01x07 - Pain

[bunniefuu]

-[John] Is the foot moving?
-[Tim] No.

[John] Toes not working now?

[Tim] I can feel it.

[John's voice] I hope that his leg
comes back so he gets both.

[Amanda's voice] I don't feel like
I'm tired because I'm pregnant.

I feel like I'm tired
because of residency.

I'm like a bad OB patient.

But I don't want it to be
at your own emotional or physical expense.

[Mirtha's voice]
You cannot choose what comes at you here.

A place where you can't judge people.

It's not just medicine. They don't teach
this stuff to you in medical school.

You don't read a textbook on how to deal
with someone's social situation.

[Phyllis] It's not worth it.
I'm going to get myself a nice pill.

So whenever that moment happens...

happily, I'll say good night.

We're comparing his new scan...

Scan looks better. m*therf*cker.

This is good film.
I just wanted to show you.

-Yeah.
-[John] If you don't mind.

-[Laura] Wait, say it again?
-[John] It looks good.

[Laura chuckles]
Okay. Like, why are we going back here?

-[John] I like what I see.
-Oh, God.

Yeah.

[group cheering, applauding]

Having you here tonight is amazing.

[whooping, cheering]

All right. We're thrilled. I'm so happy.

-Thank you.
-[David] You've been through so much.

You're such a great person.

Sherese, I'll be right there.
Did you see the scan?

How's it look?

[John's voice]
I'm going down to see Agy Pena.

She's the cop that had
all the clinical trial stuff.

This is not good news.

f*ck.

[bird twittering]

[women chattering]

-[woman] Your back looks amazing, though.
-[women laugh]

[men chattering, laughing]

[David] The winner's here.

[man chuckling] The winner is here.

[woman] You finally made it.

[David] There's so much traffic.

Justin. Let me put my sweater on.

[woman] Langer!

Oh, my God.

[woman chats indistinctly]

-[John] Sweater.
-[man] Mitchell!

[David] What's up, Mitch?

-Is he the judge?
-[woman] He's judging.

[John] All right, let's do this.

[all hooting, cheering]

[all laughing]

[David] Very good.

That's it!

Yeah!

[group applauding, laughing]

[Mitch] I think, for overall ugliness,
the winner would have to be Dr. Langer.

[all whooping, cheering]

[all laughing, applauding]

[woman] We'd like it to go
as naturally as possible.

If things don't go as planned,

we're open to whatever, but we want
to have a conversation about it,

so we feel that we're a part
of the decision-making process.

That's the plan. Right?

-[all] Yes.
-[woman] So all is well there. Okay.

I think we're gonna play our game now.
This is a values clarification game, okay?

Everybody has a stack of cards,
and, for example,

I'm looking at my card that says,

"Wear my own clothes
or wear the hospital gown."

So I'm choosing to wear my own clothes,

so you're gonna just pick out
your perfect dream birth scenario,

whatever it is.

-Hospital birth.
-[Kevin chuckles]

[group chattering]

-That's a lot.
-Vaginal birth. Yep.

[Kevin groans]

[woman] So you're going to choose

twelve cards to turn over, okay?

[Amanda]
I don't care if they break my water.

I don't care if my doctor--

-[Kevin] There's still the back.
-I can't exclusively breastfeed.

-[Kevin] Why not?
-Because I go back to work in six weeks.

Keep in mind that sometimes
things really don't go as planned.

-Doing a great job. Okay, great.
-[Kevin] But you notice how you...

overruled me at the end?

-You notice that?
-Because it's my birth.

I'm just saying,
I'm supposed to be your coach.

-You're not my--
-[woman] We identified whose birth it is.

[all laughing]

Sometimes it's just totally
not what you planned.

What we do now is the opposite.

We're gonna choose...

three cards to keep.

I think, for me, those are the keys.

All right.

I mean, it's your kid, I guess, so...

[group laughing]

[woman]
So you have your three cards, right?

There are two cards
we don't include in this game.

And that is the healthy mom
and the healthy baby card, right?

Because who would ever turn those over?

-[Amanda] Where do we get out?
-[Kevin] I just want to go home.

You really worried, boo,
about your labor, boo.

-[laughs]
-Why you so worried? I don't understand.

I don't feel like
that was a worried labor.

-Unlimited labor support, boo.
-[laughs] That is number one, boo.

I don't understand. What's--

I don't understand why you think
I don't need unlimited labor support.

-Maybe if your mom wasn't a labor nurse.
-[Amanda] Does she know all the positions?

-I don't know if she does.
-She knows all the positions.

-I was thinking about that today.
-She knows all the positions.

[car horns honking]

-[Mitch] Oh, my God.
-[group laughing]

[woman]
Everyone, stay here for two seconds.

You're so sweet.

Love you, brother.

-[John] You look good.
-I'm back.

[John] You look f*cking great.

[Mitch's voice] When I first got out
of the surgery, I remember...

I didn't even look in the mirror
for like four days.

But at some point, it settles in.
You just kind of say,

"Well, this is what I look like now."

And it was always a positive thought
in my head about coming back to work.

It was never a negative thing.

[man] Dr. Levine.

[Mich's voice] Coming back to work
represents a return to being alive.

Or a return to normalcy.

A return to a safe place.

There she is.

[all laughing]

-Watch my neck.
-I know. I'm sorry. How are you?

-So I finished the radiation on Friday.
-Right.

-So they say the next two weeks...
-Your energy.

-...it's still kinda crescendoing.
-Yeah.

Then it starts to get better.

It's good to be
on this side of the desk...

instead of sitting over there.

It's good to see you
on this side of the desk.

God.

[chuckles] Oh, God! Oh, God!

[man] David, how are you?

-[David] Today's the day, right?
-[man] Yes, yes, yes.

-[David] You all set?
-[man] Yes.

So, obviously we've talked
about the risks quite a bit,

and it's not something
that's easy to predict.

The reason why we're keeping you awake is
that we limit the risk.

Um, I'm very confident we can
take this out and make it better.

I know this has been something
on your mind for a long time.

