05x03 - The Long and Winding Road

[bunniefuu]

Previously on The Resident...

Have either of you heard from Devon?

Hey, can I get some help
in here?! (COUGHS)

They found him collapsed
in the elevator on the roof.

What happened?

Hey, sweetheart.

NIC: Hey, how's it going so far?

Mama isn't here.

We talked about that.

Hey, it's me. Just trying again.
Call me back.

She's gonna be back tomorrow night.

Conrad Hawkins?
There's been an accident.

(TIRES SCREECHING)

PILOT: This is Traumahawk Three

requesting landing field
briefing at Chastain.

- (TIRES SCREECHING)
- OPERATOR: Chastain

- helipad is clear. Go ahead.
- Chastain,

we are inbound, five souls
on board, ETA five minutes.

(TIRES SCREECHING)

PILOT: We are requesting an overhead

level- trauma on arrival.

OPERATOR: Request granted.

Handing you off to the medics.

Patient is female, s,
status post-MVC, GCS

- at the scene.
- (TIRES SCREECHING)

Single car collision.

Significant intrusion
on the driver's side.

Intubated at the scene,
tachy's to the s,

stable BP.

Dr. Hawkins?

(PHONE RINGING)

ER.

Whoa. Where's the fire?

(PHONE RINGING)

Got us a table for two at Ray's.

- I adore Ray's.
- (PHONE BUZZING)

I thought you said
you were off the clock.

(PHONE CHIMES)

OPERATOR: Do we have
an ID on the patient?

Nicolette Nevin.

♪ ♪

Conrad!

- (HELICOPTER BLADES WHIRRING)
- (GRUNTING)

Hold on, man.

They have to bring her to us!

Okay. I'm good, I'm good,
I'm good, I'm good.

On my count.

One, two, three. (GRUNTS)

- (BEEPING)
- We got a problem here.

Her pressure's tanking.

Why haven't they brought her out yet?

They must not be able to move her.

Conrad!

(GRUNTS)

Doc, we got this.

I'm not her doctor. I'm her husband.

Nic. (PANTING)

I'll update the transport team.

Nic, I'm here. What happened?

Police don't have a cause.

There were no other
vehicles at the scene,

no inclement weather.

No idea where she was coming
from or where she was headed.

She was coming home.

Wait. You're Dr. Conrad Hawkins, right?

I've heard the other medics mention you.

You're ex-m*llitary, right?

Corpsman. Afghanistan.

Syria. Air Force Para-rescue.

You know what they teach us?

Watch the monitors, not the patient.

- (RAPID BEEPING)
- _

She needs an ultrasound.

MCDONNELL: There. No lung sliding.

It's a tension pneumo.

We can decompress her here.

Pass me an angiocath.

I got it.

Really.

(RAPID BEEPING CONTINUES)

She didn't even flinch.
What did you sedate her with?

Nothing. She's not sedated
with anything.

Nic, wake up. Wake up.

(PANTING)

On my count. Three, two.

- One.
- One.

At some point,
we will have to intervene.

He can't take control of Nic's care.

I know, and we will once we know
what we're dealing with.

The pneumothorax was easily resolved,

but Nic hasn't done anything purposeful

since the paramedics found her.

KIT: Which could mean
a myriad of things.

Accidental ingestion,
electrolyte abnormality.

Sure, it's a possibility.

I mean, from the neck down,
Nic appears to be okay.

But the impact from the crash
may have damaged her brain.

Badly.

Let's not catastrophize just yet.

(PANTING): Where's Nic?

Ooh, Dr. Pravesh,
you're not looking too good.

She's right, Devon. Slow down.
You're still recovering.

I'm fine.

Hey, where's Nic?

She's in CT. Conrad is with her.

Kit's keeping me posted.

Whoa, buddy, hold on. Hey,
didn't I just discharge you?

It's Nic. I'm not going home.

Okay, but you're also not going
to badge in.

Let's find you a place to lie down.

I'll order you a neb. Come on.

No. It's fine.

(MAN SPEAKING INDISTINCTLY OVER P.A.)

It's subtle, but there's
some evidence of edema.

Yeah, but we're used to looking
at scans of older people.

A young brain is bound
to look full in contrast.

Well, these tiny
petechial hemorrhages in

the basal ganglia tell us
there's damage.

