02x08 - Heart in a Box

[bunniefuu]

Previously on The Resident...

What's the average life expectancy
of someone after a heart transplant?

Do you remember the Barnetts?

Two adopted kids with
medical needs, right?

And apparently,
you made quite the impression.

Absence seizures.

He's had them since infancy?

They've always been mild,
and we have them under control.

I've done some reading
on your vagus nerve stimulator.

- Is it everything I hear?
- It has exceeded all our expectations.

Why would anyone sell a hip
implant that could leak poison?

This is my industry... how
do I not know this is going on?

I'm been offered a spot
on a journalism team.

It's at the San Francisco Chronicle.

I've been waiting

my entire career
for something like this.

Did you hear me?

I can't pass up this opportunity.

Then take it, babe.

Will you come with me to San Francisco?

I thought you said that you
were open to me staying here.

You said a lot of couples are bicoastal.

It's our first year of marriage, Devon.
We should try and be together.

I can't just... pick up and leave.

Why not? I did that for you.

If I walk away, I'll have
to apply for a new residency.

That could take over a year.

What do I do in the meantime?

Silicon Valley is right there. You
could work on your medical devices.

- Mm, hadn't thought of that.
- But you're always complaining

about the hospital...
the hours, the pay,

- the paperwork.
- Yeah. I-I complain, sure,

but that doesn't mean I want to quit.

Priya, I...

I have worked my whole life for this.

Promise me you'll consider it.

That's all I ask.

- ♪ Don't you ever call me
again, love ♪ -(SNORING)

Are you checking my pulse?

You've been doing that every night
since I got back into town.

And you stop breathing regularly
throughout the night.

Isn't that called sleep apnea?

You didn't have it before.

I'm checking your pulse to make
sure you don't have an arrhythmia.

Look... we are never
gonna have a normal life

if you keep overreacting
to every little thing.

I'm taking you in
to see Dr. Austin today.

Hey.

Two ships passing in the night.

Your night. My morning.

I hate when we have opposite schedules.

I hate waking up
and not having you next to me.

If we were on the same schedule,

you could come with me to Henry's game.

I don't know who's more excited
about it, me or him.

My money is on you.

You're getting pretty involved
with this family.

Ah, it's just one game.

Have a good time.

Dr. Bell, you understand this
is a deposition for the case

of The State of Georgia
v. Dr. Lane Hunter?

And may I remind you, you're under oath.

Dr. Hunter is charged with
poisoning hundreds of patients

with unnecessary chemotherapy,

and raking in more than $20
million from fraudulent billings.

She's also under investigation
for the death of Lily Kendall.

So, Dr. Bell...

how long were you and my client lovers?

Yeah, yeah, yeah, yeah, yeah,
yeah, yeah, yeah, yeah!

Nice.

Henry! Henry!

(LAUGHS) Here we go, here we go.

Low, drive, swing.

Excellent. Yes.

Ball!

Keep your grip snug.
Not too tight. Knuckles.

They should align.

That's it. Yes!

Nice. Okay.

All right, you're up. You're up, buddy.

Good luck, good luck, good luck.

All right, here we go.
Here we go, Henry.

Good luck, buddy.

Knock the cover off that ball, baby!

Wait for the right pitch!

Wait for the right pitch!

Yeah!

Go! Go! Go! Go!

Yeah! Yeah! Yeah! Yeah! Yeah!

Yeah! Yeah! Yeah!

Every... Everybody take a knee.

Henry?

Henry, are you okay?

Hello, Randolph.

- You had me deposed.
- On the advice

of my court-appointed attorney.

Got you here, didn't it?

Now what?

You betrayed me to save your own skin.

Look at me.

Look at me, Randolph.

I was the top oncologist
in all of Georgia.

The head of the department
at Chastain. Self-made.

Respected everywhere and rich.

I had everything, and you did this.

- You did this to me.
- That phone call to the FBI

was one of the most difficult things

I've ever had to do in my life.

You put me in an impossible position.

