01x04 - Not Your Grandmother's Robotic Surgery

Previously on Pure Genius.

When I opened Bunker Hill, I made a promise to myself: that I wouldo everything humanly possible to save everyone who came through these doors.

Trial period is up. I need to know whether you're gonna take the job.

I want to be part of this.

Your family...

I'll go home every weekend.

Uh, how's it going with Dr. Brockett?

Bell: Subpar. Why don't you just ask her out?

You obviously want to.

Cheng: This is Louis Keating. He's been diagnosed with GSS.

Bell: It's a neurological disease.

Brockett: Extremely rare.

I want this patient.

I did have the genetic test done, and it came back positive for GSS.

I built the hospital for all the wrong reasons.

Does that really matter?

I'm so sorry, James.

(playing cello)

Dr. Wallace, did you have a good weekend back in Ohio?

Hope you and Julianna got some quality time.


Your wife.

I-I know. But I don't remember talking to you about her or telling you her name.

No, you must have.

How are the kids? Luke make the basketball team?

How do you know...?

And how's Jessica liking UCLA? Has she decided on a major yet?

Uh, do you know where my office is? I'd love to get settled in, finally.

We don't have offices.

Well, where do people work?

Anywhere. Everywhere. It's a team atmosphere.

James believes we need to always be communicating and not holing away in offices.

So where do I put my stapler?

We're a paper-free institution, Dr. Wallace.

James, I need to talk to you about an office.

W, happy you made it back.

I have a real important patient I need you to meet.

Once I'm settled into my office.

Her name is Mrs. Gardner. She was my third grade teacher.

This woman changed my life.

She has a torn meniscus. I want my best surgeon on it.

Well, shouldn't she be sent to Ortho?

Our team's focused on advancing medicine, Oh... not impressing your third grade teacher.

I want you to use the robot.

Why would you use robotic surgery on a meniscus tear?

Because it's awesome.

James, you're not a doctor.

You've hired a chief of staff. Me.

Mmm. Mm-hmm.

I need to be the one who's going to decide which cases we take, who performs surgery, whether or not it's robotic...

W, meet Mrs. Gardner.

Mrs. Gardner, meet Walter Wallace, Chief of Staff, world-renowned surgeon. He's gonna be performing robotic surgery on your knee.


Welcome to Bunker Hill, Mrs. Gardner.

Thank you.

The pain is constant.

Sometimes subtle, uh, sometimes excruciating.

The medications don't do anything to help anymore.

Well, we think we can help you, Sergeant Masood, and that's why you're here.

Thank you so much for taking us.

My wife is very persuasive.


She persuaded me to come here and persuaded you to accept me.

But I don't think there's anything you can do to help.

Well, let us try.

Bashir, the explosion that caused your blindness also damaged the peripheral sensory nerves behind your eyes.

We've localized the source of your pain to the ophthalmic nerve.

It provides sensation to the area.

The damage to the nerve endings from the blast are causing it to transmit a faulty electrochemical pain signal to your brain.

You've tried pharmaceuticals to dampen that signal, but we feel your body has likely built a resistance to them.

This happens.

We'd like to try a new technique we're developing with what we're calling electroceuticals.

We want to implant this tiny electronic inhibitor on the ophthalmic nerve in order to try to override that pain signal.

Um... how big of a procedure is it?

It's a minor surgery. We don't foresee any risks.

We can have a procedure room prepared and do it this afternoon.

Mrs. Masood: (exhales) That sounds amazing.


Well, I don't see things getting much worse.


(whirring, beeping)

Strauss: Okay, now he's scraping away the frayed tissue of the cartilage surface.

Okay. Good.

This woman is a saint, Scott.

Yes. You've mentioned that.

I can pretty much guarantee there would be no Bunker Hill hospital if it wasn't for her.

What's going on?

There is a cystic mass on the bone that shouldn't be there.

The path will tell us what it is, but... it doesn't look good.

What do you mean it doesn't look good?

It's probably cancer, James.

The shiny tissue band under my probe is the nerve.

The source of his pain.

(sighs) That is it.

Bashir, the implantation went very well.


Now we're ready to test it.


Brockett: This app controls the intensity of stimulation of the inhibitor, which we can eventually install on your cell phone.

