O.Cboth leadsed. Show sinus tach.
18-, 19-year-old male, shocky, barely responsive.
Start the massive transfusion protocol.
We didn't dare move it. We don't know what it hit.
Give me some numbers. B.P.... 60/palp.
Heart rate... 130. Page Dr. napur.
O2 sat... 85 on 6 liters and falling.
He has serious abdominal bleeding. We need to open him up.
Notifying surgery now. It either hit a major vessel or his liver.
Get anesthesia, stat, to intubate.
I'll call them.
I'll start a second line and get him in.
Nick?
Nick? You know this kid?
He's my son.
Nick, who did this to you?
Get out of the way! Move! Go, go! Let's go!
Hey!
Packed rbcs.
Clear the way! Back up! Back up!
In here! Anesthesia's ready!
Move it, move it!
They're in there, including gato.
He says he's assisting. No, he isn't.
Syd... call hooten. Get him in there in case I need him.
Get him draped... now. Yes, sir.
Only got a palpable blood pressure. He's tachy.
I don't know what we're going to find when we get in there,
but he's crashing. Did you get any labs?
No tests, no time. Got it. You can go.
I'm not going. I have the room, doctor.
You can go. Excuse me?
This is my O.R. I will not have you in this procedure.
I am the best trauma surgeon in this hospital.
Yes, you are. You are also my patient's father.
Please leave. You're not keeping me from my son.
That is exactly what I am doing, and now you're holding me up.
Get out of this room now. Gato...
Let's go...
Now.
Well, it sounds very serious in here.
We were just commenting.
For the two of us, of all people,
to be resorting to conventional Western medicine...
Oh, believe me, if I could transplant your kidney
into your sister using holistic means,
I would do it that way.
Some sister, huh?
Indeed.
So, walk us through it one more time.
You'll each be taken to separate o.R.S.
I will harvest the kidney from you
while the transplant team is preparing you to receive it.
Then I'll then introduce you to the kidney
formerly belonging to your sister,
and we'll get on with happily ever after.
Morgan...
We're gonna give it our best shot.
I know.
Okay. It's deep into the liver.
I'm gonna pull it.
Eye shields on.
Can I get another unit of rbcs?
Suction ready?
Suction.
Ohh!
Sutures. Sutures.
Let's push another five.
More gauze.
Keep 'em coming. Here you go.
Sponge stick. Sponge.
Thank you for seeing me on such short notice.
You're extremely gracious.
Not gracious... Patient service call, v.I.P.
Must see.
Ah. Okay.
Um, well, first, my name is chung mai.
Know. "No"?
Not "no"... know.
I know who you are.
Everybody know chung mai... Famous.
What wrong? May I show you?
What did you hear?
G-sharp, almost.
Exactly... almost.
I know from experience that what I played
was a quarter tone sharper than a "g."
To the lay ear, it would sound like a "g,"
but to me... I have perfect pitch.
Know. "No"?
Not "no"... know.
Everybody know chung mai have absolute perfect pitch.
What wrong? The wrong is that I've lost it.
I've had every test that...
There's nothing wrong with my hearing
except when it comes to...
Absolute pitch not necessary for a musician.
I'm chung mai.
The ear specialists say
there's nothing wrong with my ears, so...
Think in brain. Is it?
Would have to run tests, functional mri.
Okay. Okay. Um...
Looking for... Lesion, tumor, brain cancer.
Don't think have... Would show other symptoms.
How soon can we do the tests?
What caused the sister's kidney failure... do we know?
Yes, we do. Amphotericin "b."
She had a nearly fatal case of leishmaniasis.
Oh, rare. Where'd she get that?
The Sudan.
Just about everything about this case is rare...
Black fever from a sand fly,
resultant liver and spleen disease.
Is that the long way of saying, "don't vacation in Sudan"?
They don't vacation.
You know how some people thrive
on living in undeveloped lands
and they participate in the primitive cultures?
Yeah. These are they.
Okay.
Okay, time to get Tory's kidney to her sister.
Hey. "Hey," nothing.
They had no right to throw me out.
That's my son down there.
What right do they have to throw me out?
That's your son down there.
You want me to recite the hospital policies,
chapter and verse?
No, I don't.
Who would stab him? Who... who would do this?
Do they even know what happened? Was he attacked on the street?
Was he robbed?
It was a kitchen knife,
which means it was in someone's home.
Which probably means he was stabbed
by someone who knows him.
Who... Who would do this to him?
Gato, does that even matter right now?
No.
What? What? She went into v-tach.
Gave her meds. She progressed quickly to v-fib.
You shock her? Four times.