We were an incredible team,

the two of us at the top of our fields.

Together, we...

It was you, not me...

who ruined it.

I cared deeply about you.

And whether you believe it or not...

I have not been able
to stop thinking about you.

Do you think I was born moments
before you walked in here?

I mean, please, Randolph.

The only person you
have ever cared about is you.

Nice try, though.

You drew me in here with a thr*at.

What's your agenda?

To use your deposition
in a certain video

of the two of us
at the Four Seasons Hotel

to get out of this place.

You're bluffing.

Would you like the Vimeo passcode?

Once the jury sees how close we were...

I have a feeling they're gonna believe
me when I get up on that stand.

When I tell them that you were my
confidant from the very beginning.

That it was actually you who
told me to destroy those files.

To make sure that nobody weaponizes
a couple of bad outcomes.

That it was you who fueled my panic.

You misled me.

You broke my heart.

Tell me, Randy,

am I bluffing?

I want a top-notch attorney,

someone who wears
a fancier suit than you do,

and I get half a million dollars

to make bail so I
can get out of this rat hole.

Don't worry, sweetheart,

I can pay you back when I get out.

I have a couple
of loaded offshore accounts.

I just can't access them
while I'm in prison.

What do I get in return?

I make sure to keep you and
Chastain out of this entire case.

Ah, good.

I have some very big news
to share with you.

QuoVadis is going public.

- That's terrific.
- Yes. But before the IPO,

we need a successful launch
of the vagus nerve stimulator.

The profit potential
of that device is... (CHUCKLES)

enormous.

It'll be like a pacemaker for the brain,

treating everything
from depression to epilepsy.

Damn thing even cures hiccups.

I will do whatever it takes
to make the VNS a success.

But, Gordon, can I ask you

- a few questions?
- Of course.

I just assisted on a case

with a man whose metal-on-metal
hip implant poisoned him.

It made him blind, almost deaf,

and demented.

Geez. That's horrific.

Uh, the model must have been defective.

It was. I researched
the company that made the hip.

And they imported
all their devices from China

and pretended it was made in the U.S.

I discovered...

you worked for that company.

If I understand what
you're saying, uh... it's true.

But I was very young.
I was barely an intern.

Look, I founded QuoVadis

to create the change that I want to see.

That's why we manufacture everything
ourselves right here in Atlanta.

We import nothing from China,
so that I can ensure

that we are making products
that patients can trust.

You know, this...

isn't a job to me.

This is my calling.

That's what I needed to hear.

- Thank you.
- I'm calling from Chastain.

Chastain Park Memorial!

Hey, Atlanta General ER is on diversion.

This is the start of a day
from hell. Move faster.

(SIGHS) Look, I've already
been on hold for over an hour.

Patient records at Atlanta
General, poison control.

Yeah, patient in 8 has been
waiting an hour. Figure it out.

Irving!

Pravesh!

- What happened?
- Henry had a grand mal seizure

on the field...
it's lasted over 20 minutes now.

He has a history of seizures, right?

Yes. Absence seizures,
but stable on medications.

He's never had a seizure

- like this before.
- On my count.

One, two, three.

Thank you.

Hey. Go.

We got this.

Let go. All right.

- Thanks for coming in.
- Well, it's rare you call

for a peds neurologist to the ER,
so I figured it was important.

Well, he's already
on valproic acid at home.

We need to add a third agent,
phenobarbital.

Another medication?

Zoey, I know this is a lot,

but we have to be aggressive
to control these seizures.

This is Julian Booth.

Hello, I'm calling from
Medicine Tracking Dynamics.

QuoVadis pays us
to monitor prescription dr*gs

and alert them of prospective patients.

There's one at Chastain Park Memorial

that's now receiving
three anti-seizure meds:

fosphenytoin, valproic acid
and phenobarbital.

Which makes him a VNS candidate.

QuoVadis flagged this as
high priority on your account.

I don't have a patient name,

but the order came from Chastain ER.

Hey.