Well, the question is...
how will it evolve?

KIT: Dr. Sutton, what's our plan?

CONRAD: Place an ICP monitor

and treat her with meds

to lower her intracranial
pressure if it's high.

And repeat the CT in four hours.

Sooner. I want to know
if there's any changes.

Nic is strong. She's healthy.

I've had patients make it
through injuries like this.

We all have.

Got here as fast as I could.

Oh, my God. I'm so sorry.

There's nothing to be sorry about.

Nic is gonna be fine.

Does everyone hear that?

Nic is gonna be fine.

Go home, Pravesh. You shouldn't be here.

(DOOR OPENS)

(DOOR CLOSES)

I need help over here!

Mrs. Sandoval?

- It's not me. It's Gabe.
- (WHEEZING)

He's having trouble breathing again.

Hey, it's my favorite long-haul
COVID survivor. You missed us?

Not really.

- No offense.
- (LAUGHS)

Let's get you checked out.

- (GABE WHEEZES, WHIMPERS)
- (SHUSHES)

Only oxygen. No tubes.

Now you know I don't
make the rules, Mr. Sandoval.

Just try and relax. We've got you.

He's been doing so well
since the surgery.

I wrote down his pulse oximeter reading.

This is , , , .

My wife is paranoid.

She's thorough.

We like that.

CHERRY: I try to keep him alive.

His health has never been
the same since he had COVID.

That's a lot of wheezing I'm hearing.

How do you feel about checking
in to the Hotel de Chastain?

- Huh?
- I told you they'd admit me.

- Shh.
- IRVING: Page Dr. Austin.

- Mm-hmm.
- Let's get Mr. Sandoval started on a neb,

order a chest X-ray, and
give him IV Solu-Medrol.

Um, is Nurse Nevin here?

She always likes
to know how Gabe is doing.

Uh, not tonight.

Sit tight.

- We'll get you fixed up, Mr. Sandoval, okay?
- (GRUNTS)

- Shh.
- (WHEEZING)

You need to stop b*ating yourself up.

You saw the look on his face.

(TAKES DEEP BREATH)

He's not angry with you.

He's terrified.

Which is exactly

how I felt when we didn't know
what happened to you.

And Conrad was with you the
whole time I was unconscious.

I need to be there for him.

Just give him time.

If Nic doesn't turn a corner soon,

there may not be much time.

Inserting the electrode into the dura.

Tox screen negative.

She doesn't have a drop
of alcohol in her.

So her EKG and her echo were normal.

There's no evidence of any arrhythmia

that could have preceded this.

(RAPID BEEPING)

(CONRAD SIGHS)

BILLIE: Swelling on the
CT wasn't an overcall.

Her intracranial pressure is high.

- Then we start her on hypersaline...
- Dr. Sutton?

Uh, we start her on hypertonic
saline, Lasix and mannitol.

- If that doesn't work...
- It has to work.

Let me talk to you for a second.

Billie is a strong neurosurgeon,
but if you would like

a second opinion, you just name
the doctor, and I'll deliver...

- I don't want another surgeon.
- No, I-I get... I know.

What you want is to direct
Nic's care, but you cannot.

Doing so would be a risk to Nic
that we can't let you take.

You can't expect me to do nothing.

I'm not saying that,

but you must give this team the chance.

(MONITOR BEEPING STEADILY)

You don't have to stay for this.

Oh, don't mind me, dear. There's
nowhere else I need to be.

Oh, no. Cherry's an old pro.

She sat beside Gabe for the six months

he was in ICU recovering from COVID.

Six months, one week, five days.

Is "bronchoscopy" two Os or three?

- That's three.
- Ah.

I-I like to write everything down.

I-I know you keep Gabe's records
in the clouds or whatever,

but I like to keep
my own account right here.

Hey, Devi, park the scope right there.

See how his trachea collapses
every time he breathes?

That's what's causing the wheezing.

It's the tracheomalacia again.

Okay, Devi, we're good.

He needed all that time on
the breathing tube for COVID,

but it made his trachea weak and floppy.

And given his history,
I'm afraid we're gonna have

to go back to the tracheostomy tube.

- Oh, he hated that so much.
- I know.

How long will he need it?

Indefinitely.