She went into asystole after the last attempt.
Drugs? You name it.
Go. Amiodarone initially,
then epi, calcium, bicarb... no result.
How long? Nine minutes since the first defib.
Nine minutes? Come on, Morgan.
Tell me when. Anyone have hesitation?
Anything? Anything to try? We did everything.
Damn it. Damn it.
Time of death... 2:10.
Ah, right there... very small.
A tumor? Likely.
Astrocytoma, planum temporale.
Can remove.
Is that risky?
In brain, yes, risky, but can remove.
So, uh, what's the worst-case scenario?
Dead.
Not happen. I can remove.
And give me my perfect pitch back?
That not know.
Doctor, I-I need a little guidance here.
I'm a man of considerable precision.
I came to this hospital, to you, because I was told
that you were a neurosurgeon of extreme precision...
One who plays the violin himself,
one who, in fact, has perfect pitch.
I know all about you, and that's why I'm here.
But I need some precise guidance.
It brain. Cannot give exact prognosis.
Surgery could make you better...
Could make you lose music altogether.
Only thing know certain...
You have growth in head... Not good.
I listen your music. I know your gift.
I will try to save.
You have children?
Yes.
A boy, 6, and a girl, 3.
Take out tumor.
We knew her condition was precarious,
and we knew this was possible.
But, still, I am so sorry.
Oh, God.
We've been saying goodbye for a few years.
I know.
You did everything you possibly could
for your sister, and she knew it.
And I hope that thought brings you comfort.
Now, listen, Tory, I hate to bring this up at this moment,
but I have a question for you, and there is some urgency to it.
Evidently, you did not give permission
to reallocate the kidney to a different recipient...
No.
We could save... I want it back.
That probably sounds simple enough.
But in this situation,
though we've preserved the kidney,
we do not reimplant it in you.
The benefits are not worth the risk
of another, second procedure, given the fact
that you have a perfectly normal, functioning kidney.
I want the kidney.
I want to take it home with me.
Okay, this is bizarre. Tell me.
Well, I got called in as a neuro-res.
The patient can't move his legs.
No apparent physical injuries...
Could be psychological paralysis.
You see the police over there?
Here for our patient.
What'd he do?
Stabbed somebody in a cooking class.
Are you kidding me?
I am not touching this one.
Hi. I'm Dr. ridgeway. How we doing?
Been better.
I'm told we can't move our feet or legs?
No, ma'am. Mind if I check?
Oh. So no voluntary movement, but your reflexes are intact.
You want to tell me what happened?
Not really.
I'd just like to lie here for a minute, please.
Mm. What's your name?
Glenn... Glenn kubiak.
Okay, Glenn, I'm gonna level with you.
Okay? Then maybe you can level with me.
Radiology is saying there's no physical cause
for your paralysis, which means it could be in your head.
Now, I can run more tests, but in doing so,
we'd be exposing you to unnecessary radiation.
You want to tell me what's going on?
Doctor-patient privilege? Of course.
I can sort of move my legs a little.
You can?
But I want to wait till my lawyer gets here,
'cause, otherwise, there's police out there
that are gonna take me away.
Look, if you're not hurt,
we don't offer Witness Protection here...
Nor do we harbor fugitives.
Got it.
I can't move my legs.
Get me another doctor, if you wouldn't mind.
He'll be fine.
You mean it? Yeah.
He's lucky.
He's got some recovering to do, but the recovery will be full.
Sit back down for a second.
I do my best work when I'm in my zone.
I couldn't trust myself to be in that zone with the big cat,
who just so happens to be the kid's father,
staring over my shoulder.
I threw you out so I would be better.
It gave Nick his best chance. Understood?
Understood.
He'll be awake in another half-hour or so.
Thank you, Syd.
Thank you.
I'll let you collect your thoughts for a second.
Well, we'll certainly be having a drink tonight, my friend.
In there? The kid who stabbed Nick?
Well, he stabbed a 20-year-old male in a cooking class.
Nick arrived with a kitchen knife in him.
He's actually feigning paralysis
while he waits for his lawyer to show up.
Does gato know?
No, no. I didn't tell him.
Then again, something tells me he knows.
Gato, I don't think it's a good idea for you to go in th...
Mr. kubiak.
I was told you wanted to see another doctor.
Gato. I'm trauma chief here.
This is Dr. Wilson, neurosurgery.
He's here strictly to observe.
One doctor's enough, thanks.
Uh, well, actually, a hundred doctors couldn't help you.
That's what I came to tell you.
What are you talking about?
Uh, son, it shouldn't be affecting your legs.
I can't explain that.