If you're gonna grow up and be a doctor,
we gotta get this out of your head.

-Deal?
-Yeah.

[David] You're brave.
Actually, my daughter is in medicine...

so she's-- she's just like you.
You remind me of her.

Oh.

[woman] Same age?

Sixteen, yeah.

[David's voice] This girl,
she had a head injury playing soccer.

They ended up scanning her
and found this.

This one's just an isolated cavernous
malformation in there.

In general, relatively benign.
Guess we'll make a decision

of what we think is best
if it was our kid.

You guys can go down with her
if you want. Okay?

[David's voice]
When you have a patient that doesn't have

a sort of a good
third-party payer insurance,

it can often be very difficult
to get approved.

And in this case in particular,

her insurance didn't cover this
because it wasn't an emergency.

And so, in the end,

the hurdles of getting this cleared
required that

I essentially don't get paid for my time,

and, uh, it's not a consideration for me.

-[David] Is she okay?
-[woman] Yeah.

[David's voice] The fact is
that it's a human being in front of us.

[air hissing]

That's it.

That humanity, empathy, that has to drive

the decision-making first.

[woman] Thank you.

[David's voice] Ultimately,
it's the human being and the family.

That's what makes me
come to work every day.

[John's voice] We all go through emotions.

And some of it comes with disappointment,
especially after we lose a patient.

[Sherese]
I just... I have really bad weekends.

-Because of Agy.
-[Sherese] Yeah.

I just have an extreme amount of guilt.

-Why do you feel guilty?
-[Sherese]I don't know.

Even when she was getting Avastin,
she'd be here.

Look, I felt sadness more than guilt.

I mean,
I just feel like the window's long.

You know, two months to be giving people
experimental days.

I know you're down on clinical trials,

but we have an obligation,

and this is what drives us.

[Sherese] I guess.

[Sherese's voice] 
I don't know. It's devastating.

I've been doing this for a long time but
I don't know, this one hurt really bad.

[man] Five year...

[men chatting indistinctly]

A part of me just wants to say,
you know...

-go do your bucket list or sit on a beach.
-Right. I mean--

Whatever you wanna do.
But, you know, just the hope...

is dwindling, um...

for me.

You know, to give people hope.

We're still here...

you know, after people are long gone,

-Right.
-...and just kinda keep this roster

of patients that are no longer with us,

-but it's a lot to bear after a while.
-Definitely.

I've been doing this for almost 17 years.

I got a phone call over the weekend
that she died,

and I screamed, "f*ck!"

And my kids were like, "What happened?"

And I've done that maybe...
five times in my career,

where I've gotten a surprise phone call
about a death.

-It was a shock to everyone.
-That I didn't expect.

But it's hard-- It's easy to get...

discouraged, you know?

And to be demoralized and...

quit fighting, you know?

[workers chatting indistinctly]

[David] Yo.

What's up?

-[Mitch] I don't know. What's up with you?
-[David] Want to operate Friday with me?

-Friday?
-[David] Yeah.

-What are we doing?
-It's a cervical decompression fusion.

-I'd rather you do it with me than John.
-[Mitch] Yeah.

I feel fine when I'm operating.

I don't have, you know,
a tremendous amount of, uh...

stamina at night, but I come in,
I do my surgeries,

and I can't be operating
until 10:00 at night.

As long as you're here
and you feel as good as you do,

rock and roll.

And if the volume's a little lower,
I don't give a crap.

As long as the long-term-- you feel like
you're going to be able to do this

-for the next few years. That's all.
-[Mitch] See if I'm around a few years.

-[David] You're going to be around.
-Yeah, um...

[David] Come on.

From where I sit,
I have your interests at heart.

-I wanna make sure that...
-[Mitch] I've never felt any otherwise.

No, but we maximize
what we can do to support you

and that we're sensitive
to some of the stressors

that are on you
that you may not necessarily talk about.

I know what a 70% success rate means.

It means... a 30% not success rate.

I don't know where I'm going to fall.
I just don't know.

[David]
Have you ever talked to a therapist?

-Do you want to?
-Everybody tells me

-I should go see a therapist.
-[David] You should.

I have a great guy I went.

Okay. I'm back.

[workers chattering indistinctly]

[woman] Christy.

[air hissing]

-Where is the pain?
-[Christy] My head.

[woman] In your head? She said she has
a little bit of pain in her head.

-[David] Can you ask her where?
-[woman] Can you tell me where?

[Christy] On the right.

-[woman] On the right?
-[Christy] Yeah.

[woman]
Okay. It might be maybe one of the pins.

On a scale of one to ten,

one being very little pain,
ten being the worst pain of your life,

what are you feeling right now?

-[Christy] Eight.
-[woman] Eight?

-Okay.
-[man] That's not good.

-[woman] Her pain's still at an eight.
-[Christy] Ten.

-[woman] It hurts?
-[Christy crying] Yeah.

[woman] Okay. I'm sorry.

[David] Is she crying?

-[woman] Yeah, she's crying a little.
-[man] It's not good.

-[woman] I think she's in a lot of...
-[man] Pain.

[John's voice]
Every time during the holidays,

it just gives me time to pause.

I find it very gratifying to sort of know
that we worked so hard

for that years' worth of patients,
but there's always some patients

where you just look back with some sort of

"should we have" or "did we do" or...

-She's in room one?
-Room one.

[woman chatting indistinctly]

Hi, Phyllis.

[Phyllis] Hi.

[John] Hi.

How are you guys?

-She's great. I don't know about...
-Okay.

Are you weaker on the left side,
or about stable?

I don't know.
I'd have to try to punch you to tell.

Right. But you're walking with a cane,
it looks like.

I walk with a cane. I walk without a cane.

[John] Turn around. You look pretty good.

Now stand right there.

Just squeeze my hand. Don't hurt me.

Okay.

Okay. Remember, everything was involving

-your right frontal lobe.
-Right.

Which has some executive functioning.
A lot.

It's one of-- you know,
it's our largest lobe is the frontal lobe.

