01x08 - Full Circle

[bunniefuu]

-[woman] We are on the right path.
-[David] I agree with you.

-Yes.
-[woman] You feel we're on the right path.

Absolutely on the right path.
Growth hurts.

They have to understand that we have
to be compatible to New York hospitals.

Recruits for you.

[David's voice] It's a lot of juggling,
being a surgeon and a chair.

But it's the humanity of your own patient
that matters. It weighs on you.

Last night, I was great up until--
And his hand was warm.

And then he started doing this... at me,
to me, like he couldn't see it,

he couldn't see me.
And I said, "What the hell is that?"

Laura was pretty tearful when I walked in.
She couldn't explain why.

-She just-- I think she has...
-[man] She's tearful.

...a bad feeling.

[John] That looks worse to me.

But this, where his speech is,
looks better.

If I don't take this out,
he's going to die.

[Mirtha's voice]
The 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.

Oh, my God! Oh!

[Amanda's voice] Many women have not
witnessed births of their sisters,

of their aunts, of cousins.

And it's kind of a loss for women.

-[woman] More, more, more!
-Get angry! Get angry!

-[mother] No! Knock it off!
-Okay. Okay. Okay.

-[woman] Same thing. Same thing.
-I can't, it hurts!

[Amanda's voice]
I believe in the strength of women.

I strongly believe
that every woman is capable.

Eight, seven...

[Amanda's voice] It's what you can do.
You want to empower women.

I thought I was going to deliver
at 40 weeks.

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

[machine beeps]

-[Amanda] Hello.
-[woman] I see your family!

-[man] Here they are.
-[Amanda] Hello!

-[woman] My baby.
-[Amanda] Hi.

[all laughing, chatting]

[Amanda]
Hey, Daddy. Okay, Daddy, go ahead.

[Peter]
Dear Lord, thank you for our time, Lord.

Please give her a healthy,
blessed delivery.

Commit this situation to your kind,
loving hands. In Jesus' name, amen.

[Amanda] Amen.

[Peter]
What are your feelings right now about...

[Amanda] I'm fine. I'm just tired. I wanna
reserve my energy, try to sleep before I--

I feel crampy every once in a while,
but it's not crazy at all.

I'm breathing through it.

-So, Princess...
-[Amanda] Yes?

-You would like for us to...
-There's nothing to do.

-I want you guys to rest, because I--
-[Bridget] Okay.

This is not going to be
the night of any action.

So when it's active labor,
three people will be in the room...

Daddy's going to be
with his catcher's mitt on ready--

-[Amanda] No, Daddy--
-[Peter] Two, hut!

I understand you don't want me
when you're popping out the hatch--

-[Amanda] Pushing. Thank you.
-The Lord may move me to get in there.

[Amanda]
No, he's not moving you to do anything.

Mm-hmm. Mm-hmm. Good night, Daddy.

[kisses]

-I love you, baby.
-I love you, too, Daddy.

Thank you for coming.

Yeah. I'm texting Kevin.

-She'll be coming. She's on her way. Yeah.
-[Peter] Daddy's Pookie.

[Amanda] You made it, boo.

[Kevin] All right...

Everyone has been extremely nice.
Mom was like,

"Is this a normal experience?"

I'm like, "It's just... but not really.
It's a little bit extra."

-I'm obsessed with that dress.
-[woman] Your mom's amazing.

Everyone keeps saying that to me.
It's scandalous.

The back is open for massage,
and they said it's very easily accessible

for all monitors.
So the nurses don't have to, like,--

Then for breastfeeding,
this is just a thing.

[woman] That was just meant to be.

-I love it.
-This is your labor dress.

-Did you buy this especially for labor?
-[Amanda] Totally scandalous.

-You did, right?
-I planned to labor at home,

until I was six centimeters. Life changes.

-[machine beeps]
-It's decelling. You should go in.

-[woman] Oh, my God.
-I'm just letting you know. [laughs]

It's coming up.
I have turned every monitor away.

-[woman] No, she's gonna read that...
-So I've been really good.

[woman] Pleased to meet you. Exciting.

Okay, I need to go back to my retreat.

We'll see you. [chuckles]

-Sleep tight.
-[Amanda] Thank you.

[baby crying]

[Kevin]
You've got a lot of support here, boo.

I do have a lot of support, boo.

[knocking at door]

[David] Yeah.

Come on in.

So, well, the first thing I want to
talk about is this year, sort of a review.

I think, basically,
with Mitch being out, we did fine.

This is basically what we did this year,
and what our target is for next year.

Those are big numbers for men.

[David] Yeah. I'm a concerned
overall what amount of effort

-he's going to be able to put in.
-[John] Yeah.

The thing is that'll happen, though,
Griffin is not in the budget.

[John] He wants to take general call
or just spinal?

-[David] He has to take general call.
-[man] Who?

[David] Griffin. Definitely.
Then the other thing I'd do

is just do co-surgery with him, or do--
you know, assist each other.

You'll-- you'll work that out.

[David's voice] We're structured so that

nobody's personal volume
is directly related to their income.

[David] That's pretty much it.

[David's voice] In many departments,
the incentive is individual per case.

In our situation, we're incentivized
as a team to be successful together.

[David] Our volume target as a group
is up 13%, with Mitch being down.

[John] Listen, we have an office issue.

We-- we hired four new people.
We have no space for them.

We have to fix this.

[David] Yeah, I know.

[David's voice]
Ultimately, it all comes down to volume.

You bring cases, hospitals benefit.

The trouble is-- is that, over time,

we've become so successful
that we outstrip the resources.

[man] And we're trying to figure out a way
we get more treatment rooms down here.

-[David] Hmm.
-[man] We can go from,

you know, six to nine people in an area.

[David's voice] How you're measured 
in your own mind as a doctor

versus how you're measured

by the business of medicine
are two totally separate things.

And it's really hard to do both well.

If you're super busy, it's not really
what makes you happy, ultimately.

It just doesn't.

There's a tremendous degree of greed

from doctors,

patients, the world. [chuckles]

Kind of underneath all this,

it's all driven by the-- the culture.

So it breeds itself.

Using that for what it's worth,
but not making it your North Star...

is the challenge.

