02x04 - The 7th Annual Christmas Card Competition

[bunniefuu]

Uh-huh. Uh-huh.

Well, could I just ask, do you include flatus within your definition of fecal incontinence?

Oh, you do not. Interesting.

Yeah. Well, an ongoing, raging debate.

I myself have always felt that we should just stick to the loss of solid or liquid stool.

(Squeaking)

Morning.

Cones are up.

I'll just scooch by.

Hello.

Hi.

Morning to all.

I just dropped by to draw your attention to our annual Christmas Card Competition.

It's for the Kid's Oncology Ward.

You can do your own, or there's an app online that offers ideas to help get you started.

Um... (clears throat)

I think, uh, I left my credit card in your car yesterday.

I found it. I forgot to bring it in.

I will tomorrow.

I took us to the Four Seasons in La Jolla Saturday night.

You know, we needed some space to move into our new relationship.

I think it really helped us turn a corner.

Pricey digs.

Dawn: He was having a little bit of a hard time with all this.

It's a big shift, Didi, you know, thinking of us as a couple without a baby.

You know, a baby just might have been in the way.

You know, couples with children, I mean, that intimacy, you know, it shifts.

It just... it deteriorates.

I'm glad you had a nice weekend, Dawn.

(Door whirring)

Hey, you wanna see some selfies I took?

Anyone, ask me why I'm excited.

I'll tell you why I'm excited.

Well, Dawn was just getting ready to show us pictures from her La Jolla trip.

No, it's fine. It can wait.

I have been asked to participate in the Cochrane Study on Perianal Injectable Bulking Agents for the Treatment of Fecal Incontinence.

It's such important work. I mean, how many women do you know with fecal incontinence?

And yet, it's this crazy aunt in the attic of female geriatrics.

Nobody talks about it, everybody lives in terror of it. What?

It's just, you know, you do so many studies, that's all.

I do, Dawn, and you're not involved in them anymore, so I think we're all right on that account.

Didi, can you imagine how many lives would change if we could just put a dent in fecal incontinence?

Does that include gas?

Flatus, no. Generally, not.

Well, it is for me, especially these days.

There's just no such thing as an innocent fart anymore.

The fact is, we women bear the burden of fecal incontinence, because of our unique risk factors during pregnancy.

But the solution is so simple, it has literally been staring us right in the face.

Interior a**l sphincter augmentation.

Like lips.

Collagen.

Same basic principle as cosmetic surgery, only infinitely more important.

Why is Birdy Lamb... What is she in here for, anyway, exactly?

Originally? Um, she had liver cancer, then we treated a bad infection, and now she has renal insufficiency.

Well, renal insufficiency... could definitely possibly be teinal within six months, so I think that we should think about enrolling her in our Hospice plan.

'Cause I bet she could really benefit from that extra level of care.

Hello.

Man: Well, it's an hour 20, plus the ferry to the Vineyard has wifi now.

Oh, sh*t! sh**t, sorry!

So sorry.

I am so sorry.

No, totally my fault.

Oh...

Here's your donut.

Uh... my bad.

All good.

Well, well, well, who's the patient?

Which twin has the Toni?

This is Denya Thorp.

Denya is a Reiki instructor.

Oh, wonderful. Wonderful.

What does that mean, exactly?

Transferring universal energy to promote equilibrium through the placement of hands.

Um...

That is my mother, Lorraine.

Hi, Mom.

Dawn: Uh, Denya has extreme lower abdominal tenderness, significant gastric distension.

Yes, I can see that.

She was diagnosed with ovarian cancer, they did a total abdominal hysterectomy followed by two rounds of chemotherapy, before being referred here for hospice last week.

Dr. Kim, my oncologist, told me I only have six months.

Jenna: Dr. Kim is a very good doctor, and...

♪ Lucy. ♪

Mom? Mother? Oh God. She wanders.

Marguerite? We'ltake care of her.

What?

Hold my hand.

Uh, certainly.

So, gents, we have abdominal distension.

What might we be thinking?

Bowel obstruction, a midgut volvulus.

Could be looping of the intestines.

Oh, look who's back. Possible adhesions.

Yes. Hi, Mom.

