01x06 - Night of the Dead

[bunniefuu]

I need to go back to work.

It's been super fun with him,

but I need to get back in there.

I need to see people again.

The tumor was about this big.

I got operated.

The year passed, and I was in remission.

And then I got it again.

You're the eighth patient in the country

- to get this treatment.

- Yeah?

So, you're a special girl.

Thank you for your patience

and your courage.

You know, I'm gonna be a statistic

just like everybody else.

Let me manage Mitch's practice

as best I can.

I want to be the point person for this.

I'm taking responsibility for Mitch.

This guy you're looking at now

is not here anymore.

You have a newly-diagnosed

brain tumor

that's enhancing that grew in a month.

His daughter's wedding is in four months.

And I gotta make sure that he can make it.

We just feel

like she's going to be okay,

we hope that she is.

Right now that's all we have, kind of.

And now it's back again,

and it looks worse.

A little bit more suspicious

for tumor growth.

How much time before you think

it becomes time for hospice

if it doesn't work?

I remember

my very first experience with death

that I ever had in my life.

When I traveled

to my dad's country, Uruguay.

I think I was 11 or 12 years old.

And my grandmother was very ill.

Back then,

your family gathered around you.

We spent her last dying moments

with her,

and it was very surreal to me.

But I remember not feeling very scared

about it.

I was a teenager,

and I'm spending the night in the room

where my grandmother just died.

I never forgot the sight, the smell.

Looking back, I thought to myself,

"Why wasn't I more scared of that?"

But I wasn't.

Because I continued to connect

with that feeling

that vision of seeing someone die.

I revisited that moment

over and over again,

and then I realized

this is something I could do.

Hello?

Jack?

Dr. Boockvar.

What's going on?

I'm here to ask you that.

I think you're safe to leave the hospital

into an environment that you…

I don't want to leave.

You don't want to leave? Okay.

- No.

- I got an e-mail from Annie.

I'm gonna communicate with her, okay?

I'm not prepared.

I know. We want to make sure

you're prepared.

If you want…

We're still going to look

into options for whether you can get

Avastin in the next couple weeks.

You have to tell me what you want to do.

I don't know.

And it's hard. I know it's hard.

But I think

if you have some fight in you left

it's reasonable to keep fighting.

I don't know if I can.

I know.

Well, that's not a decision

you have to make now.

Okay.

Okay?

Look, I want to keep you happy

and comfortable

and with your family no matter what.

And I'm not crazy

about going to another facility.

You know.

But where else would you go?

I don't know.

Somewhere to die.

We can't just go to die.

I don't know, Doc.

Well, I think what I'd like you to do is,

let's have a discussion

with our palliative and hospice people,

and help you get some understanding

of what it all means, okay?

One hour at a time.

I'll see you later, okay?

I'll talk to you later, Jack. Okay?

All right.

- Did you see him?

- We did.

And?

His daughter's getting married

in February.

- We want him to make it. If he wants to

- Why can't they get married earlier?

I can't get a feeling

whether he wants to die before the wedding

- or stay alive to the wedding.

- Keep him alive until the wedding.

But that may not be his wish.

He wants to, "Go somewhere to die."

So the question is, do we just give him

Decadron for eight weeks,

and you go to the wedding,

then he goes to hospice?

All right. I'll call the family,

see if that's what they want.

What is that?

My daughter made this from camp.

What's it called, a hamsa?

- That's cute.

- I use it for a good luck charm.

- It's smooth?

- Yeah, because I rub it so much.

- See ya later.

- It's one of my nervous twitches.

You know what my other nervous twitch is?

I twirl my hair.

That I know. That I've seen you do.

We deal with death and dying,

and you know, I always say,

"Death dies, but regret lives."

And you don't want to have this regret

that lives on.

Why do you have cat ears

on your desk, may I ask?

This actually was

my Halloween costume this year.

- One of my patients gave these to me.

- Oh.

- A young girl who died.

- No.

You don't remember that?

Her family brought these in?

That's why I keep them,

because they represent her.

No, she was, like, 20 years old.

It was terrible.

So, I just leave them there to remind me.

That's all.

Let me find John.

Who are we seeing first?

- Let's see Marie first.

- Who?

Marie first.

Then we'll go see the other lady.

Her whole family's here from Brazil.

Hello.

- Hi, Dr. Langer.

- This is Dr. Boockvar, my partner.

- Hi.

- Hi.

- Nice to meet you.

- Hello.

Just to remind you

that my right is your left.

We're going after this growth.

It's going to be about right here.

- All right.

- Okay?

And we were just talking

when we came up here is

- We have to take this out.

- Yeah.

Sometimes we have to, then,

take out some extra.

That's called a margin, okay?

- Okay.

- Behind your motor strip.

I think the risk

of you having weakness is low,

- not zero.

- Okay.

