Hey, guys, I have an emergency at the hospital.
Whoa.
"Lights and Sirens?"
This is Dr. Alex Panttiere.
I have an emergency operation at St. Matthew's.
I need "Lights and Sirens."
Whoo. And I need hugs and kisses.
Come on.
- Thank you, guys. - You got it.
Hey.
You used "Lights and Sirens" to get here?
Mr. DeLuca needs surgery.
Mr. DeLuca's having a lung biopsy.
He's hypertensive, and the OR had a slot open,
so I rushed over here.
That's how much I care about my patient.
Yeah, and that's just how much you care about your car.
Okay, it's the only way I can blow her out on the road.
0 to 80 in 6.4 seconds,
and I brought you pretty firemen to look at.
Synced and corrected by VitoSilans - www.Addic7ed.com -
Now, Mr. Cecil, I don't want you to worry
if you feel a few twinges in your groin
where I stitched you, okay?
That's normal after surgery.
I'll check on you in a little bit.
I put in the room with the pretty nurse.
I like one with a big booty
and broad shoulders.
Let's not pop your stitches.
I'm not dead yet.
Ah, I love the smell of lung burning
first thing in the morning,
but a wedge resection at the periphery
is so by the book.
I heard that someone at Loyola University
got to do a percutaneous valve in valve procedure,
but I'm not complaining.
Oh, come on, you always complain.
You're usually on auto-complain, Pants.
Now, is it so terrible
to want the occasional Pancoast tumor?
Where's my...
Or a stab wound involving the subclavian artery?
Hmm.
I think I have MRSA.
Ew.
- It's a rash. - Please don't tell us where.
I think I got it in South America
when I was volunteering for Doctors Without Borders.
Sounds more like Doctors Without Condoms.
It's not an STD, and it's not contagious
unless you have skin-to-skin contact.
Okay, if your zeezee falls off, call me.
You know, you're gonna need a course of teicoplanin IM,
and those really, really hurt.
You're right.
MRSA's only contagious if it's transmitted through saliva or,
um, sexual contact.
If you want teicoplanin, the CDC will require a screening
of everyone you've had, um, um,
skin-to-skin contact with over the last six months.
My zeezee is fine.
Please don't talk about your zeezee in front of me.
Hmm, a Klatskin tumor
with reconstruction of the portal vein.
Okay, how the hell do you do that?
You have a blob of bile duct on your shirt.
Oh, you're so lucky.
- Ah, good morning. - Hey, Dr. Harrison.
Hey, David, Marty.
Lynn, how's the cold?
Oh, it's all better, Dr. Harrison.
- You know their names? - Yeah.
- You know they have them? - Yeah.
Birthmark, Protein Shake, Hair Extensions.
I'll... I'll see you at home later.
Home? My home?
Yeah, of course my home.
I'm sorry, did that throw you off, girlfriend?
No, no, no.
I mean, most of my stuff's still at my place,
but I can come grab my toothbrush
- unless you can handle it. - Oh, oh, bring it on.
I like being at your house.
I like being with you and the boys, unless...
Oh, you like Max's food.
He's an artist in the kitchen.
Babe, I'm bored.
You want to have sex?
You're using me for sex because you're bored?
Yes, I'd love to have sex.
It's Mrs. Lawson's liver.
Oh, I can't compete with that.
End-stage cirrhosis.
You're just saying that to make me jealous.
Aw, you guys are so cute together.
- Hmm. - It's nauseating.
Dr. Shane said to give this to you.
It's a new patient he wants you to handle.
All right, you.
I asked for Mr. Perry's labs an hour ago.
I want you to call your parents
and tell them they wasted their money
sending you to medical school.
It wasn't me, Dr. Shane.
Uh, and you can do exactly what I told her.
You're doing great.
- Dr. Shane. - You got the file.
- Great. - Yeah, you know what?
I've actually been getting referrals for patients
all by myself for years now.
Patient's presenting
with severe pelvic pain and night sweats.
Yeah, yeah, yeah, you're chief of surgery,
but I think I still control what patients I take on.
Well, of course you do, Alex.
- ♪ Worry ♪ - Emily, just sing.
You know it'll calm you down.
♪ Why do I let myself worry ♪
♪ Wondering what in the world I do? ♪
I'd like you to meet your patient, Beth,
and that's her sister, Emily.
- ♪ Crazy for thinking... ♪ - ♪ That my... ♪
♪ Love could hold you ♪
But you don't want the case, so...
♪ I'm crazy for trying and crazy for crying ♪
♪ And I'm crazy for loving you ♪
Whoa.