You look busy.

Always.

Devon, this doesn't have to be weird.

We are completely capable
of still being friends.

Agreed.

So, friend,

what can I do for you?

I got a call about a patient

in the ER who was just put
on several anti-seizure meds.

Henry Barnett. Status epilepticus.

He's looking rough.

Poor kid.

His brother d*ed here a month ago.

I didn't know it was a child.

What's this about?

Um... nothing.

Are you telling me he has cancer?

- No, that's not...
- Five hours in the ER only to get in here

to have you look at us
like he's going to die.

- Ms. Waverly, I know that...
- Are you a nurse?

What are you?

A med student?
This man is my whole life,

and you're the one
that's going to save him?

No. I want somebody
that doesn't have that look

on their face.

I'm ordering a CT...

a CT to see what is going on so I
can hopefully rule out cancer.

See you in five hours.

It's okay, baby. Don't worry.

It's okay.

I am enjoying our stroll,

but don't you two
have other things to do?

Are you kidding? I always have
time for my favorite patient.

- We know what today is.
- And we have

no intention of letting you
face it alone, Wallace.

My wife, Anna, would've been 36 today.

Remember her last birthday in ICU?

We threw quite a party.

It's hard to believe my wife spent the
last year of her life at Chastain.

I don't think there's a doctor
or nurse who didn't know her.

A great lady.

Think, uh, both of you...

and the whole staff...

did all you could to save her.

Now I'm the patient.

Another year has gone by,

and now it's my turn
to spend my days here,

waiting for a new heart.

And until we find one,
you're stuck with us, Wallace.

Oh, she means you're stuck with her.

I'm delightful.

Hey.

I heard about Henry. How's he doing?

Finally broke his seizures.

Now he's reacting negatively
to the medications.

Well, I'm sure Dr. Eckart
has it under control.

He's Henry's doctor now.

I can't step back.

Not after everything I've seen
this family go through.

I know.

But this is why we try to keep a
safe distance from our patients.

- I should get in there.
- Yeah.

Hey, buddy.

You hanging in there?

Yeah.

Is this gonna hurt?

Nah. You'll feel a little pinch.

That's just the numbing medication.

After that all you'll feel
is a little bit of pressure.

You're really brave, baby.

Got a question for you.

Who's your favorite baseball player?

- Bryce Harper.
- Washington Nationals.

That is a solid choice.

Tell Dr. Hawkins
why you like Bryce Harper.

His cleats are awesome.

Your decision's based on footwear?

He's supercool.

Henry, you are one tough kid.

And I bet your buddy Bryce Harper
would think you're supercool, too.

This boy is perfect for the VNS.

I mean, we're never gonna get
a more sympathetic patient.

Spectacular optics.

So, the VNS is approved for use
in pediatric patients?

I'm sure Gordon has crossed his T's
and dotted the I's on this one.

Indeed, I have. We're approved.

But as a 510(K) device?

I know. She's worried because
with 510(K) FDA approval,

there's often no testing before a
device gets implanted in patients,

which is exactly why
QuoVadis does its own research.

Now, we haven't published yet.

But everything is here,
and it's all that any doctor

could possibly ask for.

If you meet with any
resistance, just don't hesitate

to let me know. I want to make
sure we're all on the same page.

So, are you done?

Should we be concerned
about Micah's heart rate?

Your boy's gonna be fine.

We just need to adjust his
beta-blockers and order a sleep study.

You can go ahead and button up.

Mina, can I talk to you outside
about a separate matter?

Listen, don't let
your all-consuming worry

for lover boy make you lose your focus.

Nothing gets in the way of my work,
and stop calling him lover boy.

It's becoming annoying.

We got a heart.

Dr. Austin, you're on Wallace Troke's
transplant team this week, right?

- Just say yes.
- Yes.

Isn't this the dude
with takotsubo cardiomyopathy?

- Broken heart syndrome.
- The first case I've seen

where grief literally
broke someone's heart.

His wife, Anna, d*ed
here after a long illness.