I rather have a little consequence,

but have the whole tumor out.

We're gonna take the whole tumor out.

I guarantee.

- Oh, my God. Thank you so much.

- Okay?

Sometimes we have to take out

a little bit extra.

- Okay.

- That's called a supramaximal resection.

You're the kind of kid

we want to do this on.

- All right, yeah.

- What I would do if it were my daughter.

- I have two of you.

- Okay. Thank you so much.

I don't think she's gonna be left

with something that's disabling long-term.

Could she have a little bit

of this or that? Absolutely.

But knowing her personality,

this is not gonna be a problem.

- I'll rock it.

- No. Not at all.

This redness you have. Is that normal?

- It's anxiety.

- That's normal.

- When anxious, I get red on my chest.

- You're anxious?

Dr. Langer!

It's okay. It's normal, okay?

Yes.

Ask about the saints, to put them

Can I ask you something?

Don't think I'm crazy.

But I had surgery twice in this hospital,

and I always ask them

to put something under my pillow.

- We can do that.

- Is that okay?

I have a Jesus kit.

Where should we put it under?

- Wherever.

- Under anything.

I can't put it under her butt.

That would be wrong.

- You don't wanna put Jesus under her butt.

- All right, see you inside.

- She's gonna be all right.

- Gonna be okay.

Thank you very much, Doctor.

- All right.

- I trust in you.

- I know you do.

- My turn.

We carry the emotions in too.

We all have kids, so we get it.

God drive your hands.

My Jesus kit.

But I'm looking for the hugs afterwards.

There's when I get a thrill.

- Yes. Thank you.

- Bye, Dr. Langer.

See, he will remove everything.

Everything.

Don't cry. Don't worry.

We'll take very good care.

I'm not going to die, right?

- Of course not.

- I'm not going to die?

- You've got to realize

- No.

- Dr. Langer does these all the time.

- Okay.

- Every day.

- And he's amazing, right?

- Yes.

- Dr. Langer's the best.

This is not something

When you operate

on people's children, it's an added

kind of emotional thing.

Especially once you have kids,

you start to personalize it a little.

Her parents are there.

You see and sense their emotion

they're putting their kid in your hands.

It's a big responsibility.

I love you more

than anything in the world.

Me too.

- I trust you, Dad.

- You are the reason of my life.

Hopefully, this will go well.

- Yes.

- Ready?

All right, let's do it. I'm ready.

God bless you.

Take a deep breath.

Rock on.

- Rock on.

- Yes!

Bravo.

- Bye. Love you.

- Love you.

Any day you can give good news

to a patient is a good day.

Living longer is possible.

It's true…

- It's your first time in the MRI?

- No.

Okay. Which arm can I use for your IV?

- Here.

- This arm.

Can I check the other arm to see?

Can I check the

No

You don't want to?

- The other arm is all bruised up.

- Yeah.

Really. He's covered

He's covered in bruises.

- Why? What's wrong with that arm?

- No, nothing's wrong with it.

The flow is stopping. I'm just

Is there somewhere in particular

you want me to tell them to try?

Yes.

- It's here.

- In this spot?

No, f f f*cking

J just f*cking thing.

- The same spot they

- T-try try to

Oh sh sh sh

I can't understand.

- We're getting someone to help you, okay?

- Yes.

- Sweetie.

- Here!

- Okay. Have a seat

- Here! Here!

- Sweetie.

- Okay.

Sit down. Sit. He's on steroids

and he's having a steroid Yeah.

- Have a seat.

- Sit down.

Have a seat.

Okay, right now, you're having

- a little bit of You're

- No! No! No!

Yes. Yes.

Here. Thing.

- Okay.

- Look!

- I got it.

- Look!

Look at me. Look at me.

You know when I talk to you about

when you're flipping out a little bit?

That's what's happening right now.

You need to calm down.

I know. I get it. Calm down.

Yeah. Yeah. Yeah. Yeah.

Chris.

Sweetheart.

Listen.

I get it. I got it.

I understand. I understand.

No. No.

Can I look again?

I won't do anything.

Let me just take a look, okay?

He wants he wants

- He wants me to come in?

- Yeah.

Okay, I'm coming.

I've got to take off the

No

- You don't want me to come in?

- No.

Okay.

I'm so f*cking tired of all of this.

Ninety percent of cancers

that are cured

are cured with surgery.

In the brain, though,

for me to take out every last cell

is very challenging.

These are spider-like infiltration

where cells migrate.

They may have a central core,

but away from the central core,

even two centimeters, four centimeters,

six centimeters, there are cells.

So I take this out.

But this cell, which may be dormant,

this is called a stem cell,

it may take years for this

to just start growing.

Then you have another tumor.

This is how gioblastoma works.

You know, if I can make this

a chronic disease,

I can control these cells,

make sure they don't grow again,

maybe radiate them,

give it a pill every six months,

every couple years

How do I get the immune system

to do enough to fight cancer

without hurting my patient?