And he's most likely going

to need the ventilator at home, as well.

I mean, the damage to
his own trachea is so extensive,

it's the only way we can
get Gabe to breathe safely.

Cherry, I know this is not
what any of us wanted,

but I promise you,
it is the best that we have.

No explanation from the police
on what caused the accident?

Not yet.

I texted my prayer group to include Nic.

I hope that's okay.

How's she doing?

Listen, about earlier. I should...

- What's this?
- Elaine Quinn, patient from last winter.

years old? She had the dogs?

Two huskies.

I remember. Her car
got hit by a snowplow.

Worst TBI we'd seen, but she recovered.

If I can figure out why
she made it through,

I can help Nic make it through.

Elaine Quinn's scans were
entirely different than Nic's.

She had a brain bleed.

We were able to intervene on that.

I know that's not what you want to hear.

You think I'm in denial?

I don't.

I don't pretend to know at all
what this is like for you.

I want to help you.

I just don't want
to say the wrong thing.

No. I want you to be honest with me.

I know it's bad.

It is.

How you doing?

(SNIFFLES) Me? I'm fine.

Well, then you're made
of something much stronger

than the rest of us.
It's okay not to be okay

when your critical patient
is also your friend.

How are you, really?

This is one of the worst nights
of my life as a doctor.

And I want to cry and scream
and throw things

because my best friend
should not be in an ICU bed

fighting for her life.

And how's Nic's progress?

Her ICP is higher than
I would like, but it's stable.

Stable's not the same thing
as recovering. Right?

Which is why I think it's time

to put her in a phenobarbital coma.

And you're worried Conrad won't agree?

This is your call...
how you approach this.

You're the doctor.

If we put her in a coma,
she can't wake up

until the sedatives wear off.

How can I know she's improving

if she's being flooded with sedatives?

- We rely on monitoring parameters.
- Mm-mm.

(SNIFFLES)

Listen, I have to do something
I don't want to do.

I have to talk to you the way

I would the spouse of any other patient.

Unfortunately, despite our meds,

the pressure in your
wife's brain is still too high.

If we don't put her
in a medically-induced coma,

we risk compromising any chance
she has at recovery.

(SIGHS) Oh, Conrad.

Nic has been my best friend
since we were children.

I love her, too, and I will
do anything for her.

It doesn't compare
to what you're going through,

but you have to trust me.

I can't. I can't let go.

(SNIFFLES)

What if we do this
and it's the end, and...

... and I-I can't ever
talk to her again?

This is her best chance,

maybe her only chance.

You know that.

What would Nic tell us to do
in this situation?

What would she say right now?

She would say, "Start the drip".

It's herbal.

Caffeine never does anyone
any good at this hour.

Thank you, Mrs. Sandoval.

How are you?

Is it Gabe?

Dr. Austin said he needs
another trach tube.

I have a feeling that's gonna
go over like a lead balloon.

You can't imagine how relieved we were

when Nic got Gabe diagnosed.

Neither one of us had ever heard
of tracheomalacia.

She helped us understand what
long-haul COVID would mean

for Gabe, for both of us.

And she made us believe
that we could face it together.

Maybe it's silly at my age,

but Nic made me want to go back
to school and become a nurse.

She gave us hope.

I wish I could thank her again for that.

You can... when she wakes up.

- (DOOR OPENS)
- BELL: I hope to God you won't have to.

- No updates?
- No, there's-there's nothing yet, um,

but I brought you a visitor.

This is Santina Lopez from Nexus Life.

Hello, Santina.

I'm sorry you made the trip up here,

but I have no need of you at this time.

I'm sorry. Could you
just give us a minute?

Of course.

You know, there's never
a good time to make this call,

and if this were

- any other patient...
- It isn't.

... with a severe TBI

and no trauma to major organs...

Just given everything we know
at this moment,

we have to consider
every possible outcome.

There are tens of thousands of people

in this country
waiting for organ transplants.

I know, I have patients
of my own on that list.

If the time comes
to discuss Nic's wishes,

I promise I will handle it.

(MONITOR BEEPING STEADILY)

(WHEEZING)

CHERRY: Oh, there you are. (LAUGHS)

- You miss me?
- (WHEEZING)

How's your breathing, Mr. Sandoval?

We should talk about
what we found on the scope.

