My neighbor Kenny and his girlfriend go all the time.
The rides were actually fun, Claire,
even though they hurl you through the air very quickly
without a proper three-point seat belt.
It was worth the $300 I spent.
What kind of carnival will cost you that much money?
It was not just the carnival.
Kenny's girlfriend wanted to go to see a movie afterwards,
but I just got the second edition
of Chaikof's Atlas of Vascular Therapy
so decided not to go.
- And you paid for everyone? - I had to. I lost the bet.
Rounds will have to wait. We have a consult come up.
Hunter Denoble, 38. Came into the E.R. this morning
complaining of severe neck pain.
X-rays show anterolisthesis.
A herniated disc. 38 a little young for that, isn't it?
Unless there's a history of spinal trauma.
There is.
Hunter fractured seven vertebrae in his neck and back
in a motorcycle accident 10 years ago.
He was one of my first patients.
Suffered complete paralysis from the chest down.
…a few months back, just gnawing pain.
Ibuprofen usually took the edge off.
Every day?
Uh, yeah, give or take.
- It's not that bad. - Last night things changed,
he couldn't move his neck at all,
and the pain medicine had no effect.
So, he wanted to tough it out, but I dragged him in here.
Yeah, it sounds like you.
Feel that?
- Yeah. - And that?
Mmm-hmm.
I made partner at the firm.
I don't like to call in sick.
And let's face it I've spent enough nights in hospital rooms for five lifetimes.
Can't argue with that. Squeeze my hands.
You have any tingling or weakness in your arms?
- No. - The plain films showed
what looked like a herniated disc.
Which would mean…
Artificial disc replacement.
Day procedure, he'd be out by the morning at the latest.
You married him?
Yes, three years ago in Cancun. It was lovely.
Even though he's in a wheelchair?
- Shaun. - Oh, no worries. I get this all the time.
Sure, she can never wear heels, but think of the parking.
What happened?
Pain shot right down through my legs.
- Your legs? - Yeah.
I haven't felt anything below my chest in 10 years.
What the hell is going on?
When I saw the break of day
I wished that I could fly away
Instead of kneeling in the sand
Catching teardrops in my hand
My heart is drenched in wine
But you'll be on my mind
Forever
Mom.
Well, there's my girl.
I don't want to see you.
But I haven't seen you in years.
Don't run away from me.
- Can we talk? - Since I don't want to see you,
it follows that I don't want to hear from you, either.
I just came in to get antibiotics.
My surgeon doesn't work on Fridays.
It feels fine.
Sorry, it's not fine.
This implant is definitely infected.
Just that one, though, right?
Yes. At this point,
your butt lift, tummy tuck, lipo, and breast augmentation
appear to be healthy.
But I need to remove this one and clean the area
before the bacteria spreads.
Well, can you replace it?
Once the infection is resolved and you have a few months to heal.
I don't want to walk around with half of a face for a few months.
Isn't there anything you can do to save the implant?
I can't make any guarantees,
but if I can replace the implant without risking re-infection, I will.
Okay, Doctor.
I didn't understand the lyrics, but I liked your mom's voice.
Is she a professional singer?
She is a lot of things.
Great mom wasn't one of them.
How so?
A lot of people have issues with their parents, nothing new.
But everyone's story's different.
How so?
When I was in high school,
I babysat the kids in my neighborhood.
I wanted to buy a laptop for school
like a lot of my friends had,
so I saved up 1,000 bucks.
I came home one day,
and the money was gone and so was my mother.
And three days later,
she came back from Reno
with a designer dress and a guy named Ricky.
I never got the laptop.
My mom made pancakes.
They were good.
Mmm, what is that?
I've never seen anything like that.
Maybe, a spinal column tumor.
Hunter's initial spinal cord injury
from the motorcycle accident that caused his paralysis was at T1,
but that part looks almost completely normal now.
Hunter's phantom pain…
is real.
My former mentor, Sonya Kung,
is head of the surgical residency program at Denver Memorial Hospital.
If you want a meeting, I'll make the call.
Why?
You're gonna need a job after this year.
You trying to screw with my head, or are you being serious?
The opportunity is real.
I'm trying to be nice.
I do that when it doesn't hurt me.
And this definitely doesn't hurt you,
you getting rid of some competition.
True.
Although you're not high on my list of threats.
This would be a much bigger benefit for you.
Look, I fought to stay here.
I'm not going anywhere.
It's very rare,
but after many years
with a bruised cord like yours that isn't severed,
it can start to function again.