What's your pain scale?

About a seven.

Okay. Tell me if you experience any change.




How about now?

It-It's less.

The-the pain's less.

What number?

Uh, four. Maybe a three.




Oh, my God. It's a miracle.


(pants) Oh, my God.

Sergeant Masood.


You okay?

Uh... I-I saw a flash of light.

I... I saw light.

What do you mean you saw?

For the first time since I went blind, I, uh...

(chuckles) I-I saw light.

How is that possible?

Well, I'm not sure.

You certain?

The MRI and biopsy results were very clear.

I'm sorry, James. I know how personal this is to you.

How are we supposed to tell her?


Not now, Brockett.

I have to talk to you. This is amazing.

Yeah, Zoe...

Bashir Masood, the soldier with the chronic pain, when we installed the pain inhibitor, he saw a flash of light. He saw.

I know this sounds crazy, but I think we can make him see again.

Brockett, I said not now. Come on, W.


He's sorry.


Bell: We got the biopsy report back from Pathology and the results from your MRI.

Is everything okay?

You seem worried.

Mrs. Gardner, the biopsy of the tumor we removed from your knee shows renal cell carcinoma.

It's a very aggressive form of kidney cancer.

The MRI shows it's spread to your lung, liver, and there's a spot on your brain.

Unfortunately, it categorizes as a stage four cancer.

We'll look at all possible options, of course.

But in my experience, with a cancer this advanced, there's very little we can offer to... to cure it.

What exactly are you saying?

Well, we're going to keep you comfortable and manage any pain you might develop.

What about chemo?


The cancer is too advanced.

It... it wouldn't be wise to put you through that when we couldn't expect results.

We're not giving up, Mrs. Gardner.

We're gonna explore every avenue.

I'm not giving up.


Brockett: So, we presumed his blindness was in part due to the optic nerve being damaged in the blast, along with the rest of his eye.

When we turned up the inhibitor's signal in proximity to the optic nerve, it triggered a visual impulse, a flash of light.

What you're saying is, despite all that gnarly damage to the front of his eye, the cable at the back of his eye can still transmit visual data.


So you want me to basically connect his optic nerve digitally so he can see?

Is it possible? Maybe by modifying the same interface as the nerve inhibitor, but using it as a photo receptor?

That's a gross oversimplification, but let me work on it.

You're awesome.

If we can make him see again, it'll be revolutionary.

(chuckles) James must be stoked.

Actually, he's been super unavailable.

And kind of pissy.

Yeah, that makes sense, actually.

What are you talking about?

He's upset over Mrs. Gardner.

They just discovered she has stage four cancer, and she was basically, like, this surrogate mother to him.

She does? Wait, she was?

Well, his adoptive mother was supposedly this awesome mom.

The reality is she was this very career-focused single mom who was never around. Adopting James was just basically checking off the kid box for her, so Mrs. Gardner became this big maternal figure to him.

Wait, how do you always know stuff like that?

Well, in this case, it was just a major data research combined with intuition, conjecture, and a fair amount of guesswork.

But I'm 90% sure I'm 80% right.


Yeah, the flight was fine.

I'm just getting settled in.

Uh, no, I'm not in my office.

Apparently, uh, offices are a thing of the past.

Yeah, that's exactly what I said.

He keeps asking about an office.

I mean, who has offices anymore?

And what is this, Mad Men?

Brockett: He is legendary.

Board-certified in three surgical specialties.

He made the list of 20 Top Surgeons Alive Today.

I just don't see this lasting. I mean, him and James are opposite personalities but both equally stubborn.

Agree. I give him four months.

Please. More like four weeks. And I hope he gets that, around here, the title chief of staff is just a suggestion.

Stop staring at the poor guy. Just leave him alone.

What's in the box?

Cheng: Office supplies.

How close are we on the retinal implant?

Uh, it's still pretty hypothetical, but I think it's gonna work.


Let's check in with Bashir.


It's a miracle.

He hasn't felt any pain all day.

Thank you.

Thank you so much. It's just...

It's like you've given him his life back.

That is such great news.

Even Bashir is impressed. Right, honey?

I'm still waiting to see if it holds. But... it is working.

Brockett: We did want to talk to you about one more thing.

