Sync & corrections by Rafael UPD www.addic7ed.com/
Watch your back. Just stay with us, man.
Coming through!
Attempted suicide, single vehicle, telephone pole.
Starred windshield and bent steering wheel.
Still got a pulse, but weak. Let me see.
Raccoon eyes.
Probably a basilar skull fracture.
What did you say happened? Tried to flatten her sedan into a telephone pole...
No skid marks.
Attempted suicide by car.
Bullshit.
She just had a bomb go off in her head.
Let's get her on the ventilator, get her more fluids.
This was no suicide.
- Call Wilson. - Yes, doctor.
It's very serious. I won't kid you.
Your daughter's in rough shape. Well, what are the odds?
The odds improve with Ty Wilson doing the procedure.
There are about five brain surgeons
the rest of us in neurosurgery aspire to be.
This doctor is one of them.
♪ Uh-huh ♪ number 3, please.
Here you go.
Give me that penfield.
♪ Uh-huh ♪ well, what's her story?
Schoolteacher. 25, no prior history.
Have you found the aneurysm? I will.
Here you go.
♪ Some folks just have one, yeah, others they got none ♪ thanks.
Help you, sir?
Yeah, I thought you might be interested
in some new state-of-the-art scopes. Yeah, we're fine.
Okay, but I think if you try them, doctor... not a good time.
I need you to leave, sir. Now.
Sure.
I'll, uh, just come back at another time.
Great.
Remind me never to cross you, Dr. Ridgeway.
Gotcha.
There it is. There... pushing down on the oculomotor nerve.
You see that? Barely. Straight clip?
Uh, fenestrated.
All right. Let's see how we do.
She's gonna be fine.
We clipped it off. We expect a full recovery.
Oh. Sheila will be sedated through the night.
I recommend you all try to get some sleep.
I'm gonna be here all day tomorrow, and we can talk.
Thank you, doctor.
Mrs. Sutcliff. Look at me.
Your daughter will be fine.
Thank you.
I don't want anyone touching me!
This is a racket, if you ask me.
You give me one pill after another one,
after another one, after another one.
I've been up in here five times already!
Everything okay? Not for me, it isn't.
I think you people all want me to die.
Is that it?
We actually don't, ma'am.
In fact, we've implemented a new policy
where we now want our patients to get well.
Oh, you think this is funny?
I will jump out of this bed and crush you like a little bug.
What's going on? I got me a damn phlegm rattle in my chest.
She first arrived three months ago with headaches and a persistent cough.
They did an h&p, suspected it was a viral infection, and discharged her.
Then she came two weeks later with a fever. This is supposed to be some great hospital.
She was prescribed Amoxicillin, Bactrim, codeine.
Back again a month later, diagnosed with bronchitis.
That's what I'd like to see. And now she's here for shortness of breath.
Who's the attending? Lieberman.
Weren't you supposed to be getting engaged tonight?
Sorry, there... there... There... there was a rumor.
Yeah, well, maybe you could be less curious about my social life,
a little more so on this patient's condition.
Find out what tests were ordered,
see if she was exposed to any airborne irritants
or toxic chemicals, then contact the attending.
Yes, ma'am.
Dr. Ridgeway.
Hey, buck.
I'm sure you did get the directive
affording instrument reps access to the O.R.
Yeah. I did, buck. Thanks.
Don't you be snide with me.
The fact is these reps know as much if not more
about the devices we implant than we do, and...
They also influence the surgeons, and not for the better.
What surgeons? Name one surgeon.
Sy Greenberg.
Last year, a rep told him during a TKA
to shave a little more bone off the tibia
so his high-tech prosthetic would fit.
That patient can barely walk now. Well, hey, Dr. Wilson.
How interesting to find you in bed with Dr. Ridgeway on this.
Is there a problem? Yes, there's a problem.
Dr. Ridgeway rudely expelled
a manufacturer's rep from the O.R., which just jeopardizes
our very valued relations with Barton devices.
Yeah, the same company, it so happens,
that's paying for Dr. Tierney's heart and ambulatory wing.
I resent your implication.
Dr. Ridgeway, I appreciate your concern,
but the matter was put to a vote,
which authorized the reps to be present.
Excuse me? I didn't vote. Neither did I.
Well, it seems I did.
Room 311. Morbidity and mortality.
Who for, do we know?
I didn't kill anyone this week.
You? Not me.
Buck, you didn't kill anybody this week, did you?
You want to check your notes?
It's 007.
Dr. Martin. Yeah.
Why call Ty for aneurysm, huh?
Discriminate. Sorry to hear that, Sung, baby.