[Mirtha] Hi!

-I have some ice, okay?
-Thank you so much.

-[Mirtha] Did you need water, too?
-She needs a doctor.

I need some medicine,
because I'm in a lot of pain.

-My hand is swollen.
-It's hurting her.

-I can't feel my hand.
-[woman] She's a deli girl.

She does slices.

[patient] I can't feel it, nothing at all.
I'm in a lot of pain.

[Mirtha] Sometimes the swelling does that.
We'll give you something as well to help.

-Please.
-Let's look at your X-rays.

-I'll see who's seeing you.
-Wanna make sure she's all right,

-because she's not able to work.
-[Mirtha] Sure. Of course.

[phones ringing]

[Mirtha]
I'm gonna go see my other patient.

[knocks twice]

-[Mirtha] Hey. Hello.
-[woman] Hello.

[Mirtha]
So, why did you call the ambulance?

They said something
about your asthma inhaler?

I don't know, but I can find out
and just order it for you.

Yeah, um, discharging room 16,
she hasn't been registered.

-No insurance on file.
-I'll get it.

[woman] Are you gonna do it?

This patient has been waiting weeks to get
a simple inhaler for her asthma approved

through her insurance,
because it's a certain brand name.

I mean, I just think this is ridiculous.

This is a patient who has asthma,
who needs it to breathe.

She needs these medications every day,
and she can't get them.

Her visit's going to cost, I don't know,
a couple thousand dollars more

for her just to get an inhaler,

because CVS is not covered
under her insurance.

I mean, basically, if you have
no insurance, you're-- you're screwed.

Some people are completely okay with that,
because they don't have to worry about it.

But here, we do,

because in the emergency room,
we get people who have no other resort,

nowhere to go.

It makes me livid, actually. [laughing]

It makes me livid.

A little congested.

[Mirtha's voice]
When we went to medical school,

we took an oath to save lives.

But it's not just saving lives,
it's advocating for them,

despite whether they have
insurance or not.

We advocate for them here in the ER.

It looks more like an abrasion.

And I think we should still send you
for a scan.

-Fine.
-[Mirtha] It's better to be safer...

-Be cautious. Sure.
-[Mirtha] Yeah.

[John] How great is this wall?

I mean, look at this.

We started with four of us.

I mean, look at this, David, I...

He's have got to stop
and look at this wall.

Look how many MDs there are.

We had nothing. We started with nothing...

and we can double it in no time.

-[woman] Morning.
-[John] Morning.

How are you?

-Okay?
-Pretty good.

-[John] Thumbs up?
-Pretty good.

Can I ask you about a theory
we might kinda have with him?

[John] I love theories. Yeah.

We were wondering
if, like, there's tumor in there,

can it have been left over
from the first tumor.

And then that's what you're gonna
go in and take out?

You know what's unusual
about this whole thing is,

it's actually in a separate location.

This is basically
the entire occipital lobe.

-So that's like back here.
-Yeah.

[John] The other tumors were here,

-in the frontal and temporal lobes.
-Okay.

-[John] Here, in the vision center...
-[Chris] Yes.

[John] ...you're all swollen.

Yes! What--

[John] I showed you guys this
in the office, right?

[Chris] Yeah.

[John]
So we have a vascular conference at 8:00.

-We're going to go over your films first.
-[Laura] Okay.

I'm going to get a whole bunch of opinions
as to what am I looking at.

All these black things are
big blood vessels.

-[Chris] Yeah.
-[John] Now, sometimes,

tumors can do that.

Other times, we talked about
venous congestion can do that.

But I want to know why you have swelling
of those blood vessels.

[David] We have this new spine recruit.

His name's Griffin Baum.

He's actually the great-grandson
of L. Frank Baum,

who wrote The Wizard of Oz.

[chuckles]

He'll be Mitch's junior guy.

It's sort of given Mitch relief.

I think it's helped Mitch's practice.

Hey, Griff, come with me.
There's a meeting I'll take him to.

Are you busy? Just come sit with me.

-John should be ready to go.
-[woman] Okay.

[whispers]
What time is your case starting?

[man chatting indistinctly]

[John] Can we do Amundsen?
Thank you for putting him on the list.

I just want your insight
as vascular specialists.

Christopher Amundsen's a 41-year-old male.

He was diagnosed
with a glioblastoma in 2015.

He has, um, speech abnormalities

that have actually improved
since intravenous Avastin.

What has exploded is
this left occipital lobe,

which is really congested.

It looks like...
either a venous congestion,

or is this all tumor and just

exploded on IV Avastin.
This occurred over the course of a month.

I can tell you, clinically,
he has really minimal headaches.

These long-term survivors,
when they're three--

This is like new territory.

-Have you seen weird behavior in tumors--
-[John] Completely.

-We're seeing radiation changes...
-You have?

...that we never saw.
So what I'm asking you guys is,

is it not possible this is just
a chronic venous congestion infarction?

I think that's all congestion.

That's a very unusual picture

-for a recurring GBM.
-[David] But he's a very unusual patient.

Actually, what's that little
enhancing thing, right there.

Stop right there.

-[John] Here.
-[David] That.

-[John] That's splenium.
-[David] It blew up.

It's pushing the ventricle this way.
Look at the ventricle's going like that.

-The thing blew up.
-[John] Nah...

[David] He had tumor
on that side of the ventricle.

[John] Look at this, Dave, wait.
This picture is not a tumor.

This is not a picture of tumor.

Yeah, but I think that when you've thrown
the kitchen sink at the guy

for the last four years, what you're going
to select for, ultimately,

is kind of like giving antibiotics,
and you end up with like a really bad bug.

That you select for the worst,

-most rapidly--
-[John] I…

I think, look, you could be right.

So, what are you gonna do?

[John]
I'm taking out the whole occipital lobe.

[David]
The answer is, I think, get a biopsy.

If it's cancer,
you take as much as you can safely.

If it's not cancer, then you just do--
you know, then you come back and say,

"Hey, it's not a tumor, we're done."

But the guy's fine, clinically, so...

[John] The guy's as good
as he's been, clinically.