You're going to put

a smiling emoji over my face, right?

Yeah, we'll look it over.

- Are you okay?

- Uh

- What hurts? What hurts?

- My head. Oh, my God.

- Her head hurts.

- Yeah, my head hurts now.

Oh, God.

It's okay. I got it right here.

Two seconds. Two seconds.

Give me a number.

Like a four.

Oh, okay.

I'm just giving you a little fluid

to make sure

we flush everything through, okay?

Oh

So, in the old days,

we didn't have navigation.

Using this probe's eye, I know that

I'm behind the tumor with the opening.

Using facial surface landmarks

which tells the camera

where her head is in space,

and it's matching that to the MRI.

What that does is it gives us guidance.

Without this, we'd be

Have to just sort of wing it,

make a big opening, and find the tumor.

Because this latest young girl was 15

when she was diagnosed

with this brain tumor in Brazil.

And, uh, she down there,

it looked like a low-grade tumor.

They wanted to leave it alone,

which is debatable, but it's not crazy.

It's been growing on successive imaging,

When she was 16, she told her mother

she wanted to be an actress,

move to New York. They actually did it.

Okay, I'm just going to get

under the sheets here.

Promised her I would do this.

This is her Jesus package.

I have to put this underneath her body.

Just don't forget it.

Using this vibrating technique,

it vibrates off

the critical bone on the inside.

I'm pushing down the drill a little bit

There's a little bit of an angle.

Just think of the drill grabbing the bone

rather than pushing the drill

through the bone,

in your mind.

- It's perfect.

- Yeah.

- See how that works?

- Beautiful. Yeah.

Perfect

- I got it.

- We all carry lessons

that our teachers teach us.

And whenever I'm doing an opening,

I always think of Flamm

- who trained me, 'cause…

- Can I pull this please?

In our heads, we're always

hearing the voices of our teachers.

- Hopefully they're not yelling at you.

- I don't think so.

Well, hello to you too.

She's kicking

All righty. So

- Yeah.

- Questions.

Um, do you have questions, Kevin?

Let me see.

Has there been

any latest research findings

about how this manifests in an infant,

as a fetus?

The condition that she possibly has?

- On terms of what science…

- Well, I need to clarify something, Kevin.

This isn't possible.

This is definite.

Oh, yeah. Okay, sorry. Definite.

- Okay.

- But, like but, um

- Any other signs in the fetus?

- So far we haven't seen anything.

- Okay.

- But that's why we're monitoring.

In the babies that we see

with this particular genetic lesion,

all we have is percentages.

So 99% have the skin lesions.

The baby may not be born with them,

but will likely develop them early on.

Also the electrophysiology of the heart

can be abnormal.

We will be prepared. We know that she has

potential issues when she's born.

I know, but I don't think about it,

though. I don't know if that's naive.

Because I guess I'm the one carrying her,

I don't think

about her diagnosis every day.

I don't think that's a bad thing,

because you've made

the decision to have this baby.

Mm-hmm.

So, to harp on what could

potentially be wrong with her

could steal your joy,

and I want you to still enjoy

your pregnancy.

Normally I daydream about it,

and have a shopping list of things

I'm gonna buy her,

all these things, so it's just…

Yes. I want everyone to remember

how Kevin treated me

when he thought that

I was such a daddy's girl

when we started dating. He was like,

"Your dad spoils you.

I don't know why he does this stuff."

And I want these things to be remembered

for when he has a daughter

and he does the exact same thing.

I think I'll be

No, he's not gonna be a disciplinarian.

So, Dr. Johnson,

I also want to talk very briefly

I know you said

that you'll come in, however

- Yes, I intend to attend your delivery.

- Okay, great.

Not only are you family,

but you my mentee.

- This is my mentor. I think that's

- Yeah. So crazy.

- She knows my deepest, darkest secrets.

- No, I don't. Thank you, Dr. Johnson.

You've worked with me for four years.

You know my deepest, darkest secrets.

Before you got here,

Kevin and I were talking. I said,

"We have to meet, because haven't heard

anything about her research project."

He's like, "Research project?"

She has the project,

she has to complete her residency,

have a baby,

pass her boards, and relocate

to the other side of the country.

All in the next six months.

You gotta do what you gotta do.

What are you gonna do? Stop?

And that's my girl.

It is the way we're wired.

She will get it done. I have no doubt.

But I don't want it to be

at your own emotional or physical expense.

Today's mass sh**ting

at the Tree of Life Synagogue

in Pittsburgh

had an extensive anti-Semitic,

anti-Jewish digital footprint.

- Good morning.

- See this?

Hey, Jimmy. Come here.

Take a look at this.

- You just move it a little bit?

- Yeah.

This is the edge of the tumor, right here.

This is obviously all tumor.