Every day for a year he walked
three miles just to be with her

and then three miles back home.

Were there no buses running?

He liked to walk. Said it
made him feel the importance

of his daily commitment to be with her.

Oh, adorable, if nutty.

His only chance of surviving
is this transplant.

The good news is we found
an organ that's a match.

But we need you to harvest it
at Methodist Memorial.

Have you ever assisted in
the harvest of a heart?

No.

Is that an invitation to accompany you?

Do you need it embossed on stationery?

- I do not.
- Then let's get this ball rolling.

Dividing the pulmonary veins

and main P.A.

It is a perfect organ for Wallace.

And what are we looking for, Dr. Okafor?

Defects and vegetations on the valves.

And an adequate rim of atrial tissue

next to the coronary sinus.

I was getting to that.

I know.

Charge.

Clear.

Now, back to Chastain,

where the transplant team
will put this beautiful organ

in our man Wallace.

Henry's LP ruled out an infection,

and his MRI didn't show
anything concerning.

And that's good news.

Yes, but it still means we don't
know what's causing his seizures.

Truth is, sometimes we never know.

Henry's EEG still shows runs
of nonconvulsive seizures.

With their length and frequency,
if this goes on much longer,

he can sustain permanent brain damage.

Brain damage?

What do you suggest we do now?

If the seizures continue,

we're gonna have to put Henry into
a coma so that his brain can rest.

Are there any other options?

Actually, there is.

Julian, this is Henry's mom,
Zoey Barnett.

Julian Booth works with a cutting-edge

new medical device company, QuoVadis.

I am so sorry Henry's going though this.

But we may have a solution.

We have a new VNS device designed
for cases exactly like your son's.

VNS devices are a last resort.

And they've all had significant side
effects, including sudden death.

This newest version
is thoroughly tested and safe.

This is for Dr. Eckart.

He is the doctor who makes this
call, along with Henry's mom.

There are trials that show it can
be used much earlier in epilepsy,

sometimes removing the need
of medications altogether.

If you have access to an improved VNS

that can be used sooner in epilepsy,

it's a game-changer.

Henry could lead a life
free of seizures.

If the alternative
is putting Henry in a coma

or keeping him on toxic meds,
isn't this worth the risk?

We don't know that yet.

This is not a decision
I would rush into.

If it were me,

I would have Dr. Eckart
go over all the data,

and then you take it from there.

- Dr. Eckart, would you mind?
- Not at all.

I'll get back to you.

Right.

They'll take you up to pre-op
and get you ready

for when your new heart gets here.

Thank you.

You worried about the surgery?

If I die...

when I'm under...

I'm ready.

I'll get to be with Anna.

Wallace, this is a chance
at a whole new life.

I'm starting to think

that heart might be
better served in somebody else.

Not sure I want a whole new life.

Not if it still feels like this one.

Grief is horrible.

Breaks you
into a million pieces, I know.

But I promise you,

it will get easier.

How?

By keeping Anna's memory alive.

If you die, all that goes with you.

Who's gonna be here to talk
about how special Anna was?

How amazing you were together?

I'll see you in recovery.

Yeah.

And... and thank you.

Thank you for coming down to consult.

No problem.

Did you lose a little weight
since the last time I saw you?

The day hasn't started off so great.

Hi.

Finally, a specialist.

We've been waiting two hours,

and this Indian doctor is
the only one who's seen us.

- What's the story?
- 75-year-old male

with two days
abdominal cramping and vomiting.

CT shows a partial SBO.

Mm-hmm. Okay.
Can I talk to you for a sec?

What is this?

- He has a bowel obstruction.
- Partial.

- With a soft abdomen.
- But he has significant

pain and is still vomiting.

- He needs to be admitted.
- To medicine. This is not surgical.

Next time, check with your resident
before you call for a consult.

Do not waste my time again.

Find a pair of scrubs that fit you.

Could you imagine loving someone so much

it could literally break your heart?

No.

What about Micah?

