not like her.
It's so sad to lose your lover.
I should know.
He's sedated.
Yeah, he's, he's sedated.
People say crazy things.
Nutty things.
Okay, here you go.
What's up? Imagine her Excuse me.
night after night lying there alone in an empty bed, needing Dr.
Foster.
I think we're ready to put Mr.
Boyle under.
- Oh, yeah.
- What's he saying He's sedated? All right.
Good luck, guys.
You know, I was thinking So I was thinking - You first.
- No, ladies first, come on.
Well, I was thinking about counseling and what you were saying - about that kind of - Me, too, me, too.
I mean, if we change our priorities W-W-W-Wait.
And I'm working on not interrupting you, too.
Andy, what's a counselor going to tell us that you're not a doctor and I'm not a cop? Is he going to give us five more hours in the day? What, you think this is about time? I saw what you do.
You're a rock star.
No, I'm not.
In almost anybody else's hands, Phillip would have died.
You save lives, Andy.
What's more important than that? Having one.
Family, you know, a home.
We have homes.
Three Rivers is your home.
The squad room that's my home.
I have eight great detectives that I spend Christmas with, birthdays.
I mean, when's the last time that you didn't spend Thanksgiving with Pam? Is this is this all because you don't want to have kids with me? I don't want to have children that we ignore.
Would you have them with someone else? Maybe somebody that was willing to meet me halfway.
Is that you? I love you so much, Rena.
I love you, too.
That was never, ever the problem.
Good night, Andy.
Good night.
Andy.
Uh, I had to crack his chest.
You did the right thing.
By doing it in stages, you slowed the bleeding so the clotting factors had time to work.
If you had done a thoracotomy right off the bat, he would have died.
Sometimes, Andy, you have to rip it all apart to fix it.
- Hey.
- Hey.
It was good to see Rena; I miss her.
Yeah, me, too.
Good morning, Mr.
Boyle.
The transplant went well.
Your liver numbers are all good, and you are going to live a very long life.
As the world wept.
What are those? Oh, those are from a secret admirer.
Okay, I mean, after I violated you, I thought it was the least I could do.
Here.
I underestimated you.
I am so sorry.
You are a young man of much substance and grace.
Thank you.
Excellent, you've come to join me.
Turn it off.
I don't understand.
You stole my keys, then you wake me up, Kuol? Why don't you just play in the hospital, play in the common room? But then I would be alone.
Give me the guitar.
Watch a rock star do it.
I don't think you are a rock star, Andy.
Really? My wife thinks I'm a rock star.
What do you think of that? Why do you live here if you have a wife? Well, uh that's a good question, Kuol.
The truth is, I don't think I have a wife anymore.
Dr.
Yablonski? Hmm? Let the rock gods soothe your troubled soul.
Thank you very much.
Watch this.
("Mississippi Queen" by Mountain playing) This is awesome.
Mississippi Queen Hey, Kuol.
Yeah.
I think you should leave this here in my room.
I don't think so, Andy.
Do you want a heart? That's not fair.
sync, corrections
We have a warrant for the arrest of Michael Arriano.
You guys see him coming out the back? Negative.
This is the Pittsburg Police Department.
We have a warrant for the arrest of Michael Arriano.
We got a female Hispanic coming out the back door.
She's running.
Take it down.
Clear.
Clear.
Michael.
You don't want to do this.
It's okay, guys, we got this.
You're going to take my daughter.
No.
I would never do that.
She's not going into foster care.
Now, look I'm about to become a dad, too.
Girl I'm going to marry has got two boys.
It's hard.
Hope I can do it good.
I wish I'd I did better at it.
Don't worry about what you did in the past.
Be the good dad today.
Right this second.
And put the gun down.
You love her that's what you do.
You're a good dad today, Michael.
- See if you can find the mother.
- There you go.
Michael Arriano, you're under arrest on charges of cocaine trafficking.
You have the right to remain silent.
Anything you say can and will be used Phillip! Officer down! Officer down! I need an ambulance to 2417 North Edgemont, apartment 135.
Tell 'em we're going to Three Rivers.
