02x23 - The Unbefriended

[bunniefuu]

Scrub in with The Resident.

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- Previously on The Resident...
- A few weeks ago,

a wonderful man who loved me
proposed.

I took so long to decide
that he changed his mind.

- Wait, is this for us?
- Yes, of course it's for us.

- We can get a hot tub. Raise chickens.
- What?

I don't move in with you,
so you just leave me.

If you're not interested
in going forward, for me,

it's time to take a step back.

So my kidneys will
never work again?

You have to stay on dialysis

- for the rest of your life, Jess.
- Come on.

There's got to be
another option.

It's not that you can't
give Jessie your kidney,

it's that you won't!

Why can't you for once,
for once,

do something that
is not selfish?

That's exactly my point!

- Hey, this is Kyle.
- You know what to do.

What's wrong?

Everything okay?

Can I come in?

Look...

I've been thinking a lot
about us.

And I realized something,

so just hear me out.

Of course.

Life is hard.

And the problems keep coming.

And I keep... trying
to solve them all by myself.

Jessie, my dad, our patients.

I seem...

completely incapable
of asking for help.

I don't know why I do that.

Well, you lost your mom

- as a kid.
- No, no, I don't...

I don't want to do that.

I don't want to make excuses.

I want to see the pattern,

take responsibility, and change.

Okay, I'm listening.

You said you want
to move forward

in our relationship.

I want that, too.

I just need you
to meet me halfway.

- What do you mean?
- It means...

I want to start talking
about moving in,

marriage, a family, all of it.

But you can't push me.

You can't rush me.

Let me do this at my own pace.

Okay. Yeah.

I can do that.

This is a big deal.

Yeah.

I'm in.

I just...

I just only have one request.

What?

I really want those chickens.

No chickens.

Your company,
Red Rock Mountain Medical,

is the top health care
conglomerate in the Southeast.

Your motto? "We're like family."

But your family is missing
a crucial piece.

We now own every major hospital
within a hundred-mile radius.

We don't need Chastain.

But you do.

To control pricing.

You need to eliminate
the competition.

Chastain is in no position
to undercut our pricing.

You're $100 million in the red.

We have an amazing staff.

Talented doctors and nurses.

We're a top facility.
We're unmatched.

But our research shows the words
most closely associated

with Chastain are "Dr. Lane
Hunter" and "QuoVadis."

That's behind us. It's old news.

And, in fact,

I view it as a success story.

We were instrumental
in exposing corruption.

We helped bring down QuoVadis.

We will be stronger together.

Guaranteed.

Well...

we will discuss internally
and get back to you.

In the meantime, Dr. Bell,

do avoid
any further PR disasters.

A bit of news for you.

I'm putting a pacemaker
in Micah today.

Alert the media.

I know.

It's minor.

So, don't worry.
You don't need to be there.

Why wouldn't I assist?

Because you're emotionally
involved with the patient.

No, I'm not.

Our engagement ended weeks ago.

"Weeks"?

Well, that's hardly enough time
to get over heartbreak.

Take it from the heartbreaker
in chief.

Please.

Shira, we're closed here.

We have another surgery.

All good. Let's pack up
the patient and take him to ICU.

We'll never make a 730 show.

And, anyway, I'm not going
to the Atlanta Gore Fest.

Well,
if you love your boo, you will.

Hard out at 645.

Mwah.

Love is complicated.

Sacrifices must be made.

Horror movies aren't my thing.

I see enough gore all day long.

Want to take my place?

Jessica wouldn't want
to hold hands

and scream with me in the dark.

And I have
a previous commitment.

Double shift.

This place is my main squeeze
these days.

You're aware that's pathetic.

Adult male. Age unknown.

Found him in Piedmont Park.

Put him in two.

BP 95/60, blood sugar 82,

possible broken left arm, minor
scrapes and bruises. Okay.

Let's start another large
bore IV and hang another liter

- of normal saline. One, two, three.
- One, two...

Okay.

Can you tell us your name,
please, sir?

No wallet. No phone.

Okay.

Torn clothes.

Dirt under his fingernails.

He could be homeless.

Sir, your name, please.

Okay, let's add LFTs,
coags, UTox,

aspirin/acetaminophen levels,
and a blood alcohol level.

Page social work.

See if they recognize him.