All of this white,
they're likely radiation-induced changes.

Even though what we were targeting is
somewhere in here.

This caused some of this swelling,
and now the radiation is causing it,

so it's not--

For this amount of swelling,

the fact that you don't have
left-side weakness or paralysis

and other things is-- makes me optimistic.

And this is even
before we started Avastin.

So my guess is the Avastin has
diminished this.

The frontal lobes
actually don't really do much,

except they inhibit us
from doing other things.

So some of this lack of inhibition
is causing you to have motor function--

I always have lack of inhibition.

That's when you said
you wanted to k*ll Saul.

That's when it-- that was like--

No joke. I'm not--

I don't wanna take this lightly,
but if she's inappropriate,

-saying things that seem otherwise--
-I was a maniac, yeah.

And some of that, obviously, steroids,
but this is--

Your frontal lobe has--

You've become disinhibited.

Mm-hmm.

That can be scary. Now, fortunately,
your left frontal lobe is still intact,

and that's inhibiting a lot of things,
and that's your dominant hemisphere.

So you have to be careful.

I'm in favor of an image... soon.

Also depends upon
what your insurance will allow us to do,

since we imaged you in September, but--

How many cancers
do you have to have before they say,

-"Okay, we'll approve this?"
-No one's going to say no to Sherese.

I think she's better.

Carol Jacob said it. Carol Kaman said it.

I think she's just a little more--

She's Phyllis.

[John] Phyllis. I-- I see that too.

So she's definitely more Phyllis.

-So I'm--
-[Phyllis] Sometimes I keep swearing...

[Barbara] She swears. That's...

The swearing's from this. Okay?

-[Barbara] No, no, no. Pre-this.
-[Phyllis] No, no, no.

You don't know. You don't know.

Thank you for helping.

Thank you so much.

Always a pleasure. Good seeing you.

You too.

You're doing well. Okay?

-Thank you.
-One day at a time.

-Hey, Christy. It's Dr. Langer.
-[woman] Christy?

[David] Are you awake?

[woman] Please open your eyes.
Open your eyes.

Open. Open nice and wide.

[David] This is such t*rture.

[machine beeping]

[man] Yeah, it's hard.

-[woman] Keep those eyes open.
-[man] Poor thing.

[Christy moans]

[David] She's feeling it.

-That's a good thing.
-[man] It's always this balance,

because you need them awake,
but it's hard to be awake.

[suctioning]

-[David] Give me--
-Christy, it's Dr. Ramanda. How are you?

-[David] She's so good.
-[man chuckles]

[Ramanda] You're good?

-You're doing so awesome.
-[Christy moans]

[Ramanda] Can we chat a little bit
about the World Cup?

Did you watch the World Cup on Sunday?

-[Christy] Yeah.
-[Ramanda] Where did you watch the game?

[David] She's much better. Nav off please.
Nav off.

-[Ramanda] Try to do it quickly, guys.
-[man] There it is.

-That's deep.
-[Ramanda] Can you keep talking to me?

[David] We can put her back down.
We're through the cortex.

-Let me put her back down.
-[Ramanda] You did so well.

[David] I can't operate on a crying child.

[suctioning]

[David] That's better. So much better.

-Look at this thing.
-[man] Yeah, it's a monster.

Just a big, angry…

mulberry.

There you go.

Nice.

[David]
God, this business sucks sometimes,

-doesn't it?
-Yeah.

[man] You can call the family.
We're going to start closing soon.

-[David] Thank you.
-[man] Thank you.

[Amanda] First off, I've been so sad this
week, because I have not met any goals.

Yesterday, I was like,

"If I don't walk home, I won't get
the exercise goal for five days in a row."

[laughing] I was like--
I was like, "I have to walk home."

We need more Christmas music
on this floor, guys.

[woman] What did you say?

Said we need more Christmas music
on this floor.

-Christmas is almost here.
-Is that not Christmas?

-[music playing faintly]
-Is this Christmas?

-[woman 1] This is Christmas.
-[woman 2] Yeah.

[woman 1]
Your ear doesn't know Christmas music.

It sounds very sad. [laughs]

[woman 2] Sometimes Christmas is sad.

Oh, no.

[all laugh]

-[woman 1] Christmas is sad?
-That's so depressing.

-[woman 2] I didn't mean it like that.
-I'm like...

[women chatting indistinctly]

[Mirtha] How you doing, sir?

[man] Oh, thank you.

[Mirtha] The holidays are especially
painful around this time of the year.

[woman chatting on radio indistinctly]

[Mirtha] People are supposed to be

in good spirits,
sharing with family, friends.

[man] She go first.

[Mirtha] He loves to be here.

-My lady.
-[man] Your leg hurts?

My lady right there.

My lady.

[Mirtha]
Your son's gonna come pick you up?

[Mirtha's voice]
It kinda grounds me and reminds me...

What time?

[Mirtha's voice] ...humans need support.
They need love.

They need to know
that somebody knows that they exist.

[Mirtha] Hi.

-[man] Hi.
-I'm Dr. Macri.

-How are you?
-[Mirtha] How are you?

So what's going on?

[man] Um...

-I'll probably start crying.
-That's okay.

So I am a tax accountant, and…

I'm sorry.

[Mirtha] Okay.

They just put a lot of pressure on me.

So, busy season, they won't--
I had to work 50, 60, 70 hours a week.

-Okay.
-I'm staying up all night, sometimes 3:00,


then I also found out that my partner...

has had a husband.

-Okay.
-So it's just…

one thing after another.

[Mirtha] Okay.

I--

[voice breaking]
I'm just not getting any relief.

It's just been getting worse,

-and I lost my appetite.
-All right.

It just keeps getting worse.

-I just felt I couldn't take it anymore.
-Have you seen anybody? A therapist?

[man]
I've tried to. I've been e-mailing. But…

I haven't got anything back.
I couldn't take it anymore.

[Mirtha] Do -you have any family here?
-Mm-mm.

-[Mirtha] No.
-That's another thing.

My family's from Mississippi and I'm g*y,
so, like, that doesn't really...

help anything.