All right. Let's get started, Uh, wait.
Can I have the floor for one brief second, please?
I implanted a pacemaker this past week on a man
with severe cardiomyopathy as a result of Chagas' disease.
Good for you. Listen... We are seeing a lot more diseases
once reserved for the third world and tropical climates.
Thank you, doctor. We now have a patient, Joanne Whitman.
She has been in five times...
Come on, doctor.
Hey! You know what?! Forgive me for caring. Shoot me.
Oh, okay! Bang! There's an idea.
Settle down.
Come on.
Dr. Martin.
Let's talk about Mary Michaelidos, shall we?
Please.
Mary Michaelidos, age 39,
presented on August 12th with soreness of her left hip.
She was an avid runner, 30 Miles a week.
I thought the hip irritation was due to all the running.
I prescribed 1,000 milligrams of extra strength Tylenol
until the pain subsided.
Did the pain subside?
Well, I didn't know. I... didn't hear from her.
The next I saw her was on, uh, December 19th.
She was in the E.R. with a broken hip.
From all that running?
No, sir.
I ordered an MRI with contrast,
which revealed stage iv bone cancer.
Doctor, that first time you saw her,
did you do a full physical examination?
Did you order any x-rays?
Blood work?
No, sir.
Did you do anything other than prescribe extra strength Tylenol?
In retrospect...
"In retrospect."
We all so love to separate the conjoined twins, don't we?
Rebuild the shattered faces,
but sometimes it's the little things.
Isn't it, Dr. Martin?
This is what can happen when you let
a runner with a sore hip limp out of here
without a second thought.
You allowed metastatic cancer
to run amok for four months.
So, please, tell us.
How does this particular fairy tale end?
Ms. Michaelidos was admitted to the I.C.U. On December 19th,
aggressive cancer treatments were started immediately.
She died yesterday.
Three weeks from diagnosis.
Yes, sir.
Dr. Martin, you're affectionately known
among your peers and colleagues as "007."
Do you know why that is?
Please tell us, doctor.
I believe it has something to do with...
License to kill.
Hmm, that's not a very nice nickname for a surgeon,
is it, doctor?
I shall be recommending to the board of this hospital
that your medical privileges be pulled immediately.
You're excused, 007.
Any further conversation in this room you shall not be privy to.
That's it?
Is that it?
So, he can kill people
as long as he does it at a different hospital?
You're out of line, doctor.
There's at least three people that we know of
who might be still alive if it wasn't for this hack.
And everyone in this room is feeling sorry for him? Gato.
"Mary Michaelidos, 39, beloved wife of Stephen Michaelidos,
"beloved mother of Eric, 10, Darren, 8,
"and little Danielle, 6,
"who adored her mother's everyday kindness,
"beloved daughter of Frank and Martha Kelly,
"who couldn't have prayed for a daughter
as loving, kind, and beautiful as their Mary."
They should have prayed she got a better doctor!
Dr. Villanueva! I've been paged.
What's all the fun in here?
Oh, this is Quinn McDaniels,
future Olympic soccer star, and his mom, Allison.
Hi. Dr. Villanueva.
How you doing, Quinn? I'm fine.
Quinn had a head-to-head collision in a game last night.
He was having some headaches,so his mom brought him in just to be safe.
Okay. Got it. Now look straight head.
Geez, I'm seeing ice cream in those eyes.
Mm-hmm. Are you feeling okay, buddy?
I feel fine. Good.
Walk with me a sec?
We ordered up an MRI, mainly as a precaution.
My God.
I couldn't believe what I was seeing.
Well, it's got to come out, obviously.
The mother's outside.
A brain tumor? In his temporal lobe.
It's very large and my fear is it could be malignant.
Oh, my God. Ms. McDaniels,
if we don't operate immediately, your son is at risk to die.
I don't mean to be so abrupt, but we cannot delay.
I won't know exactly how serious it is until I get in there.
In the meantime, we'll get some more imaging studies,
and I need to get any relevant history from you.
When would you operate? Now. This morning.
I have done every test known to man.
There is nothing left. Well, you can't just discharge her.
I'm sorry, but aren't you a surgeon?
Meaning what? I should stick to my own patients?
Seems I should worry more about yours!
And that makes it official.
You are the most obnoxious person I've ever met.
You two are giving me a truckload of confidence right now!
Hey. You paged me? I did, actually.
I was wondering if you would take your rogue pit bull
back to the surgery kennel.
Excuse me! What did you just say?! Syd, come on.
No! He paged you? Come on.
I'm not wrong, Tina.