[man] It's leaning on the surface
or the seizures or the headache or--

[John]
All right, well, thank you. I think.

-[David] That's what I think.
-[all laughing]

[man] Just take it out.

Honestly, it's going to probably swell
quite a bit.

I know, that's what I'm thinking.
So, uh, keep your phone on.

Well, that was interesting.

You know,
David brings up a good point, that...

you know,
we're seeing these long-term survivors,

and the long-term survivors,

anyone who's living after three years
with a glioblastoma,

you really can't predict...

what the cell is right now...

what the tumor sort of imaging is
going to look like...

and how it's going to behave.

You have to stand by the main tenet
which is,

"The patient looks good.
Trust the patient."

All right.
I'm going to give you a fancy hat.

Yeah, I saw that.

[John's voice] Even ten, 15 years ago,
we didn't have three, five-year survivors.

[woman]
You can adjust it if it's uncomfortable.

[John's voice]
He's in the five percent of patients

that we treat that live this long.

When you're dealing with a small number
of patients, you're basically anecdotal.

[Laura]
Walking around with his skinny legs.

[John's voice]
So, we're in really uncharted territory.

[Chris] Mm.

[John's voice] It's unfathomable
the courage this family has,

and the optimism.

-[Lisa] Hi, Kevin. Good morning.
-[Kevin] Good morning.

[Lisa] How was your trip?

-It was, uh...
-[Lisa] Full of anxiety?

A little anxious, but...

I got here in time.

You'll feel my fingers.

[Amanda] Mm.

And some pressure.

-A loose one to two.
-Okay.

-So... are we in agreement?
-[Amanda] Yeah.

-About active management.
-[Amanda] Yes.

-All right.
-[Amanda] Pitocin.

[Lisa] Now we're going to get to work.

[Amanda] Yes, I agree.

Okay.

[Amanda] Yeah. I don't want to--

I'm not trying to fight anybody
or anything like that.

-I don't think you're being combative.
-[laughing] Okay.

You know I know how to drop the hammer
when I need to.

-[Amanda] Yes, okay.
-Okay. That's our plan.

[Kevin] Pitocin's supposed to make you...

[Amanda] It's gonna make
my contractions regular.

So it could be now,
it could be in the morning.

-It could be tomorrow.
-[Amanda] Who knows when it can be?

[Kevin] What is the timeline after the--

I have no idea.

[Kevin]
No idea, okay. So it's just going on.

Very much depends on your daughter's
participation in this process.

-[Kevin] Okay.
-[Lisa chuckles]

You're going to have a baby.

-[Kevin] Sweet.
-[Lisa] Okay.

[David] I was so worried.

I called you, I was like,
"They're not answering."

Because we wanted you to be first.

-Right.
-[David chuckles]

This is, who's [indistinct],
bodyboarding on the beach

and hit his forehead and...

basically had extensions
where he was quadriplegic,

briefly, on the beach.
I have got to get his legs back first.

I, for better or worse, was there.

That's how I met him.

[man] You were there?

Yeah.

[man] Crazy.

[David]
With Langer, Baum, Levine, and Crouse,

goal here is to stabilize the spine
and decompress his spinal cord.

Okay, Griffin.

You the man.

[Griffin] Okay.

[David] Basically, with his accident,

he just had some area pressure
against the cord

and he basically
just flexed against the cord,

and it looks like a bruise or a contusion.

What we're doing is we're going to go in,
we're going to remove two of the discs

to decompress the canal.
Then we're going to put a plate

to hold the whole thing together.

Once we do that, because he's unstable,
and ultimately unstable,

we're going to flip him over,
just instrument the back to get

what's called circumferential fixation,
it allows very little movement.

That's the plan.

This is crazy.

You know, what's a neurosurgeon gonna do
at the beach most of the time?

It's like, what am I going to do,
you know?

Thank God I actually knew
what I was doing with this,

or at least I had some knowledge.

Skin knife.

[David's voice] No, this experience
is just, it's almost fake.

And how close he came just--
he could've drowned.

And then for me to experience
that with him

and then be able to be a healer

and help him and get him to
the hospital like this is extraordinary.

[David] That's the spinal cord.

[David's voice] If you question

what you do with your life, whether
you did the right thing for your life,

if you ever question that
and you go through something like that...

[David] Yes, baby!

[David's voice] You just have to be
so grateful for this opportunity.

I mean, how much better can it get?

[David] Lights on, please!

Hey, we're done with the front.
Everything went fine.

So we're just turning him now.

-[Amanda] Hey, good morning.
-[woman] Do your thing, baby.

Thank you.

-That's the NICU down there.
-[Kevin] Oh, cool.

-Just so you know.
-[Kevin] Yeah. Thanks.

[Amanda's voice] I'm going to try to do
an unmedicated delivery,

-and I can't give anyone a reason why.
-[exhaling]

It's just something
I personally want to do.

My mom had a medicated delivery.

My mother-in-law had a medicated delivery.

Sometimes there's so much guilt with,
"I got an epidural." Who cares?

[Amanda and Kevin humming]

[Amanda's voice] You shouldn't face
judgment no matter which route you choose.

[Amanda and Kevin chanting] Mm...

[Amanda exhaling]

[both chanting]

Hello, my princess.

Mom, why didn't you put on
the shoes I gave you yesterday?

-Because I'm going to put on booties.
-Okay.

-[Kevin] The contractions have started.
-[Bridget] The contractions have what?

They're intense. They're getting intense.

-Oh, okay.
-[Kevin] Yeah, it's...

-Good job. Good job.
-It's pretty intense.

Yeah. I told you, it hurts. [chuckles]

It's gonna be a long road, you know,
but it's okay.

-See, just two centimeters.
-Yeah.

[Amanda] Don't say "just", Bridget.

[all laughing]

-I mean, she has really progressed.
-[Kevin] She has.

[Amanda] Mother, just say, "She's two."
Just make a statement, please.

Don't make a judgment.

I didn't see
why she wanted to go to this class

-because she's a doctor.
-But she never did this--

But then
there's a lot of new stuff that...

-[Bridget] See that?
-...we learned at that thing.

-They don't really contribute.
-[Bridget] She doesn't know how to manage

-the pain during labor as a patient.
-[Kevin] Yeah.

