At the beginning of every procedure I typically try to close my eyes
And visualize my breath.
In through the nose,
Then all around the sinuses.
First, the Maxilla, then the Ethmoid, then the Frontal.
I visualize the breath
going from my trachea down to the lungs.
I got sent back.
It wasn't my time.
I went too soon.
Too soon, Dr. Wilson.
Too soon. Too soon.
Too soon, babe.
She came in last night, nearly collapsed,
severe abdominal pain, which has since spread to her chest,
fever, muscle soreness.
I thought Ischemic process, but it doesn't fit her history.
We've considered gastritis, cirrhosis of the liver,
T.B., hepatitis... did you order a differential?
I did, and it doesn't look good.
Her white-blood-cell count is spiking,
and at this point, we're stumped.
I realize that you're not an internist,
but on the chance you've got another diagnostic rabbit
you could pull out of your hat... call Gato.
The trauma chief?
You want to find out what's wrong with this woman?
Call Gato.
I don't understand. Need surgery.
I understand, and my decision is not to have the surgery.
Not do, dead. Need surgery.
She's thought a lot about this, doctor.
She understands the risk.
She 13.
Look picture. Hmm? Localized, but growing.
I've seen the scan, and, no offense,
but I probably know more about brain-stem Gliomas by now
than most neurosurgeons.
If I have the procedure,
the likelihood is you won't be able get it all... chance will.
In which case, I will get chemo, radiation,
and the drugs would wreck my brain, my organs.
Look, surgery is only... I've had surgery!
Need again. No!
I'm tired.
Enough is enough.
Not do, dead.
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Where the hell is Gato?
He stepped out for a minute. He'll be back any second.
You. You're a neuro resident? Yes, sir.
I need you to pronounce this man dead. Quickly, please.
I beg your pardon? Gunshot to the head.
He's got an organ-donor card,
but we need to pronounce him brain-dead.
Uh, this man is... Not my patient.
He's nobody's patient at this point.
He's a donor, whose organs I cannot harvest
until you pronounce him Brian-dead.
Well, can't you? No, I cannot.
The transplant surgeon is not permitted to do the final.
Could you get on with it, please?
I've got a man waiting for this heart.
Sir? Sir. I'm Dr. Robidaux.
Uh, can you open your... Eye?
Oh, great. Can you hear me, sir?
Could be that he's a poor listener,
or that he doesn't have a head.
Mister...? Jasper.
Gavin Jasper.
Where the hell is Gato?
Uh, pupils fixed and, uh, dilated.
No response to pain stimulus.
Mr. Jasper, if you can hear me, could you take my hand?
Oh, come on.
That's Brainstem reflex.
A reflex?
Are you kidding me?
Mr. Jasper, hold up a finger, please.
Would you like me to second that motion?
Does he speak?
He'll figure it out.
50 bucks.
100.
200.
Done.
Mrs. Gonzales? I'm Dr. Villanueva.
How you feeling?
Do you like to cook?
Yes.
Do you make Linguica Chorizo?
Yes.
Ahh. The other day.
Ah, muy bueno.
Trichinosis.
I beg your pardon?
Well, see the little cut on her finger?
She probably touched the seasoning on the raw pork.
This lady's got worms.
Damn.
You owe her 200 bucks.
Bu...
Hey. Hey.
Right, let's get started, shall we?
First, a very good Monday morning to all of you.
Dr. Ridgeway?
Please join us on stage.
I have here the file on Francine cash.
Would you do the honors?
Okay.
Francine cash arrived at Chelsea general on October 23rd
with a Meningioma.
A procedure to remove the tumor
was scheduled and performed on the 26th.
The procedure seemingly went well with no incident.
"Seemingly"?
Would you walk us through it, please, doctor?
Certainly.
After I...
actually, before we get to that,
um, I assume Ms. cash was informed
as to the risks of the surgery,
and she consented to it?
Of course.
Excellent. What were those risks, doctor?
There were several... uh, bleeding, infection,
stroke, possible damage to the olfactory nerve,
which ran proximate to the growth.
Yes, that one. Let's talk about that risk, doctor.
Well, should the olfactory nerve be either nicked or cut,
the patient could lose her sense of smell.