That woman just keeps getting sicker while that hack sits on his ass.
Oh, I take it it did not go well last night.
That has nothing to do with this.
Syd, what happened?
Nothing, it was a normal date. We had wine, food,
he gave me a diamond ring, took it back, and I went home.
Whoa, what was that last part? I went home.
Before that. He gave me a diamond ring.
Oh, my God.
I got a page while he was proposing.
Evidently, he hates it when that happens, and, uh...
We broke up.
You broke up?
It's no big deal. Oh, honey.
She's been this way almost two years.
It's like she's possessed by the devil.
I can't write. I can't... drive.
She's been tested so many times, but no one seems to find anything.
It's God. He's punishing me for some reason.
Oh we know he works in mysterious ways, doctor,
but... we also feel we've been sent to you for a reason.
Do you have a relationship with Jesus Christ, doctor?
No. You want God, go to church.
Come back when you want to talk about facts.
There's no call to be rude.
Not rude. No God here. You go.
You want facts? Okay, here's a fact.
It stops when I drink wine.
I don't normally partake in alcohol,
but it stops when I have wine.
Don't drink alcohol normally? No, sir.
Depression medication? No, sir.
Tremors when sleeping? Yes, sir.
Do you think that y... Quiet!
Thinking.
Okay, Quinn.
You may feel a little pressure as we drill, but no pain.
Is it big, the drill?
Not too. Here it is.
Here. Tiny little bit there. You see that?
Yeah.
It won't hurt at all, I promise.
Vitals are stable.
All right. All set?
Yep. Okay.
A 10, please. Here.
Ms. McDaniels?
I'm Harding Hooten.
I'm the chief of staff here at Chelsea.
Oh, there's no news yet. They've only just started.
You know...
One of the things they don't teach us in medical school
is how to talk to a parent
whose child is undergoing major brain surgery.
I can tell you that Dr. Tyler Wilson
is not only one of the best surgeons in the world.
He is also a committed and compassionate doctor
who will treat your son as if he were his own.
Would you like me to stay here for a bit?
What else? You need know.
Beta blockers. Guessing!
Benzodiazepine. What else?
Need know... What difference between
intention tremor and essential tremor?
Intention tremor is
dyskinetic movement during voluntary movement.
Etiology? Cerebro-cerebellum.
How treated? Well, medication is the most comm...
My daughter could tell that, huh? She 5!
Isoniazid, ondansetron, Propranolol, primidone...
Not effective. What surgical?
Deep brain stimulation?
That the way you talk to patient? Hmm? Asking?
Like a foreigner... "Where is rest room?"
I thought DBS was a last resort.
Thought wrong!
Okay. Let's resect it.
Irrigation. Here you go.
Right here.
What is that?
Okay, suction. Irrigation.
You okay, there, Quinn?
Yes.
Blood pressure's dropping. Put him out.
Irrigation.
He's out. Let's get him intubated.
- Keep that suction going. - Through the cords.
Pull out. Hook up the vent.
Heart rate is still climbing.
Gelfoam.
He's throwing PVCs.
Come on. Come on. More gelfoam.
We've got three transfusions going. Why the hell won't he clot?
He's going into D.I.C. I got the page. What do you need?
I got a bloodbath here. I need more hands.
Okay. Transfusions? We're up to three.
He's going into v-fib.
Give me the paddles.
Right here.
Pressure's still falling. It's charged.
Hang another two units. Clear.
Hanging the unit on the rapid infuser. Damn, it's still v-fib.
Again. Clear. Charged.
Clear.
He's in asystole.
Chest tray! Get out of my way!
Come on! Keep up! Chest tray!
Nurse! Give me the knife. Give me the 10 blade.
Come on! Come on, Quinn!
Don't leave me now, Quinn! Come on!
Come on, Quinn!
Come on!
Come on.
Ty.
No. No. Ty. He's gone.
We need to call it.
Time of death, 11:47 A.M.
Ty.
I need to go talk to the mother.
No, hold on. You can't go out there like that.
Go shower and change first.
Yeah.
I'll be awake while you're poking around my Brain?. Only way do.
I find exact part of brain cause problem.
And you've... You've done this before?
Once. How is that patient doing?
Dead.
How soon could we do it?
Wait. Wait, wait, wait, wait. No, no. Honey.
Did you not hear what he just said? I don't care.
I want these things to stop as soon as possible.
I know. I know. I know that... I... doctor?
What's the worst-case scenario?
Dead. Always, dead worst-case.
You okay?
Ty, we all lose them.
There was no chance. It was everywhere.
Is he okay?