[Cynthia]
Nobody does until you go through it.

[Kevin] Yeah, I know.

I'm sad
that my theory isn't right, though.

-I was hoping my theory would be right.
-I thought it was.

-So this is a different area now. 
-Yeah.

But they don't know
how much tumor is in there anyway, so...

[John]
You're doing Christopher, right, with me?

[Donald] Yeah, in your room.

This thing is going to swell like crazy.
We just reviewed it in Tumor Board.

Mm-hmm.

I need you to be ready
for lots of bleeding.

-It's going to swell like crazy...
-I'm always ready for lots of bleeding.

-...as soon we open it.
-Mm-hmm.

And, um...

All my blood products are always
ready to go.

-It's not even an issue.
-And then I just--

we'll just pack and suck it out.

[equipment whirring]

[Donald] Standard craniotomy equipment
is in the room.

We have our micro instruments on the field

and we have a Sonopet
which will be set up,

a perforator and a [indistinct]
ready to rock.

[John] Could you come over
to my other side? I got the head.

-Could I have a blue towel, Dorothy?
-[woman] Just one?

[John] Speaking of names,
were you named after Dorothy?

Uh, after my aunt and my grandma.

[John] Were they named after the Dorothy?
The most important Dorothy in the--

-[woman] From The Wizard of Oz?
-[John] That's the only Dorothy I know.

[Donald] I like that movie,
but ain't enough brothers in it.

[John] There's zero brothers.

-Is there a single one?
-[Donald] They gotta fix that.

[John] We're going after
this left large occipital lobe mass.

I don't know what we're gonna see
inside here.

[suctioning]

[John]
Dorothy, you're not in Kansas anymore.

-[woman] I know.
-[John] You're at Lenox.

[woman] I am.

[John] Students, come stand
next to [indistinct] carefully.

Do not touch anything blue or plastic.

This is really full occipital lobe.

I'm just poking on the dura here.

It's pretty full, which we expect.

Look at that.
That's all radiation induced changes.

[woman] Mm.

-[man] sh**t.
-[John] This is just necrotic tissue.

[woman] Yeah.

[John] I'm gonna say
it's going to be a mixed picture.

There's definitely going to be

some brain cerebral venous
congestion-slash-infarction.

I don't think it's going to be tumor.

Look at these big--

big engorged veins already.

Swollen, just swollen brain.

[suctioning continues]

[woman] Let's get some irrigation with it.

[John] All right, any big cotton ba*ls?
There's blood in the room.

[man] Everything is ready, John.

No, I don't see any tumor yet.

Let's cut open all this.

[John] Now, look.
This is looking more like tumor in here.

[woman] Yeah.

[John] Guys, look at this tumor.
I mean, this looks like classic GBM.

Unfortunately for Chris, this is...

this is a problem.

Because this is not just like
a small recurrence.

This is a massive expl*si*n
of probably a resistant tumor.

Oh, man.

[woman speaks indistinctly]

[John] This is just massive.

Absolutely massive.

It's just all this stuff is just...

massive, massive glioblastoma.

I'm glad we're here and I'm glad
we're doing this today, not waiting.

He would've gotten sick over the weekend.

-[crowd cheering]
-[rhythmic music playing]

[crowd whistling, cheering]

[man shouting in Spanish
over loudspeakers]

[crowd continues cheering]

Yeah, you know, I wanted to work--

I wanted to work
this whole weekend in the city,

because I-- I just think
the energy is so good.

It's the colors, the people.
People are so happy.

It's humans.
It's self-expression. I love it.

-Hi.
-[men] Hi.

-How are you? I'm Dr. Macri.
-Nice to meet you.

-[Mirtha] You guys look so colorful.
-How are you?

[laughs] I know.

-[Mirtha] What happened?
-Good day up until this.

Um...

-Want me to talk so you don't have to?
-Yeah.

He just has, um, severe TMJ.

-Um, so it just pops out.
-[patient] I had surgery.

I was, yeah, hugging him
and I yawned and it popped out.

-[Mirtha] Unfortunate.
-Up until then it was the best day.

This all started, I was kicked
in the face by a patient.

-In 2016, I worked as a paramedic.
-[Mirtha] Oh.

[patient] EMT. Sometimes they can just
pop it back in.

Sometimes they have to just give me
medicine

-or like knock me out completely.
-[Mirtha] Okay.

[Mirtha] Let's see if this helps you,
the Dilaudid.

-Okay.
-And, uh...

[inhales]

...if we can't, then we'll just give you
Propofol and we'll try to pop it back in.

Let's relax.

-We're going Zen in the room, everybody.
-[Mirtha] Everyone.

Happy Pride.

-No reason to hide.
-[Mirtha] Turn down the lights.

So, let's try, okay.

[patient] Oh! Oh-h*-h*!

-[Mirtha] No? Okay.
-[moans]

We'll give you a break.
Wow, you're really tense.

I can't do the movement
if you lock against my hands.

Worst-case scenario,

-we have to do a contrasedation.
-[patient] Okay.

-[Mirtha] Deep--
-[man] Deep breath, babe.

-[Mirtha] Deep…
-[moaning] Oh!

[Mirtha] Okay.

-[crying out] Ah!
-Okay. Okay.

[groaning] Ah! Ah!

Ah!

[muffled] Please knock me out.

[Mirtha] You want me to knock you out?

[patient] Yeah.

I mean, I can do that. Sure.

[all laughing]

I think we're gonna
have to consciously sedate him.

-Do you want to take a crack at it?
-[woman] Sure.

I've done many mandibles.

Hannah...

it's your time.

[David] Okay.
Does this-- Now we're gonna flip him.

We're just going to turn him on the table.

Yeah. Dr. Bob's in charge.

[Bob] Okay, so we need six safety straps,
and we need six feet of wrapping.

[man] Not yet. On the side.
Take this side, it's…

[David] Are we ready?

[Bob] One more down here, for his legs.
Ready?

One, two, three.

[man] Does this whole thing come off here?

[David] It's like a magic trick.

[Bob] Take that out of the room.

[David] Can I get some thousand drapes?

-That was way better than two tables.
-[man] Yeah.