The patient was told this?
Yes.
Did you personally tell her?
That would have been the responsibility
of the resident to go over the risks with the patient
and have the patient sign the consent form.
So, personally, you have no idea what risks... if any...
Francine cash was made aware of before the surgery?
We could ask the resident.
And who would that be?
Michelle Robidaux.
Excellent.
But before we get to Dr. Robidaux, once again,
do you have any direct personal knowledge of what risks
that Francine cash was told about before the surgery?
No. I did not personally hear
what Francine cash was told before her surgery.
Mm.
Uh, please walk us through the procedure, doctor.
Mm-hmm.
After the patient's head was immobilized,
an incision was made on the scalp
and the skull was exposed.
Entry to the brain was made through a burr hole
behind Ms. cash's right eye.
From there, it was a matter of gently cutting away
the outer layers of the brain and then Resecting the tumor.
Hmm. Oh, you describe it very well.
Do you know, I can almost...
I can almost visualize you doing it.
Did you do the surgery, Dr. Ridgeway?
No.
No? Who was operating?
Dr. Robidaux.
Dr. Robidaux?
You allowed a doctor-in-training
to operate on this young woman's brain?
Dr. Robidaux is an extremely competent neuro resident.
And Francine cash was someone she could practice on?
Oh, come on.
Well, how is it that Dr. Robidaux
was chosen to operate on Ms. cash?
That was my decision. Ah.
A decision I made because
she was perfectly capable of handling a Meningioma.
She'd preformed the procedure before?
Yes, she's assisted me dozens of times.
How many times had she performed this procedure on her own
before cutting into this patient?
None.
So you thought she could just try her hand on Francine cash?
That's what a teaching hospital is.
No one hatches from an egg as a polished surgeon.
Dr. Robidaux is a better doctor
for having done this procedure,
a better surgeon for the scores of others
she'll treat in the years to come, and you know that.
Thank you.
And how does that inure to benefit Francine cash?
By the way, what does Francine cash do for a living?
She...
She was a chef.
A chef would quite need a sense of smell,
wouldn't she, Dr. Ridgeway?
Comments?
99 out of 100 patients
would dismiss the potential side effects
without a second thought.
Compared to a tumor growing in his or her brain,
that loss of smell would, I suspect, mean very little.
But when dealing with a patient whose olfactory nerve
is inextricably linked with who she is,
then perhaps the surgeon would do best
to go over those risks personally with the patient,
instead of turfing the duty to a resident.
Perhaps that surgeon might even do the procedure,
instead of handing the scalpel to a doctor-in-training
who has never performed it before.
Or am I out of line, Dr. Ridgeway?
You're going through my nose?
It's called Endoscopicl go in Transnasal brain surgery.
I'll be threading an endoscope
and miniature tools up your nose.
I won't be looking directly at the tumor.
Rather, I'll be watching a TV monitor using computer mapping.
And... I'm sorry... are you any good?
That's probably an offensive question.
Sandy, I'm about to go into your brain.
It's not an offensive question.
In fact, it's the first question you should be asking,
and the one that patients never do.
Probably because we just assume you to be infallible.
Did I say something wrong? What?
No. No.
You actually hallucinated? I guess I did.
I thought I saw
Allison Mcdaniels standing there.
I...Heard her voice.
Dr. Ridgeway.
Harding, you mind telling me what that was about, really?
We're instructed and encouraged
to let residents do procedures if possible.
That's what a teaching hospital is.
A-are these Monday-morning things
really to make us better surgeons,
or do they just exist to establish you
as the almighty-in-chief, because I'm not sure
what good came out of that inquisition.
Well, I suspect you might be better prepared
should the questions I asked be put to you
by Francine cash's attorney, which they will be.
We're being sued. This is a notice of your deposition.
Need consult.
Well, it's clearly got to come out.
What I say. Patient refuse.
She's 13 years old.
Parents refuse, too.
Did you explain to them
the consequences of not operating?
Yes, tell them... not do, dead.
Tell! Not care.
You explained it that eloquently, sung?
I find it difficult to imagine
their taking issue with "not do, dead."
You such good talker, you explain.
I send to your office.
Heart, lungs, liver, two kidneys, a cornea.