If not, have them call
local shelters,

see if anyone's missing or fits
the description, while we try

- to get his pain under control.
- I'll order an X-ray

and get Dr. Voss
to take a look at that arm.

Must be very rewarding
to be a transplant coordinator.

It is, but it's frustrating.

We need more donors to step up.

Too many people die waiting
for an organ.

That's my biggest fear
with my sister.

How is she doing on dialysis?

Not well.

Um, she's
in early heart failure.

It's causing a lot of problems.

A new organ
could help her heart.

Yeah. But we can't wait years
to get one.

Excuse me.

Hi. Welcome to Chastain.

- Can I help you?
- Yeah, maybe.

I'm looking for a doctor.

Her name is Shira Smook.

Shira... Smook.

Okay. Anesthesiology.

Would you like me to page her?

Nah. Anesthesiology.

I'll call her myself,

tell her I'm here.

They had to abort dialysis
because her pressure dropped.

Your sats are a little low.

Please-please make it stop, Nic.

Gonna do our best.
This should help.

First order of business

is to switch up
your heart medication

so you can tolerate dialysis.

All right, Nic and I need
to discuss our options.

Then I'll be right back.

It's gonna be okay.

Just give me a sec.

Elevated JVP.

And I saw signs
of hepatojugular reflux.

Her heart failure
is getting worse,

more rapidly than we expected.

This is a disaster.

Treatment of dual organ failure
is challenging,

not impossible.

Heart failure alone
could k*ll Jessie.

She needs a new kidney.

Soon.

There are cases where that alone
improves heart function.

She might not need a new heart
for ten years.

Your father's
still the most logical donor.

He's here. He's a match.

Kyle refused to donate.

And now I can't find him.
He's disappeared.

- I-I've called him over and over again.
- Which is why

I asked my dad to try
and track him down.

He put his private investigator
on him,

and now I have an address.

You want it?

Trying,

um,

i-ingman...

Dad bum.

He has expressive aphasia.

He knows what we're saying,
but he can't speak.

Maybe when he fell and broke
his arm, he-he hit his head.

Still no kin we can find,
no proxy to tell us who he is.

Squeeze my hand.
Squeeze my hand.

All right. There you go.

We're up to the letter "S" now?

We're calling him Sunflower One.

Nothing personal, my friend.

When we can't identify patients,
we name them after flowers.

Yeah.

He needs a CT.

Bell's been tightening
the screws down here.

He told me, and I quote,

"Platinum care
is reserved for those

with platinum credit cards."

Since when do we do anything

but try to work around Bell?

Her...

herb.

Herb.

Given his age
and how he was found,

he might have dementia.
In which case, this...

is his baseline.

We need to take care
of this man.

Whether or not he's homeless,

or whether or not he's insured.

If there is an underlying
diagnosis,

like a brain bleed or a tumor,

delay could cause irreparable
damage, even death.

At the bare minimum,
a CT is standard of care.

Good.

Let us know
when we have the results.

Take it from there.

So it's definitely a type 2
second-degree heart block.

Which explains my dizziness.

Electrical impulses

aren't getting through
to your heart.

How serious is the surgery to...

- implant a pacemaker?
- It's no big deal, bruh.

Quick procedure; In an hour,
you'll be a new man.

Good. Thank you.

So, otherwise...
everything okay?

You seem to be in good spirits.

Man, I have never been better.

Seriously, on top of the world.

- Nice.
- Yeah.

Sorry I'm late.

- Traffic was terrible.
- Yeah, yeah.

Come in, come in.

This is Dr. Austin.
He's going to be putting in

my pacemaker this afternoon.

- Jolene Landis.
- Hi.

Thank you for taking
such good care of my Micah.

- Hey, I've been looking for you.
- What are you doing here?

You promised me.

Leave or I'll call security.

I'll meet you
in the parking lot in an hour.

My ex. He's a stalker.

Terrible choice in men,
working on that.

Hey.

I've been trying to reach you.

I didn't want to be reached.

Look, I know things

ended badly and I'm sorry if...
you've been upset.

But you're not sorry
for what you said.

Look, can we just...
Can we go inside?

- Can we talk?
- No, I just...

moved in, it's, um...

it's a mess.

Sit.

Nice?

I'm the caretaker.

Free rent. Good job.

Want a beer?