[David] Definitely saves time.

[man] All hail the Czar of Spine.

[Mitch] Yeah. What are you wiring?

[David]
So we ended up taking, bone, Mitch.

That looks good.
Great angulation on the threes.

Looks amazing.

[suctioning]

[Mitch] Old school, I do old school.
I put bacitracin ointment.

[David] Okay.

[Mitch] And I put some Xeroform,
and then some 4x4.

[Mitch] Yeah. That looks good.
[indistinct]

[David] Yeah. Agreed.

[Mitch] That's it.

You did it.

[cell phone ringing]

[David] Langer.

It's really-- it's really crazy.
I just want to make sure you know, again,

my concerns about it,

and the patient's
the most important thing.

-[Amanda chanting] Ah...
-[Bridget] Incredible.

[Amanda and Kevin chanting] Ah...

[Bridget]
Relax your arms. Relax your arms.

Focus on relaxing your legs.
Relax your legs.

[Amanda and Kevin continue] Ah...

[Bridget] Good.

You're doing good. You're doing good.

-You're doing good.
-[Amanda's voice trembles] Ah. Ah...

[Bridget] Blow that one away.

-[Amanda's voice trembling] Ah. Ah! Ah...
-Relax your legs. Relax your legs.

You've done an excellent job
throughout this entire pregnancy, honey.

[Kevin chanting] Mm...

Baby, are you okay?
You're doing good, okay?

I just can't really rationalize
why I need to have unmedicated,

-at the end of the day.
-[Bridget] I'm trying to rationalize

-why not get an epidural?
-I think I'm gonna get one.

-[Bridget] Why not?
-Because I don't want to--

I feel vomit-- I think
I'm going to vomit constantly.

-[Bridget] You look tired.
-I didn't sleep last night.

[Bridget]
You haven't been sleeping for a long time.

I haven't been sleeping for months.

-[Bridget] Okay.
-[Kevin] It's not good.

-[woman on intercom] Hi, can I help you?
-Hi, can I get an epidural, please?

[woman on intercom] Sure. Hold on.

-[clicks]
-[Kevin] It's all good, boo.

-[Amanda inhales, exhales]
-Okay?

You got anything?

[man] It's probably going to be a tumor
based on the smear.

Let's take a look here.
It's definitely very cellular.

These cells look too atypical. I see
some microvascular proliferation here.

These are endothelial cells
that are much plumper than normal.

I mean, it's a recurring GBM.
It looks nasty.

[man] Yeah.

[John] Oh, man.

I'm thinking about taking it out.

Then I'm thinking about

he would be a great case
for our new trial...

-[man] Yep.
-[John] ...which is not open yet.

Radiated patient,
take a big hunk of omentum,

tie it into a vessel in the neck,

stuff that whole area that I'm taking out
with a big piece of fat

and just see what it does.

It's gotta change the microenvironment.

It can't hurt.
We got nothing else for him.

There are new devices,
new vaccine approaches...

new ways to bypass
the blood-brain barrier.

We'll have to think of something.

-Just the man I was thinking about.
-[suctioning]

Look at this, David.

Like, my finger...

-...is in this plane.
-[David] Yeah.

[John] It's all tumor. Look at that.

-[David] That's awful.
-[John] Massive tumor. Massive.

[David]
All that crap grew like that quickly.

[John] In a month.

-Look at this.
-[David] That's insane.

Oh. Poor guy.

[John] One month. Four years later.

One cell gets out of control.

You want to come in?

[David] Sure. I'll scrub in for a second.

[John] Give David a tumor forcep.
Give me a bipolar.

Save all of David's specimens.

Look at this.
This is all just nasty necrotic.

-[David] Does he have kids?
-[John] Yeah, one daughter.

-[man] He has a kid?
-[John] Yeah.

[David]
He had a kid after he knew he had GBM?

[John] Yeah.

[suctioning]

-[John] Got married in the hospital...
-[David] That's so sad.

[John] ...but he's lived four years
and it's just going to...

[David] It's getting worse.

[John] Remember, he was getting
systemic treatment,

but it probably wasn't crossing
the blood-brain barrier.

Look at that. You guys see the border?

There's actually a discreet border here.

David's in that plane of white,
and I'm just taking out tumor.

It's actually, he's cutting
like a hot knife through butter.

This is the challenging part,
is knowing when to stop.

And we're getting close to maximizing

our extent of resection.

I took out his whole occipital lobe here.

I'm just going to dry this up.

This is the limit of our resection
right here.

-I can't do better than that, right?
-[David] Nope.

-[John] That's really good.
-[David] Yeah.

[John] I think we're done.

I'm gonna go talk to his wife.

-Everything went perfectly.
-[Laura] Okay.

-We're not quite done.
-All right.

I just wanted to talk to you real quick.

-Okay.
-It was all tumor.

It was all tumor.

I know. I'm surprised, too.
It was a massive regrowth of tumor,

and I took it all out.

I was able to take it out
like a-- like a discreet lemon.

-And I did that.
-My God, it was the size of a lemon

-in two months?
-Yeah, in two months.

What does this...

This is what happens.

Look, I don't know
what it's going to look like genetically.

I went up to Pathology
and looked at it myself, and it's tumor.

It looked like tumor.

[crying]

[John] So, I think what we have to do is
wait a little bit.

Just kind of realize
I took out everything.

It's clean, and I have to...

think about what we treat him next for.

And we'll-- we'll do that as a group.

He's gone through every known treatment
for glioblastoma.

I-- I'm cautiously optimistic that we'll
configure something to give him treatment.

But what I like to do,
and I know you're good at this,

is we like to think outside the box
and think about ways.

-Once I see the genetics, we'll do that.
-[man] Thank you.

[John] I know. It's hard.

[crying]

[John] Hey, Chris. It's Dr. B.

Squeeze my hand if you hear me.

Good.

Everything went beautifully, okay?

You're waking up.

[woman] Little bit of oxygen--

Chris, wiggle your toes for me!
Wiggle your toes!

Wiggle your left toe now!

Good! What about the right side?

Move the right side.

Okay.

Chris, could you
squeeze my hand here? Squeeze!