It's all in play here.
His skin, too, but not until he's clinically dead.
So, in the meantime... hold on.
Gato.
Gunshot to the head... where do we stand?
Mr. Jasper was pronounced dead four minutes ago. Ah, where is he?
This is Mr. Jasper's mother.
Mrs. Jasper, I'm so sorry for your loss.
I...
Please forgive my insensitivity.
I'm coordinating the transplant procedures which, uh...
you might want to quit while you're behind.
I'm getting sued? We're getting sued.
I haven't even finished my residency.
Michelle, doctors get sued every day,
especially surgeons, whether we make a mistake or not.
As long as lawyers like to heat their pools with med-mal claims,
as long as congress refuses to get serious about tort reform,
we will always, always be saddled up for nuisance claims,
which is what this is.
Thank you.
For? For... Protecting me.
For standing up like the big umbrella that you are.
At the m&m, so many surgeons
would just throw the resident under the bus,
but you are just this gigantic, big, generous...
Umbrella.
Debakey.
Get suction?
Okay.
Let's prep for cross-clamping.
Need suture.
Suction.
Trisha. Dr. Hooten.
That was impressive.
Are your parents around?
They went to the cafeteria, and it's decision.
How old are you, Trisha?
Here we go.
Look, in england, a 13-year-old named Hannah Jones
decided to forgo life-saving heart surgery.
In Minnesota, a 12-year-old boy
refused chemo for a treatable form of lymphoma.
The courts have generally
found a right in all persons to refuse treatment.
I've done the research.
How about the math?
Without surgery, you'll die.
Cool bedside.
You play this thing?
Mm-hmm. Well, not as good as you.
But then, I have other attributes...
one of them being a will to live.
Really cool bedside.
What do you play when you play?
I fancy Beethoven.
That's funny?
Beethoven almost saved my life.
How so?
"Sonata pathétique."
When I first heard this,
I got this weird sensation that God was singing to me.
Or thinking about me.
Anyway, I told my mother I heard God in some sonata.
Her mind went straight to a delusional disorder,
one thing lead to another, then to a cat scan... brain tumor.
Well, then perhaps Beethoven saved your life after all,
because now you're here.
I'm here because my parents refuse to accept
what every other hospital has told them.
I'm gonna die, Dr. Hooten.
No, we don't know that for sure. It's growing.
Yeah, which is why we need to operate.
You know, you don't strike me as a white-flag waver.
Do you really choose to die?
I choose to live.
Even if it's for a few months,
I'd like to live without chemo,
without being hooked up to wires.
I'm writing an opera.
Mm. I didn't know 13-year-olds did that anymore.
There's also a boy.
Our school has a Valentine's dance.
He's gonna ask me, and I want to go.
And then there's my house, my bedroom, my family.
I want to spend all the days I have left
with the people I love, doing the things I...
It may only seem like a few months to you.
To me, it's a lifetime.
I'd like to live it.
$150, $175...
You don't pay off a debt in gift cards.
These are iTunes gift cards.
They're more stable than the U.S. dollar, the euro.
What's wrong with you? If you want to ask me out, just do it.
What?! Why in God's name would I ever want to ask you out?
I don't know, and I don't care, but I'm busy.
I have patients.
If you want to have dinner, just ask.
We're not in high school.
Dinner?
Which you'll pay for in cash.
Not iTunes gift cards.
For God's sake.
You're going to let a 13-year-old make this decision?
The medical opinion seems to support her analysis.
Her quality of life would be so... h-hold on.
If that tumor doesn't come out...
why is this doctor even here?
To successfully bully you, since I failed.
You spoke to Trisha. Is she wrong?
Can you save her?
I would say that if scan be saved,
Dr. park would be the man to do it.
That doesn't answer my question.
Mrs. Miller. I can maybe save her.
Hmm? How we not try?
How we not try?
Hmm?
We would love nothing more than to try.
But we will not compound her suffering just to spare our own.
She has been battling this for months, bravely, but...
She's losing.
Doctors... you just want to cut, cut, cut.
Our daughter has earned her perspective.
And we will respect her.
If she gets nothing else... She'll get that.
Hello?
Mrs. Mcdaniels,
this is Dr. Wilson from Chelsea general.