We want to put in
another tracheostomy tube.

No? Honey, this isn't
a yes-or-no question.

Page Dr. Austin.

He should be a part
of this conversation.

We'll be right back.

(MAN SPEAKING INDISTINCTLY OVER P.A.)

(GABE CLEARS THROAT)

When the trach tube came out last time,

we agreed I'd never have another one.

It's okay. Our insurance can cover it.

It's not the cost, honey.

I'll be tethered to a machine.

(WHEEZING)

The noise, the inconvenience.

All you do is take care of me.

With a trach, it's endless.

I signed up for better or worse,
sickness and health.

I love you.

And I love you.

(WHEEZING)

That's why I've made up my mind.

I'm done, honey.

No more tubes,
no more chest compressions.

- Uh-uh.
- (RAPID BEEPING)

- (LOUD WHEEZING)
- No.

Doctor? Dr. Devi!

(WHEEZING)

- (RAPID BEEPING)
- We need a code airway!

DNI. DNI. DNI.

- DNI.
- Mr. Sandoval, you could die without intubation.

REENA: Dr. Devi?

(LOUD WHEEZING)

Cancel the code. Mr. Sandoval
just informed me he's DNI.

Get the BiPAP machine, please.

We can keep you breathing
for now, but you need

a permanent solution.

(WHEEZING)

Conrad told me not to come,
but I had to.

How's Nic?

- I think he'll be happy you're here.
- (GIGI BABBLES)

All right. Kyle's on his way.

He, understandably,
is taking this very hard,

and I'm worried.

I'll see to Kyle.

Why don't you get GiGi to the nursery,

and I'll have one of the staff
from Peds come

- and help you get her settled?
- Okay.

(GIGI FUSSING)

(ALARM SOUNDING)

- Her ICP is up again.
- I can get more mannitol.

No. Her osmolarity is already .

Asymmetric pupils.
Nonreactive on the right.

That's new.

(ALARMS SOUNDING)

So is the bradycardia.
This could be a bleed.

That could be something we can fix.

Let's get her to CT to find out. Now.

Kyle.

Hey. Hi. Hi. Hi.

Hi. I, uh... I, uh, found this,
you know, message board online.

They said that sensory reminders
can be helpful.

Uh, where's Nicky?

She's just been brought to CT.

I want to prepare you
for when you see her.

Oh, is it... ? It's that bad?

On the outside Nic looks okay,
like she's sleeping.

Well, that's good, right?

Not exactly.

The impact from the accident
was powerful enough

- to injure her brain.
- (GASPS)

- It's, uh, like a severe bruise you can't see.
- Don't.

And we don't know if or when

that bruise will improve or worsen.

It's got to improve.

It will improve.

I'm afraid, at the moment,
that's far from certain.

Okay, I want...
I want to... I want to see her.

I need to talk to her.

(VOICE BREAKING): I want her
to know that I'm here.

Of course. You can see her after the CT.

Can... can-can-can...
can I wait in her room?

Yes.

There.

I see it.

Diffuse effacement
of the gray-white junction.

Ventricular compression.

Her brain is herniating.

All right. So, we do
a decompressive craniotomy.

That could stop the herniation.

- No, I can't.
- Yes, you can.

I can't reverse the injury.

Nic won't recover from this, Conrad.

That's my wife in there.

GiGi's mother. The center of our world.

We are not giving up on her.

♪ ♪

(SIGHS): I love you.

(SNIFFLES)

(SIGHS)

This is unsurvivable.

Yeah, I know.

These images make it clear.

Nic is gone.

There's only one thing left
to do to confirm the diagnosis.

The brain death exam. I...

I don't think Billie should handle that.

She's going through enough.

Conrad will insist
on performing the tests.

No, we can't allow it.

Who does that leave?

Are you sure you're up for this?

Am I up for it?

No.

Is it gonna destroy me? Yes.

But it's not about me.

It's about two people I love
and their child.

And I'm gonna do it for Nic.

And Conrad.

And GiGi.

(MONITOR BEEPING STEADILY)

(CONRAD GROANS)

I got you.

GiGi's asleep in the nursery.

(SNIFFLES)

Kyle, I'm so sorry.

Well, she looks okay.

Right?

I think she's gonna be okay.

MARSHALL: Kit said there are tests?