Can he break your heart?

No man can break it.

What have you been through
that makes you so invincible?

It was 2014, and I was finishing
up medical school in Nigeria.

My mother is a surgeon,
working non-stop and

gone for all hours,

so it was my responsibility
to look after my sisters.

One night, after dinner,
I put them to bed

and... and decided to take a quick nap.

A quick nap turned into a deep sleep.

And when I woke up,

the whole house was on fire.

Immediately, I knew...

I had left the stove on.

I tried to save Kadara and Ngozi, but...

I couldn't.

They were 12 and 11.

Wow. I'm... sorry.

I loved my sisters very much.

The grief and...

guilt consumed me.

Emotions can enrich our lives,
but they can also destroy us.

Now, I never want
to talk about it ever again.

It's been an hour. I think
it's time you called it.

Time of death, 12:03.

I'll speak to the family.

Take a break.

My husband is still in severe pain!

Where are we at with his treatment?

Can you just do the right thing
and come check on him?!

Hello.

Okay. Okay.

All right.

We'll up his pain meds and...

If you just, um, give me a minute.

Excuse me?

I have a 75-year-old man
with a small bowel obstruction,

ER Bay Three. We need to admit him.

Absolutely not. Call surgery.

I did. They won't admit.

Neither will I. I'm not taking an SBO.

If he gets better, he goes home.
If he gets worse, they operate.

I'm not going
to admit him just to baby-sit.

We need a doctor over here!

Paramedics found him on the
freeway with a meth pipe in hand.

Let's get him ten of IM haloperidol
and check his blood sugar.

Eye station, now!

What happened to your break?!

All right, let's get him to Bay Nine.

Is he all right?

His seizures are getting
harder to control.

And the medications
we're giving him are starting

to affect his liver function.

So what do I do now?

I know you're scared, Zoey,

but, just-just give this
a little bit more time.

That's not an option.

Zoey needs to make her decision.

Soon.

Dr. Randolph Bell,
chief of surgery and the CEO

of Chastain has heard
about Henry's case, would like

to talk to you about the VNS device.

As we've discussed, the VNS

is the best option
available to your son.

Well, I've looked
carefully at the data, and

- the results aren't clear.
- Doctors aren't trained

to consistently evaluate
this type of dense research.

The man can read.

And what he read said
the sample size is dismal.

But the device has been approved, right?

It has... by the FDA.

So then why is everyone so nervous?

- Everyone isn't.
- I am.

A high percentage of devices

are recalled after
they've been put in patients

- and have caused permanent damage.
- That has happened

with other companies, but not QuoVadis.

I wish there were more options
with less risk. There are not.

You've already lost a son,

and I want to do
everything possible to ensure

that doesn't happen again.

I strongly recommend you do not
go down this path with the VNS.

Ultimately, this is your call.

But I will tell you,
if this... were my child,

I would move forward
and implant the VNS.

Dr. Chao has done
several of these surgeries.

He's highly-experienced with the VNS.

Has he implanted it in a child?

I want this to go perfectly.

I-I feel responsible.

And if the data isn't really there...

You really think Gordon Page would
manufacture products that aren't safe?

Hmm. Well done, Dr. Bell.

This is an historic day.

The first of many, I'm sure.

Whoa. Hold up.

The front of the heart stopped moving.

It's acute hypokinesis
of the anterior wall.

There's a block
in the middle of the LAD.

The heart is having a heart att*ck.

Yo, let's go!

Is Wallace ready for surgery?

Yes, in OR Two under general anesthesia.

Good. He'll die if we put him
back on the waiting list.

This heart may not be perfect,
but once we fix it,

it'll be his best sh*t. I need
to get his saphenous vein.

Should we use his LIMA?

It'll take 20 minutes to open his chest.

You can get a saphenous vein in five.

Time is heart.

Get me a vein retrieval kit

and start prepping the left lower
leg for saphenous vein harvest.

Octopus clamp.

I thought you'd be quicker.

Please. That was a world record.