- So, this mass is causing Hunter's pain? - Yes.
If the cord is healthy, why aren't I feeling more than pain?
The mass is compressing the healthy cord,
just letting the pain through.
We still have to do some more advanced imaging to map the mass,
but I am fairly confident that if we removed it that could change.
You may be able to walk again.
We were able to clean out the infection
and swap in a new implant. I am very pleased.
- You think it looks okay? - I love it,
and you are going to look great at the beach.
Wailea?
We went there on our honeymoon.
Thank you.
Ooh. He's taking you to Hawaii. You should be hugging him.
Oh, I'm so relieved.
Satisfied customers.
This is why cosmetics is the most fun specialty.
Now, we're gonna monitor you closely.
There is a risk the infection could have seeded to other implants.
- Keep me posted. - Yes, Chief.
I'll take the early shift.
Once I'm on my feet, I'm never sitting down again.
I'm gonna take Cora dancing.
She's a great dancer.
Oh, no.
I push myself.
No offense. It's my rule.
Right.
If this works,
after a considerable amount of physical therapy
you may be able to walk,
but that doesn't mean you'll be a very good dancer.
After years of atrophy from not moving your legs,
you will likely be very bad.
You know what the worst part is?
It isn't being in the chair.
It's that people see the chair first.
They don't see me.
You know what I'm talking about.
Why would I know what you're talking about?
My brother-in-law's on the spectrum. So's my assistant.
I make it a priority of hiring people with disabilities.
Let me guess. When you first started working here,
- no one believed in you. - They didn't know me.
They didn't know that I was going to make a good surgeon.
No.
You were different.
I guarantee you every other doctor
started with a basic level of respect.
It's implied they're competent.
We waste our time and energy trying to prove that we belong.
I'm fine.
She's just being thorough, honey.
You've been over my body three times.
Early infections often mimic blemishes.
It pays to be thorough.
Is this sore?
Maybe a little.
- What's wrong? - It could be nothing,
or it could be a carbuncle, an early sign of infection.
Dr. Andrews needs to have a look at this.
This varicocele is raising testicular temperature
and causing your sperm count to be low.
Surgically, I go in, ligate the varicocele
and re-check your numbers in a few weeks.
It's done under a local,
so no anesthesia risks, minimal blood loss.
There's a risk of low testosterone and impotence,
but recovery time's usually a week at most.
So, I could have kids, I just might not be able to make them?
As I said, it's low risk.
I only mention it because I'm obligated to inform you.
Well, you're obligated to inform me because it's a risk.
It's an unlikely complication, but, yes, it happens.
It's outpatient. I do it right here in the office.
What I see here is a chance to fix a problem.
And I see a chance to create a new one.
I'm… I'm sorry, I have to go. I have a patient.
Look, I see a lot of men with this issue.
Sure, they come in because they want kids,
but I think what they really want is to reaffirm themselves.
And that's a good thing.
Thank you.
It's a spinal arachnoid meningioma.
Have you seen one of these before?
Much smaller.
They usually don't get this big
because the pain and weakness brings the patient into the E.R. fast.
But in this case, no pain,
no E.R. visit until it got this big.
And it's wrapped around the spinal cord tightly and fused with the dura.
Can we get a fiber-optic laser and take it out in segments?
No, I don't think so.
It stopped growing and settled in this position.
But I do think that we can dissect along the subarachnoid plane
down to the largest segment at T2 and remove it in one piece.
That's an extension of the mass.
Mmm, no. It's the medullary pyramids.
No.
It's an extension of the mass.
The pyramids are more central and the color is wrong.
Murphy's right.
The extension's tightly adhered to the brainstem.
Who caught it?
Jared did.
Nice work.
Most first-year residents would have missed this.
It's very small on the surface,
but I can feel the fluctuance under the skin.
What do we need to do to fix it?
We need to remove all of the implants
and some of the healthy underlying tissue as well.
Unfortunately, it will cause significant permanent scarring.
No, no, no, you You can't do that.
I'll look worse than I did before.
I don't get it. You removed the bad part from her face, and it's fixed.
Looks good, no more infection.
Let's just do the same with the rest of 'em.
It's not that simple.
When we removed the infection from Emma's cheek,
it was under the pretense it was a localized issue.
If we just take out the infection from the new area,
it could jump again.
I won't do it.
When an infection spreads, it often moves very quickly.
What Dr. Andrews is saying…
I understand what he's saying.
I'm 50-years-old.
When I went to drop my daughter off at Michigan,
we went to that bar on Liberty Street,
where we first met.