Why don't we, uh, take a walk,
get some air?

KYLE: Nah, I'm gonna stay
here in case she wakes up.

MARSHALL: The doctors have
to run some more tests.

We can come back
as soon as they're done.

(SIGHS)

(CONRAD SIGHS)

(SNIFFLES)

Need a hand?

I called them just in case.

We want to help.

Thank you.

Pupils are fixed and dilated.
No corneal reflex.

No oculocephalic reflex.

Negative oculovestibular reflex.

Now I'm gonna test her pain response.

She's not feeling any pain.

(HUNDLEY CRYING)

Once I disconnect the vent,
we wait eight minutes

to see if she breathes.

(RAPID BEEPING)

- Enough.
- You're a fall risk. Lie back.

- Give me my clothes.
- Why? You got a hot date to get to?

- I want to go home.
- I'm not taking you home.

- Then I'll call a cab.
- I won't give you the phone.

I'd rather die at home
than in this hospital room.

Sweetheart, can't you just let me go?

Don't sweetheart me,
you pain in my ass! (GASPS)

(GABE WHEEZING)

(CHERRY WHIMPERING)

CONRAD: Everything okay?

(CHERRY SHUDDERS)

Is it Nic?

(CHERRY SIGHS DEEPLY)

When Gabe was at his worst,

people would tell me it was God's will.

- (SCOFFS)
- Or "The universe won't give you

more than you can handle".

They didn't mean any harm,

but they didn't make things any easier.

(CHERRY SIGHS)

She's going to live forever
in your heart.

You need to carry Nic inside you now.

For you and your daughter.

(CHERRY SNIFFLES)

Cherry.

Don't let him give up.

(DOOR OPENS)

(DOOR CLOSES)

- (BEEPING)
- _

Time.

I appreciate it.

What are they doing?

Wait, whoa, whoa, wait, stop!
Stop! What are you doing?

Conrad, they're... What are they doing?

- They're pulling the plug?
- No.

No, Mr. Nevin. That is not
what's happening.

No one here wants to hurt Nic.

Don't-don't manage me, Marshall.
That's my daughter in there.

What you saw was a test

of Nic's brain stem responses.

We had to confirm her diagnosis.

What diagnosis? What?

Diagnosis?

I'm sorry. Nic is brain dead.

N-No, no. We... uh, we saw
her hand move earlier.

Conrad, tell them. We saw it.

Involuntary movements can be
triggered by spinal reflexes.

I-I can see with my own eyes.

She's not dead.

The way Nic talks about you,

she thinks you're a miracle worker.

You can save everyone
in this damn hospital,

but you won't save her?

Her heart is still b*ating!

CONRAD: Her heart is b*ating
because of a machine.

Her lungs are inflating
because of a machine.

Fine, fine. Then let them
do their work. J-Just go,

please, do your work.

I don't care if it takes days or weeks

or months for her to wake up.

- Just do it...
- She won't wake up.

Nic is gone.

And being kept here,
hooked up like this...

that was her idea of hell, and
I'm not gonna do that to her.

I will not lose another
daughter in this hospital.

(CRYING): She's all I've got left.

Please.

I intend to honor Nic's decision.

(KYLE BREATHING HEAVILY)

It's all I can do for her now.

I will never forgive you for this.

(CONRAD CRYING)

(CLEARS THROAT, SNIFFLES)

Uh... are they here?

I don't normally discuss

a... a patient's wishes with the family.

Nexus Life does that for us.

But I insisted.

While nothing can compare to your pain,

I hope you know
how much we all loved her.

I do know that.

She loved you.

In time,

I hope it will be
a comfort to you and GiGi

that Nic chose to be an organ donor.

She'll be able to save the lives

of eight critically ill patients...

(SNIFFLES)

... and vastly improve the lives
of dozens more.

She helped so many people
during her time at Chastain.

(SOBBING)

It's quite miraculous

that her life-saving work will continue.

If there is anything I can do...

This is what she wants.

So... (SNIFFLES)

... this is what I want.

(EXHALES)

(SIGHS DEEPLY)

So, we need to get Mr. Sandoval

on my surgery schedule immediately.

He is a match for a donor

who can provide a trachea replacement.

A trachea transplant?

We never knew that was an option.

Oh, it wasn't. Until now.