♪ Luuuucy. ♪

(Weakly) ♪ Ricky. ♪

I had cancer and chemo at Cedars.

Brutal. She just can't take it.

You're like that mother in "Night of the Iguana," or whatever that movie was where there was that mother who was always just there.

(Sighs) What does it matter?

The world's coming to an end, anyway.

Well, it might feel that way.

I saw a documentary on the beaver, and, uh, they're making quite a comeback.

Let's get a scan, Dawn, and perhaps consider a nasogastric tube to relieve the distress.

Will that hurt?

Uh, no. No.

Doctor: You gotta do this three times a day, the next month.

Woman: Okay.

Rotate it like this.

And in six months, you'll be doing this.

(Woman laughs) Doctor: Wanna try it?

Well, well, well.

Miss I-don't-have-the-time- of-day is interested.

What are you talking about?

What's his name?

I don't know.

Well, go say hi.

I am not going to say hi.

Dawn: Don't be shy. (whispers)

Dawn!

Doctor: You're improving already.

Look at you.

Denise, this is Dr. Parker Owens.

Hi.

Hello.

This is Denise Ortley.

Dr. Owens is an orthopedic surgeon.

He specializes in shoulders and hips.

He's here at Mt. Palms for two more days, and I told him that he could use our phones if he needed.

Denise, maybe you'd like to show him our phones.

We got one right there and one right there.

All right.

Well, it was nice to officially meet you, Denise.

Bye. All right, don't feel like you have to say thanks or anything.

I cannot believe you did that.

Why?

Because!

Dawn: I was just helping.

I don't need any help.

Dawn, we're implementing new procedure for the dry-erase board.

Patient's names are protected health information.

So let's just use a first name, unless you have written authorization from the patient, okay?

Okay. Can I come over tonight?

Dawn, no, not tonight.

I told you my mother's coming to stay.

I thought you said she was going to Cuba with your father.

Yeah, she can't. After what she did last time, they won't let her back in.

So...

Can we at least have dinner?

(Whispering) Dawn, I have some negative feelings. Okay?

Not positive feelings.

Well, I have feelings, and some of my feelings are not positive, too.

Well, some of my not positive feelings are about you. Okay?

Well, me too. Me too.

You know, but I know that the not positive feelings that I feel about you, they're not really about you.

And our ability to talk about it makes the negative feelings actually very positive.

Okay.

I gotta get back to work. Okay? Hey, guys.

Excuse me. So here's this. I think...

Okeydokey.

Up your nose with a garden hose.

It's gonna hurt. The doctor said it wouldn't, but I'll bet it does.

A little bit, and then it'll be over.

I'm a pro.

I'm gonna put this tube into your nose, and then it is going to go up and around and down.

Slather, slather, slather.

Where do you live?

I used to live in Guatemala and Santa Fe, but now I live here with her for the last seven years.

I was actually born in this hospital, 51 years ago this January.

You do not look 51 at all.

Didi.

I'm putting it in. I'm putting it in.

(moaning)

I think there's enough lube, so I'm putting it in.

Are you feeling any discomfort? No?

Okay, 'cause you can squeeze my hand if you feel uncomfortable. Okay?

Okay. Okay.

There's an obstruction.

Didi: Okay. It's okay. Ooh!

Obstruction is what we got going on here.

Didi! No, no, no.

You can squeeze my hand.

On a scale of one to 10...

Dawn: It's like a traffic jam.

We can get around it.

Didi: Ooh, ooh, okay. No, no.

Dawn: Didi.

Please, I need you to focus here, okay?

Can you relax, ma'am?

Denya: I'm fine.

Okay.

Okay, can you swallow for me?

Swallow. Swallow. Swallow. (yelping)

Done. Yay!

That wasn't so hard, was it?

Okay. Now I'm getting some tape, 'cause we wanna make sure to secure this into place.

Nice and easy... on your nose.

Okay. Now I'm gonna get some...

(gagging)

Oh sh*t.

(Mouse clicking) I am actually excited about this Christmas Card Competition.

Maybe I should submit, too, huh?

How about one of these?

One of our selfies.

Intimate selfies, here.

Oh...

This one, or this one.

Jesus, Dawn!