I saw myself sitting there 25 years ago,
young, confident, full of potential.
Then you raise a kid, and…
look after your husband,
a home.
You lose touch with who you were.
You… You said it was an infection, right?
Like strep throat or something.
That's what antibiotics are for.
Couldn't we just use that?
We could try strong, broad-spectrum antibiotics,
but I really don't want to do that.
You could become septic. You could die.
It'll work.
It has to.
The brainstem is complex.
Even our best imaging can't provide a complete picture.
So, then, you would just leave the cyst in him?
Other than the pain, it's not harming him.
It's stabilized now and done growing.
But what about the pain?
An implanted nerve inhibitor will completely remove the pain.
But, I won't be able to walk.
No.
Exactly how risky is removing the mass from the brainstem?
Everything that keeps your heart beating
and you breathing is right there.
The nerve inhibitor is a day procedure.
You'd sleep in your bed tonight pain-free.
- Give me a percentage on this thing. - Don't do this to yourself.
I don't like to give those kinds of numbers.
They're population-based,
and they don't apply to your exact circumstance.
I understand how statistics work. But there's a number, and it's relevant.
There's a 15% chance the surgery would kill you.
I remember the moment I accepted I'd never walk again.
It wasn't when Dr. Melendez told me after the accident.
It was a few months later…
when I was in rehab
and I was trying to get up in the standing frame.
I looked out the window and there's all these people just living their lives.
I'm trying to fix something that I can't change,
and life was going on without me.
So I started living again.
But now there's something I can do.
Hunter…
I want to talk to Dr. Melendez.
- No. - Please.
Just go get Dr. Melendez.
You curious?
About why I gave you the credit?
I assume you thought it was a set-up,
that Andrews thought you were wrong and you tried to throw it on me.
That's very cynical.
The other alternative is that you were being kind,
which seems very unlikely.
There is a third possibility.
I'm proving a point.
When you lose their respect, no matter what you do,
no matter how many wins you chalk up,
you'll never get it back.
The game's already over.
You lost.
Does anyone like you?
I like me.
I've got results.
I know this is her first cycle of antibiotics,
but I'm not seeing any improvement.
Her neutrophils are through the roof.
You'd be under anesthesia for nine hours,
and I'll need to make sure
that your body's healthy enough to handle the stress.
Will you tell him not to do this, please?
- You don't care what I think? - I'm the one in the chair.
- You have no idea what that's like. - I'm right there with you.
Who carries you up the stairs?
Who pushes you out through the sand
so you can put your feet in the water?
This way you won't have to do that anymore.
So you want to gamble this life for the life that you had?
Cora.
We have a great life,
but I want to walk again.
And I want you to see me walk.
I'm not gonna stand by and watch you die.
If you want to selfishly gamble your life away,
you're doing it on your own.
I'm doing this for us.
No, you're doing this for you.
She'll be back.
Dr. Tolles to Obstetrics, please. Dr. Tolles to Obstetrics.
Hey. Uh, I got a page?
I'm busy, and I don't like being tricked into coming down here.
- Yeah, I know you hate me… - I don't hate you.
Seeing you is not healthy for me.
Okay, wait… Well, I just need to tell you that I was sick.
I am sick.
I know, you've been telling me that for years.
You were right.
I got help.
They have me on mood stabilizers.
I'm doing better now.
I mean, sometimes the meds make me feel flat.
You know, no highs, no fun.
No lows, though, either. It's worth it.
I'd like to try again to be your mom.
I mean, maybe we could just talk some more?
I'll think about it.
Well, take these.
They need water or they're gonna die.
My number's on the card.
I think I just won the Tour de France.
It's a long surgery. It will put a lot of strain on your heart.
Your cardiovascular fitness is excellent.
Huh!
You get it, right?
Get what?
Why I want this surgery so bad.
You'd jump at a cure for autism, wouldn't ya?
There isn't a cure for autism.
Well, last week I didn't think there was a surgery to help me.
The surgery isn't guaranteed to help you walk.
Why would you risk losing a person
who accepts you the way you are?
You may not find another one.
There are a lot of reasons to marry me, you know?
I'm sure there are a lot of reasons to marry you.
Yes. I'm organized, I have excellent visual-spatial memory,
and Lea says I'm refreshingly honest and fair.
I suppose Cora loves me because I'm determined…
I'm pretty smart,
committed to helping others,
and most of all, probably because I'm patient.
Were you always those things?
Were you those things before you were in the wheelchair?