Look! Dr.
Yablonski! Rock and roll computer game.
-My church bought it for me.
- Ah.
I need the key to your hotel room.
- My room in the Med Stay Inn? - I heard those rooms have 42" flat screens.
- I could crank it up in there.
- Oh.
You know, oddly, I find most transplant patients are not big fans of this game.
It's crazy, isn't it? They don't want to spend what could be their last hours on earth playing "Welcome to the Jungle.
" Is there a heart for me yet? Not since you asked me an hour ago.
Please let me have your key.
Kuol, you can't be alone in my room.
Andy the rock gods are in my soul.
Kiss, AC/DC, Motorhead.
Motorhead? You're Sudanese.
What is up with you? It's a final request from a young man with a severe congenital heart condition, that could cause my death at any moment.
Cancel his heart transplant.
Transplant canceled.
You have both hurt me.
deeply.
Son of a bitch.
He took my keys.
Jackson! I know you're in there with her! I see your car parked out front.
Where is he? Get out! Jackson! Come on, honey.
Come on out.
I don't have my gun.
I just want to talk.
I'm calling the cops.
Hey, go ahead, call 'em.
Jackson! Tell me where he is! Your husband is not here.
Yeah, right.
Okay, Jackson, I lied.
I do have my gun.
I need the police now! There's a woman with a gun in my house.
Jackson! I'm going to count to five.
One, two, three, four What was that? Detective Phillip Lombardi.
39-year-old male, sudden acute onset crushing substernal chest pain radiating through his back.
SOB, diaphoresis, pain at ten out of ten.
He's had four of MS and three nitro sprays, ASA given.
- You okay? - Okay, on my count.
One, two, three.
Now down to five over ten in the rig.
BP 110 palp.
Pulse 120.
Pulse ox 95 on ten liters.
- Non re-breathing mask.
- Thank you.
- You can step outside now, Detective.
- Uh, it's okay.
She's, uh, she's my wife.
Nice to meet you.
Okay, Mr.
Lombardi, I'm Lisa Reed.
I'm one of the ER doctors.
Are you having pain? Real bad.
Hey.
- Andy.
- Hey, buddy.
Did Rena call you? Yeah, she's looking out for you.
Don't worry, you're in good hands here, Phil.
Okay.
Lisa's the best.
Okay, BP's 100/50.
Pulse 130, resps 22.
Okay, let's get Mr.
Lombardi ten liters O2.
And then four of MS.
Metoprolol 15 slow, IV push.
Cardiac panel, repeat EKG, and a portable chest X ray.
Okay, is the cath lab standing by? They've got somebody on the table, but they'll be ready by the time we get him up there.
- Bring that X ray machine over here.
- Hold the X ray.
- Is this a STEMI? - Yeah.
Yeah.
Well let's get him up to the cath lab.
Just going to do a quick chest X ray first.
Let's get him up, please.
He's got an acute ST elevation on the interior lateral leads.
It's a heart attack, and time is heart muscle.
Andy, let's just get him upstairs.
I'd rather have all the information.
And I would rather have him alive.
Look, I see ten of these a week.
99 out of 100, it is a heart attack.
Let's roll him, Lisa.
Someone needs to call my fiancée.
Rena.
Call Rebecca.
- Don't worry, I got it.
- Let's have that X ray - machine back over here, please.
- Uh, Maguire said I want that X ray.
It could be something else.
Don't worry, we'll go fast.
Three Rivers 1x05 Alone Together sync, corrections Okay, let's get you upstairs.
I'll check the X ray.
Andy, don't let me die.
I'm going to dance at your wedding, pal.
Yeah, Maguire's looking for him in the cath lab.
Get him up there fast.
Go, go, go.
We'll get the X rays back in about five minutes, and they'll check for blockage in the cath lab.
How you doin'? I've been a lot better.
I can imagine.
I called Rebecca.
She's on her way.
Okay, good.
Phillip finally found somebody.
I didn't think it was ever going to happen for him.
Did you get my text yesterday about the-the couples counseling? The guy I found, he's supposed to be - he's supposed to be great.