Stop, stop, stop. Okay, no, no, no.

Seriously look. Okay, so what I want to do now, I wanna put the letters at the top. How do I do that?

Oh, that's easy. You just go to the, um, text pull-down box.

Can you do it? Please? Just...

Now, should I put this up to 22? Right now it's at probably at, like, 18.

You think it should be bigger?

Yeah.

Okay, bigger.

Yeah. Okay.

I'm really scared he's gonna dump me now, you know?

Without the baby.

What's the matter with all these dogs, by the way?

Oh, I used dead ones.

That's the North Pole.

And I Photoshopped in a sleigh and some huskies.

I mean, it's just the... the eyes are mismatched, kinda.

Didi: Right, but I just figured if they liked the general direction I was going in, they would fix that.

(sighs) Move. Dawn.

We need to download some large format vulvar C-types.

The file's in sub-folder C, document l27.

Can you attach that, email that to me, please?

Uh, Dr. James, I have the certification of Terminal Illness for Birdy Lamb, plus three new pre-certs.

Great. Great job.

(Woman sneezes) Grim Reaper.

(laughing)

Sending. And away we go.

Nurse, I need a new chair up on Six, without the wheelie-balls, 'cause I wouldn't want to run over one of my mice.

You let them loose? Out of their cages?

I just... no.

All these new TVs, by the way, where's that money coming from?

Departmental Augmentation.

Many of our patients can now visit and Skype with family members who are unable to visit in person.

Well, that's nice, but I think that that's my money.

I earned that money.

Yes, but it is my job to ensure that the equipment is sufficient to adequately meet...

Not when it's my money.

It's my hospice money for my institute.

I mean, I can't even...

I'm studying anogenital distances, gender flips, vaginal atrophy.

I have been invited to participate in the Cochran Study on a**l Augmentation for Female Fecal Incontinence.

And yet always, always it's this opposition.

Hey! Excuse me! I'm supervising nurse.

Birdy: Why? I don't wanna move.

Didi: Well, it is your new, special hospice suite.

It has a sofa and a recliner.

It does?

Yeah.

And you got a flat-screen TV.

Birdy: Really?

Yeah, and look at that wallpaper.

Ooh, honey. Ooh-la-la.

I was told you wanted to... (knocks) see me, Ms. Thorp?

Yes.

I really want to die.

I want a quickened ending.

You could gently up my morphine, which, as we know, would depress my respiration and hasten things along.

Lorraine, surely you don't want to see your daughter leaving us so quickly?

Oh, I'll be fine.

I can take care of myself.

And I want to die here.

I may not have been some punk-rock star, or some Maharani princess, but I would like to believe I made it somewhere further in life than just my mother's condo.

I mean, I'm sorry I was irresponsible.

I didn't save for my retirement.

But in all fairness, I should have had my inheritance years ago.

We all should have.

My father was a physician.

Doctors always used to prescribe extra morphine to help their patients get through it a little faster.

Well, physicians can definitely not do that anymore.

Every death is reviewed by a nurses' panel, and the whole system, these days, is set up so everybody rats everybody out.

The world is filled with such ignorant douchebags.

Oh, the stories I could tell you.

So I skipped college and I lived in Guatemala by myself.

Not because of some guy.

And I studied painting with Nan Cuz.

(Sighs)

So then we got this license from the city of Albuquerque and we started the shelter.

Mostly dogs and cats at first, but then birds, too.

Mother!

But then poor Shotzie could only get by with her hind legs in a wheelbarrow, peeing everywhere, and then Noodles got this rare form of canine leukemia and Mother kicked me out. (snoring)

Yeah, I lived in a shelter until I put them down, and then she let me move back in.

Well, pets are wonderful companions, but really, this should be about you.

This is about me.

Cats and dogs used to wander off when it was their time to go.

Now we have them cooped up indoors, they have pet insurance, and we keep them going, too.

It's not right.

It's my time, and I want to wander off.

Did you take your pills?

Let me see.

Lucy.

♪ Ricky.♪

Here.

(laughs)

It's not unreasonable, Jenna, to put TVs in patients' rooms.

Gosh, next they're gonna want telephones?

Paul, it's not fair. I made that money.