Your autism helped you. That's your point.
You're saying this chair made me a better person.
The difference is
losing this chair now
won't make me lose the lessons it gave me.
The antibiotics aren't working.
I told you if they didn't, we'd be doing surgery next.
No.
She's going to die if we don't act now.
Honey…
we need to listen to the doctors.
I need you to trust me.
I can't go back to being like it used to be.
You don't have a choice.
She wants a second opinion.
She's going to die.
I told her that.
Sometimes, it's tough to actually get out of those doors.
When I was a kid,
my little sister had an accident climbing a tree,
a traumatic brain injury,
and I woke up every morning dreaming that she was better,
but she wasn't.
I took care of her a lot.
Brushed her teeth, combed her hair, fed her.
Hunter was my first patient as an attending,
and I had to walk in that room and tell him
that there was nothing I could do for him,
nothing I could do to fix him.
And now there is?
But there's no guarantee.
There is never a guarantee.
I'm sorry,
but I can't risk losing the man that I fell in love with.
You're not just afraid that the surgery will kill him.
You're afraid that it might work.
You've only known Hunter in a wheelchair.
Walking would be a fundamental change in who he is,
a fundamental change in who you are as a couple.
You're worried that no matter what happens you're gonna lose him.
Hunter seems to have a great life.
I don't know if I'd risk giving that up.
What if there was an operation to make you a perfect doctor,
never make a mistake,
but it had a, you know, 5% of killing you?
Would you do it?
That's not a fair comparison.
Well, you said Hunter's doing fine the way he is,
but we're talking about giving him something more.
What about 2%?
I don't think there's a number for me.
Oh, of course there's a number.
Every time you get in your car,
every time you leave your home,
you take a risk something bad could happen but you do it anyway,
you know, to make yourself better,
to make the world better,
sometimes just to have fun.
Sometimes to go to a carnival.
Kenny's not your friend.
He's using you.
I… don't think so.
We have fun.
He's got a rap sheet.
Mostly misdemeanors,
but there's a couple felony theft cases
that were bargained down.
Wait, you ran a background check on Kenny?
Well, you start by talking, I start by gathering evidence.
I'll forward it to you.
In my experience, there are only two reasons
why a married person has this kind of cosmetic surgery.
Either you're halfway out the door or she is.
Emma loves me.
That's what I figured.
The antibiotics aren't working,
so your wife is going to die
unless you get in there and you convince her
that she doesn't need any of this cosmetic surgery
because you are a faithful, loving husband.
How's the pain?
You know, I think the adrenaline of actually doing this is helping.
It's the oxycodone.
That's good.
I'm glad you came back.
I never left.
I don't want to do this without you.
I don't want to do anything without you.
If you can walk,
you'll be different.
You won't need me anymore.
You think I married you 'cause I was having trouble
hanging clothes in my closet?
You're my girl.
I will always need you.
Even if I could fly.
Who's gonna remind me to call my mom on her birthday?
Or to floss? God, I hate flossing.
Who's gonna remind me to be a better person?
Who's gonna hold my hand when I'm scared?
That was nice.
You have to have the surgery.
You were distant before.
Since the surgery, you can't get enough of me.
It worked. You're happy, I'm happy.
I love you. I always have loved you.
- I always will. - You stopped loving me.
No. Never.
If you were in love with me, you never would've cheated on me.
Barry,
please, no more lies.
You were never home. We never talked.
You were never there.
There was never another woman.
I was gambling…
a lot.
I did it because I was ashamed of the man that I'd become.
When we got married, I promised you the world,
and instead I gave you a mediocre life.
When I was up,
it made me feel like a winner.
And I was too embarrassed to let you see me like that,
so I hid it from you.
She's gonna do the surgery.
Thank you.
Andrews needs an O.R. for Emma Newton.
Claire,
you're beautiful, smart, and very good at your job.
Thank you, Shaun. That's a very sweet thing to say.
Would you ever date someone with a disability?
Yeah, sure.
You could choose the ideal mate, Claire.
Why would you want the unnecessary burden?
Everyone is dealing with something.
We just have to love other people for who they are
and hope they love us, too.
O.R. 1's prepped for Hunter.
I'll join you in a minute.
So, what changed her mind?
Jared did.
Morgan, you're my first assist.
Make the call.
Thanks.
This is as far as you can go.
Nurse Matthews will take you to the waiting room.
Can I, uh… Can I give him a kiss?
Of course.
I can't do this.
Yes, you can.
This is what you do in a relationship, right?