- Yeah. Can I come in and play?

- You can play.

I hereby declare myself to be

a brain tumor doctor.

It's like that fortune cookie I once got,

"Mediocrity is self inflicted.

Genius is self-bestowed."

Like, "Behind every great man

is an astonished woman."

Or "Behind every great chair

is an amazing vice chair."

Yes. Correct.

- That was so easy, right?

- So easy.

Such a setup.

There it is, dude.

Give me a Penfield 3.

So awesome.

Does surgery play a role in the longevity

of a patient who's had a low-grade glioma?

Absolutely. Take the tumor

and then a margin that's safe,

and make sure the patient's not

neurologically compromised.

See this kind of snotty-like consistency?

That's a low-grade glioma.

He's putting a patty right between tumor

and normal brain.

You basically can almost lift this tumor

right off the adjacent area of the brain.

You can see where the snot becomes

a little bit more firm

in this whitish substance.

That's normal white matter.

- This is normal, right?

- Yes, that's normal, for sure.

I think we're good here, bro.

Check that with the nav. On.

I'm happy there. I'm happy there.

I'm happy there!

That's tumor.

Can I get, um, second frozen

What's this? That's tumor. Isn't it?

We had a margin there.

I don't buy the navigation now with that.

We had a good margin there, John.

I don't believe it.

I'm telling you, something changed. Look.

I don't agree with you.

I think this is tumor.

Let me see something.

That looks like tumor to you?

That's the problem.

Now I can't tell.

- That could be margin right there.

- Yeah. See that?

Okay, I'll buy that.

I agree.

You're good there.

- That looks more normal now.

- Yeah. Okay.

I don't think that's tumor.

Frozen.

- I think we're done.

- No, we may send you one more.

We're gonna send one more.

That's tumor right there.

Look at this right here.

- Here comes a frozen.

- This is the deepest

The most deep.

- Are we cutting it off?

- Yes, please.

Yeah, I'm very happy with it.

I think we're okay.

- Yeah.

- That's it.

Four-hand surgery, bro.

Four-hand surgery.

Four-hand.

- I'll tell the family all is well?

- Yeah, go talk to them.

Okay, have a great case.

Thank you for letting me help.

- Yeah, it was awesome.

- We'll see what the final path is.

- Finished?

- We're finished. The tumor's out.

- No way. Everything?

- Absolute?

Dr. Langer's just closing

Finishing closing the scalp, so

- Okay.

- How she is?

She's doing perfectly.

Everything so far is going perfect.

Everything

Everything's going

- Everything is so good

- Can see? Can talk?

No, we're still finishing up

the operation.

- But is

- The tumor came out.

Thank you.

Oh, I

Save some hugs for Dr. Langer.

Mom! She's fine! They took everything out.

Where is he? I want to talk to him.

Here!

Everything went fine.

- Can I give you a hug?

- Yes. Of course.

Hello.

Okay.

[chatting in Portuguese[.

Um

I don't think so,

because we then took

I don't think we can take more, do you?

I'm not I'm not convinced.

Okay, real quick.

Actually, Dr. Langer and I,

we're going to go up to pathology,

because he sent one last margin,

and that's going to be our confirmation.

Then we're done.

But she's already in recover

- No, they're closing up.

- No. They're closing. Dr. Langer,

- and then Dr. Kwon will close the scalp.

- Okay.

I'm just out of the OR.

I've got to go to patho

I've got a patient thing.

I'll call you as soon as I can.

I saw his text.

I'll call you right back.

Hello.

Because last thing,

deepest white matter. What did you see?

I want to see deepest white matter.

Yes, so that one also showed

a low-grade infiltration.

- Deepest?

- Yes, the deepest.

By three.

You can see the neurons here.

You still see these infiltrated

low-grade glio cells, right?

There's more than usual for normal brains.

They're like not evenly spaced as you

would see

with normal, you know,

reactive glio cells.

They're more like clumped.

And to compare that,

I'll show you the first one.

You closed the dura and skull?

Yeah, we can reopen.

I just told them to stop.

I mean, this is an important call,

because we're contemplating

reopening her

with the risk of making her weak.

If we compare the cytology

to the first one, they look similar,

but they don't belong there.

Let's just go back

and just go deeper there.

Let's just do it.

- Thank you.

- You're welcome.

You're going to send a deeper?

Yeah. I'm going to send one more.

Hey, Sherese.

- Hey

- No, we're going to go back in.

Um, not great. I mean, not terrible.

- Hello?

- Hello?

Sherese, I'll be right there.

Did you see the scan?

How's it look?

Awful?

Jesus Christ.

- All right, I'm sorry.

- Go back to your office.

I'll get this thing set up

- and I'll call you.

- All right. Bye.

- Going to take me 15 minutes

- What's up?

Let's just take a time out.

Give me a couple

I'm going to call you this afternoon.