We think it might be possible to develop a technology to activate your optic nerve digitally.

Mrs. Masood: Are you...? You're saying he might be able to see again?

Not with his eyes. He'd wear goggles equipped with cameras that would process images digitally, but... yes, he would see.

Oh, my God.

I-I want to manage your expectations.

This is highly experimental.

I understand.

It's just that... This is amazing.

No, thank you.

I appreciate what you're trying to do, but...

I've had 12 surgeries over the last five years.

I've spent a lot of time in hospitals.

I'm done being a guinea pig.

Maybe we just... need a little bit of time to let this sink in.

Yeah, yeah. Of course.

What have we found on Mrs. Gardner's case?

Unfortunately, there's very little we can do.

What about new chemo and radiation treatments her body can handle?

The only way for chemo to be possible is if we could reduce the amount of tumor cells through surgery.

Okay. Surgery.

W, what have you got?

James, I've looked at every possible way of doing this.

Surgery just isn't viable.


She has tumors in four locations. We'd have to coordinate four lengthy and highly complex surgeries simultaneously.

Her body simply couldn't sustain the assault for the roughly 18 to 20 hours that we would take to complete this operation.

So that's it? We just give up?

One meeting, we say no, we're done.


I want pitches on saving Mrs. Gardner's life.

I didn't spend a billion dollars to have people tell me no.

We need to do better.


Everyone take ten.

Just *** developing a treatment. that will help you.

All the hospitals have been pretty clear.

There's nothing that can save me.

You haven't been here.

I've hired the best doctors in the world, and we don't give up on people around here, Louis.


Okay, James.

(door opens)

How's Mr. Keating?

He's lost his dignity.

He'll probably die. Uh...

He says the worst part of it all is how boring it is to be a patient.

Could be me in five years' time, W.

(grunts) Maybe sooner.

Well, we're gonna do everything we can for him.

Find out whatever we can about GSS as quickly as possible.

For him and for you.


We're gonna fight like hell on this one, James.



But, James, you can't, um, lash out at your team that way.

Was I too strong?

People, they look up to you. They want your approval.

Oh, and if you like Brockett so much, why the hell do you keep yelling at her?

I don't know.

She just elicits responses in me.


I'll order a food truck. They like it when I order food trucks. What do you think, W?

Fresh baked donuts or grilled cheese truck?

James, this is not about a food truck.

Just... be kinder.

At first, it was hypothetical, but I believe our team has figured out a way to make it real.

I think it's magnificent.

And Bashir?

He won't even consider it.

He seems kind of headstrong.

Please. He's one of the most stubborn men I know.

How did you two meet?

I was a volunteer at a vet center, where we were placing wounded vets back in the workplace.

He walked in, and all the volunteers started drooling.

He was assigned to me.

At first, he was angry and bitter.

He had just been through so much.

But I kept coming at him, and... eventually he opened up.

What do you think is behind him not wanting to do this retinal implant?

Honestly... it's been hard.

Being in chronic pain, it wears on him.

And lately he's been so irritable.

Well, I understand.

He wakes up in these sweats and he can't go back to sleep.

And he has these intense mood swings.

One minute, he's fine.

The next, he's just impossible.

Natalie, do you keep track of how much pain medication Bashir is taking?

I used to.

But he said it felt like I was babying him.

Feel the air around you, the gentleness of the breeze.

And be in the tranquility.

Let the sounds of the water and all these sensations melt inside of you and become part of your consciousness.

Oh, my God.

Its legs working simultaneously, each one weaving and stretching the silk.

But one master designer oversees the incredibly intricate web.

What if we automated Mrs. Gardner's surgery?

You were right, W. We can't have four surgeons working on Mrs. Gardner at once.

But what if we don't use four surgeons?

What if we program it all ahead of time?

We have one central brain controlling all four surgeries.

Like the spider.

You're talking about automating the surgery?

Removing the doctor?

We'll teach the robot everything it needs to know beforehand.

James, hold on. It's one thing to have machines aid in medicine. It's another to cede control to machines.

We can't do this.

It's irresponsible.

It's immoral.

What better chance does she have, Dr. Wallace?

If we do nothing, she dies.

You said that yourself.

Yes, but just because a patient's gonna die doesn't mean you turn them into a guinea pig.