- Yeah.
Um let me think about it.
Of course.
I'm going to go wait for Rebecca out front.
Okay.
Good.
Good morning, Mr.
Boyle.
Look the United Colors of Benetton ad for doctors.
I vomited.
Profusely.
Oh, projectile.
Yes, you did.
On the floor.
Thank you.
You know, we gave you - bags for that.
- I like to be different.
Anybody can throw up in the bags.
This is why none of the nurses want to take care of you anymore.
I've noticed your unending concern for nurses.
If I wore a brassiere, would you pay as much attention to me? Dr.
Lee, would you check the size of Mr.
Boyle's liver? When Dr.
William Foster did this, it didn't hurt.
When my father was treating you you weren't as sick as you are now.
Or maybe your father touched me like I was a human being, and not a ball of pizza dough.
I don't feel liver, but he has ascites.
Oh.
Ugh You threw up here, too.
Yes.
I did.
What now, Dr.
Lee? I'm going to go clean up.
Can you hold out your hands, please? The flapping is asterixis.
It's a sign of advanced liver disease.
You notice that your skin is almost the same color as mine? Do I have to take this? Mr.
Boyle, your liver function is deteriorating rapidly.
Your clotting factors are critically low.
Serum ammonia level is doubled.
I'm sorry.
Handsome Dr.
Lee, what happens as your serum ammonia level rises? As your serum ammonia levels rise, you go unconscious.
You'll fall into aoma, and And within hours die.
My name is Falo Matafi.
I'm the organ procurement coordinator here at the hospital.
You understand your husband is now brain dead.
I learned that on my honeymoon in Puerto Rico.
That's a joke.
Good.
Um Your husband signed his donor card.
Most of his organs were damaged in the accident, but his liver, it seems, can be used to help someone in need.
Where do I sign my consent? Now you have to listen to me.
You know all that, um BS about if you love something set it free? Well, I was lying in our waterbed thinking about all that, and it hit me.
You know, even if you left me cold and you went off with that tramp I mean, that's what she is, Jackson.
I'm sorry, but I saw her shoe collection.
I was thinking even if I couldn't have you well, I'd still wish that you were alive somewhere in this world.
Be free, my love.
I just got a match on a liver for Mr.
Boyle donor is Jackson White.
Mr.
Boyle's going home? Oh, yes! There is a God in Heaven.
Get me the paperwork on it.
Let's see if we should accept it.
Oh, just sayes so he'll go home.
I don't mind treating Mr.
Boyle.
I would rather stick a pencil in my eye.
He's a theater professor.
He's just a little dramatic.
Tell them we accept.
- Miranda.
- Yep? You're going to make the procurement run.
Whoo.
All right.
Let's see.
New York, Chicago West Virginia.
The land of coal mining.
And the first federal prison for women in the United States.
Have you had sex ever? You better behave.
They're going to lock you up.
I know.
All right, guys, let's go.
Not you.
You are going to stay and do Mr.
Boyle's pre-op.
And I am being punished because? You have done lots of procurements.
I think it's time you start treating patients who are not brain-dead.
It's got a whole different feel to it.
Let's get moving.
Mr.
Boyle's critical.
Here's Lombardi's X-ray.
Take a look.
What do you think? Widened mediastinum? Absolutely.
It's not good.
I mean, it could be an aortic aneurysm.
He might be bleeding internally.
They're about to give him anticlotting medication.
We have to stop them.
Tim.
Yeah.
Don't anticoagulate him.
Oh, it's too late.
Already have.
How much anticoagulant did you give him? Full dose just about a balloon in.
Why? What did you see? A widened mediastinum on the chest X-ray.
He has an MI on the EKG.
His aorta could be dissecting and cutting off the flow to his left pulmonary, causinm to bleedbe internally.
and cutting off We need to fluoroscope him.
Take a good look at his aorta.
See if this is an aneurysm or a heart attack.
BP's heading south.
We need to move, people.
Crank up the dopamine drip, hold the beta-blockers.
And guys good call on the X-ray.
Injecting dye.
There it is.
Look at that aneurysm.