I'm just in the middle of doing something.

Nothing's going to happen

without my being involved.

I'm going to go

Agy Peña's scan looks terrible.

You're going to go talk to the family?

They're going to intercept you.

Ah. I'm going down to see Agy Peña.

She's the cop that had

all the clinical trial stuff.

This is not good news.

See this?

This part is completely exploded.

All this now is tumor.

Tumor, tumor, tumor, tumor.

Okay, let's go talk to her.

Agy, we're not going

to overthink this, okay?

You got a trial that is

one of the most novel on the planet.

We're going to see things

that nobody has seen before.

That's the only thing I can tell you.

So standard radiology'll say

there's a lot more white,

therefore I think

the tumor's getting worse.

They have no idea the novelty

That's what you said.

You said that, um, in your presentation

is how it is.

Yeah.

And the truth is,

we have no idea what's going on.

You're the, what, eighth person

in the country that's gotten this drug.

We're giving you bacteria into your brain.

That can set your whole brain on fire.

And I don't know what that's going

to look like on an MRI scan.

Some of that's going to be

frustrating to you,

but that's how

we're trying to beat this disease.

I will tell you when I'm really worried

about your longevity.

I don't necessarily understand

everything that's going on

in this image,

which is unusual for me,

but I know Avastin

is what we need to give you.

You'll start feeling better very quickly.

Okay?

Okay.

Thank you.

All right, thank you.

I know it's been a long day, okay?

Get home safe, all right?

- Thank you.

- All right.

f*ck.

Okay, my friend.

f*ck.

That is a confusing picture.

Our immunotherapy agents should cause

this mass of inflammation in the brain.

I mean, that's

That's what we're asking it to do,

and I hope to God

this is just inflammation.

Successful inflammation

that's combating her tumor.

Um

It's sad.

She, uh

Sad.

Yeah, no.

We thought we were done,

but the frozen We were surprised.

It's a couple cells in there.

It is what it is.

- But you are going

- That's great.

- No, it's good.

- That's great to find now

- Rather than do another operation.

- Yes, for sure.

- Thank you very much.

- No no no premature hugs.

Okay. But we're a hugging family.

Okay. I could tell. Me too.

This Brazilian girl

Langer and I are operating on has

a grade-two glioma.

And then, this woman Agy Peña has

a grade-three glioma.

And then you've seen guys who have had

grade-four glioblastoma, it's a spectrum.

And so

we want to prevent Marie

from ever grading to a grade three.

I don't care if I've got to get

every damn cell left behind

before we close.

That's what I would want.

Yeah. You're like a cell away.

You're a cell away.

Give me a Rhoton.

We cure cancer!

One cell at a time.

- Louder.

- One cell at a time.

- There you go.

- Monitor looks good?

All good.

Take all that.

- All the way to that margin.

- I think we're there, bud.

I really do.

I think we found what was abnormal.

Beyond that white matter is

Is no man's land for us.

I wouldn't go beyond it.

Yeah.

Okay. Let's close. Scope out.

- It's normal.

- Okay.

I'm glad we went back, bro.

Me too. This is why teamwork

makes the dream work.

Stopping

and restarting again, it's hard to do.

That's why having us both there, you have

different people pushing each other.

That's the value of having a great team.

This is the only time it's worth

This is what

I know. Look, if you're gonna

send frozen, you better…

Once they told me it was positive,

what are you going to do?

Hello?

Hi. Can we help you?

- You okay?

- You okay?

- Okay.

- She pushed the emergency button.

Emergency button going off.

It's a good way to meet everybody.

Come on.

You're good.

Yeah, she almost tricked me.

It was an accident.

Do you guys have recommendations

for baby CPR?

- American Red Cross.

- Okay.

The nurse educator for Peds does it

as well.

Thank you. But there's no hospital one?

The one we do in the NICU is

non-certification.

I don't need certification.

This is just for my baby.

You should know it. You should know.

I want to be able to know signs

and do quick resuscitation if needed

for my

- Seriously.

- Really, Amanda?

What Doesn't every new mother

have to do baby CPR?

No. It's not mandatory.

I feel like it's mandatory.

I also want to know

all the developmental milestones.

You know what? She's going to be a mess.

I really just want bases.

I want to know at two months,

what are they supposed to be doing?

But your pediatrician will go over that

with you too.

Yeah. You don't

need to necessarily do that.

'Cause, I mean, I don't

have a completely normal pregnancy.

Yeah, we have our video too.

- Oh, you have a video?

- Yeah, yeah.

- Thank you.

- Yeah, of course.

All right. Hopefully I won't see you

- for the rest of the night.

- Yeah

Where am I going?

Room two.

Thank you, Tasha.

Hi, guys.

- Hi.

- You've had a long day.

- Yeah.

- Yes.

- I'm sorry about that.

- It's all right.

I've had a long day too.