This is a human being we're talking about here.

We have no other recourse.

James, we need to talk about this privately.

I don't think there's time for talk.

We have two weeks to get a robot through med school.

I'm pumped! Let's do this.

A lot of the behavior you're experiencing... cold sweats, mood swings... are all symptoms of dependence on pain medication.

What are you suggesting, Dr. Brockett?

It is very, very common and understandable, especially for someone who's been in chronic pain as long as you have. It's treatable, and it's something we can absolutely help you with.

I'm not a damn pill popper, Dr. Brockett.

I don't take any of those pills. I hate the pills.

The pain I've been having, the symptoms... they're from not taking any pills.

Do you want to know why I don't want this surgery?

I don't deserve it.

I don't deserve to see.

Bashir, you served our country.

You protected us. You deserve to see.

You're a hero.

Bashir, it's... it's okay.

We were protecting our position on an enemy line.

I was on a post for ten hours straight.

I asked to be relieved.

Sergeant John Howard relieved me.

One of my best friends.

He took my post.

And a mortar shell exploded right on us.

I lost my eyes.

He lost everything but his eyes.

My pain is nothing compared to what he went through.

He won't ever walk again.

Bashir, it's not your fault.

That was my mortar shell, not his.

(rapid beeping)

Channarayapatra: She's having a seizure.


What are her O2 stats?

They're still dropping.

Try to get a mask on her.

And let's push two more of lorazepam and prep a gram of phenytoin.

Should we intubate?

No, not yet. Let's see how she does with the meds first.

Channarayapatra: It's okay, Mrs. Gardner.

Bell: Why is she seizing?

The tumor has infiltrated vital areas of her brain and is causing swelling. I think we have it under control now, but this seizure won't be her last.

We're running out of time.

Wish I come back more after I graduated.

You're such an important person in my life.

Don't think you could ever know how important.

Aw, James.

You practically drove me insane every day you were in my class.

Actually, I always suspected I was one of your favorites.

You know I don't play favorites, James.

Gave us quite a scare, Mrs. Gardner.

What happened to me?

Uh, the tumor, the one in your brain's causing swelling.

It's, um... not good, Mrs. Gardner.



We... have a plan.

We're working very hard.

It's-it's-it's complex.

But I'm not giving up.

I'm gonna try, Mrs. Gardner.

I'm gonna give it... everything that I've got.

I've had such a wonderful life.

I just didn't know I was done teaching.

Hello, Doctor.

I know what you're gonna say.

You don't use paper or books or office supplies, but this is how I work.

I can't change everything overnight.

I was just heading to the break room, and I was gonna ask if you wanted me to pick you up a cup of coffee.

Oh, uh...

Yes, I would.

Thank you.


Doctor, what do you think of this automated robotic surgery?


I think it's brilliant.

You do? Really?

We may or may not make it work this time.

It's a million to one, but around here, million to one are pretty decent odds.

I started to realize that if I wanted to change the world, that maybe the first things I needed to change was myself.

My own belief systems.

Milk and sugar, Dr. Wallace?

Just milk.

Wallace: Given the size of the kidney tumor, I'd take big bites with a 36 mm needle on a 2-0 Vicryl suture to get a tight closure on the renal defect.

Also use a LAPRA-TY and flow seal to minimize the blood loss we're expecting.

Okay, the mannequin is in position.

(clears throat) Are we ready?

We think so.

You think so?

Good point. We are definitely not ready.

Let's just try.

Cheng: Okay. Let's run the test.

(system whirring)

Wait. Why is number three not going?

It should be. Angie.

The multiplexer must not be accepting data from the relay.

(metal clanging)

(clanging and creaking)

Shut it down.

Just... down, shut it down.

This is not working.

I have to go back to square one.

What, W?

I didn't say anything.

Hey, dumb-ass.

Long time.

Who is that?

Well, it's me. Your ears broke, too?



One of your doctors called.

What are you doing here?

Well, I'm here to see you, brother.

It's a long time.

You don't write, you don't call.


I should have been on that turret.

Yeah, you should have.

You should've just peed your pants instead of taking a bathroom break.

Where's your dedication?

Everything we stand for, Having each other's back, protecting each other, and I let you take that mortar for me.