I'm not sure.
I'm sorry. He didn't make it through surgery.
I'm so sorry.
The, uh, tumor was just...
I know.
You did all you could.
This must be so hard for you.
Tried to keep dinner warm. It's in the oven.
Oh, thanks.
I was called to the O.R.
Ah.
Wake up! What's your name?
Dr. Ottobrini. I'm Dr. Sydney Napur.
I want you to order up a lung scan or a C.T. angio
for a patient named Joanne Whitman.
Joanne Whitman.
Uh... You mean the bronchitis?
Not bronchitis. She's at risk for an embolism...
If she hasn't thrown one already.
Wake up your attending. His name's Lieberman.
It's 2:00 in the morning. Wake him up.
Tell him his patient is circling the drain,
and so will his career be if he doesn't get his ass in here.
Hey, you.
It's the middle of the night.
Now, sometimes you got to hit the off button,
or you won't survive this place.
That "do no harm" rule? It goes for yourself, too.
Oh, please, Gato. Like you hit the off button?
You're here at 2:00 in the morning. What's that about?
I hit the off button all the time, and you know I do.
Yeah, well, six beers and sex with a stranger
isn't my idea of a breather, so...
You ever try it?
Look, um...
...what's going on with you?
He said I'd make for a horrible mother.
What's-his-name, the guy I used to go out with.
He said I'd make for a horrible mother.
'Cause I'm too married to this place.
Well, right now you are.
But when the day comes
and you decide to become a mother,
you'll probably be the best at that, too.
Thank you.
Now go home and get some rest.
Go. Yeah.
Bye!
Damn chopsticks.
Dr. Napur.
Thank you. You were right.
Mrs. Whitman had a pulmonary embolism.
She's now on round-the-clock infusions of heparin.
She'd been throwing tiny emboli to her lungs.
You... You have my gratitude.
Bet you're feeling all cocky now, huh?
Itty-bitty little cocky thing, you.
Hey. Never mind with the "hey."
It's time for you to listen to me now.
Thank you. You probably saved my life.
More than I can say for this one. And as much as I'd like to stand here
and chew what little fat you have on your hips,
he doesn't want me throwing a clot.
Thank you.
Anyway... what she said.
You probably did save her life.
Another m&m?
What really goes on in those meetings?
Just once, I would love to sit in on one of those things.
Yeah? Yeah.
Become a surgeon.
Look there. Ventral intermediate nucleus of thalamus.
Doctor, will this be painful?
Is it gonna hurt?
Not hurt. Be quiet.
Please, God, no.
No! No!
Hmm. Maybe just discovered fear center of brain.
Hmm. Write paper.
Try again.
You going to be okay, son?
Ty?
What are you thinking about?
Hey. Look at me.
You know, she never even asked...
The mother...
"What makes you...
Why should I trust my son's life to you?"
She never even asked. They never do.
Ty, there was nothing...
I saw his brain.
There was nothing you could do.
What did she say to you after?
I saw her say something.
She said, uh...
"This must be so hard for you."
She... was consoling me.
Stimulate bolt.
Oh, my God.
Forceps? Oh, my God.
Mrs. Hostetler. Reach for my hand.
Oh, my God.
Take my forcep.
Give me forcep.
Stop clapping.
Okay. Wave left hand twice.
Okay. Make okay sign.
We're done. Dr. Ali, close up, please, hmm?
Amazing.
Thank you!
Oh, my God.
Dr. Park. Success, I'm told.
Complete. Tremors stop.
Oh, that must be quite thrilling.
I imagine most neurosurgeons would be
quite excited to perform a DBS, but I'm curious.
Did we fully exhaust all pharmacological options
before opting for this procedure?
Yes. Between rock and 8-ball,
DBS only viable option.
Insinuate me? Oh, now, first of all, I did not insinuate you.
If I insulted you, that certainly wasn't my intention.
It's just we doctors are human.
We can all get caught up
in the excitement of exploring our craft.
And the chance to perform a deep brain stimulation
must have been very tantalizing.
Now, accepting your word that you were caught between
a rock and an 8-ball, perhaps we should be
discussing your language skills, Dr. Park.
But we're both late for a meeting.
Can we say my office in the morning?
Shall we walk together?
You talk to all doctors about language?
Only those between rocks and 8-balls.
So you saved the woman, after all? Yes, I did.
And Lieberman even admitted it, so there.
All right. Here we are again.
Uh, I really appreciate you all agreeing to stay on a little bit later.
Um, first, a quick congratulations to Dr. Sung Park
for a very successful deep brain stimulation.