His aorta is shredding.
I got to operate before it blows completely.
Man has a ton of anticoagulants in him, Andy.
If you operate now, he will bleed out in minutes.
If we don't operate he's a dead man.
This is Phillip's fiancée, Rebecca.
How is he? He's not having a heart attack.
The main artery that goes through his heart is quickly weakening, and it's leaking blood into his chest.
Well, how bad is it? If we don't operate, the artery will burst, and he'll die.
- Oh, my God.
- So, can you fix it? Not right away.
When he came in, he was given anticloting medicine because we assumed he was having a heart attack.
If I operate now, he'll bleed to death.
Are you telling me that Phillip's going to die? He loves my kids.
We were going to get married.
- No, Rebecca - No, Rebecca, Rebecca, listen to me.
We're giving him clotting factors to help his blood coagulate, but they need time to work.
Once his clotting levels come up a little, I'm going to try a very new procedure.
It's called an endovascular stengraft.
Instead of opening his chest, we go in through an artery, and we fix the aneurysm from the inside.
There's much less bleeding, and it just might work.
Have you done this before? No.
But I've studied it, and I've assisted on several.
Okay.
Sit tight.
Mr.
Boyle.
Good news.
There is a matching liver for you.
I sent Dr.
Foster out now to procure it.
I think this is the first time I've ever seen you speechless.
I wasn't prepared To live a long life? Actually, yes.
Your serum ammonia level is now up to 834.
But if you can hang in there, we can make this work.
Dr.
Lee is going to do your pre-op work.
Uh, I'd rather a resident not oversee my care.
Well, let me assure you, I am qualified to perform You will assure me of nothing.
Mr.
Boyle, this is a teaching hospital.
I don't want Yo-Yo Ma here working on me without supervision.
Residents are always supervised.
And, believe it or not, I run the transplant unit, not you.
Look, if I'm making Mr.
Boyle uncomfortable, I do not have - to do this.
- No, no.
I think the two of you will be good for each other.
Get going on that pre-op work.
Keep an eye on his serum ammonia level, and I will check back in with you soon.
And good luck to you both.
Uh, Wheeling County General has no landing pad, so we have to land on the high school football field.
Welcome to West Virginia, ladies and gentlemen.
Hey, I'm from Indiana.
Don't underestimate the heartland.
We'll impress you.
One minute, okay? Then we need to take him into surgery.
Hey, baby.
They they tell me I might not make it.
Phillip, you listen to me.
You are loved too much to go away from me now.
The boys need you.
You are so so beautiful.
Now you have to stay alive, so you can keep telling me that.
I hate how every moment of my life, I spent doing something stupid instead of being with you.
The kids.
Uh-uh.
We are going to have a lifetime together, baby.
We have to go.
Okay.
I'm going to see you soon.
I love you.
Okay? Oh, Dr.
Lee.
Your hands are so soft.
Your blood pressure's falling.
That's part of your liver failing.
And your accent is almost perfect.
I was born in Detroit, Mr.
Boyle.
Take a deep breath.
You know I'm American.
If you're just trying to get under my beautiful yellow skin, it's not going to work.
Don't challenge me, young man.
You do your worst I can take it.
Let's see.
You wear $700 Barker Black loafers on a resident's salary.
You drive an SLK300 Mercedes.
I can see the parking lot from my window.
You were born of privilege.
And my guess without a cashmere cardigan and a soy latte, you would start to cry.
I have to do a rectal exam.
Roll onto your side, Mr.
Boyle.
Are you going to buy me flowers afterwards? You know, I noticed there are no flowers in your room.
Maybe, if you were a nicer guy, you might have some friends who would send you some.
Are you going to tell me about life and friends now? No.
That is not my intention.
Life is watching your lover of 15 years die of AIDS in a hospital room that you can't get into because you are not so-called immediate family.
I know firsthand about life, Dr.
Lee, so don't you dare tell me why I don't have flowers in my room! We can't get out of here? All the exits are locked.
Oh, my God.
We come all the way to West Virginia for a critical transplant, and nobody thinks to unlock these gates? I'm impressed.