So, Beth, you've been feeling nauseous
and having night sweats?
And Emily, have you experienced
any of the discomfort your sister's having?
- I'm the healthy one. - Ah, not entirely.
You get short of breath when I'm not doing all the work.
Want to hear a Siamese twin joke?
Uh, sure.
I'd like to hear your heart.
Man walks into a bar and says,
"I was dating a Siamese twin for a while,
but then I got bored."
Bartender says, "So what'd you do?"
"Starting dating her sister behind her back."
Ba-dum-bum. Emily got the sense of humor.
- Beth got our spleen. - We share it.
Oh, that's good to know.
Okay, can you show me where the pain is in your pelvis?
It's right...
Wait.
Oh, that better not be Kathleen.
Emily, she broke your heart.
She has the worst taste in women.
You have the worst taste in men.
Yeah, we can't totally see each other's faces,
so if we want to fight, we FaceTime on our iPads.
Okay, you were just about to show me
where the pain is in your pelvis.
- I'm sorry, it's right... - Ooh.
She's faking.
We don't feel each other's pain.
We have separate nervous systems.
Emily, you're not experiencing any of the symptoms
your sister's having?
No, I feel normal.
I'd like to run tests on both of you.
- Sure. - Sure.
What do you think is wrong with Beth?
I don't know. I'll find out.
Group hug.
This is weird.
Yeah.
Hey, you're quiet back there.
Why'd the Siamese twin move to England?
So the other one could drive.
Ba-dum-bum.
I like a girl with thick ankles
and a little hair on their face.
Um, what is...
- It's the women, yeah. - Who slept...
- Mm-hmm. - With Callahan?
Fun, huh?
Lights had to be out.
MRSA can be transmitted a number of ways.
Bacteria in the water,
lack of sanitary conditions.
Um...
did he tell you he was dying?
Is this some kind of Make-A-Wish situation?
No.
The CDC requires us to test each of you for MRSA
and complete the questions on this form.
Do you want us to check your vision while you're here?
Can you see my hands?
What was the date, you know,
you had sexual contact approximately?
- November 26th. - The exact date.
Did he tell you he was dying?
Was the intercourse...
The most romantic, amazing night of my life?
No. Vaginal.
- No. - Okay.
You know what?
Maybe you can actually fill this out.
It's just fascinating.
We had a pair of conjoined twins born in Cleveland Clinic.
I was part of the team that worked on them for 20 hours.
They nearly didn't survive.
They... they rarely do.
One of them goes to church, and the other is a Buddhist.
They're not even registered for the same political parties,
and Beth told me that when they were in college,
Emily played Evita in their spring production.
I don't know how they did it, what life must be like for them.
Well, superficial differences in intellect, personality...
No, on the contrary.
They're very much individuals
who have probably struggled all their lives
to find personal identity.
Right, but they still had to learn
to regard themselves as a single living organism
rather than two separate human beings
in order to survive.
I mean, they share a liver.
And a spleen,
but look, they have separate hearts, lungs,
and reproductive systems.
I mean, they could each have children at the same time.
Lab results came in.
Beth has a cancer,
and her sister doesn't.
All right, look,
I know it's been a long evening, but this is a unique case,
and there are medical and ethical considerations
involved that the Bio-Ethics Committee will rule on,
so we have to make some recommendations.
I recommend we stop catering to that committee.
They're a conservative bunch of...
Not helping.
Beth has stage three leiomyosarcoma
in her retroperitoneum.
Look, there's no signs of metastasis,
but the tumor has to be removed.
It's encasing her inferior vena cava,
she's got compression,
and it's decreasing blood flow back to her heart.
So I assume removing the tumor presents complications.
Yeah, because we'll have to follow up surgery
with an aggressive course of chemo and radiation
to fully eradicate the cancer.
We did do a pharmacogenomics,
and it will only respond to doxorubicin.
How will that affect the other twin?
Emily has class 3 heart failure.
That's why she's always out of breath.
Doxorubicin is a cardiotoxic.
It's gonna tip her into end stage heart failure.
That'll kill her.
And if we don't operate?
Beth's gonna die from the cancer.
And then so will her sister.
The remaining body of a conjoined twin
can only survive a few days if the other one dies.
She'll die of sepsis from her sister's decomposing body.
You cure one, you kill the other,
and then they still both die.
That committee will never let this hospital
operate on those two women
unless there's something in it for the hospital
to benefit from, like a bit of PR
about performing a separation on adult conjoined twins.
Oh, is that possible, separation?