It's a little early for me.

I've got a...
a long drive back, so...

So... what's this about?

You know what
this is about, Kyle.

Jessie.

She relapsed again?

No.

No, she's... she's sober,

and she's determined
to stay that way.

But her situation has changed.

It's not just
her kidneys anymore.

Her, um...

her heart's failing.

Wait, what...
what does that mean,

- her heart is failing?
- We're trying to stabilize it

so she's still eligible
for a kidney,

but the truth is,
she has a very...

narrow window right now, so...

If you would
reconsider donating,

she might have a chance.

I know you wanted her
to be sober six months

to make sure
she doesn't relapse,

but she doesn't have six months.

How long do we have?

Days.

Weeks. I don't know.

But what I do know is that...

right now you're the only person
who could save her.

I'm 63.

I smoked.

I still drink
more than I should.

I can't believe that my kidney
is her best option.

It's her only option.

Strange I ended up by a lake.

Never learned how to swim.

I hate dark water.

You're scared.

Yeah.

Is it so wrong of me?

I mean, the risk is...

is pretty low... for the donor.

But it exists.

There is a risk.

I'm sorry.

Next time I see you will be
at Jessie's funeral.

And it'll be the last time
that I see you.

He does have
a ruptured aneurysm.

But it's small, right there
in your Broca's area.

Which could explain
why he can't speak.

Or all his symptoms
are caused by dementia,

so we'll ask
for a neuro consult.

What if they say
he needs surgery?

He's uninsured.

He's been classified
as "unbefriended."

No living relative, no proxy.

Which means the hospital
decides all his care,

and Bell is the hospital.

Right.

Let's be conservative
a little while longer.

Take him to the ER
for observation.

If Sunflower gets worse,

then we have a stronger case
to make to Bell,

one that will be harder
for him to refuse.

Hey.

Where you been?

Nowhere good.

But now I'm here with you.

What's this?

It's my advance directive.

You're my proxy.

All my wishes are spelled out.

The hospital has a copy, too.

Nic?

Let's be brave

and honest, okay?

That's what I want.

The truth.

We're in a bad spot, aren't we?

Yeah.

No one's giving up.

If I die...

I know you'll find a way
to blame yourself.

This is not your fault.

Sorry.

You went to see Dad, didn't you?

Conrad found him, and...

I went to let him know
where we stand.

I was hoping he'd step up.

I don't understand. He can't.

He's not a match.

He's a match.

He's, um...

he's scared of the surgery.

How is this
not infuriating to you?

I'm disappointed.

But I understand.

I'm a lot like him.

You are not.

You're like Mom.

He's not a bad person.

He's just...

weak.

We have to keep fighting...

together.

Okay? You promise me?

We will.

But if we lose the battle...

there's just one more thing
I'll ask, okay?

Try to forgive Dad...

if you can.

And let him know
that I forgive him, too.

Okay.

430, OR Two.

Is that the surgery
you and Dr. Austin

were talking about earlier?

With your ex-fiancé?

You're doing it with us?

Yep. See you in there.

- I have a request.
- Same here.

I wish this corned beef
was more tender.

Shira is the anesthesiologist
on Micah's surgery.

I need you
to take her off the case.

- Why?
- Gut instinct.

Something's up with that girl.
I do not trust her.

And you want
what's best for Micah.

Okay. Deal.
I'll get Paul Chu on it.

Hey.

You still planning
on scrubbing in?

Yes.

Micah has a new girlfriend.

She's here at the hospital.

She's very pretty.

And he says he is happier
than he has ever been.

I'm sorry, Mina.

I did not enjoy delivering
that ten-blade to your heart.

But I had to see if you still
had feelings for your ex-fiancé,

and by your reaction, you do.

So no, you will
not be scrubbing in.

And for what it's worth...

you deserve better.

Anybody who could
replace you so quickly

doesn't deserve you.

All right. Thank you so much.

Jessie just gave me
her advance directive.

I can't bring myself to read it.

Yo.

Nicodemus.

Nickelmeister.

Anybody need a kidney
around here?

Thank you, Dad.

I've got some good news.
Thanks to Dr. Hawkins,

your heart failure
has improved for now.

We can move ahead with the
transplant if we move fast.

So what's next?

First, we'll bring you
to the OR.