Shouldn't they have sent an ambulance - to pick us up? - Hey, come on.
We can climb the fence.
No.
B-b-bad idea.
Dumb.
We're doctors.
We don't climb.
Listen, I can't.
If I sprain my wrist, cut my hand, who's going to procure the liver? You've got to be kidding me.
They should turn off in a few minutes.
After you.
David, what the hell happened with Mr.
Boyle? I didn't say anything that out of line.
As a doctor, you have got to be above this.
He was making racial remarks.
I don't care.
The earth is shifting under this man's feet.
One minute, he's dying, the next minute, hope's being dangled in front of him.
He gets a big fat flaming pass.
So I'm just supposed to put up with it? Yes.
If you want to be an average doctor, just put up with it.
And what does that mean? David, you have the potential to be a great doctor.
You're smart as hell, you've got good instincts, and you work hard.
But one of the most important things about being a great physician is loving the unlovable.
So you want me to love Mr.
Boyle? Hello.
Hi.
I'm Dr.
Yorn.
I'm head of surgery here.
I'm Dr.
Foster.
Dr.
Patel.
Hi.
Ryan Abbott, Assistant Transplant Coordinator.
Why wasn't an ambulance sent for us? I'm sorry.
Uh, why are you here? Uh, we're the organ procurement team from Three Rivers, Pittsburgh.
We're here for a liver from Jackson White.
Uh, that liver was assigned to my patient, Alan Lang, here at Wheeling General.
I was about to do the procurement myself.
No, no.
No.
I got a call from the OPC, Falo Matafi.
Me, too.
He works here.
Okay.
All right, all right.
Listen, it was There was just a huge mistake.
I'm sorry you had to come all this way.
Um, we have a a very big problem here.
I don't have a problem.
That liver is mine, and as soon as I procure it, it's going in my patient.
Okay.
Listen, you get UNOS on the phone right now.
- All right.
- Hey, don't procure that liver until we get this straightened out.
UNOS thinks one of the OPCs screwed up.
They're figuring it out now.
What? Wait, wait.
What are you doing? If Yorn procures that liver, it will go in his patient within minutes, and UNOS will never order it removed.
Well, we can't physically stop him from operating.
Why not? Oh, no.
No, no.
He's a very big guy, Miranda.
And this isn't our hospital.
He has friends here.
And security guards.
Dr.
Yorn?! Just hear me out.
You are not authorized to be in here.
UNOS is figuring this out as we speak.
It's Jackson White.
He's procuring the liver.
Jackson White's body is beginning to shut down.
I am obligated to move quickly here.
Okay, okay, okay, listen to me, listen to me.
My patient, Mr.
Boyle, may not make it through the night.
And I'm sure you're gonna tell me he's a great guy.
In good conscience, I can't say that, but that's not the point.
I am procuring the liver.
Ryan, get UNOS on the phone right now.
Yeah.
No.
No.
Get out of the way, or I'll call security.
Call security, and somebody remove them - now, please.
- We have a Code Gray, in scrub room two.
I repeat No, no, no.
No.
No.
No.
Get off me! - Oh! - Oh, my God.
Oh, my God.
Whoa.
Okay, okay, it's no big deal, no big deal.
- That looks really bad.
- You know what? Can we not make it a bigger deal than it is? It was an accident.
Let me just Just Here.
Just, come on.
Shh, shh, shh, shh.
- Oh.
- Put some pressure on it.
That's a bleeder.
She broke my nose.
- It was an accident.
- I can feel - the bone move.
- It was a pure accident.
- It was an accident.
It was - Get them off the premises now! Where are you taking us? Miranda, apologize to him! Listen, I'm sorry.
What do you want from me? Here you go.
Thank you.
Sure.
Andy makes such a mess.
I don't even know what Phillip's mess looks like.
He still makes sure everything is neat before I come over.
No wonder you want to marry him.
I want the chance to know his mess.
I want to know everything about him.
You guys are lucky.
You have a history.
You grew up together.
Yeah, that makes it harder.
I know you guys are separated, but I see the way you look at him.