But your scan showed
a pretty significant growth on your liver.
It appears to be malignant. A growth?
On my liver? Wait, like a tumor?
Yeah, there's spots on your lungs, your kidneys.
It's spreading all over everywhere.
What's everywhere?
Cancer?
Is there someone you would like me to call...
A family member, clergy?
Clergy? Like I'm gonna die?
Yeah.
I didn't tell him. He heard. I just sort of...
Confirmed it. Was I wrong?
I didn't want to lie to the guy.
Well, with any luck, he won't kill him.
Oh. Yo.
I got his confession.
You not want to call family?
Meaning what... I might die?
No die, but brain surgery, so...
Well, first, my family is all back in Illinois.
And second... and I realize this may sound strange...
But my gift is extremely personal to me.
And since I might potentially lose it with this procedure,
what I'd actually like to do
over the next two hours... Is just play.
Play?
Yes.
Since this could possibly be for the last time...
I'd like to just play.
First of all, my deepest condolences
on the untimely loss of your sister.
Thank you.
If there's anything we can do to help...
With counseling, patient services.
You've all been more than kind. I-I just want the kidney.
Yes. I have here a pamphlet
that outlines the hospital's policy...
No, no. I don't want a pamphlet.
Thank you. Just the kidney. Yes.
Unfortunately, under Oregon law,
I first have to ascertain the answers to a few questions
that are designed to be unobtrusive in nature.
Who is this person? Oh, my name is Fran horowitz.
I'm from patient safety.
Why can't I just have my own kidney?
Unfortunately, there are rules in place...
Biohazardous concerns,
infection-control issues, legal implications.
Let me get this right.
If I passed a kidney stone at home, it's mine,
but if I pass it here, it's yours?
That's correct.
And who exactly are these rules designed to protect?
Tory, the kidney has probably been rinsed by now
in a formaldehyde preservative.
So? There's formaldehyde in flu shots.
If I could just get an explanation as to your intent...
I don't owe you an explanation.
Ohh. I really don't mean to be rude,
and since you don't, as well...
That kidney is the last thing I have
that I shared with my sister.
I don't care if that seems meaningless to you.
It does not seem meaningless.
You're my doctor. I needed your team to save my sister.
That didn't work out so well.
But this is what I need from you now.
W-women get around these rules all the time
when it comes to placentas.
They do? Why would they take their placentas home?
It helps with postpartum depression.
The nutrients in the placenta
are very effective in averting postpartum depression.
They eat it?!
Is this what you have in mind here with the kidney?
You can't tell me how I should express grief.
Morgan and I witnessed a ceremony
where a grieving mother consumed some of her child's organs.
In their culture, they believe that it helps
assimilate the personality of the deceased into their own.
It was beautiful, joyful.
You may think that's creepy, but what would they think
about burying people in the dirt and letting them rot?
So you do plan to eat the kidney?
Nick?
Hey.
Sydney napur. Remember me?
You're gonna be absolutely fine.
Yeah, your abdomen's gonna hurt for a bit,
but... it's all good.
This kid... He... he just stabbed me.
I'm hearing they got him, by the way,
so you don't need to worry about that.
Where's my dad?
Is he all right?
He's a mess, but other than that, he's totally fine.
Okay, we're gonna keep you here in the icu for a couple days,
and then we'll move you to a regular room, okay?
Okay.
Hey.
Don't cry, okay?
So it would seem, ants to eat and the more I think about it,
the more I'm inclined to agree with her.
Yeah, well, you and thought, buck,
haven't always been terribly compatible.
Harding, I am not someone
you could accuse of having an open mind.
Yeah. Can we discuss this later?
When? When I say.
Excuse me a moment.
Doctor? Shh!
Listening.
Is that Mr. mai? Shh!
Listening.
Hey.
He's okay? He's okay.
How's dad doing?
Dad's great.
You know...
I've been sitting here,
replaying all the conversations I've had with my son.
And what jumps out...
Is all the conversations we haven'had.
Well, it's not too late.
Right now, you got him hostage in a hospital room.
Go get started.
Well, I wouldn't even know where to start.
Cooking school?
I sure as hell didn't know about that.
Cooking school? He... he might be gay.
Would that be a problem? If he was gay?
No.
That I didn't know?
That would be the problem.
You know why that kid stabbed Nick?
Because Nick criticized his baklava.
Yeah, what the hell?
I mean, what kind of world is this?
I mean, I used to always think
I had the world by the balls,
but I don't have squat.
You got a son upstairs
who probably could use some downtime with his father.
Well, it's small enough.
I don't know much about absolute pitch. I do.