So wait, wait, wait.

That's why you don't want to have this operation?

You don't deserve to see because of what you did to me.

(clears his throat)

Do you know how freaking stupid that sounds?

Get over yourself.

It wasn't your mortar; it wasn't my mortar.

It was the guy's who were trying to kill us.

It was their mortar.

So let these doctors do their miracle surgery.

Then you can come and see me in Albuquerque and you'll see me with your own eyes.

And you know what you'll see?

You'll see that I'm happily married, and I've got a beautiful daughter.

And I'm doing just fine.

Then you can buy be a beer and we'll call it even.


How's that sound, brother?

(machinery whirring)

(clanging and beeping)

(typing, system powers down)

Any ideas?

From me?

Yes. (clears his throat)

Sometimes the least knowledgeable person can have the best ideas.

James, I'm trying to get on board with this, I am.

It's just I keep thinking you're trying to get robots to act like people, and, unfortunately, no matter how sophisticated they are, they're still robots.

W, you're brilliant.

I am?

They're robots.

And we're having them stand around the surgical table like they're doctors, Human doctors, which is embarrassingly two-dimensional thinking.

We need to be operating on an X, Y and Z axis.

We hang the fourth arm above the patient, giving us an extra 12 degrees of rotation for each device.

W-we can hang them up from a lighting rig like at a concert.


Those things can hold the weight?

Have you ever been to a concert?

Well, uh...

I have season tickets to the symphony. Is...?

I know the lighting guy with Phish. I'll get on it.

James, they're getting started in Mrs. Gardner's room.

Okay, great. Everybody keep working.

We can do this.

Uh, W, I want you to see this.

Mrs. Gardner: Abby, honey, great job.

12 times 12, oh, my goodness.

How did you get that far?

Okay, my wonderful mathletes.

What do we say to Abby?

All: Abby is awesomeness.

Okay, mathletes, remember one thing.

Everyone has a different way to learn numbers.

'Cause you know what?

We're all different.

And that's what makes us all so beautiful.

(quietly): Thank you, James.

Okay, mathletes.

Let's get out those tablets and rock and roll.

Do you see how awesome technology is, W?

We're making miracles here on a daily basis.

Mrs. Gardner: All right.

Big and small.

Mrs. Gardner: You ready? Let's go.

They're positioned behind the retina, right above the optic nerve.

Nice work.

It's a suprachoroidal hemorrhage.

He's hemorrhaging between the layers of his retina.

I need to increase the intraocular pressure to tamonade the bleeding or his eye will rupture.

All right, let's raise the pressure to 80.

I'm pushing .5cc's.

It's working.

The choroid is retracting, the bleeding is stopping.


Hey, how'd it go?

The procedure was successful.

Once he wakes up a little more, has a little more energy, we'll see if it works.


It's exciting.


And terrifying.

What do you mean?

It's stupid.

No, what?

This is a picture of Bashir's girlfriend before his last tour in Iraq.

This was the woman he was with before that.

Notice any similarities?


They're both gorgeous.

He's never seen me.

I never thought he would.

I'm not like these... girls.



You're beautiful.

And you have something these girls don't have.

Please don't say a good personality.

He loves you.

(chuckling softly)


Channarayapatra: Mrs. Gardner's vitals are stable.

Wallace: She's tolerating the procedure well.

Channarayapatra: It's starting with five laparoscopic ports to simultaneously access both the liver and kidney tumors.

Basic three-port thoracoscopic technique for the lung.

And a single-port approach for the brain lesion.

(whirring and beeping)

Wallace: What's going on?

Why is it defaulting to an anterior approach?

It's changing its initial plan.

Blood pressure's dropping and damaging these lateral blood vessels here, at this pressure, would risk a stroke.

Oh, my God, I know what it's doing.

It's gonna pass right through ventromedial prefrontal cortex to access the tumor.

Hold on, guys, what does that mean?

The computer is choosing the safest and most expedient route to remove her brain tumor.

Why isn't that a good thing?

Because it's gonna pass right through the VMPFC... that's the higher emotional center for her brain.

Wallace: The birthplace of compassion and empathy.

Burring through this will change her in fundamental ways.

Okay, what are our options?

It's risky, but we could do an Endoscopic Endonasal Approach.