I've never done bypass on
a b*ating heart. Can I assist?

Oh, now was that ever a question?

Hand Dr. Okafor the pickups.

Spatulate the end of the saphenous vein,

and I will do the arteriotomy.
11 blade to me.

7-0 Prolene.

Be careful with your bites...

keep them evenly spaced out.

A little quicker.

I am suturing the aorta.
This is delicate work.

The heart is losing oxygen.
It could not care less.

Done.

There's a small leak.

Mm. I see it.

Adding another stitch.

There.

You fixed it.

We fixed it.

Shall we give Wallace
the gift of a new life?

Everything went perfectly.

How long until we know if this works?

His seizures already stopped.

Thank you.

Of course.

Thank you.

Well done, Dr. Bell.

Today was a good day,

both for Chastain and QuoVadis.

To a wonderful partnership.

I hear it worked.

Nice save.

Yeah.

Great learning opportunity
for Dr. Okafor.

It's not often you get to
operate on a heart in a box.

Does she know you're in love with her?

I beg your pardon?

I'm her teacher, her mentor.

To be anything else would cross
a line that I would never cross.

That must be hard on you.

I deal.

And life is long.

Eventually, one day,
I will not be her mentor,

and she'll be my equal.

For a guy who doesn't wear
his heart on his sleeve,

that was an impressive share.

Let's just keep this between us,

all right?

Hey.

You're on in 20.

Ships passing.

Henry's in recovery,

if you want to check in on him.

Thank you for the update, but...

I think it's best if
I just let his mom be with him.

Rough day?

Not really.

A touch of racism from a paranoid wife.

Got physically att*cked
by a psychotic meth head.

And what am I forgetting? Um...

Right. Priya told me we have
to move to San Francisco.

Your turn.

I have always been sure about my field.

But now...

I wonder if I'm making a difference

or if I'm adding

to a very big problem.

You are smart, Julian.

And passionate.

And honest.

The device industry needs people
like you to fix a broken system.

If you see something that's not right,

you will be there
to blow the whistle and fix it.

Could the same be said about you?

There aren't many people
like you, Devon.

Hardly any, in fact.

You were meant to be a doctor.

- Randolph Bell.
- You have a collect call

from Atlanta Correctional Facility.

Inmate 08790, Lane Hunter.

Will you accept?

Yes.

So, have you got an answer for me?

If it's not the one I want
to hear, that video of us

gets released tomorrow.

I've, um,

narrowed the list of attorneys
down to three.

Heavy hitters?

Yes.

- What do they say?
- That juries

trust doctors and it's possible
we will get off.

And if you do,
it'll help me undo the damage

you did to this hospital.

Oh, so you're making this
all about Chastain, huh?

Now, I suggest we play on
the same team from now on,

or at least pretend to.

When do I get to breathe
fresh air again?

Soon.

Very soon.

Hi, I'm one of the sales reps
for QuoVadis.

I know we don't normally come down

to where we actually build the devices,

but I need to double-check on an
order for, uh, Chastain Park.

Could you help me?

I will be so quick.

I promise.

You've got five minutes.

Thank you. That's all I need.

We manufacture everything
ourselves, right here, in Atlanta.

We import nothing from China.

This isn't a job to me.

This is my calling.

Oh, my God.

What happened to you?

(SIGHS) The question should be
what didn't happen to me.

I have had some pretty terrible days

as a doctor, but today

just might take the prize.

(SCOFFS) That looks really swollen.

Are you sure you're okay?

Today, I got kicked around.

Abused.

Unappreciated.

At times, I just felt
completely useless.

Then come with me to San Francisco.

It's not easy.

If it were,

everyone would be a doctor,

because it is the best job in the world.

Despite everything.

Because of everything.

I wouldn't trade my worst day
at Chastain for my best

making medical devices
in Silicon Valley.

I can't leave.

I'm sorry.

But, hey, hey...

this doesn't mean

that I don't want to figure out
how to make this work.

But is it really what you want?