Squeeze!

[beeping]

[John's voice] We don't stop.

[John] Squeeze my hand here!
Squeeze, Chris, squeeze!

[John's voice]
One of our defense mechanisms

is that we just go.

We don't want to reflect.

We don't want to dig deeper.

We're vulnerable.

If you told me I had to pause and reflect,

I-- I'd probably cry every time.

I just have to open the next door...

and just clear my mind.

[indistinct chatter]

[John] Ah, man.

Ah. What a beautiful day.

The sun comes out.
The sun always comes out.

-[woman] In through your nose...
-[Mirtha] You just close your eyes

and try to forget about everything, okay?

[woman] Take some nice, deep breaths.

-[alert beeps]
-[Mirtha] There you go. 

[patient moans] Oh!

-[Mirtha] Okay. You might need to give...
-[patient moans loudly] Oh!

[Mirtha] Give him
half of the other Propofol, please.

-[woman] Okay.
-[Mirtha] That might-- that should do it.

-Okay.
-[moans] Oh!

[alert beeping]

[Mirtha] Yeah, no, it's fine.
It's not even a good way for him.

-[beeping continues]
-[Mirtha] Hold just for a second.

Yeah. I think it's in.

He can fully close his mouth now.

Okay, we'll wrap it up.
Just hold his, I can hold--

[man] I could hug you all.
I love you all so much.

-[Mirtha] Awesome job.
-Ooh!

[Mirtha] You did well.

You were all aligned when you were
super relaxed, so we're hoping

that you're feeling better.

Let's sit you up now. How do you feel?

-[all laughing]
-[alert buzzing]

[man]
Does it feel like it's back in, babe?

[mutters] Something... feel right.

[Mirtha] Does that feel better?

[patient] Whoa.

[Mirtha] We can try again.

[moaning]

-[woman] Tyler, relax. He's biting.
-[man] Relax. Relax.

-[moaning]
-[woman] Try to relax, Tyler.

[Mirtha] It's okay.

There you go.

Can you close them? Let's try.

-See?
-[woman] He's closed.

[Mirtha] Okay.

Okay.

[man] Just relax. Don't talk.
Don't talk. Don't talk. Just breathe.

[Mirtha] Don't open your mouth, okay?
Just going to look at your teeth.

So, aligned.

Do you feel okay?

-Yeah.
-Yeah. Okay.

Just don't try to move it, babe.

[groans]

[woman] Dr. Langer, where are you going?

[David] I'm going to see my discharge,
then I'm coming back to--

Fantabulous.

-[man] Dave.
-[David] Yeah.



[beeping]

[Phil] I just, like, it's, uh--

I remember laying on the beach
talking to you and saying,

"I want your name."
You were just so... nice about it.

You were like, "Don't worry about it.
It was my pleasure to help."

I needed to know who you were.

To have the opportunity to care for you
on both sides of this--

It's never going to happen again.
It's just impossible.

And I know, honestly,
with your son being there

also having had, obviously,
an experience with my own dad,

getting pulled away from your dad

like that
and not being-- and that's really rough.

I feel like we've known each other
for 30 years, you know? It's just--

We made up for a lot of lost time
in those 20 minutes.

-[woman] Right? Really bonded.
-[Phil] It's an incredible experience.

This hopefully is the beginning

-of a friendship, so...
-Yeah. Absolutely.

-Yeah.
-[Phil] I love you, man.

-Okay. You too.
-Thank you so much.

[Amanda] No, she texted me saying...

she hopes she's at least five. "LOL."

[Lisa laughs] Blessing. Think eight.

[Amanda moans]

It's okay, whatever it is.

[Kevin] You're doing
a great job, boo, okay? Mm-hmm.

[Amanda chanting] Mm...

-You're doing good, sweetheart.
-[Kevin] Doing good, boo.

You sell yourself short.
We are fully dilated.

With the way she was acting
when I walked in...

[woman]
I've got everything set up, but the setup.

-My baby, she's fully dilated.
-We're LOA.

[Kevin] Good job, boo. Good job. No.
We're here. You can do this, boo, okay?

[Lisa] Do you want a top off,
or do you want to start pushing?

[Amanda crying]
I don't know how-- I don't know--

-[Lisa] Okay, you just take a minute.
-[Kevin] You're doing great, okay?

-[Lisa] Take a minute.
-[Kevin] So, breathe in.

[Bridget] Breathe.

[all chanting] Om...

-Turn the music back on, please.
-[Kevin] Okay.

-[exhaling]
-[upbeat music playing]

-You can turn it down just a little bit.
-[Kevin] You're almost there, boo.

[Bridget] You can come now.
She's starting to push.

[Kevin] You're doing good.

Time just flew by.

-Mm-hmm.
-I'm so glad I got the epidural today.

It intensified quite quickly.

We didn't even have to go up past nine
on the pitch.

[Bridget] Wow.

[Lisa] Um, Dr. Little-Richardson?

-Yes, ma'am?
-[Lisa] Stop minding my business.

[all laughing]

[Mirtha] You're feeling better? Yeah?

I mean, as soon as you wake up,

-we can try to get you home.
-Oh, my God. You're amazing.

We have the train ride home.
I'll be with him the whole time.

-[Mirtha] Okay.
-[man] Thank you. You're a sweetheart.

No problem. Thank you
for being a good patient.

-Thank you.
-[Mirtha] It's still banging out there.

We can go back to Pride! [laughs]

[indistinct chatter]

[crowd shouting, chattering]

-[Mirtha laughing] It's nice out here.
-[woman] It's beautiful out.

[Mirtha] We have, like, a front-row seat.

The night shift gets a Pride parade.

-[Mirtha] Yeah.
-[whistle blaring]

[Mirtha] It's beautiful out tonight.
I love the colors.

[laughing]

All right, some days
I talk sh*t about the city,

-but this is a good thing. [laughing]
-Yeah, I know.

It's a good thing.

[upbeat music playing]

Perfect.

[upbeat music playing]

So, as much... as I sometimes get sick
of New York City for various reasons...

um, this is-- that's pretty beautiful.

-[man] Hi.
-How are you?

[woman] Hello, sweetheart.