[Mirtha] Yeah. So you're away from home.

That's never-- that's never fun
for a lot of people.

I'm sorry.

Yeah.

So are you having any thoughts
of trying to hurt yourself

or trying to get away from everything?

I mean, yeah,
I would love to just get away.

Okay. But not in-- for reasons
that you just wanna, like, not live.

Yeah, not any of that.

[Mirtha] Not that.

[phones ringing]

Okay. That poor kid.

[Mirtha's voice]
It's not very nice to you, the city.

The socioeconomic demands,

affording to have your own apartment,

having the simple things

that you're used to having in life,
you can't necessarily

just have them in New York City.

You can see a lot of times these patients
that come here

are not having just medical--
They have some psychiatric issue,

they're having social issues.

Then there's the insurance issue,

whether they have insurance or not.

And they're put under a lot of pressure.

-[woman 1] Okay? One, two, three.
-[woman 2] One, two, three.

Let go.

-Nice.
-Okay.

[Tim] Thank you.

[woman 1]
How do you feel about trying to stand?

-[John] How do you feel, Tim?
-[Tim] Yeah.

-[John] Are you nauseous at all?
-[machine beeping]

[Tim] No.

[woman 1 ] He was a little dizzy
when he first sat up, but it calmed down.

-[Tim] Headache's… bad.
-[beeping continues]

[John] Yeah.

[woman 1] Tim, you don't have to stand.
I know you really want to,

but you have to tell us
and be honest how you feel.

[Tim] I don't like the way I'm sitting
is the biggest thing.

[woman 1 and 2] All right. Let's do this.

-[woman 1] Push on this side.
-[woman 2] One, two, three. Push.

Push down this arm. There you go.
You're up. That's it. Okay. Good.

[woman 1] Do you feel yourself leaning?
Do you feel what side you're going to?

-[Tim] Yeah.
-[woman 1] All right.

- Leaning to my right.
-[woman 1] Exactly.

I want you to fix yourself to your left.

Think about putting more weight
through this leg.

[John] Looks like they won.

-Good.
-[woman 3] They won.

You're up. You're standing up very well.

-[John] Yeah, look at that smile.
-[woman 3] 160...

-Okay. Breathe. Relax.
-[John] May I come in front and look?

-Sure.
-[woman 1] Of course.

You're leaning to your right again.
Go back to your left leg. Good job.

-Look up.
-You feel that right leg on the ground?

I do.

Is it a weird sensation
on the bottom of the foot?

-No.
-Can you actually feel it?

-Mm-hmm.
-Can you feel my hand hitting?

-I do.
-Okay.

-[woman 3] Nice.
-[woman 2] Perfect.

-[woman 3] Okay.
-[woman 2] Good job!

Gotta let go of his hands so I can
give him a high five.

-Good job.
-[woman 3] All right.

Can you wiggle your toes?

Move your feet.

There you go.

[David] Okay, give me a squeeze here.
Squeeze your right hand.

-Good girl. Okay.
-Okay.

You're all done, sweetie, okay?

You understand? Surgery's all over.

You were brave. You did great.

[woman chatting over PA indistinctly]

[man]
All done. Everything went very well, guys.

Got the whole thing out. She's cured.
She's done.

-She's going up to ICU, but she did great.
-[David] All right.

-[man] Thank you.
-[David] Yeah, we'll walk to the ICU.

You wanna grab the rest of your family?

[chatting indistinctly]

-You can just-- Does she wants to come?
-Guys, your family keeps growing

every time we see you.

-It's bigger and bigger.
-[David] We'll take you down there.

She's still a little sleepy.

Go ahead.

[murmuring]

[Mirtha, in Spanish]
I'd like to see the baby.

Well I miss him, how...

Mom, I don't know what to do tomorrow.
I'll talk to John.

-[alert rings]
-[Mirtha] Hello.

Did you ring your bell?

I'm just going to close the curtain, okay?
What did the psychiatrist say to you?

She said that she's going to look
for, like, psychiatrists in the city.

[Mirtha] Resources. Okay.
I can bridge you with some medication.

A very short, like,
maybe two or three days of medication

that will help you initially feel better.

I'm not comfortable
with just starting an antidepressant.

You need therapy.
You need to talk to somebody.

I also want you to do your research
before you just start a medication.

If you're not comfortable
with the person, see somebody else.

Again, open 24 hours, anything happens,
you just come back.

Okay. Sounds good.

-All right, it was nice meeting you.
-[man] Nice meeting you.

[Mirtha's voice] I-- I just think
there's this knee-jerk reaction

that's happening now
with a lot of providers.

You know, you'll send these young patients
to trial a therapy,

and it's-- they're very quick
to just refer to a psychiatrist,

and then psychiatrists now are quick
to start

a slew of medications now.

An antidepressant, an antianxiety.

To help with the sedative side effects
of these medications, let's add Ritalin.

They're getting piled on.

Patients are easily on two,
three, four medications.

And young. You know, very young.

I feel a little helpless sometimes.

[Amanda] Ask me, really. Oh!

-[women chatting indistinctly]
-[Mydena moaning]

-[Amanda] Hello.
-[Mydena] Ow!

[woman] Hey, Dr. Little.

Is your nurse in here?

-Okay. I'm going to check you, okay?
-[continues moaning]

-Hi, Dr. Little. I'm her grandmother.
-[Amanda] Hi.

Okay. Nice.

-You look too young to be her grandmother.
-God bless you.

[Amanda] If you're still four to five,
I'm gonna call the anesthesiologist back

-to redo the epidural, okay?
-[man] Yeah.

[Amanda] If it's favorable,
I'm gonna break your water.

-Okay?
-[moaning]

-[Amanda] All right.
-Just break it.

-[Amanda] Okay, I'll break it.
-[all laughing]

[Amanda] She's the same.
Maybe six. I ruptured her, though.

[woman] Oh, great. Awesome.

[Amanda] You know Kevin's not here.

[woman] This is her, right?

Do you guys FaceTime every day?