- Well done, Dr. Park. - Congratulations.
Okay.
Moving on.
Dr. Wilson.
Could you take us through the matter of Quinn McDaniels, please?
It was approximately 7:30 in the morning
when I was called to the emergency room
to evaluate a 7-year-old boy, Quinn McDaniels.
His mother had brought him in as a precaution
after a head-on-head collision in a soccer game.
He presented in excellent health.
His B.P., heart rate, respiration were all normal.
His C.T. scan, however, revealed
a massive temporal-lobe tumor, which appeared malignant.
The decision to operate was made immediately.
By whom? Me.
Consult with esteemed colleagues?
I discussed with Dr. Villanueva.
Gato trauma, not neurosurgeon.
Why not ask for help, Dr. Wilson?
You're surrounded by a lot of talent here.
Why not seek a second opinion?
It seemed pretty straightforward.
Potential life-threatening surgery,
and you didn't even bother to discuss it
with your colleagues in neurosurgery.
Isn't there anyone in your department with whom you've developed... some trust?
What about the boy's history?
I spoke to the mother. There was no remarkable history.
And his father? No, the father was out of the picture.
The boy had never even met him.
Oh, please continue.
I mapped out
a left-sided craniotomy with awake speech mapping.
After placing immobilization pins in the right frontal area
and the left occiput, we woke the boy up.
I then made an incision in front of his zygoma
in front of his left ear all the way 'round to the midline.
The bone was removed without incident.
Bleeding?
Yeah, but it was easily controlled
with cauterizing and clips.
Continue.
Then...
...when I saw the... the tumor, I knew we were in trouble.
It was malignant.
There were tentacles reaching into the normal-appearing brain,
and it had a very angry reddish color.
I began to remove it as best I could.
And...
it started bleeding way more than I expected.
There was just so...
So much bleeding.
I couldn't stop it.
The boy died?
Yes.
Dr. Ridgeway? Do you have anything to add?
No.
Dr. Wilson, you said the boy's father was out of the picture.
Uh, genetically?
No, genetically, he would still... And you didn't ask the mother
to provide a contact for the father?
N-no. I-I never thought to.
You never thought to.
Um, could you, um, pass this to Dr. Wilson, please?
Dr. Wilson, you have in front of you
a brief medical history of the boy's biological father.
Could you please read out the... The highlighted portion?
"Von Willebrand's disease."
And what is the primary symptom of Von Willebrand's disease, doctor?
Uncontrollable bleeding.
The boy had a 50/50 chance of being an uncontrollable bleeder.
Anyone?
Comments?
Well, I have a comment.
This boy was likely to die soon,
but he died yesterday because of a doctor's arrogance.
His unwillingness to seek a consult,
his neglecting to get a full and thorough history.
Arrogance.
We are clinicians, scientists.
We observe time-honored procedures and analyses.
That's how we are trained.
And this is what happens
when we subjugate that training to arrogance.
You messed up. We all do.
Tina? I cannot hear this right now. Okay?
Beat it, Tina.
Please.
None of us came here for the bells and whistles.
It's the personnel.
These meetings, like the one where you got your ass kicked,
that's what makes you a better doctor.
That's all that matters, number one.
Number two, we got a teenage boy being helivaced in from bend.
Severed spinal cord,
and he's due to arrive here in about two minutes.
Well, maybe you should call Sung.
I'm calling everybody. But I'm especially calling you.
It's an atlanto-occipital dislocation.
That's right... Internal decapitation.
Now, you got about 30 seconds to pull yourself together.
Don't take him off the backboard. Yes, sir.
Subarachnoid hemorrhage. Craniovertebral junction.
Oh, my God. Do one, Korea.
How did that work out? Dead.
Hmm. Let's get our own C.T., plus a craniovertebral M.R.
Are you sure we have time?
Probably spinal shock.
Okay, we need to know what we're dealing with.
Michelle, make sure anesthesia knows we're on the way.
Keep his neck stabilized. Sung, get the halo from O.R. 16.
Oh, God. All right. Watch what you're doing, Thor.
The only thing connecting his head to his torso is skin.
He's got a strong chance of heart failure.
We've got to secure the airway before we bring him up.
I need a fiber-optic tray. Buck, you better scrub up.
We don't know the extent of his other injuries.
Harding, I'm gonna need the scans from bend,
make sure we can do live fluoroscopy throughout.
What's his heart rate? Jorge, get his coags.
- I hear from bend. Normal. - Get on trauma time.
What are you thinking?
Occipital-cervical fusion to start.
Sync & corrections by Rafael UPD www.addic7ed.com/