As we're removing your kidney,

a second transplant team

will prep your daughter
in a separate OR.

When she's ready, we'll implant
your kidney into Jessie.

Six to eight hours from now,

you should both wake up,
ready to make a full recovery.

Six to eight hours
from right now?

Right now.

Well, you guys, um... you don't
fool around, do you?

It can't wait.

See you on the table.

Dr. Voss, I need your help.

Dr. Bell, meet Sunflower.

Sunflower?

- We don't know his real name.
- It's...

It...

I...

can't... even...

Unbefriended and uninsured.

- Yes.
- But you understand

I have a patient like Sunflower
on every floor of this hospital.

This is exactly the kind of case
that's bankrupting Chastain.

Sunflower has a brain bleed, and
his symptoms are getting worse.

Well, it could be sundowning,
nighttime confusion.

It's common with dementia.

It's possible,
but I don't think it's dementia.

Well, I... You can't be sure.
This bleed is small.

Well, it could be the cause
of all his symptoms.

It could be curable, Dr. Bell.

We had a neuro consult,
and he recommended surgery.

Are you going to deny it?

Look at this man.

He was found in Piedmont Park,
wearing sweats.

If he was jogging, had a fall,

that could explain why
he had no wallet or I.D.

There is no police report,
no missing persons file.

Yeah, he could be
from out of town.

Even if he's homeless,
what does it matter?

Pravesh, a hand!

What about the health
of this hospital?

We can't keep doing this.

Chastain is on the brink
of a disaster.

I need to save it, too.

Just stay with him
for five minutes.

That's all I'm asking.

See the human being
and not the numbers this time.

Want to...

beg... beg...

What are you trying to say?

This... awful.

I...

I-I-I can't even...

You can't... what?

Help.

Wait. What's that...
What is that for?

That's to start an IV, Dad.

My-my-my... my mouth is so dry.

Can you give us a second?

We have
an excellent transplant team.

Great doctors, great staff.

Brave is not my resting state.

You're gonna come out
of this just fine.

And for the rest of your life,
you are going to be happy

that you did this,
I promise you.

For Jessie.

I was leaving

for the day, and I saw this guy
breaking into a car.

He says he's a friend
of a doctor here,

but nobody has this amount
of dr*gs

unless they're dealing,
or using or both.

Who is this registered to?

Shira Smook?

Hey, man, come on.

I forgot my phone.

Shira, you all right?

Yeah.

Just tired.

I'll get a coffee.

I've been working long hours.

All good.

Hey.

Dad.

D-Dad, thank you.

Thank you.

Nothing I'd rather do,

no place I'd rather be.

You're my baby girl.

I'll s... I'll see you
in a few hours, okay?

Yeah. Yeah.

Nic? Nic, there's something
that I really need to tell you,

s-something I should have
told you a long time ago.

You can tell me
on the other side.

- No, no, sweetheart, this is important.
- Dad.

It's gonna be okay.

Hello there, Mr. Nevin.

I'm Dr. Shira Smook.

I will be your anesthesiologist
tonight.

They're about to ligate

the vessels
and remove the kidney.

- Dr. Bell?
- Yeah?

We have a problem.

I've been working long hours.

You promised me.

I'll meet you in
the parking lot in an hour.

OR One.

The recipient is open and ready
to receive the donor kidney.

Ten-blade to me.

Time to give this kidney

a new home.

What the hell?

Lap pads. Suction.

We lost his airway. IV's out.

My God, he cut an artery.

She's not breathing!

- Call a code!
- Start bagging Shira!

Get another anesthesiologist!

He's crashing!
Jump in. My hands are full.

Tubes and lines are all pulled.

I'll re-intubate.

His airway's full of blood.
Suction!

He can't go much longer
without oxygen.

It's too swollen.
I can't get the tube in.

Sats are 60 and dropping.
He's gonna code.

We need to do a cric.
It's the only way.

Betadine. Give me that.

- Ten-blade.
- Okay.

- Trach tube?
- Got it.

In.

Got it. Okay.

Thank you.

- Done.
- All right, we're in.

All right.

Come on, Dad.

Come on, come on, come on.

Come on, Dad. Come on, Dad.

Oxygen levels are still
really low.

Bilateral breath sounds.
Tube is in place.

His sats are climbing.

- What happened?
- Shira collapsed.