- It's not your fault.

- Yeah.

I'm going to go look at your film, okay?

- Okay.

- Okay? It's been a long day in MRI, huh?

- Yeah.

- Had trouble getting a vein?

Yeah No

Yes. That's what happened. Yeah.

- Yeah

- Okay. It's hard. I'll be right back.

- Okay.

- Okay? Let me take a look.

We're comparing his new scan

Scan looks better. m*therf*cker.

I don't understand how

scan's going to look better.

Can you bring them in here?

Problem is he's not f*cking speaking,

and he's going to live.

He's going to be f*cking locked in.

This is good film.

I just wanted to show you.

- Yeah.

- If you don't mind.

- Wait. Say it again?

- It looks good.

Okay. Why are we going back here?

I like what I see.

Oh, God.

Yeah.

Look at this.

Oh, my God.

It's like a hornet's nest.

- Here are all the hornets.

- Yeah.

Now you just have the nest,

everything's dead inside.

Does that mean it's dead?

If we had to guess.

The hornets are dead. The nest is there.

The hornets are dead. The nest is there.

- You consider hornets the tumor itself?

- Yeah. The cells

The cells are buzzing around here

Bzz, bzz, bzz.

Then we spray with Avastin,

then they're kind of dead and dying.

I'm trying to understand,

the nest itself is still the tumor, or?

The nest is still there,

much like a hornet's nest would be there

in the bush even if you sprayed it

and k*lled all the hornets.

- We never get rid of the nest?

- No.

This is indicative of what we call

a positive treatment response.

What I think you're struggling is

The communication between

speech production and reception is

- There's basically something blocking it.

- Yes.

Okay. You know

what we're going to do here.

Good.

I'm pleased with this.

- Yeah.

- So am I.

I want you to be pleased with it.

- I want you to sing all the time.

- Yeah.

- He's better.

- Yeah. Yeah. Yeah.

- I'll see you in a month.

- Okay.

I want you to come in. I like seeing you.

- Okay.

- Push yourself. Don't get frustrated.

Push yourself until

you're just done pushing yourself.

- Thank you.

- I'm proud of you.

Keep up the good work.

We recently got NYPD coverage

in the ER now.

Every day,

which I'm very happy about.

Coming back, it's, uh

I felt I felt a lot safer.

There's going to be

a lot of intoxicated people tonight.

Psychiatric, intoxicated.

It'll be fun.

- Boo.

- Where's your costume?

You're playing doctor tonight. Okay.

How's the baby?

Good. Good.

We dressed him up as Chewbacca today.

I'm sure there'll be pictures.

He's so little. We walked down

the whole Halloween run by our place,

and my husband's like, "All right."

- So no gummy bears?

- No gummy bears.

All right. Damn.

Terry. What happened?

I hope it's not just one sandwich.

You hope it's not one sandwich?

- There's two sandwiches here.

- Okay.

All right?

Can I ask you something?

Yes. Here you go.

Can I ask you something?

Ask me what?

I want to die.

Terry.

My my my

I've seen you three times

this week from the BRC.

I'm asking I'm asking you,

Would they take me back?

I don't know if they'll take you back,

because you drink. And you have to stop.

If they don't

I'll roll into traffic.

No, you're not going to do that.

Yeah.

We're not gonna do that, okay, Terry?

We're not gonna say things like that.

Why don't you hang out here

for a little while, but don't shout.

Because you're going to scare

all the other patients.

Yesterday in the ER

he threw himself on the floor.

Do you want to do the lab test?

Yes. I didn't do one yet.

Hello. Dr. Little.

How are you?

- You know we're always watching baby.

- Yes.

We're always watching you.

If ever anybody appears stressed,

we come in.

Uh-oh.

- You feel another one?

- I'm going to.

You're allowed to push.

That means that's good. Let it go.

- I just push?

- Yep.

- Good. Great.

- Keep it going.

Try to keep that chin down to your chest

like you're curling down.

Eight, seven

- Good.

- Six,

five, four, three, two, one. Relax.

Everything is still perfect.

This isn't as bad as I thought

it was going to be if this is how it goes.

I'm going to regret saying that.

I was gonna say,

- "You're going to regret saying that."

- I know.

Okay, Marie. Give me a squeeze here.

- Good girl.

- Nice.

Strong right hand. Wiggle your toes.

Wiggle your toes there.

- Good girl.

- Good.

I did it! Peace and love!

Peace and love?

At least you didn't lose your personality.

I did it, Dr. Langer.

She's unbelievable.

This kid is off the charts.

Dr. Langer, peace and love. I did it.

Now I can Give a hug.

Yeah, now I'll take a hug.

Here, we had this under her

the whole time.

- Thank you.

- My God. Thank you.

Bless you.

All right. Let's see how you're doing.

What are you doing in here?

Oh!

Are you having a picnic?