[all chatting indistinctly]

He does call me,
and then I don't call him back,

because I've been here.

It's been rough.
Like, he called me today, and I was like,

"I'm gonna call you back," and then--

But I'm--

-I'm seeing him in two weeks.
-[woman] You gotta take your pictures.

I find those so corny, though.

[woman] You can take, like,
a picture in a bath of milk...

-with some petals around.
-[Amanda laughing] That's for you.

That is too extra for me.

No, I'll show you the picture I wanna do.
It's very natural. It's very me.

[Amanda's voice] My dream would have been
to raise a city child,

but we'll be moving to California,

and like,
California is definitely diverse,

but where we will be living, there's not
a lot of African Americans there.

This one.

[Amanda's voice] I really don't want
my daughter to kind of experience

what I experienced,

which is growing up in an environment
where she's one of the only black kids.

I mean, it does affect you.

I don't hate it, though.

[Amanda's voice] There's something
about seeing people who look like you

defining beauty, defining worth.

All those things will happen,

but it's slightly easier
when you're not the only person.

You have to see it. It's good.

But I like this picture.
I think it's very natural and...

-[woman] Yeah, that's cute.
-[Amanda] Sweet.

You're very natural.

Yeah, you can have
your 'fro out and everything.

-[Amanda] I know.
-Mm-hmm.

-That's beautiful.
-Isn't that nice?

Like that. Like just trees, sitting.

-But Kevin has to be with you.
-That's so funny, people keep saying that.

Of course. It's his fault, you know?
He's a part of this.

"Dr. Langer, thank you
for all you've done to help Mitzie.

She speaks high of everyone involved
with her surgery and recovery.

I was impressed when we came in August
to stay with her at the hospital.

Thank you so much."

From the Washington County
Sheriff's Office.

Here's the Johnson City Press.

[chuckles] Front page.

Oh, Mitzie.

It just talks about her getting there,
and says,

"There were cheers, hugs, and tears

in the Washington County Sheriff's Office
parking lot Thursday

when officers and the staff

welcomed one of their own home
after a five-month stay in New York City

for brain surgery."

[Mirtha] Hi, Marlon. How are you?

I'm Dr. Macri. I haven't seen you
in quite some time.

So what's going on today?

Um, well,

I fell on this leg.

[Mirtha] You fell?

And it's been hurting me.

My sickle cell has been bothering me
for three days.

[Mirtha] Right. You were at Lenox
not very long ago.

Yeah. I threw up last night.
Like, mucus and vomit.

And since you were at Lenox Hill
five days ago,

where else have you gone?

[Marlon] Nowhere.

[Mirtha] Okay. Who's your hematologist?

I'm trying to find a new one right now,
because I just came back from school.

What type of school?

[Marlon] I go to college.
In college I study business.

This is my third year.

[Mirtha] Oh, good. Okay.

Stick out your tongue.

Say "ah" for me. Lift up your tongue.
You're not too jaundiced. Okay.

[Mirtha's voice]
Sickle cell disease patients

have an abnormality in their blood

that causes
their red blood cells to sickle.

They can't absorb oxygen,

and so, what happens
is their extremities start to die down

and they get chronic pain,
and it's excruciating.

You're born with a disease
that essentially makes you

dependent on pain medication.

I try my best to come into an agreement
with them about how

we're going to treat their pain,
because oftentimes,

if you give them one round,
they will want several rounds, and...

they abuse it.

What is your regimen
when you come to the ER?

-They give me--
-[Mirtha] I can check,

but I just want you to--

If I can tolerate O,

but I told them
I've been vomiting a little bit.

So they usually give me, like, IM,
but they're--

They're always choosing the dosage,
one or two of dilaudid,

so I don't really know.

[Mirtha] Okay.

So why don't we try that?
We'll do IM dilaudid.

After two doses, if you're not better,

then we should do labs
and-- and see if you're in crisis.

If you're not in crisis...

-[Marlon] I can go home.
-...you can go home after two rounds.

Is that okay?

[Marlon] Yes, ma'am.

[Mirtha] Okay.

The nurse is gonna bring you
the medication. We'll see how you do.

Okay.

All right. I'll come back, Marlon.

[Marlon] Okay.

[Mirtha]
To me, you have to give these patients

some type of treatment for their pain.
They're in true pain. It's real.

He has confirmed disease.
So I like to be realistic with them.

If I think they're asking for too much
dilaudid at once or narcotics,

then I tell them that's a little high
for my comfort level.

I can't imagine what it's like
to be in 24 hours pain,

but I'm sure it produces this temperament

that you're just
so frustrated with the world, so...

He says if he feels better
after the second round, he'll go home.

If he does not, we have to do labs
and see if he's in crisis.

He doesn't seem to be in crisis.

-[all chatting indistinctly]
-[machines beeping]

[Amanda] Hi. Dr. Little again.

Are you still having
a contraction right now?

[woman] It's a lot. Hang in there.

[Amanda] You're doing good.

You can do this, okay?

-You can do this.
-[Mydena moaning]

[Amanda] So when you feel
that really intense pressure,

you can basically moan for the full


If it helps you to make sounds,
you can make sounds.

You can do whatever helps you.

-[man] Mm-hmm.
-You can-- you can own it.

So you can just--
You don't have to hold it in.

[machine dings]

[Amanda] You're doing really good.
Mylin is doing really good too, okay?

Hmm.

-[Amanda] He is. His heart is good.
-[man laughing]

His heart is very good.

[all laughing]

But since we're going to start pushing,

I think we said usually two people
in the room.

Yeah.

[Amanda's voice] I'm really putting a lot
of pressure on transferring to California.

It'd just be so great.
I think there's something

really wonderful about community,

and I think that saying is true.

It takes a village to raise a kid.

So this is the key.

When you have the contraction,

instead of pushing in,

I want you to bear down
like you have to poop.

The sensation that you feel,
you have to follow that.

-It takes some time -to get into it.
-[Mydena moaning]

Okay, let's do it right now.
You feel a contraction, right?

-I want you to push.
-[Mydena shouting] Oh! Oh!