You take chances, together.
Okay.
That's a large tissue defect in the left breast.
If we'd been in here six hours ago,
I could have salvaged more underlying muscle tissue.
I'm noticing her heart rate jump.
You seeing that, JL?
I am now.
- How's her surgical sites? - I'm not seeing any bleeding.
Morgan, what about your side?
Everything looks good here.
Maybe the anesthesia's light?
Nope. No, something's definitely happening.
Jared's right.
Suction, Claire.
Give me a 25 on a 130.
All right, Murphy, I want you to cut right under my forceps
very carefully.
Section's cut.
How are the motor evoked potentials?
Signal's coming through, spinal cord's functioning normally.
The mass has fully encased the medullary cord.
Give me the ferromagnetic wand.
I can't get the caudal end clear of the underlying cord.
Got a big drop in potentials.
We are compressing his brainstem.
- What's his pressure? - Mean arterial pressure's 70.
- I got nothing now. - Push IV fluids. Keep that MAP above 90.
Hunter's going into neurogenic shock.
- We need to stop the surgery. - Almost there 20 seconds.
Pressure's 60. Push vasopressors.
The last piece is right there.
It's probably edema. Push 100 of dexamethasone.
Still nothing.
He's dying.
It's one damn centimeter of tissue.
All clear.
That's her second dose of amiodarone. She's not responding.
She's thrown her septic embolism.
I'm cracking her chest.
10 joules. Clear.
Again.
Clear.
Starting cardiac massage.
It's time to call it.
DR. Time of death, 10:23.
Welcome back, Hunter.
The mass was tightly adhered in some spots,
so we're not exactly sure what to expect moving forward.
But, the cord looked healthy.
We're gonna be bringing in several specialists to work with you.
- The first will be a neurophysiatrist… - Thank you. Thank you.
Thank you. I'm grateful to all of you.
Would you mind if we talked about the rest of this later?
I just want to sit with my wife.
Thank you.
Hey. Hey. Hey.
I met a couple today that lost their way.
They loved each other,
but by the time they remembered what really mattered,
it was too late.
I don't want us to be like them.
I want to be fully committed to you.
I love you, too.
There's a surgery I could have that should make me fertile,
but there's a risk of impotency.
What do you want to do?
I want to give you what you want, what we want, a family.
We are a family.
Yes, I want children,
and there are many ways to do that,
which we'll explore together.
But, I draw the line at anything that risks our sex life.
It's just one night a week,
but I think this could be my big break, you know?
Well, you always had a beautiful voice.
Well, everyone's got one thing, right?
But enough about me. I want to hear about you.
Do you have a man?
I did.
Pretty young thing, should have plenty of choices.
Hmm, I'm not looking to complicate my life right now.
Still looking after everyone else but yourself,
like you did for me.
You know, I know brag to everyone.
"My baby. She's a surgeon."
- Surgical resident. - Right, sorry.
You like it?
I love it.
Where are you staying? You're… Are you in town for a while?
Yeah.
I'd like to be closer to you.
I found a place.
You'd like it,
but I just need to put up first and last.
I'll pay you back.
How much do you need?
$2,500.
Plus I have to get furniture and, you know, all of that.
Maybe you could help me pick that stuff out.
You've always been so good at that.
I really appreciate it. I'm good for it.
Uh, Celeste isn't coming. She broke up with me.
I hate her.
But I'm not gonna let that ruin our night.
That's what friends are for.
They got each other's backs, rain or shine.
By the by, I found a $20 in your battery drawer,
so, I got us Chinese food.
- Don't thank me. - I don't like Chinese food.
Aw, come on now.
Trust me, everybody likes Ma Jong's Kung Pao.
There you go.
I'm pretty torn up about that Celeste thing.
She was a real keeper.
You said you hated Celeste.
I do. I… I hate her 'cause…
I don't know… I kind of love her.
This tastes terrible.
Okay, then he hates Chinese food.
More for me.
Plain white rice?
Oh, uh, I got a gaming console,
and I hooked it up to your bad boy over there.
We can play some Mortal Kombat.
Come on.
We doing this or what?
It sounds fun.
Yeah.
Yeah, there you go.
This one's you.
That's you on the left right there.
- Okay. - Yeah.
You got four arms, but you're naked, so here we go.
I gave you a pneumothorax.
Ah, I didn't realize how bloody this game was.
Ooh, a fireball. I got you there.
Have you played this before?
That looks like a spinal fracture.
Yeah, I'd say… there's a huge fracture there.
You died.