We could in bring that team from UCLA.
You could safely separate them, though?
- Yeah. - Yes.
Not necessarily.
We're talking about separating them physically.
What about emotionally, spiritually?
These two women have a bond
that no one in this room can comprehend.
A separation could save their lives.
Maybe, but you have to wonder
why they never considered this before.
Because their lives didn't depend on it until now.
Speaking as a psychiatrist, I would suggest
that we make sure that is absolutely true
before we force them to face the decision.
They are extraordinary human beings.
They live in their own private world
that we are not a part of,
and no amount of technology will truly allow us in.
They can understand death, but will they be able
to understand living without each other?
_
Do it over.
It's three layers below the skin.
- No chance of dehiscence. - Everted.
There's a slipknot there.
- Another one there. - What?
You need a vertical mattress stitch
with an incision like that.
Don't get sloppy on me.
I'm on hour 27.
Yeah.
No one cares, freshman.
We're not gonna talk about last night?
No, we're not.
Oh, you're acting like I attacked you.
Because you did.
You didn't stop me, and I wouldn't make a move
if you weren't sending me mixed messages.
You're always sending me mixed messages.
Like this. You see this?
This right here?
That's a mixed message.
Well, I guess it's mutual, isn't it,
this mixed message thing?
I'm not giving you mixed messages.
I want your ass, Shane.
Well, get in line and take a number, Panttiere.
Oh, please, you want me too.
Right?
I'm your superior, Alex.
You ask me to help you, and I will.
So you're denying we have any sort of connection.
Oh, I'm not denying anything, but I'm not that guy.
I'm not the one you want me to be.
My work comes first.
Always.
I'm glad I worked that out before I met you.
Terrific.
Well, it'd be very easy to forget that.
To forget who I am,
but I'm probably gonna take this job in Cleveland.
What?
And you can't afford to make
mistakes like that when I'm not around.
You're serious?
You're leaving,
and this is how you're telling me?
Alex, the minute I'm out of here,
my colleagues will do everything in their power
to kick you down as hard as they can.
You're the girl who wants to be a cardiothoracic surgeon.
You want to be part of that fraternity?
I can handle myself.
When I'm here to protect you, maybe.
I got here all by myself.
No more horizontal stitches.
Vertical.
Do it over.
I can survive without you, Dr. Shane.
You're dreaming, Panttiere.
You're my hero, Callahan.
The love doctor is in.
I have to do my first injection.
And I care about that because?
I hate shots.
And I care about that because?
I don't want to give it to myself.
Chicken.
Roll up your sleeve.
You know that's not where it goes.
It is if I'm injecting it.
I have a gastrectomy in a half an hour.
Please.
Fine.
Go.
Be gentle.
The needle's long. The fluid's thick.
It's gonna hurt like hell.
I care about that because?
Is that a tattoo?
It's a poem by Ralph Waldo Emerson.
Hey, you want to read it?
No, I'm not into poetry.
I am.
I really like it.
Been reading a lot of Langston Hughes lately.
"Out of love, no regret,
though the return be never."
Wait, so if you... you take out my tumor,
the chemo could hurt Emily?
If you can take it, I can take it.
Well, actually, Emily, the chemo we'd give Beth
could seriously affect your heart condition.
And that's our only option?
No.
We could perform a separation.
You're recommending a separation?
It would allow us to operate on you without hurting Emily.
We'd bring in a team of experts who'd perform the procedure.
Our mother was a very simple woman.
She was a peach.
If she could have sold us to the circus, she would have.
She had her good moments, Emily.
She told us when we were born,
the doctors said they couldn't separate us.
Which was a lie.
She believed we were God's wish as we were.
We used to talk about what it would be like to be separated.
Remember when we went to Cabo and those guys at the resort
wouldn't let us go parasailing.
You made them take us up.
When we were in the air and all the people on the beach
were pointing at us,
it felt different to be flying next to you.
For one moment I couldn't feel you.
I could only feel me.
You want to make me half of who I am.
I want you to live.
This is who nature intended us to be.
It isn't natural to you, but what you are
isn't natural to us.
We wouldn't be surviving apart.
We would be dying alone.
No.
No separation.
You might not survive without it.
Then we'll die together.
- Hey. - Hey.
So Millicent said we have to wait
for the Ethics Committee to decide what we can do,
and she said she doesn't think they'll respond until tomorrow.
She doesn't know if they'll let us remove the tumor
without the twins' consent for a separation,
so it's a...
Jeez.
Oh. Hey.
Oh, don't call them over.