Don't hold your breath.

Push down.

-You have to push against the pain.
-[Mydena] Oh! I am!

-Listen to me.
-[woman] Look at me. Mydena.

-Take a nice, deep breath.
-Yes.

-[woman inhales] Nice, deep.
-And go.

-Oh, my God, that hurt!
-[Amanda] And push.

Oh! Oh!

We'll just wait for the next contraction.

This one's done.

[Amanda]
They key is that when you have the pain,

I want you to push against.

-[woman] Yes, that's it! Look at that.
-[Amanda] There we go.

[woman] Yes, yes! Good. Keep it. More.
Yes. Deep breath, you got this.

-[Amanda] Yes, good. Get angry.
-[woman] More.

-Get angry, get angry.
-[woman] More, more.

-[Mydena] No! No!
-Get angry.

Okay. Okay.

We can wait. If you feel like
it's too painful, we'll wait.

You're doing really well.

[Mydena moaning]

[Amanda] Okay?

Get your peace.

What do you think?
It's doubling or that's true?

[beeping]

We're gonna come back in a little bit,
okay? You're doing good.

Oh!

I'm calling about labor room three,
Miss Haskett.

Um, so now, she's like eight centimeters.

But there's some fetal tachycardia
and maternal tachycardia.

The patient is just not getting relief
from her epidural. It's been redone.

I tried to push twice to see
if I could reduce it,

but she couldn't, like, push really,
and it was not reducible.

Okay, sounds good. Thanks. She said try...

-[woman speaks indistinctly]
-[Amanda] My gosh. Thank you.

-Should I open it here or in private?
-[woman] Yeah, open it.

[women laughing]

-[woman] Do it!
-"I love my mommy"!

-So important.
-[woman] That's what it says?

[women laughing]

[woman] Oh, my God!

-That's really cute.
-[Amanda] This is so cute.

-This is for when she's older.
-[woman] Yes.

When she really actually loves me.

[women laughing]

[Amanda]
Thank you. You did not have to get that.

[Amanda's voice] I grew up in a very
loving home. I was very fortunate.

My mother really is
just a very gentle, kind person.

My mom has this thing
of not reacting in anger.

Or if she was angry at you
for something you did,

she would walk away.
Then when she had calmed down,

you would get your punishment,

because she felt like it would be
a more fair, just punishment.

She's gonna be pink until she's three,
because all these clothes have been pink,

and so... [laughing]

Thank you.

[women laughing]

[Amanda]
That's so nice of her. So many clothes.

[Amanda's voice] And so I hope
to kind of carry that forward

with my daughter as well.

Oh, my God.

I'm real tired, actually.

[woman] You need a nap?

I'm very tired. I don't know why.

[sighs]

[Mirtha] Marlon.

Where is Marlon?

-He's not coming out?
-[man] Full!

Okay.

-Are you going to be out soon? Because...
-[Mirtha] He's been in there for a while.

-Yeah.
-[Mirtha] Is he okay?

Sir...

Okay, just...

Can you listen to me first?
Because we're just making sure it's safe.

You've been in the bathroom for too long.

[Mirtha] He got two of dilaudid,
then he went into the bathroom.

[man] He's very unresponsive,
because he's very agitated.

[Mirtha] What is he saying?

He's like, "Why do we keep bothering me?"

[Mirtha] Because he's been in the bathroom

for a very long time.
We just gave him a high dose of narcotics.

Um, six, nine, zero...

[Mydena screams]

-[woman] All right.
-[Amanda] Let's use it, grab this leg.

-[Mydena screaming]
-[Amanda] Push the baby out.

Just like we talked about. More. No.
Like you did before. Get angry. More!

-Extra! Extra!
-[Mydena] I can't!

Yes, you can. Listen to me. You can.

Go now.

-Push.
-I cannot.

-I can't.
-[Mirtha] You can.

You're pushing-- The head is coming by.
Passed it, but... Go again.

Yes!

[Mydena] No, I can't.

The head-- No, the head is more--
The head is passed it.

-[man] Okay. No more pain.
-No.

-[man] Outside, okay?
-[Mirtha] Okay.

[Mydena moans]

[man] We'll be right back.

Why don't we do a vaginal [indistinct]?

Because she cannot be reducible.
I don't think so.

She's like you said, seven at most.

-Mm-hmm. Mm-hmm.
-We cannot reduce it.

Okay, dear, so I need to give you
an update, okay?

So the baby's heart rate is fast,
which can be from the infection.

The infection we call is chorioamnionitis.

That's a fancy word.
It's very common in labor sometimes.

That could be why you're feeling hot.

The treatment is delivery, okay?

But you're still
around seven to eight centimeters.

[Mydena] Seven? Okay.

[Amanda]
We may need to proceed with C-section.

I want you to have vaginal delivery.
I really do.

But we want to do
what's safest for you and baby.

Okay?

[man] So, basically,
the baby is showing a lot of signs

that it's going to be
very hard to come vaginally.

We're do it the other way, now.
Have good results, okay?

[Amanda]
You're still gonna meet your baby. Okay?

It's nothing that you did or didn't do.
It's very common.

Okay?

[Mirtha] Remember,
we're only gonna give two rounds.

No more after that.

Let's take a look.

I'm trying to figure out what I'm
supposed to do for my pain, because--

I know.

[Marlon]
I don't have nothing for pain at home.

We can give you a scrip for Percocet.

-Okay.
-Okay?

I'll give you a scrip.

Is there a pharmacy
where we can call it in?

Not right now that I know of.

There's a 24-hour pharmacy
over in Union Square.

I don't know if my insurance accepted it.
I don't wanna go there--

Unfortunately, Marlon, you know
we don't dispense medications here,

-We don't have a pharmacy that's open.
-I'm not saying that, miss,

all I'm saying is I don't want you to send
my medicine somewhere

that I go there and they tell me
they don't accept my insurance,

then I'm stuck.

Which pharmacy do you go to?

I go to the pharmacy in my neighborhood,
which is called Melbran,

and they're not open
until tomorrow morning.