Yes, but there is a greater, common good, and your fecal incontinence, maybe it's all just a bit too ambitious.

Maybe you should just stick to geriatrics.

We can no longer sweep female fecal incontinence under the rug.

What about that greater good? What about the untold lives of the millions who are affected?

The embarrassment, the self isolation, worrying for 20 years over its onset, considering invasive colostomies to prevent it?

Okay. Yes, all right.

Sitting in one's own filth?

All right.

It's quality of life, Paul.

I understand.

Mental health.

Yes, don't go to the barricades.

We plump up our lips with collagen to give better blow jobs, and make ourselves more kissable, but for us to use that same material in tissue that is infinitely more meaningful to us...

Got it.

Our a**l sphincters, is to live out our lives with dignity instead of discarded dirty dolls.

(Door slams)

(sighs)

Excuse me. Dawn?

Could I have a minute, please?

Yeah.

Okay, I'm wearing my Children's Oncology Christmas Card Competition hat here.

Didi: Did I win?

An obscene picture was sent to the competition.

Why are you telling us?

(laughs)

You took those pictures at the Four Seasons.

I thought maybe you sent it by mistake.

You actually think this is my...?

Hm.

You can't tell the difference?

Patsy, this is, like, an 80-year-old vag*na.

This is one of Dr. James's vulvas.

Jenna: Yes?

What?

Dr. James, I'm sorry, but... (clears throat) looks like one of your large-format vulvar C-types made its way down to Children's Oncology department for the Christmas Card Competition.

I'm not tracking.

Oh my God!

You're telling me that we are dealing here with a photo of a patient's vulva?

(Didi laughs) This is not funny.

Nurse, no. No!

This is add protection and should clear clear and blatant HIPAA violation.

HIPAA compliance and data protection have got to get involved.

Clearly, this vulva belongs to somebody, and we need to find out who it belongs to.

This vulva is anonymous!

There is an apology due to whomever has appeared in this photo.

Okay. Well, how do you propose we identify it, because apparently they all look alike?

Jenna: It's a blind study, so it's impossible to tell.

Everyone look closely, and maybe somebody will recognize it.

What's going on?

There's been a major HIPAA violation.

Okay, people, even having his conversation here like this in public is a potential HIPAA...♪ violation. ♪

Paula: Either we identify it, apologize to the patient and resolve it, or this has to be reported to Administration.

Okay, well, how do you suggest Dr.

James even identifies whose it is?

I mean, she's taken hundreds...

Hundreds!

And even if it was my vag*na, it came from Didi's account.

So how do we know it's not hers?

Okay, even if it was sent from Didi's account, for some very odd reason, Didi.

It's not even black!

What are you talking about?

Who cares what color it is?

The data is still yours, so you are the responsible party.

Okay! Where is it? Let me see!

Dawn: Okay, jeez.

All right, um... severe labial deterioration, um, it does look familiar.

So, uh, oh, it's right on the tip of my tongue.

It is Birdy Lamb. I can absolutely confirm that she is the lady in question.

Good. Great. Bingo. Tell her.

Jenna: No.

Dr. James, I am the union rep on the Data Protection Committee, and we are duty-bound to disclose to patients or their relatives when information pertaining to the patient has been released into the public sphere.

For pity's sake, it was the harmless transmission of an errant vulva.

People, we cannot f*ck with HIPAA!

I heard about an investigation by the Department of Justice, with prosecutions!

They actually... they actually put people in jail for this!

I am five years from early retirement, people, so this is not a risk I am willing to take.

(Playing piano)

Parker: Okay, try to make a fist.

Woman: That's good.

That's good. Okay.

Nice. Can you do that?

He's a doctor, I'm a nurse, and I'm married.

That doesn't mean you can't have a little fun.

I'm like my life, Dawn.

Dawn: Good.

Does that hurt?

Checking in.

I'm sorry.

I didn't mind when my hair fell out.

But it k*lled me when I lost my eyebrows.

Hey. Come with me for a sec.

Where?

To the, uh, beauty shop.

You ever think about doing something different with your hair?

No. Come on, let's take the stairs.

What?

I do not wanna talk to him.

Dawn?

Wait up!

I'm so over him.