This is an extremely rare
opportunity for Gabe.

It could mean an end to his pain.

(SOFT LAUGH)

I don't know how to convince him
to have another surgery.

He is refusing any and all treatments.

(WHEEZING)

Where are my shoes?

Did my wife hide my shoes?

- Mr. Sandoval, please.
- AUSTIN: Mr. Sandoval.

Word has it that you want to check out.

That's right. No surgery.

No surgery? Wow, you talk a big game

for a man who can barely breathe.

I can't live with that tube.

Okay, so how about we ditch the tube?

Huh? No more looking for a quick fix.

I'm talking a total trachea replacement.

A trachea transplant would mean
breathing on your own again.

- What if it doesn't work?
- What if the sky falls?

What if the simulation fails?

Most importantly, Gabe,
what about your wife?

- Cherry knows my wishes.
- CHERRY: Don't fool yourself.

You're not making wishes.
You're giving up.

AUSTIN: Damn straight you are.

And there's not a soul in this hospital

who wants to hear anything
about giving up.

Not today. Not after we've lost
the best nurse practitioner

we've ever known.

Nurse Nevin?

- She didn't make it.
- (WHEEZES)

And now Dr. Hawkins has to figure out

how to live without
the love of his life.

Like you want me to do.

Gabe, listen to me.

When millions lost their lives

during the pandemic, you survived.

There's no rhyme, there's no reason.

You are a unicorn, Gabe.

And every person in this room knows

that your party is not over.

So come on, brother, what do you say?

You want to see what life
still has left to offer?

(CRYING)

- Let's do it.
- (SOBBING)

You heard the man, Dr. Devi.

Let's do this.

(LAUGHING)

(GIGI BABBLING)

(CONRAD SPEAKS INDISTINCTLY)

You know, you don't have
to do this right now.

Not until you're ready.

I don't think I'll ever be ready.

Thank you, Dad.

Look who's here, Nic.

(GIGI GRUNTING)

(CONRAD GRUNTS)

Brought your favorite person.

GiGi...

(CONTINUES INDISTINCTLY)

("IRIS" BY VALERIE BROUSSARD PLAYING)

♪ And I'd give up forever to touch you ♪

♪ 'Cause I know that
you feel me somehow ♪

♪ You're the closest to heaven
that I'll ever be ♪

♪ And I don't want
to go home right now ♪

♪ And all I can taste
is this moment... ♪

CLARA: Why do you do this?

Not many people get a chance
to make a difference.

A good nurse can.

♪ It's over ♪

♪ I just don't want
to miss you tonight... ♪

Jess? Hey. Jess?

Jessie, hi.

♪ See me ♪

♪ 'Cause I don't think
that they'd understand ♪

♪ When everything's made
to be broken... ♪

HUNDLEY (SOBBING): Can you please
tell Raylee I love her again?

NIC: You will tell her yourself

because you will wake up.

- (SOBBING)
- Now let us fight for you.

♪ ♪

She's moving.

♪ Can't fight the tears
that ain't coming ♪

♪ Or the moment of truth in your lies ♪

♪ When everything feels
like the movies ♪

♪ Yeah, you bleed... ♪

- DEVON: Devon.
- NIC: Nic.

Watch and learn.

Conrad's the guy who tightens the bolt.

♪ See me ♪

♪ 'Cause I don't think
that they'd understand ♪

♪ When everything's made to be broken ♪

♪ I just want you to know who I am ♪

♪ ♪

♪ And I don't want the world to see me ♪

♪ 'Cause I don't think
that they'd understand ♪

♪ When everything's made to be broken ♪

♪ I just want you to know who I am. ♪

("FOREVER YOUNG" BY BOB DYLAN PLAYING)

♪ May God bless and keep you always ♪

♪ May your wishes all come true ♪

♪ May you always do for others ♪

- ♪ And let others do for you ♪
- _

♪ ♪

No tears, Devi.

Nic gave us a gift.

We're going to save this man
right here, right now.

We focus on that.

Be grateful for the miracle.

- (SIGHS)
- ♪ Forever young... ♪

She's going to save so many lives.

Exactly.

♪ Forever young ♪

♪ Forever young ♪

♪ May you stay ♪

GIGI: Mama.

♪ Forever young. ♪