[Mirtha] All right, we can send it there.

I can give you a couple Percocets
before you go.

You fell on it.

Yeah, it's a little bit swollen
right here, yeah?

-Okay.
-I don't know why.

-It's all sore.
-[Mirtha] But it's not red, which is good.

It doesn't-- it doesn't look like
there's a big fluid accumulation in there.

So why don't we do this,

we'll give you Percocet right now
to hold you out until morning time,

then we'll have to call it in
to your pharmacy.

You have to pick it up at 8:00 a.m.
Do you wanna do that?

Honestly, I don't-- I don't care.

[Mirtha]
Percocet is your home medication, right?

I understand, miss, but it's like,
this is what happens all the time, too.

The first thing out your mouth was,
"I'm sending you home."

So I feel like that part didn't even
really matter to you.

'Cause that was the first thing
we established.

That's not what I said.

I said, after two rounds
we would be sending you home,

but we can definitely do the labs, okay?

Would you be amenable to that,

or do you want to not do that?
I'll stick to the plan.

I feel, honestly, miss,
I'm trying to hold tears back now.

Like I said, every time I come
and I complain on my pain,

y'all do what y'all do,
'cause y'all are doctors.

-I'm trying to help you.
-My whole thing is, like I said,

if somebody talks to me this rough,
and I respond, it's a problem.

How you expect me to sit here
and let someone disrespect

and you're not my mother or my aunt?

And like, for instance, when I went
into the room,

y'all put me in a holding, miss

I don't know if I was uncomfortable
or not uncomfortable.

And I was very uncomfortable,
because I'm in pain,

laying on a flat chair
that has no support, basically.

But nobody cared about that.

[Mirtha] Listen, Marlon,
I'm very comfortable giving you Percocet

so you can hold you out
until the morning time.

If you give me the pharmacy, I'll send it.

No problem, miss, no problem.

Is that something
that you would be okay with?

[Mirtha] Okay.

[Marlon]
We're gonna set this up right now.

Like I said,
I'm in pain. I don't feel well.

[Mirtha] Okay.

[Marlon] Do you know how many pills
is it gonna be? A three-day worth supply?

-Usually--
-It's about 18.

All right.

[Mirtha] Okay?

There's no point in making him
more agitated.

I tend to try to meet them halfway
in the whole process,

because there's nothing
I'm gonna change today,

and it's only gonna make him more mad.

I feel like just de-escalating it,
talking to him,

taking that five or ten minutes
that I took out to just talk to him

definitely just calmed him down.

And I'm comfortable giving him
pain medications.

We're not talking about massive doses.

[mumbling]

Oh!

[workers chatting faintly]

[Marlon] No, I'm not mad.

So he was just dispensed...

thirty Percocets, a high dose...

ten days ago.

[man] Yeah.

So he's just eating them.
I'll give him enough

until Monday
and see if he'll call social work.

I guess I have a soft spot in my heart
for those patients.

I cannot imagine being in 24 hours pain...

for all of my life.

It's a parent's worst fear to have
their child just be lost

to drug dependence.

And we see so much of that
in the ER here in New York City.

It's insanity how much we see.

This city gives you anxiety.

It gives me anxiety.
Especially now that I have a son. I--

I don't think that we can---
we can continue here forever.

I think I-- I--

I wanna raise him somewhere else.

I-- I want him to grow up
somewhere a little bit less, uh...

I don't know how to describe it.
Just not New York City.

I don't--

Um, I think we see too much--
I've seen too much here.

Toxicity, drugs, um...

trauma that I don't--

I don't know
that I want him to be exposed to all that.

[man on TV] Oh, okay.

-Like she was an exorcist or something.
-[audience laughing]

She said, "I see what the problem is."

Mmm! Dinner!

[audience laughing]

Mmm! Good dinner!

Like we're space aliens

in a play about human beings

that they wrote,
but they didn't work that hard on.

Mmm! We're eating dinner!

[man's voice fades]

[TV chattering indistinctly]

-[all chattering]
-[baby screaming]

[Amanda] That's his voice.

-Happy birthday!
-[woman 1] You hear him crying?

-[woman 2] Congratulations.
-[beeping]

[Amanda] You were excellent.

[woman 3 chuckling] You look like Nay-Nay.

[woman 2] So he needs to come
to the NICU, because of your fever. Okay?

You'll be able to see him when you're able
to get up. Probably later in the morning.

-You've gotta sleep.
-[all chattering]

[woman 4] Thank you.

[suctioning]

[women chattering indistinctly]

-[Amanda] Congratulations.
-[all] Thank you.

[man] Thank you.

[Amanda]
Did you guys get to see Mylin yet, or no?

No, I've got to wait 25 minutes.

[Amanda] Twenty-five minutes? Okay.

-Yes.
-[woman] When you due?

End of March. I'm right behind her, yeah.

-[woman 1] You have children already?
-I don't. This is my first child.

-Congratulations from...
-I only had one.

-[man] Yup. Right there. Yup.
-[woman 2] That's my baby.

-Thank you, Doctor.
-[Amanda] You did so good.

Just tell her she did good.

I don't want her to feel bad.
She did good.

Congratulations, everybody.
Have a good night, okay?

-[man] Congratulations to you too.
-Oh, thank you, sir.

[man]
You know why I'm calling you, don't you?

[David laughs]

Yeah. Uh, I mean, what's happening now is

that we're bringing in a new spine surgeon
in June or July,

who's a complex spine guy.

And we're gonna need another spine tower.

We're just busting
the volume through this thing,

and we're going to run into problems.

Uh, let me call you right back.
Gotta run-- Call you right back.

[woman] First floor...

I don't walk in with everybody.

[man laughs] I was gonna say.

[David] I usually-- I have--
I usually have too much sh*t to do.

[man laughing]

-[Mitch] You've got to go this way. Over.
-[David] Chill!

-[Mitch] All the way to the end.
-[David] Chill!

[Mitch] Problem is, you call me to help,
I take over. You know that.