- Hey. - Hey.
Hey, um,
can we have four shots of your best tequila please,
and by "best" I mean "strongest."
I'll just have a coffee. Thank you.
Bottle stays with me, all right?
I'd like to see you finish that.
Listen, babe, my mother's British.
My father's Goan.
I was raised on 90-proof n aughty water and Sura,
which is what they used to give patients
before there was anesthesia.
I'll drink you under the table anytime.
If I'd had known that about you
when we were interns, I would have liked you
so much more.
- Cheers. - Cheers.
Cheers.
You gonna drink that?
It's all yours.
♪ You're crashing into me like waves on the coast ♪
♪ Every time we talk, you move in close ♪
Alex, you're leading.
Oh, I'm... I'm... I'm sorry.
Come on, let's go home.
Home? My home?
Oh, yeah, of course, right.
Yeah, well, I can drop you off at your home
and then drive to my home.
Pierce.
We don't have to spend every night together.
We don't spend every night together.
- Huh. - Yeah, huh.
♪ We're buzzing like that no vacancy sign out front ♪
♪ Your skin is begging to be kissed ♪
Ah, so, my dad called.
Oh, is he still in London?
- Yeah. - Great.
Of course he asked how you're doing.
Did you tell him I'm happy to be back?
I did.
He made your life hell, didn't he?
Oh, my God, he still does.
"What are you doing, Millicent?"
"Um, I'm COO of the hospital, Dad."
"Uh, no you're not.
You're a paper pusher, not a real doctor."
Is he still banging on about that?
Yeah.
Fine, I suck with change.
Yes, you do.
But I'm working on it, Harrison,
and I'm getting used to you being around,
and I even kind of like it,
and if there is an Olympic category
for what you did to me last night,
you win the gold.
I think it was more of a synchronized event.
I know you came back for her.
Whatever it is you're thinking...
don't.
That's it.
I'll have one more, and then that's it.
Cheers.
- Cheers. - Yeah, cheers.
Ah, come on, come on, come on.
Are you kidding me?
Uh, hi.
Hey, Mama!
We missed you.
Yeah, Mom's home.
Your boyfriend called.
He'll be here in ten.
What are you doing awake?
Oh, man.
We're done.
- Hi. - Hi.
How'd the algebra test go?
- I aced it. - You aced it?
- Yeah. - Go to bed.
Cartman, take him to bed.
Let's go, boy. Come on. Cartman.
Whoa-ha, ha-ha-ha!
He's awake too?
Oh, my God, you guys are mental.
- Hi, Mom. - Hi, baby.
You stink.
Shower.
Good night, Daddy.
Yeah, get to bed, mister.
Yes, sir.
Oh, now you say... oh, yeah?
Mr. Discipline?
That's me.
With an iron fist.
Or is it steel?
Are you going back to the club to see Bryan?
- Hmm? - Yeah.
Is that a new tattoo?
We got matching ones.
Oh, my God, that's so cheesy.
Whatever.
Did you ever feel like when were together
that you couldn't live without me?
Nope.
Wow, well, you really had to think about that one.
I loved you desperately.
Still do.
But you never felt like if I died,
you wouldn't want to live?
No.
Neither did I.
What brought all this on?
I'm just wondering what it feels like
to be so connected to someone
that you couldn't live without 'em.
Can I help you?
Follow me.
_
- Oh. - Mm.
_
Callahan?
_
I knew it.
Alex.
The Ethics Committee have refused to allow
the hospital to take Emily and Beth's case.
Unless they consent to a separation,
we can't operate.
It's just... it's... it's too great a legal risk
to the hospital.
I'm so sorry.
Hi.
Hmm, so you've heard.
I'm so sorry.
I want to help.
Make my sister's cancer go away.
Beth, you need to have that tumor removed.
I can set something up for you over at Loyola.
They're running medical trials
for people who can't tolerate chemo.
Beth? Beth?
What's happening?
Beth, what's wrong?
Weak pulse, she's hypotensive.
Get me a bag of LR!
Beth!
What's happening?
What's wrong?
What's wrong? Somebody tell me!
What's happening?
You start an I.V.
Oh, God.
Those are my patients in there.
Who need me to do their ultrasound.
Beth has stage three leiomyosarcoma,
and Emily has class 3 heart failure
with diastolic dysfunction.
Crap.
Okay, Emily... Emily's so scared.
I should be in there with them,
and how can you tell me that asking them for a separation
is some sort of an amoral disregard for who they are?
I don't believe I said that, Dr. Panttiere.