Dawn: He's the world's biggest loser.

He's too lazy, he won't come down the stairs.

This is stupid.

Why didn't you choose wait?

'Cause I don't want to talk to you!

Thanks for that shitty weekend.

Oh, and, you know, thank you for sticking me with the apartment, by the way.

Did I... did I say that?

No, I actually didn't.

Well, then where's your half of the money?

Do you guys have to do this right here?

You know what? I feel like you tricked me into getting you pregnant.

Oh, you do?

Yeah, I do, and then I feel like you trapped me into that apartment, and I am only speaking my deepest, most inner truth.

You know what? Eat me. Okay?

Get out of my way, Freddie.

Cones are up. Stairs are wet.

Patsy: I have to say my truth, because it's my truth and I have to say it!

I suffered a blighted ovum, okay?

I lost our child that never existed, so why don't you just stop thinking about your g*dd*mn self!

Go back... Oh!

Didi: Hey! Dawn!

(Squeaking)

There's your freakin' stairs, Freddie.

Are you crazy?!

Dawn: And I didn't trap you.

All I wanted was to become the person I was meant to be instead of being the f*cking me that I am.

Is that so much to ask?

You and me and a baby would have made me that person, and now I'm just f*cking me.

Dawn. (speaks Spanish)

(speaks Spanish)

Dawn?

No!

I can do this on my own.

I don't need you.

I am auto-sufficiente!

Oh! Girl! Hey!

Dawn! (thudding)

I see it. What?

She fell. Stairwell.

Oh, God. Get this over with.

Well, I should call Paula first.

No. Eh, leave her out of it.

Good afternoon, Miss Lamb. I certainly hope you had a nice bath.

You remember that I asked you for your permission to include you in my vital medical research?

Yes.

Yes.

Jenna: Well, there was a slight confusion, which resulted in the photograph of your vulva being distributed throughout the hospital, uh, via the Internet, in the form of a Christmas greeting card.

Oh. All right.

(laughs)

Do you know what this is, Miss Lamb?

No.

It's genitalia.

Miss Birdy? That's your little p*ssy.

No. Mine's big as a bucket.

(laughs) (chuckles)

(soft music plays)

Didi: Okay, let's try this.

Great color.

Okay, don't peek. Don't look.

Don't look just yet.

Let me get you around.

Okay, wait a minute.

Yeah.

Open.

(laughs)

Oh my god!

(laughs)

Ooh! Sorry.

Hello again.

Just getting my potato salad.

I don't bite, you know.

What do you mean?

Where you from?

Richmond, Virginia.

Where'd you go to school?

Yale. You?

I'm from right here, all the raggedy parts.

I saw your, um, dance moves earlier with the patient.

It's pretty interesting... (chuckles) for somebody from such a fancy school.

So now you're gonna show me how it should be done, huh?

No. You show me.

All right.

(Classical music playing)

Okay.

(Classical music continues)

You certainly got the moves in you.

Orthopedically speaking.

(Music continues)

You know, this could never, ever be anything more than this.

I got the results of your scan.

There was indeed some intestinal looping, which would explain the abdominal pain.

We can address that.

The scan also showed new lesions on your kidney and spleen, consistent with fresh metastases.

Um, I'm afraid that the six-month timeline might be over-optimistic.

We have a choice.

You are sick enough to stay here with us, if that's what you wish, or you can go home... now I want you to listen very closely... with your mother and a nurse and a morphine pump to be adjusted to your level of pain.

You would be in charge of making yourself more... comfortable.

Do you understand?

Thank you.

Dawn! Can you come here for one second?

Yeah? What the hell do you think you're doing?

Well, I was just walking him to his car, and then I was gonna try to get into his junk.

The hell you are! You're not doing anything like that!

Why? You don't want him.

Such long, full days.

"Like sands through the hourglass, so go the days of our lives."

Who said that? Walt Whitman?

Is that "Leaves of Grass"?

I think it was on a soap opera or something.

Well, I'm leaving. I'm off, off, off.

Do you know that mice run on a wheel not because they are neurotic, but because they just like to run?

New studies have proven that...

(farts)

(farts)

Not gonna happen.

Don't even think about it.

(Classical music playing)

♪ ♪