I have.
You have absolute pitch? Yes.
Wow.
Can you assist?
You want me to assist on the procedure?
Yes. Man has gift. Cannot lose gift.
He chung mai.
Want backup.
Well, if you feel like you need backup...
Not need...
Want. Difference.
Please.
Now you want me to see a shrink?
Look, I am willing to champion your position,
but I need to satisfy people
that you are not a raving lunatic.
I'm sorry if that came out wrong.
But, Tory, you have just lost your sister.
You are grief-stricken.
And you did just come out of general anesthesia.
And you are susceptible to questions
as to whether you can make a rational decision...
Not the least of which, you want to eat your kidney.
And as I say, I am willing to fight that fight
if that's what you want, but I need to be armed.
Fine.
Send in your big shrink.
Hey.
How you feeling?
Fine.
I'm sorry. For what?
I don't know... showing up to your job, all stabbed.
Well, you know, it seems if your new school
is going to be passing out knives,
they ought to vet their students better.
Yeah.
Well, otherwise, Mrs. Lincoln, how was the theater?
What?
Uh, um, nothing.
So, um...
Cooking, huh?
Sorry.
For? I-I don't know.
Look, I know it's not football and it ain't medicine.
Buddy, you should do whatever makes you happy.
Really?
Really.
Okay.
Well, look, there's something you don't know about me, dad,
that maybe now is the time to tell you... as good as any.
Uh...
Okay.
I want to be an actor.
An actor?
Sorry. No, no, no, no, no.
Acting is great.
I mean, if that's what you want.
But, dad, you always said there's a name for actors...
Actresses.
I said that? Many times.
Well, you know, maybe I've evolved some...
You know, like you, Nick.
You know, we've grown. Um...
Maybe we should talk more,
fill in each other on our growing.
You hate talking.
I'm working on that.
Okay. Everybody's busy. Lnow, where shall I start? E?
Well, I've had grand luck with buck lately,
so let's have the buck stop here, shall we?
These are exciting times, are they not, buck?
Tell us what's new in your busy life.
A transplant patient died this week.
The circumstances are not relevant.
Suffice it to say that the intended recipient
of a kidney transplant expired just prior to implantation.
Now, the donor, who is the recipient's sister,
did undergo procurement
and seeks now to retain custody of her kidney.
She has not said so directly,
but I believe she intends to eat it as part of a funeral ritual.
Now... cannibalism?
I'm done wasting my time with this nonsense.
Uh, sit down, gato.
After all, you might turn out
to be a featured performer in today's theater.
Now, as the patient has properly maintained,
we do release placenta for its nutritional benefits.
So why not the kidney, if that's what she wants?
Because it's sick? Because it's ridiculous?
'Cause it's barbaric? Why? Because it's not Western?
Oh, please, not everyone is east versus west.
Look, there are all kinds of nontraditional healing methods
that we frown on in Western culture.
Name three. I could give you 10.
I'll take three. Fine.
There are doctors in both the U.S. and Europe
who have successfully treated ulcerative colitis with whipworm eggs.
We used to scoff at using maggots to eat bacteria...
Now it's mainstream.
In Scotland, they're using human feces
to treat strains of c. Diff.
Do you want me to keep going? I'd prefer you make a point.
My point is, we are arrogant.
There are so many forms of holistic medicine,
some ritualistic.
Just because they can't always be
statistically quantified doesn't mean...
Hey, you know what?
How dare all of you?! How dare any of you!
Do you really mean to suggest that we have all the answers?
I mean, look at this country... The United States of America
may be the unhealthiest nation on the industrialized planet.
A third of all our people are obese.
10% of our population suffer from diabetes.
We are 25th in preventing heart disease.
We are 7th globally in cancer, 27th in life expectancy.
It can be said that our medicine here sucks.
It can safely be said that we do not have all the answers.
So if this patient feels strongly
about eating her kidney, who the hell are we to say no?
Comments?
Anyone else?
Release the kidney, buck,
and tell your patient "bon appétit."
Time for the big cat to join us now.
First of all, gato, our sympathies
for what have had to have been
a rather enduring couple of days.
Thankfully, Nick is going to be all right.
But the matter does occasion us to revisit
a rather time-honored policy here
that doctors do not treat family members if it can be avoided,
and that especially applies to our children.
Are you with me so far, Dr. villanueva?
No. The policy stinks.
The policy should be "heal," period.
If I'm in a position to help my son heal,
the policy should be "get the hell out of my way."
So you feel you were the best doctor available
in this situation to render emergency care to your son?
Yes, I do. Excellent.