That doesn't mean we're supposed to be together.
Phillip chased me for almost a year.
I don't know what the hell I was thinking, because I could have had that year with him.
Something like this happens, priorities get clear really quickly.
Rebecca, it's not that simple.
Yeah, it is.
You love him, Rena.
He wants things that I can't give him.
If it were all over tomorrow, would you spend your last day with him? You broke his nose?! Are you kidding me?! It was an accident.
Listen they're gonna try to procure the liver before we have an answer.
What did the OPC say? Nothing.
Nothing.
They threw us out before we had a chance to talk to him.
So, you have no ETA? At this point, we may not even get it.
Mr.
Boyle's liver is on the verge of shutting down completely.
Look, I hate to say this, but if Mr.
Boyle's too sick to transplant, then I shouldn't be fighting for this liver.
If UNOS says the liver is ours, I will make a decision then.
Yup, got it.
Okay, bye.
Okay, I'm inserting the catheter through his femoral artery.
Hopefully we can fix this aneurysm from the inside.
There it is.
There's the aneurysm.
I've got to get my catheter past it.
- BP's dropping.
- We're losing a lot of blood.
Let's get another unit of packed cells into him quickly, please.
I'm seeing a run of PVCs.
That's 'cause the catheter's near the aortic valve.
It's irritating the heart.
Lots more PVCs.
Okay, let's ease out for a second.
Let his heart get a constant rhythm so that I can try again to get this stent back in.
Up his amiodarone drip.
Upping drip.
BP is still dropping.
We should stop.
No, we can't stop.
I'm gonna try again slowly.
More PVCs.
I'm almost there.
You should back off.
He could go into cardiac arrest.
Run of V tachs.
Andy, he's in trouble.
Okay, I got it.
I got it.
The graft's in place.
Deploying now.
Let's inject some dye to check for leaks.
Injecting.
Look at that.
The stent has sealed the inside of the artery.
No leaks.
Looks great, guys.
Let's get out of there.
You awake? Hey, how you feeling? I'm dying.
Rudy Boyle, do not give up.
I put my faith in Dr.
Foster, and he died.
Why am I any better? Let me tell you something.
Dr.
Foster was just a man, true, but he built this center, and he taught me to do what he did.
He's still healing you, so you don't give up.
I miss him.
terribly.
So do I.
Oh.
Oh, my.
You loved him.
He was a great doctor.
He was a great man.
Hi.
So, we've got him back in his room.
It's still touch-and-go, but I'm gonna stay with him for a while and make sure the stent holds.
Is he gonna be all right? I'm not gonna know for a couple of hours.
Can I see him? Andy, Lombardi's crashing.
They're moving him back to the OR.
BP hit the skids 60 palp.
Pulse is up to 140.
Graft must have started leaking.
Pam, get me ten units packed cells and meet us at the OR, super stat.
BP's 50/30.
Pulse is up to 150.
He's crashing.
Let me see the post-op X ray, please.
Left hemothorax.
He's bleeding into his chest again.
Prepare for endovascular entry? No.
This time we need to crack the chest.
Prep for thoracotomy.
- He could bleed out.
- We don't have a choice.
Pump in the saline, and give me four units of packed cells on the rapid infuser right away.
- Let's go, people.
- Right away, Doctor.
BP's 40/30.
Pulse is 160.
- Scalpel.
- Scalpel.
Okay, bone saw.
Okay, rib spreader.
Here it is.
Oh, my God.
His chest is full of blood.
Lap pads keep 'em coming.
Faster, more.
More, faster.
Lots, lots, lots, lots.
I can't see the aneurysm.
BP's 40, systolic pulse is 165.
Pam, suction, please.
I see it, I see it, there it is, there it is.
The distal end of the endoluminal graft.
We've got to stop this bleeding fast.
Okay, give me a 40 nylon on a swedge.
I'm gonna do a running stitch.
- All right.
- Need some more suction.
- Suction.
- We're not getting blood into him fast enough.
BP is dropping.
I'm going to reinforce the suture with fibrin glue.
BP is still dropping.
What's going on? Falo Matafi.