Yeah. We're cleaning up now.

You don't have to.

So, the reason why you've been here

so long is because the baby

keeps wheezing.

Why don't we take a look?

You guys want to see something cool?

- Yeah. Yeah.

- Okay.

So

- That's Prince?

- That's Prince.

Remember the picture we took of you?

The one thing

I've noticed after having a baby is,

it's much harder for me

to see children.

I think his chest x-ray looks great.

He doesn't have pneumonia.

It's just the emotional aspect of it.

If he doesn't stop wheezing,

I've to keep watching you.

Do you have anybody else

that can stay with the children?

Not over here,

because we live in the Bronx.

- Oh.

- We're pretty far from home.

Okay.

- The kids have school tomorrow?

- Yeah.

Oy.

- You know.

- I know, right?

It's already really late.

I know.

Well, let's see what we can do.

If he can't go home because he's wheezing,

would you be able to stay here, or

I I don't know.

I would have to see what I could do.

- If somebody could get them.

- Okay.

Do you have anybody close?

I have their grandmother,

but I don't know

if she's even going to answer right now.

Very first thing

I thought about when I saw her

was frustration.

She has no social support

and five children.

I I know from experience

within my own family that

I feel that women could easily fall

into that problem for many reasons.

That's the way I have to relate

to a lot of people here is

not getting easily frustrated.

I do get frustrated internally. I do.

- I think he's better.

- He is, right?

He is. See?

I'm so happy. Thank God.

It'd be great if we can

get her home,

and can you get her metro cards?

She has to put all the kids to bed.

- Yes.

- Okay, I'll print out the paperwork.

- Okay.

- Thank you.

Such a cutie pie.

Dad, stop crying.

I've stopped.

Stop crying.

You made it.

I'm perfect.

[WOMAN OH, MY GOD! I LOVE YOU!

Sh.

- I'm sorry.

- Rock on.

All right, I'll leave it alone.

Okay, guys.

Dr. Langer, thank you.

All right, guys. All right.

Okay?

THE FIRST TWO WORDS: "I'm perfect."

Yes yes, yes, yes, right there.

Beautiful. Four, three, two, one.

Deep breath.

Again. Use that contraction, that force.

- Press in. Go. Push down.

- Yes. Oh, beautiful.

Good.

And more, more, more.

Extra, extra, extra, extra! Yes!

- That's good. Good.

- Hold it.

Apparently in Mexican culture

when the head comes through the vag*na,

they call that the ring of fire.

It's going to burn,

it's going to be painful,

but it's going to be over.

They talk about the baby

- getting power from the female ancestors.

- Oh!

It's a whole thing.

Good job.

Good job.

She's pushing well.

She feels her pressure.

- Hi.

- Are you guys getting closer?

Uh, not yet.

How are you?

Where the f*ck are you?

Are you here yet?

Okay, we're upstairs. What kind of drink

do you want? I'll get it ready for you.

Whoo!

Whoo!

Hello.

- How are you doing?

- I'm okay.

Shake your hand.

You're the man.

Doing good. Good.

I'm so happy you're here. Seriously.

I need to say something.

Can I say something real quick?

You know, Mitch,

your experience and who you are

has brought us back to the core,

and has really, honestly, energized me,

because you represent

what's great about medicine,

what's great about being a neurosurgeon.

We cannot wait

until you come back full-steam.

We all miss you.

Having you here tonight is amazing.

So, the future is bright with you back.

Thank you for being here at all.

You know, when I first came here,

this was our our department, and, uh

We're living out of, like,

a single room.

The the reason why

we've been successful,

we each have filled a role.

Every one of you represents

how we've spread our wings

and developed more and more a momentum.

This all grew out of that one tiny office.

And this is just the beginning.

Looking back on this,

it's been f*cking t*rture

But, retrospectively, it's been

the greatest experience of our lives.

Thank you for coming out tonight.

Full full respect.

Kalman's here.

Whoa!

Hey!

- You missed my speech.

- I know. I'm sorry about that.

It was played live.

Jill, thank you for everything.

Mitch is here.

- Who's here?

- Mitch.

Oh, is he really? I want to go see him.

- I'm going to go say hi.

- Go say hi.

Don't look inside, but from the outside,

you know.

If you look here I'm okay.

You're gonna do awesome.

Dr. Langer, honestly, I want to be you.

No, you want to be you.

- I want to be you.

- I'll help you be you.

- Yes.

- All right?

Thanks for everything you've done.

- So awesome.

- Thank you.

- Okay.

- Ready, ready, ready.

- Okay, ready?

- Yep.

Okay, you know what to do.

Nice, big, deep breath in. And go.

- Push down. Push down.

- Beautiful.

Oh, my God. He's like right there, right?

- Okay. He's coming.

- He's coming.

- He's coming. Just breathe.

- Relax.