Hi. Who's this?

[Peter] Are you okay, Amanda?

[Amanda] I'm okay, Daddy. Thank you.

He can stay behind the curtain,
but I'm actively pushing.

Are the socks, okay, boo?

[groans]

The feet, that's-- Okay.

[Bridget]
I'm not taking anything personal.

[Kevin chuckles]

[Amanda] Thank you.

My daughter's seen all kinds of blood
squirting out of people.

I can see the baby squirting out,
but she said, "No, Daddy, no."

[Amanda] Daddy, what are you doing
back there? You have to be quiet.

-Am I having another one?
-[woman] Yep.

-Am I having another contraction?
-[woman] There you go.

[Amanda] Does it look like?
Okay, can I use it, please?

-[Bridget] Yes, let's use it.
-[woman] Okay.

[Bridget] And push.

Yes. You got this.

-You got this.
-[Kevin] There you go.

There you go. There you go. Good job.

-[Bridget] Push it. Good job.
-[Amanda moaning]

[woman]
Do you want to stay in this position?

[Amanda] Okay.

-[Kevin] You're doing good, honey.
-I think I'm having one.

-[Kevin] Ready?
-[Bridget] You ready?

And push.

[woman] We're gonna make this one
as long as you can.

Outstanding. Good job. Good job. Good job.

-Good job. Good job, Amanda. Yes.
-Come up more.

-[Kevin] Good.
-Outstanding.

-Outstanding.
-[Amanda moaning]

-[Bridget] Good job.
-[continues moaning]

[Amanda]
I wonder if a mirror would help me.

-I was just going to ask you.
-[Amanda] Can I see if that'll help me?

It might help me to visualize better.

See if I can see something.

-You are opening your introitus.
-[Amanda] The labia is opening? Okay.

-[Lisa] Can you see?
-[Amanda] Yeah.

[Lisa] Okay, you have to use
your entire body. Good.

[Bridget] Curl that body over. Yes.
Excellent. Excellent. Excellent.

Very good. Very good. Very good.

Perfect.

[Amanda] If you want to pray for the baby,
you can do a prayer out loud, Daddy.

[Peter chuckles]
Thank you for everybody, Lord.

Take care. Amen.

[all laughing]

[Bridget] And push.

-[Kevin] One, two, three...
-[Bridget] Oh, excellent!

[Kevin and Bridget]
...four, five, six, seven,

eight, nine, ten.

[Bridget] Outstanding.

-You got this, princess.
-[Amanda grunting]

-[Bridget] You got it, princess.
-[Kevin] ...four, five, six, seven, eight,

-nine, ten. Good job.
-[Bridget] You got it, princess.

Outstanding!

Excellent. Have a little bit more?

No!

[panting]

[piano music playing softly]

[Kevin whispers] Good job, princess.

[shrieking]

-Good job, princess.
-[Lisa] Yes. Yes. Yes.

-[Bridget] Okay.
-[Amanda groaning]

[Bridget] Can we use that?

-No.
-[Kevin] It's okay.

[groaning]

[Bridget] You don't want to waste it.

Sh!

[Bridget] And push!

Good job, princess.

-Yes.
-[Bridget] Outstanding.

-Outstanding. Outstanding.
-Nice.

-[Bridget] Good job, baby.
-[Lisa] One more time.

[Bridget] You got this. You got this.

Good job, princess! Outstanding!

[screaming]

-[Bridget] Oh, outstanding!
-Nice!

Outstanding!

-Okay. All right.
-[Kevin] He got so much hair, boo.

[gasping] Take a deep breath. Okay.

-[Kevin] Little curlicue.
-Kevin, what are you doing--

-with your hand?
-[Kevin] Oh, oh, oh, sorry.

-I was gonna do a selfie--
-[Amanda] No, Kevin.

-[Kevin] Okay. Okay.
-[chuckling]

-I wanted--
-[Bridget] You're doing wonderful, Kevin.

-Okay.
-You're fine.

-[Bridget] You're doing wonderful.
-[Kevin] I'm a little distracted--

-[Amanda] Focus on holding my leg--
-I'm focusing on you.

or you have to be replaced.

-Okay.
-[Amanda] Okay.

[all laughing]

-[Amanda screaming]
-[Bridget] You got it, princess.

-Let's go!
-[Kevin] Almost there! Keep going!

-[Bridget] Don't lose it!
-[Lisa] One more.

[Bridget] Good job, princess.

[all cheering] Oh!

-[Amanda crying] Please. Oh, please.
-[Kevin] It's okay.

-[Bridget] We're here. We're here, honey.
-The pressure's really... bad. Okay.

[moaning] Ah!

Almost there. You're almost there, boo.

[Bridget] Let's go.
So good. So good, princess.

[Lisa]
Come on, give me a little more. Yes!

-[Bridget] She's coming, sweetheart.
-[Lisa] Good!

-[Bridget] Look at her, princess.
-[Lisa] Yes. Come on.

-Come on, boo.
-You got this.

-You got this.
-Okay.

-[Bridget] You got it.
-[exhales]

-Push. You got this, princess.
-[Kevin] There's the head.

[Bridget] Oh!
Look at-- Look, there you go, Amanda.

Awesome!

-[Lisa] Yes!
-[Bridget] There you go!

Come on!

[all shouting, cheering] Oh!

[Kevin] Oh-h*-h*!

-[all cheering]
-[Bridget crying] Our little baby is here!

Our little baby is here!

[all laughing, crying]

[woman murmuring]

Hi, sweetheart.

[Bridget] Our little baby!

-I knew you could do it, sweetheart.
-[all cheering, crying]

[Bridget] Our little baby is here!

[Amanda and Bridget sobbing]

[Bridget] Our princess is here.

Good job.

[sobbing]

-[Amanda] Can I see her? I can't see her.
-[Kevin] Is she crying?

[woman] She's breathing.
I'm pumping in some oxygen.

[alert dinging]

[Cynthia] Are they pumping oxygen?

I have no idea about that.

[baby crying]

[all cooing, chattering]

[Bridget] We hear that first cry!

-It's okay. You can cry, little girl.
-[woman] See your baby?

[Cynthia] She went through
a rough ride there, didn't you?