And you don't think that I respect how difficult
it'll be for them if they're separated.
Your patients have already decided
what they want to do, Dr. Panttiere,
and the only one grappling with this decision is you.
They have a chance to live.
Okay, you have a point, but at what cost?
I mean, yes, they may never adjust to being separated,
but... but what if they do?
Well, I think you've already made your decision, Doctor.
But why does it feel so hard?
Because there isn't a right answer.
Yeah.
Thanks.
I'm going back in.
Dr. Panttiere!
We did an ultrasound,
and it is as we suspected.
The tumor is compromising
the blood flow back to your heart.
Is Beth gonna be okay?
No, she's not.
She has a tumor that has to be removed.
So we'll go someplace else, and we'll have it removed.
- It's not that simple.
We can resect the sarcoma,
but you will likely die from the chemo
if you remain joined.
You have to have a separation.
- Oh, are you serious? - Yes.
Beth, if I thought there was another way,
but your cancer is advancing,
and it will metastasize to your sister.
- Yes. - What?
Yes.
I consent to the separation, Emily.
Hell if I do, Beth.
I don't know how you feel.
I don't understand.
No, don't even try.
I can't even begin to imagine
how frightening this is for you two
to figure out who you are without your sister,
but you will be with your sister
throughout all of this.
I'll get you a psychologist.
Damn it, Emily, your sister is going to die.
I cannot even begin to describe the type of pain she's in,
but I can show you.
The pain is only gonna get worse.
Yes.
Trust me.
I'm sorry.
I'll be here when you wake up.
I don't want to wake up.
_
First shift is over!
Okay, team one, get some rest.
You're up, Doctor.
Who are you?
Dr. Panttiere.
These are my patients.
Emily has class 3 heart failure
with an ejection fraction of 20%.
Her hemodynamics need to be micromanaged.
We have a TEE in place.
We'll keep tabs on her.
Just stay out of my way.
Yeah, like that's gonna happen.
Okay, people.
It's going to be a long night.
_
Second shift is over.
Ma'am.
Emily has class 3 heart failure
with an ejection fraction of 20%.
Thanks. Suction.
You're welcome.
_
Third shift is over, Doctors.
More suction.
You're not gonna replace the hip?
Clamp.
How is she gonna walk properly?
- More retraction. - I'm sorry.
You're gonna leave it up to what, cowboy?
- Some Zumba lessons? - Get her out of here.
Right.
This is my OR.
Don't you hold the record for being
thrown out of the most...
I think we're ready.
One, two, three.
She's got a septal shift.
Someone look at the monitor.
Emily's heart's decompensating.
Someone look at the monitor.
Look. Look!
I think Dr. Panttiere's trying to tell you something.
Now what?
Look at the echo.
Look. Look at the echo.
Bolus her with milrinone and chase it down with Bumex.
Yes, Doctor. Right away.
Increase her dobutamine to ten MICs.
Her heart's decompensating.
Her right ventricle is dilating.
Are you boarded in cardiac surgery?
Because I am.
I'll deal with the cava.
Santinsky.
Thank you.
Suction.
_
Who are you,
and what are you doing with my cadaver?
I'm Dr. Harrison,
and Mr. Cardelini is my patient.
Nice job.
He had a pulmonary embolism post-op.
You a liver surgeon?
Yeah, it's my first week here.
Okay, freshman, this is my cadaver.
Mr. Cardelini is the first death we've had in a week,
and I need someone dead to demonstrate on for my interns.
Okay?
Hmm.
Zero eversions.
Oh, but the stitches are too far apart.
Sloppy.
And you use vertical stitches on an incision like that.
- That is old-school thinking. - I was taught by old school.
Weren't we all, but we leave that behind.
Stitch him up, freshman.
I want my body in perfect shape.
Don't.
- I don't even know your name. - You don't need to.
- Don't be so sure. - Excuse me?
What if I end up being the guy you can't live without?
Hey.
Emily.
Emily, Emily, wake up.
Wake up, Emily.
Emily.
Emily?
I can see your beautiful face for the first time.
I was right.
I am the pretty one.
These are all the questionnaires
of those women we had to test.
Oh, just leave 'em. I'll handle it.
- Serious? - Yeah, go home.
- Oh, I love you, thank you. - Go.
Oh, and here's that book you ordered on Langston Hughes.
- Thanks. - Okay.
- Yeah. - I'll see you tomorrow morning.
- See you tomorrow. - All righty.
All right, I still have a little work to do.
I want you to take an Uber, all right?
You're too tired to drive.
- Good work. - You too.
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