Okay. Remember, we're staying

What am I feeling?

You're feeling his head.

People have no idea

about the time it takes

to go through labor,

and it's painful the whole time.

A lot of women not really understanding

or knowing the complete process.

Great. Relax.

Ten, nine…

Get that head down.

But I find that for many women,

especially with pushing

or getting very close to delivery,

they still have pressure.

That pressure can be so uncomfortable.

I have no idea what that feels like.

- Push.

- Ready?

Just remember, everything is normal.

Okay. Everything is good.

When you have that pain and pressure,

just stay focused, you'll be done.

This is the ring of fire

Dr. Brennan was talking about, okay?

- Right now? Okay.

- Potentially.

It seems like it.

- Ready? Go.

- My God. It hurts!

I believe in the strength of women.

I strongly believe every woman is capable.

Eight, seven, six

It's what you can do.

You want to empower women.

- …four, three

- That's it.

- Two

- Yes.

- One.

- Yes.

Touch your baby's head right now.

- Take your hand. Feel it.

- Oh, my God!

Oh, my God.

Now we'll let you stretch some more.

Easy does it.

Now, give me one more little millimeter.

Look. Open your eyes. Look down.

- I can't see

- Open your eyes.

- Oh, my God! Oh, my God!

- Put the feet in the stirrups.

Yeah. Now, take your hand

and grab the baby's body with your hand.

Not the arms, but grab around the chest.

- Oh, my God.

- Now, in a minute,

you're going to lift him up, okay?

Ready? Lift him way high up.

- Then a little bit forward.

- My God. He's

- He's just holding…

- Yeah.

Okay, now you can lay him down

You can lay him

right there on your chest.

There it is.

You did it! You did it!

Oh, my God.

What a great job

You're okay.

- I know.

- You can open your gown

and put him right on you.

I'm, like, afraid.

You delivered him,

so you can't be afraid now.

Yeah, there's a big blood clot sitting

right here.

- Is that okay?

- Yeah.

Yeah, it's very common.

We make sure that it gets out last.

The uterus has to contract down,

so your bleeding stops it. It will.

Everything that happened to you

is completely normal and good.

Congratulations.

Thank you so much.

- Congratulations.

- Thank you.

- Thank you for everything.

- Nobody coaches like you.

Oh! You're so sweet. Thanks.

Walter, we're gonna get you

a room. Wanna come with me?

- What?

- I'm waiting for your lithium level

so we can give you your medication, okay?

Come on, Walter. Let's go.

What about your Odyssey?

- The book.

- The book.

They fought all this w*r for a woman.

We know Walter.

He's a rather

unfortunate gentleman who is young,

and he had his first psychotic break

I don't know when.

We're gonna ask you

to chill out here for a little while

until we get your lithium level back.

But I'm wondering

where are your medications right now?

They're at home.

Okay. Why haven't you been home?

Basically, I love being out

and about outdoors,

and I also love to be able to do my own

little security check for Halloween.

I'm not out there to plow or to prowl,

but I saw Catwoman out there.

You were admitted in the hospital

not too long ago.

You know what happens

when you don't take your medicine.

You end up here,

and we take you to Zucker Hill.

I would like to see you go home

and take your medicines at some point.

If you release me at 6:00,

I will take the medication in the morning.

How are you going to do that?

I will do it…

whenever you give me a metro card.

- A metro card.

- Exactly.

When your lithium level's back,

if your lithium level's okay,

- we're going to give you 450 milligrams.

- Okay, that's wonderful.

'Cause you don't wanna be

- on 666 on Halloween night.

- I don't want to break the 666 code.

I'll be back, okay?

- All right.

- All right.

He could go home,

but I don't think he wants to.

He likes being out on the street because

he does have an apartment, actually.

He has an apartment assisted by the city.

Schizophrenia is considered a disability,

so you can get

Medicare assistance for that,

but most of the schizophrenics that I've

met don't have an established apartment.

They live on the streets.

They check themselves into shelters.

He is one of them that has help.

The ones that don't

they're just kind of lost to the system.

Sounds like he had a normal life.

He went to college, he was a painter.

Now he's like this.

It's either genetic or a product

of how he grew up. Who knows?

It's scary, your child just be lost

to a psychiatric disease.

Now that I see young kids

coming in with alcohol intoxication,

it's a worrisome thing.

Right now we have two, four…

Six teenagers in the ER,

and they're all from alcohol or drugs. So…

We had a dad that called into the ER

and said,

"I want my teenager drug-tested."

Because he was a nerdy kid

who passed out, and his dad thinks

he's on drugs. All right.

Actually, looking back,

I understand his worry.

I may have done the same thing.

I definitely would have done

the same thing.

I would drug tested Joaquim

when he's 18 and he comes in the ER

after passing out on Halloween night.

It's the first thing I'm going to think.

"What were you doing?"

You never know. You never know.