-[Bridget kisses]
-[Lisa crying]

[group chattering]

[Bridget] Say hi to Mommy.

Say hi to Mommy. Say hi to Mommy.

[Amanda and Bridget crying]

Granddaddy's here.

[Kevin murmuring indistinctly]

Hi, boo-boo.

I don't know what her name is yet.

[woman chatting indistinctly]

-[Amanda] Okay.
-[Kevin] That's good.

[Amanda] Okay.

[Amanda] A vaginal birth.

-I know. Thank you, Jesus.
-[Kevin] Boo, that's what you wanted.

[Kevin] Mm...

-I think her name is Ava Rose.
-[Kevin] Ava Rose.

[woman] Aw, that's sweet.

[Peter] Ava Rose Little-Richardson.

I love you, baby.

I love you, too, Daddy.

[woman chats indistinctly]

Ava Rose.

[distant siren wailing]

[John] Oh, my God.

His tumor has just exploded.

[clicks teeth]
It's taking over his entire brain.

-[sighs]
-[phone call ringing]

-[Laura] Hello.
-Hi, Laura. It's John Boockvar.

-[Laura] Hi.
-You got a minute?

-[Laura] I'm sorry.
-You got a second to talk?

[Laura] Yeah.

Chris is at a point
where he can't even lift his head.

Is he in bed?

[Laura] He's in bed. He can't walk.
He can't move his arms, almost. Um...

He's just-- he deteriorated very quick,
and it hit out of nowhere.

[John] You know, I--

His tumor has completely spread
to the other side.

[Laura] Okay.

[sniffles]

Yeah, I know.

I-- I'm trying to make him understand,
and...

I'm trying to make him understand
that this is it.

Um, but he--
I think he needs to hear it from you.

[sobbing] Oh, my God. I can't believe
this is f*cking happening.

I hate this so much.

[Rosalee] Dr. Boockvar,
this is Laura's Mom, Rosalee.

We can't tell you
how much our family appreciates

everything you've done.
And Laura feels that way.

It's our pleasure.

You guys are family.
I told Laura that yesterday.

[Laura sobbing]

We love you.

-[Laura] Love you, too. Bye.
-Bye.

[phone beeps]

[sighs]

Ah, f*ck.

[John's voice] It's an unbearable thing
that these families are going through.

And so, it's highly motivating,
but almost in like a... infuriating way.

Where each of these events is just,

"How can I not help these people?"

[cell phone ringing]

Then you get distracted by your PA
with an acute issue.

Then your day goes on.

And you put a smile on your face
and you keep going.

Dr. Boockvar calling...

emailing you...

[sniffs]

...to set up a meeting with you and
the American Brain Tumor Association team.

[sniffs]

[Mirtha's voice] There's a lot of concern
now for burnout and being tired.

And I'm definitely feeling that now

that I have a family
and a husband and a child.

Sure.

The part that most gets to me is
when someone passes,

is really their families feelings

of watching them grieve, you know?

But for now, I don't feel burned out.
I just really love the clinical work.

What are your medical problems?

[Mirtha's voice]
I still have the same respect for it.

The people I see and the families I get
to interact with and the stories I hear.

[Mirtha] You have spine problems?

[Mirtha's voice] I love it.

Big pain.

Okay, and you're not allergic
to anything medication-wise?

I thought about not wanting to raise
my son in a city like this, but...

I also don't want to leave this city.
Like, this city...

really is the most amazing place.

Every time I come here,

I learn something personally
that brings me back

to why I went to medical school and why
I pursued this specialty and this career.

I'm not ready to let it go. [chuckles]

[baby crying]

Oh, look at my little baby.

[baby coos]

Okay. No?

[baby crying]

[sighs]

[Kevin laughing] Hey. You ready to go?

Your mommy's a doctor now.

-Did you know that?
-[Amanda] I was a doctor four years ago.

-[Kevin] You want to listen to music?
-It was a good view, full sunlight.

[laughs] Full sunlight.

I'm just thinking I really liked
my identity as a New Yorker.

Even though I'm like a faux New Yorker,

but...

this is not my neighborhood anymore.

We'll be back. I hope so.

[sniffs] If not,

California's beautiful.

But you know, there really is no city
like New York City.

[Rema] I just want to...

[David] Hey, Rema.

-Hi, David.
-[David] What's wrong?

-Are you tired?
-Yeah.

-You don't want to do the second case?
-No, we're not doing. I can't do it.

-What's happening Friday?
-[Rema] Friday?

[David] Yeah, Ralph and Jason are gonna
do the case,

-but I'll be back--
-You're not involved?

[David]
Ralph and Jason get the case started.

-Is it safe for you not to be involved?
-[David] Yes.

[chuckles] Very safe. It'll be fine.

-[Rema] We'll call you.
-[David] Okay.

-[Rema] Have a good day.
-[David] Thanks.

["Weird Fishes/Arpeggi"
by Radiohead playing]

[David's voice]
The transition to leadership

is giving up some of those things
that used to make you happy.

[elevator dings]

Whether it was a patient care or surgery
or doing tough cases,

you have to give that up to some degree.

Looking back,
I would hope that there's a recognition

that we did things for the right reasons
and we focused on the right stuff

and we ignored all the noise.

We listened to our hearts
and went ahead and did it.

But the truth is that
things are going to change inevitably.

-[David] Hi.
-Hello.

-[David] You guys are new?
-[women] Yes.

[David] What are you doing here?

-Everything.
-Really? I'm Dave Langer.

♪ In the deepest ocean ♪

♪ The bottom of the sea ♪

♪ Your eyes ♪

♪ They turn me ♪

♪ Why should I stay here? ♪

♪ Why should I stay? ♪

♪ I'd be crazy not to follow ♪

♪ Follow where you lead ♪

♪ Your eyes ♪

♪They turn me ♪

♪ Turn me on to phantoms ♪

[vocalizing]

♪ I follow to the edge ♪

[vocalizing]

♪ Of the earth ♪

[vocalizing]

♪ And fall off ♪

♪ Yeah, everybody leaves ♪

[elevator dinging]

[clattering]

[air hissing]

[footsteps clacking]