Endonasal? Through the nose?

You want the computer to pull the tumor out of her nose?

It's too intricate a procedure.

The robot's not gonna have the dexterity to pull that off.

You might not, either.


We need to make a decision.

We need to run a survey.

Stop the cranial unit.

Keep the others going.

We'll finish the brain tumor ourselves.

Dr. Channarayapatra, we're going in.

♪ ♪
♪ Hold your head up high ♪
♪ Were you born too old and are afraid to die? ♪
♪ 'Cause the light is fading out of your eyes ♪
♪ I'll give it all ♪
♪ I'll give it all ♪
♪ Come on, feet, don't fail me now ♪
♪ 'Cause I fall too hard if I hit the ground ♪
♪ And these worn-out souls... ♪

Mrs. Gardner has a long way to go, but we might have just saved that woman's life.

I might have to change my belief system.

It doesn't happen overnight.

In fact, I have something that I want to show you.

♪ Ooh ♪
♪ I'm afraid, I'm afraid I'm afraid ♪
♪ That I'm falling apart ♪
♪ Ooh... ♪

Son of a gun.

I guess I'll always be a little old-school myself.

Dr. Channarayapatra, you're full of surprises.


I think that that desk has your name on it.

Our little secret?

Our little secret.


Are you ready to see your wife for the first time?

I am.

Are we all ready?


I think so.


(switch clicks, glasses power up)


(sighs): All right.

What are you seeing?


All white.



Oh, my God.

What are you seeing now, Bashir?

I see...

Is that you, Natalie?

What does she look like, Bashir?

She's the most beautiful thing I've ever seen.

Mission accomplished.

How'd you get him to change his mind?

I channeled James Bell.

Found a person who could talk sense into him, and flew him in on the Bunker Hill jet.

Hearing that come out of my mouth, I realize I probably should have gotten you to sign off on the jet.

Brockett... you didn't give up.

You didn't let anybody tell you no.

And what you did could give eyesight back to thousands of people.

That is Bunker Hill in a nutshell.

Well, it wouldn't have worked without Talaikah or Angie, but... thank you, James.

Listen, um, Brockett.

I wanted to apologize.

I know I snapped at you the other day...

No, it's okay.

No, it's not okay.

I shouldn't snap at anyone.

You, of all people.

Look, I get that you were going through a lot with Mrs. Gardner.

I know that she was, like, a surrogate mother to you.

What? Who told you that?

No one.

I'm sorry, I feel like I might have hit a sensitive subject.

I don't know what you're talking about.

I mean, mother issues are a deep well.

Mother issues?

I certainly have a wellspring...

I certainly don't have mother issues.

No, I didn't say you did.

I think that you did say that I had mother issues.

I just heard that your adoptive mother wasn't very maternal.

I don't think this is an appropriate conversation for us to be having.

So it's understandable that you would inflate your relationship with your third grade teacher.

Okay... Brockett, please!

Okay... let's not talk about anything personal... ever.


Pawn to king four.

Knight... to bishop three.




(monitor beeping)

I've got something for you, Mrs. Gardner.

(voice breaking): How beautiful.

We did it.

Thank you.

No, Mrs. Gardner... thank you.

For the first nine years of my life, everybody told me I was a bad kid.

You just told me I was a weird kid.

All the other teachers would send me to the principal's office, but...

...you sent me to the computer lab.

You saw me.

You were the only one who saw me.

I can't believe you did all of this for me.

You were one of my favorites, James.

I won't tell anyone.

I knew.

I did. I knew that.

I knew that.


How was your first week?

I'm still standing.



(deep breath)

I'm sensing an awkwardness.

Maybe it's because you haven't yet admitted to me that my idea to automate the robotic surgery was correct, and your resistance to it was incorrect.

Or maybe the awkwardness you're feeling is that you haven't yet admitted to me that without a human doctor present, that robot would have cut the soul out of Mrs. Gardner without a second thought.

Touché, Dr. Wallace.

(elevator bell chimes)

Guess we're stuck with each other.

For the moment. (chuckles)

James, as Chief of Staff, I'm used to having full control of the hospital.

I think you and I need to clarify which one of us has final say when it comes to medical decisions.

Yeah, I probably should.