Yes?
I was wondering if I might meet with you.
Why?
To be perfectly honest, I don't know.
Well, what exactly do you plan to say?
I have no idea.
Ty, you got to get some clarity on this,
because whatever you do say
could have some very serious legal consequences.
I've been having bad dreams, nightmares.
I don't know what's going on.
Honey, whatever you've lost,
I don't think Quinn Mcdaniels' mother can give it back to you.
And I really think it's a mistake to see her.
Syd, I'm worried about him. This is not like Ty.
Can I ask you a personal question?
No. No. I'm married.
My personal life is to be kept secret, especially from me.
Yeah, all right.
How serious is this between you two?
I'm not stupid. I know what's going on.
Is it serious?
I have no idea.
You love him?
I don't know. Maybe a little.
I know, I'm such a stupid cliché.
You okay?
Michelle called me an umbrella.
That's what mark calls me sometimes...
an umbrella, 'cause I block the sun.
Hey.
You don't block any sun around here, lady.
Thanks.
Guess what.
Dr. lieberman asked me out.
Really?
Well, I kind of made him, but, yeah.
Well, that's great.
A little soon, though, don't you think?
Probably.
But...
That kid with the glioma...
Just reminds me life's so short, you know?
Yeah.
I like John lieberman.
He's not too dorky, is he?
No. He's just dorky enough.
He did great.
The new heart is beating, it's strong,
the procedure was without complications.
I could not be more confident.
Oh, thank you, doctor.
And you can see him in maybe three, four hours.
Oh, bless you.
Why is she here?
You're here, uh...
Where would you like for me to go?
There is neither an apology nor an excuse
to justify my earlier insensitivity.
But if I might console you,
there are six people who are living right now
because of the extraordinary sacrifice made by your son.
Of the organ recipients, one is a schoolteacher.
One is a pediatrician.
Another is a biological engineering student.
And the contributions that they can now make to society
have only been made possible by your son's...
I hear what you're saying.
My son was a gang member who got shot in the head.
My son was nothing.
But 'cause you harvested his organs,
and gave 'em to people who matter, now he mattered.
I hear what you're saying.
You can go to hell, doctor. You can go straight to hell!
You okay?
Yeah.
Tricia, what I see in you
in addition to a young girl with a ferocious appetite for life,
is a young woman willing to bet on herself.
Now, I'm asking you to make that wager one more time,
but on us in this process.
Because I promise you... we are that good.
Dr. Hooten, I've seen the mri.
I've also had a taste of Dr. big shot here,
and I have no desire to be used as his practice tee
just so he gets to make a hole-in-one someday.
Do you know what "deus ex machina" means?
Very bad writing in a Greek play.
Essentially.
An illogical-if-not- preposterous resolution
plucked from nowhere.
Euripides' answer to a hail Mary.
Now, Aristotle would go with the mri.
I favor euripides.
Surprising, 'cause I figured you to favor hallmark.
What hayou got?
Trisha, I can tell you this.
I came into this equation thinking
you didn't have the maturity to be making this decision.
I take that back. You're a very smart girl...
so smart, in fact, I'm gonna lay this on you.
Medicine, science... often doesn't add up.
There's so many inexplicable mysteries,
like how behaviors like compassion and morality
can be genetically based.
How cells in the womb
know how to migrate as the fetus develops.
So many mysteries. One being your point?
My point is miracles, however unquantifiable, they do happen.
Are the odds against you? Yeah.
Is it game over? Hell, no.
I agree with him.
Deus ex...
Uh, what was that? Machina.
Yeah, uh, machina.
And you?
What have you got to say?
Not do, dead.
This better be worth it. That's all I can say.
Well, if it makes you feel any better,
I think it looks rather good on you.
Okay, we're all done. You want to see?
No, thanks. I've seen it.
Give it to me straight. How do I look?
Bald.
This is why I like him... just says it how it is.
If I die...
are you gonna cry?
People die in this hospital every day.
If I were to stop and shed a tear to every life we lost,
we wouldn't get any work done.
But if we lose you, Trisha...
I shall cry.
Because I think you suspect
just how much you've managed to touch my heart...
Which is why I so want to do this procedure...