Let's load her on a gurney,
and we'll take her to the ER.

What the hell is that?

An IV port.

She's an addict.

That's her... Dr. Smook.
What-what the hell happened?

She OD'd in the OR.

Tell the ER
we're gonna need Narcan!

Can we proceed
with harvesting the kidney?

- The risk is higher, but the bleed is stopped.
- Are you sure?

Because he's been through a lot.
If we get him to the ICU,

he could fully recover
before we move on.

But Kyle is currently stable.
Airway is secure.

- BP is holding.
- Jessie's window for a kidney is closing.

Her best sh*t is now.
I say we go on.

Okay.

Administering Narcan.

Come on, come on, come on.

Wh-Where the hell am I?

You can't do this.

I'm a doctor.

You OD'd in the OR
in the middle of surgery

and you almost k*lled a patient.

Let me go, get away from me!

Thank you for covering for me

while I was stuck
in the other OR, Dr. Austin.

Looks good. Stand by
to reperfuse the kidney.

How's it going?

So far, so good.

They're about to see
if Jessie's new kidney works.

Unclamping.

- She's in V-tach.
- Get the defibrillator.

- Give 300 of amio.
- BP is dropping.

I'll reclamp until she
stabilizes.

Charged to 120.

Clear.

Charge at 200.

- Clear.
- Her heart is too weak.

V-fib. We need to get that
rhythm under control now.

We're at max joules.
Charge again.

Clear.

Okay. Sinus tach. All right,
that's what I like to see.

Let's unclamp these vessels
and, try this again.

Unclamping again.

Rhythm's holding steady.

All right, it's showtime, baby.

That is a beautiful thing.

It's urine.

The new kidney is working
like a champ.

Her heart took a b*ating, so
she's still not in the clear,

but... this is good.

Hey.

Hey.

Devon told me
you okayed the surgery

on our unbefriended patient.

And good on you.

Yeah, well, it's gonna go
in the red column for Chastain.

That column is already
very long.

Why did you do it?

I saw myself in him.

I should probably let you know

I'm, I'm back
with my ex-husband.

Um... Okay.

But I care about you
and I believe in you.

Nurture the man
I see right here.

Well, I will... if I can.

Any change?

The same.

I still can't believe
all this happened.

Nic.

Take a break, get some air.

I'll keep watch.

I promise I'll page you
if anything changes.

Thanks.

I discharged Micah.

He's in fine health.

Great.

Good news.

What have we got next?

Lung biopsy.

Cool.

Hi.

I'm Dr. Pravesh.

You just had surgery.

It went very well.

Do you know where you are?

You're at Chastain Park
Memorial Hospital.

And we've been
taking care of you.

Can you tell us your name?

George.

Wilson.

George Wilson.

Well, it's nice to meet you.

Is there someone we can call
for you, Mr. Wilson?

To let them know where you are?

M...

My wife.

For the record,

Dr. Smook was not our fault.

I've learned the medical board
of Pennsylvania pulled

her license for drug abuse,
so she moved here.

Doctor's records don't travel.

They can lose their license
in one state

and just move to another.

I know.

You are fortunate
that your original pitch

was so well received.

Red Rock Mountain is still
willing to move forward...

with some conditions.

Well, I remain as CEO,
that's nonnegotiable.

Agreed. But your authority
would be curtailed.

All administrative decisions

about the running
of the hospital would shift

to Red Rock Mountain Medical.

Your signature, please.

I have to read this, I have
to consider it carefully.

No, you don't. There's nothing
left to consider, Dr. Bell.

Nic. This time I'm here.

For her. For you.

There you go.

Anybody need a kidney
around here?

I'm afraid.

You're gonna come out
of this just fine.

You're my baby girl.

Get the pads, one of epi.

Where's the crash cart?!

- What happened?
- Nic, no, don't go in!

- I have to.
- Conrad's running the code. He's got it.

You survived your shift
with The Resident.

Now here are a few more shows
to check out from Fox.

I tried to force a fairy tale.

But that doesn't happen
for people like us.

I still believe we're gonna
all get our happy ending.

Star needs everybody
that loves her by her side.

I'm just gonna say bye.

I'm just gonna say bye.
Let me say bye!

We're a family, no matter what.

You built this life for yourself.
Keep fighting.