I'm the OPC.
This is all my mistake.
Three Rivers was the primary recipient and Wheeling was the backup.
You both accepted the offer, and I I confirmed both by mistake.
I'm sorry.
You tell UNOS about this? UNOS called.
Your guy's MELD score doubles mine, so they said the liver's yours.
We're prepping him for procurement now.
All right, let's do it.
- Come on.
- Dr.
Foster.
What? I am a dynamic eligible bachelor in my dating prime.
My nose is going to have to be fixed perfectly, and you will be receiving the bill.
Won't help.
Hey, Ryan, get that chopper ready.
Hey.
So the aneurysm was repaired.
He's stable, and we're watching him in the ICU.
You can go and see him now.
Wow.
Great.
You know, the Talmud says if you save one life, you save the world.
Well, tonight you saved the lives of one man, a woman, and two children.
Thank you thank you.
You're welcome.
Mr.
Boyle, you're in the operating room.
- You're going to get your new liver.
- You loved him.
You loved Dr.
Foster.
Everybody loved Dr.
Foster.
No, not like her.
It's so sad to lose your lover.
I should know.
He's sedated.
Yeah, he's, he's sedated.
People say crazy things.
Nutty things.
Okay, here you go.
What's up? Imagine her Excuse me.
night after night lying there alone in an empty bed, needing Dr.
Foster.
I think we're ready to put Mr.
Boyle under.
- Oh, yeah.
- What's he saying He's sedated? All right.
Good luck, guys.
You know, I was thinking So I was thinking - You first.
- No, ladies first, come on.
Well, I was thinking about counseling and what you were saying - about that kind of - Me, too, me, too.
I mean, if we change our priorities W-W-W-Wait.
And I'm working on not interrupting you, too.
Andy, what's a counselor going to tell us that you're not a doctor and I'm not a cop? Is he going to give us five more hours in the day? What, you think this is about time? I saw what you do.
You're a rock star.
No, I'm not.
In almost anybody else's hands, Phillip would have died.
You save lives, Andy.
What's more important than that? Having one.
Family, you know, a home.
We have homes.
Three Rivers is your home.
The squad room that's my home.
I have eight great detectives that I spend Christmas with, birthdays.
I mean, when's the last time that you didn't spend Thanksgiving with Pam? Is this is this all because you don't want to have kids with me? I don't want to have children that we ignore.
Would you have them with someone else? Maybe somebody that was willing to meet me halfway.
Is that you? I love you so much, Rena.
I love you, too.
That was never, ever the problem.
Good night, Andy.
Good night.
Andy.
Uh, I had to crack his chest.
You did the right thing.
By doing it in stages, you slowed the bleeding so the clotting factors had time to work.
If you had done a thoracotomy right off the bat, he would have died.
Sometimes, Andy, you have to rip it all apart to fix it.
- Hey.
- Hey.
It was good to see Rena; I miss her.
Yeah, me, too.
Good morning, Mr.
Boyle.
The transplant went well.
Your liver numbers are all good, and you are going to live a very long life.
As the world wept.
What are those? Oh, those are from a secret admirer.
Okay, I mean, after I violated you, I thought it was the least I could do.
Here.
I underestimated you.
I am so sorry.
You are a young man of much substance and grace.
Thank you.
Excellent, you've come to join me.
Turn it off.
I don't understand.
You stole my keys, then you wake me up, Kuol? Why don't you just play in the hospital, play in the common room? But then I would be alone.
Give me the guitar.
Watch a rock star do it.
I don't think you are a rock star, Andy.
Really? My wife thinks I'm a rock star.
What do you think of that? Why do you live here if you have a wife? Well, uh that's a good question, Kuol.
The truth is, I don't think I have a wife anymore.
Dr.
Yablonski? Hmm? Let the rock gods soothe your troubled soul.
Thank you very much.
Watch this.
("Mississippi Queen" by Mountain playing) This is awesome.
Mississippi Queen Hey, Kuol.
Yeah.
I think you should leave this here in my room.
I don't think so, Andy.
Do you want a heart? That's not fair.
sync, corrections