And why I so want the scalpel
to be in the hands of this doctor here.
And, not to put too much pressure on him...
he will save your life.
And then the tears that I shall no doubt shed...
Will be ones of pure joy.
Do you believe in God?
No God here.
Oh, yes, there is.
He'll be in the operating room.
I shall speak to him myself.
And he listens to you? Yes.
I'm chief of staff.
I read that my chances improve if my outlook is positive.
Is that true?
Very much so.
You want to do something to make me smile, then?
Name it.
What the hell have you gone and done?
Well, I've always rather liked the look of your head, gato,
so I thought I'd give it a try.
I look good bald. You don't.
Yeah, I do believe you're jealous.
H-have you glanced in a mirror?
You look horrible!
Seriously, why did you do this to yourself?
She asked me to.
Oh.
Oh, my God.
Okay.
I'd like you all to direct your attention to my head,
and for the next few seconds,
please indulge your misdirected delight.
At your peril.
Good. Dr. Tierney.
Join me on stage, if you would.
I figured.
You've been very good, Dr. Tierney.
A successful heart transplant, performed personally by you.
Hmm?
You've also oversaw or coordinated
other organ donations,
thus furthering fruitfully the preservation of life...
very good indeed.
You've also been very bad.
Tell us how you've been bad, Dr. Tierney.
I displayed a shocking insensitivity
to the mother of the organ donor,
for which there was absolutely no excuse.
I am appalled and embarrassed,
and to the extent that my egregious conduct
reflects poorly on this hospital,
I apologize to each and every person in this room.
That's all very admirable,
but I refer not to your indecent behavior towards the mother,
but rather your breach in protocol towards your donor.
You notified three hospitals,
you had four transplant teams deployed,
six patients admitted to the hospital,
and almost had operations started to remove organs...
and all the while, your patient-donor wasn't deceased.
Did you personally examine Gavin Jasper, doctor?
I did, and I determined incorrectly
that he was brain-dead.
You determined incorrectly that he was brain-dead?
As oopsie-daisies go,
that's rather a big one, don't you think?
Which is why, in compliance with transplant protocol,
I asked the neuro resident... uh, her, there...
to examine Mr. Jasper.
"Her, there"? Who's "her, there," doctor?
Um...
I believe it's Dr. rob... I...
Robidaux.
Uh, Dr. robidaux.
What did you find?
Um, well, at first, the patient appeared to be deceased.
But while examining him, he responded to voice command.
How do you mean?
First, I asked him to take my hand, and he did.
And then Dr. Tierney asked him to raise a finger.
He was responsive? And reflective.
This is exciting stuff, this transplant business.
I can imagine
how you can hardly wait to get started sometimes.
You're such a predator, buck.
No. A vulture.
No.
Trolling around the I.C.U., scavenging to harvest organs,
not to be bothered with any such annoying little details
like whether or not your donor is alive or dead.
"Shocking," "egregious," "appalling"...
these are your words, buck.
Do you think these words go far enough?
I do my job, and I do it very well.
For 20 years, I have run a transplant service
that has made Chelsea
one of the highest-volume centers in the country.
For every 10 minutes that goes by
before an organ is transplanted, the risk of rejection escalates,
as does the risk that the organ itself will fail.
So I... Time things as perfectly and as precisely
as I humanly can to keep our success rates high.
There are over 115,000 people out there
waiting for an organ
and in the last four months, fewer than 5,000 donors.
Now, when things go well, nobody stops to think
that there were over 200 steps
and precise points of coordination
to make things work at this hospital.
And I made things work for six people
who are alive today because of my efforts.
And I will not have you refer to me as a predator.
I am not liked.
God knows, even a patient missing half his head
still managed to flip me off,
to everyone's great delight and entertainment.
I get it, but I am not a predator.
I am not a vulture.
Trigeminal nerve...
Abducens nerve right there.
Everybody quiet.
About to go into brain stem.
Quiet.
Wake up. Wake up.
Trisha.
What... What happened?
Do. Not dead.
What name?
Who you? Who me?
I'm Trisha Miller,
and you're Dr. big shot.
You shaved.
She fine. Go get parents.
Make hole in head.
I... I believe he meant to say...
He made a hole in one.
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