-[David] Look how great that is.
-[Mitch] It's amazing...

[David] It's a taping fellowship.

[laughing]

-That's a great tape job.
-[Mitch] Now.

[man] We have a shaver?

[David's voice] The Mitch experience
with his illness and stuff 

was one that we had to prove that we could
not only survive as a department,

but we were gonna win this thing.
He's gonna come back.

He's going to step right back in.

-[Mitch] Try as much as you can to get it.
-[man] Stay higher.

[Mitch] Yeah.

We'll try and get the T1 screws in, and--

[David's voice]
Honestly, of all the things we've done,

to be honest with you, all the growth--

I think my one thing I'm most proud of is
the way that that was managed.

The way that Mitch's illness and his exit
and re-entry have been handled.

I-- I'm super proud of that.

[woman] Close.

[all chatting indistinctly]

[David's voice] First key is people.

Getting good people, giving them

an opportunity to be
as successful as possible

and provide the structure that allows them

to be supported, mentored.

These all are so important.

Would it help if I send you
for new blood work and EKG right now?

-Or no?
-Um...

-No. We have blood work coming tomorrow.
-Okay.

Last night, I was great up until--

his hand was warm,
and then he started doing this...

-[Sherese] That facial movement, yeah.
-...at me, like he couldn't see me.

-I said, "What the hell is that?"
-[Sherese] Okay.

-You need a hug?
-[sobbing]

[Sherese] Here, let me give you a hug.

-[sobbing]
-[Sherese] Give me a hug. Give me a hug.

Don't worry, okay?

[John] Okay, so Amundsen
had a study done this morning?

Yeah. Laura's pretty tearful.

When I walked in,
she couldn't explain why.

-I think she just has a bad feeling.
-[John] She's tearful.

His speech seems better.
I mean, last time he was, like, mute.

What's interesting is
that looks worse to me.

But this, where his speech is,
looks better.

But his tumor's progressing.

Should I take this out?

-If I don't take this out, he's gonna die.
-Yeah.

[David] So you're doing okay?

-[Christy] Yes.
-[David] Still wanna be a cardiac surgeon?

-[Christy] Yes.
-[David] You sure?

-[Christy] Positive.
-[David] I haven't converted you?

-[Christy] Not yet.
-[David] If you haven't decided,

-I'll see you later. Bye.
-[all laughing]

[David] You look awesome.

-Thank you.
-[David] Can I have a hug?

Oh, my-- Oh, my God.

I'm so happy. I was so worried about you.

Do you remember any of the surgery?

Um, I remember it being cold,
I feel like it was a cave.

-I was in a cave.
-[David] Yeah.

You know,
during the actual resection, she had pain.

She started feeling pain back here
really bad.

-She was moving around and--
-Oh, really?

-[David] You were hitting your head.
-[woman] You don't remember. Funny.

Do you think you feel better
than you did before the operation?

Yeah. I just felt relieved.

-[David] Yeah.
-Yeah.

[David]
I bet. But it's healing pretty well, huh?

-[Christy] Yeah.
-[David] It looks very good.

Now you have to go back to school
and kick some a*s, right?

-Yep.
-You ready to do that?

If you have any problems or help,
I can help her.

-[woman] Thank you.
-[David] Okay? I have you forever, now.

-[laughs]
-[David] All right? Okay. Bye.

-Thank you.
-I'll see you soon, okay? Stay in touch.

Don't work too hard.

[all laugh]

[Amanda] Hey, Kevin.

Okay. It's no emergencies.

We're okay.

I was sleeping, and I was like,

"Oh, my God. Did I just pee myself?"
I thought I was incontinent. Right?

Then I ran to the bathroom

and I was just in the toilet,
and it was just gushing out.

Okay, I've gotta stay calm.
I just arrived in my room, okay?

-Okay, let's do it.
-All right. What should I do?

-We're gonna tell you what to do.
-First of all, you have to get undressed.

-We're gonna give you a gown.
-I did--

[Lisa] One girl stepped out.

-I did bring my own labor gown.
-Sure. This makes it... [indistinct]

I love it when they come with their plans.

-[laughing]
-[woman] Plans. I know.

-Do you need help getting undressed?
-I don't.

Okay. [laughing]

But thank you.

Thought I would offer. [laughing]

We are going to treat her like
we'd treat any other patient.

-Of course. I'm so excited.
-[device dings]

[woman on device] Maggie Singer.

-Okay. I'll be back in with you.
-You can be excited, but still treat her

-like you would treat any other--
-I'm gonna be objective.

Yes.

-[woman] Hello?
-Be objective,

while you're rubbing
your classmate's belly.

-I already have a plan.
-Okay.

["Prepared" by Jill Scott playing]

♪ Some bridges I needed to mend... ♪

[Kevin] Hey, girl. You're such a soldier.

[Amanda] Don't be upset
or anything like that. Everything's fine.

[Amanda laughs]

Kevin, literally, I didn't ever imagine,
ever, first off, breaking my water first.

I always thought I would have
contractions, but delivering--

I thought I was going to deliver
at 40 weeks.

But, like, we are literally going to meet
our daughter in, like, 48 hours.

♪ For my life to grow ♪

♪ I just want to be prepared ♪

♪ Yeah ♪

♪ I just want to be
I just want to be ♪

♪ I just want to be prepared ♪

♪ Get myself ready
For what's coming for me, yeah, yeah ♪

♪ I am ♪

♪ I just want to be
I just want to be ♪

♪ I just want to be prepared ♪

♪ Prepared ♪

♪ Hear me now ♪

♪ I been getting recipes
Off the Internet ♪

♪ Most times they be bangin' ♪

♪ I realized they're only good
When I put ♪

♪ My little spices ♪

♪ All up in the rices ♪

♪ I been ♪

♪ You know I been enjoying people
Who love each other ♪

♪ Husband and wife ♪

♪ Sister and brother ♪

♪ Father and mother ♪

♪ I let the queen inside ♪

♪ I let her shine ♪

♪ I been listenin' for God more ♪

♪ I been doing my chores ♪