Should be as simple as that, then.
Any issues, anyone?
Good. Well, it seems you're off the hook, Dr. villanueva.
You may go.
A-actually, just out of curiosity,
as you went about diagnosing your son's medical situation,
what questions, if any, did you ask him?
Did you ask him anything, doctor?
I-I really don't remember.
Oh. It's not like you not to remember.
You're a bit of a steel trap in that regard.
Were you having a bit of a day? Was the blood flowing?
Were you unusually excited, doctor?
Not hear the question?
I was a little worked up.
Oh. I happen to know what you asked your son.
It was overheard by many.
You said, "Nick, who did this to you?"
Of what diagnostic value was that, tell me?
I can quite understand a police officer
making an inquiry to that effect, but a doctor?
Who did it to him seems to me
to be of very little medical relevance.
Perhaps more relevant is that the question
suggests rage to me, doctor.
Rage, emotion.
Now, does rage, emotion, fear...
Do those qualities improve your medical performance?
Does retribution now become part of your diagnostic DNA?
I suppose it's tough to be objective about these things,
which is why we are lucky
in that we have colleagues to offer perspective.
Now, take here, for example.
You had one of the best colleagues, Dr. Sydney napur.
In addition to having splendid hands,
in addition to being one of the best cardiothoracic surgeons
in the pacific northwest,
she brought perspective into the operating room.
And you sought to make that perspective and all that skill
take a backseat to your emotion.
Well done, Dr. villanueva.
That was splendid doctoring indeed.
You having fun?
You done?
No, I'm not done, and I'm not having fun.
This was a very dangerous situation because,
first, your son sustained life-threatening injuries.
Second, because you are a legendary trauma surgeon,
you are a man of imposing mental intensity,
not to mention physical girth.
It would be very easy
for a doctor to feel intimidated by you.
Your son might very well be alive today
because he had in his doctor, Dr. Sydney napur,
the one person who doesn't put up
with your particular brand of bullshit.
Look, I agree with you, gato.
The best policy might well be "heal."
Let's go with that, then.
Let's make sure that every patient
has the best possible chance to heal.
And more often than not, that policy is best served
by doctors who are not mentally or emotionally compromised.
Now I'm done.
Mm-hmm.
Now, tumor exposed.
Well-defined in planum temporale.
Make patient awake.
Your turn at hem.
Helm.
Chung mai... rest over, hmm?
Work now with me.
Oh, wow.
Wish I could watch all TV shows on goggles.
Did you drill yet? I didn't hear anything.
That point of goggles. We are mid-operations.
I've got the speech boundaries set.
Let's start with sound.
"C."
E-flat.
I hear it. I-I can't name it.
I still don't have it. Do better.
That was pathetic, you big, bald bastard... pathetic.
Really?
I thought I was rather easy on you, actually, gato.
After all, I didn't even raise the notion
of you telling a cancer-free patient
that he only had several weeks to live,
extracted a confession to be handed over to the police.
Shall we discuss the various ethical
and hospital-policy violations
that you committed with that little gem?
How is he?
He's getting better.
Uh...
He's got to get up, shake off some of the anesthesia.
My son and I are going to take a little walk tonight.
And truth be told,
I'm really looking forward to it.
I haven't always been the best dad.
Yeah.
He wants to be an actor.
Mm. Kids.
Yeah.
Kids.
"F."
D-flat? You're asking me?
D-flat.
"C"? Wrong. Guessing.
"C." Right.
G-sharp.
I can hear it clearly.
It was "g," and it was sharp.
Psych called me.
You are sane...
Enough, anyway.
It's in there?
It's pulled from pathology.
We'll keep it in our refrigerator
until you are discharged.
Thank you.
I wish you could walk out of here holding your sister's hand
instead of, uh...
Dr. Tierney...
I know... You did all you could.
I also know you extended great hope to my sister,
that, when she died,
she did so with hope in her heart.
She's lucky in that she saw promise...
And opportunity... Right till the end.
You gave her that.
God bless.
♪ Oh, I can't go on
♪ fighting through every day buck, this is a surprise.
I thought I'd celebrate.
Somebody said something nice to me today.
You're joking.
You're drinking alone? Where's your friend?
Not here...
Something about needing to go for a walk.
What can I get you?
Uh, seltzer water, please.
Oh, I say. Don't knock yourself out.
It's amazing lives we lead.
I'm not sure I mean that in a good way.
It's just amazing, I suppose.
A patient died on me.
She died.
And now...
Now, here I am in a bar
because somebody paid me a compliment.
Patients die every day, buck.
Why don't you make that a double?
You're a good man.