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00:05In college, I was the hungover pre-med who fell asleep at her study cal.
00:10If you're just joining our podcast, my guests are doctors Teddy Altman and Winston Ndugu from
00:16Gray Sloan Memorial, who pioneered the creation of a ventral aorta surgery.
00:20At what point did you think, we just broke new ground?
00:23Immediately.
00:24Really?
00:24Yeah.
00:25And once that staple held, I knew.
00:27Sometimes you just have a feeling.
00:28In med school, I was the famous surgeon's daughter.
00:31It wasn't like that for you?
00:33Honestly, there was so much going on that night, I didn't have time to process it all until later.
00:38Now, I'm the famous surgeon.
00:39So you had doubts?
00:41Oh, yeah.
00:41I was never certain it would work, but our patient didn't have any other option I knew that we had
00:46to try.
00:47In medicine, your identity is constantly changing.
00:51It's your job to keep up.
00:53Safe to say it worked out.
00:54What's next for you both?
00:56Well, we're still monitoring our patient's progress.
00:58And?
00:59So far, so good.
01:00They sound really good.
01:02Very competent.
01:02Yeah, I come to this hospital.
01:04Well, speaking of, I made an appointment for you.
01:09We talked about this, Catherine.
01:10I don't need another opinion.
01:11I like Dr. Freeman.
01:13I know you do, because it goes along with whatever you want.
01:16You don't think doctors should listen to their patients?
01:18I think you need objective advice from someone whose paycheck you don't sign.
01:24It's just another opinion.
01:27Who am I seeing?
01:29Kaplan.
01:30Laura Kaplan in Boston.
01:32I thought you made an appointment here.
01:34I sent for my plane.
01:36She landed about an hour ago.
01:43Morning.
01:44Hey.
01:45Hey.
01:45Hey, nice job on that podcast.
01:48I didn't realize you and Altman came up with that at our wedding.
01:50Yeah.
01:50You never know when an idea will strike.
01:53Go ahead, Dr. Adams.
01:54Uh, yes.
01:55Uh, Joe Wilson, post-op day seven from emergency section and Impella CP placement.
02:01Now post-op day three from a 5.5 placement through the right axillary artery.
02:05Her heart function continues to recover with her EF up another 5%.
02:09And I heard she got to meet her babies yesterday.
02:12How are they doing?
02:14Peyton's off of CPAP is still fragile.
02:17Addy's bilirubin levels are bad every time they pause phototherapy.
02:21And you're all headed in the right direction.
02:23That's what matters.
02:24I just really want the six of us to finally be together.
02:29Joe, you will never guess who Marcus walked out with last night.
02:32Dr. Ndugu.
02:33Hey.
02:34I didn't know you were doing rounds.
02:36Yeah?
02:37I'll come back later.
02:42What was that?
02:44What was what?
02:45Did you sleep with my favorite nurse?
02:48Uh, should I leave?
02:49We've just gone out a couple times, that's all.
02:51Well, are you going to take her out again?
02:53Uh, maybe.
02:54It's new.
02:55And none of our business.
02:56She is the entire department's favorite nurse.
03:01Everybody loves her.
03:02Everyone.
03:08Mormons.
03:09Okay.
03:10Uh, I need to check on my next patient.
03:12Are you going to be okay?
03:13Yeah.
03:14Uh, Paige, me if you need anything.
03:17Please.
03:19Good morning.
03:21Traitor.
03:22Trouble in paradise?
03:23I broke our pact.
03:24She's bitter.
03:25No, you should break it too.
03:26What, like I could just snap my fingers?
03:28Who am I supposed to sleep with?
03:29I ordered an x-ray for Ms. Johnson's left arm.
03:33That was the right arm, wasn't it?
03:35I will fix it.
03:37An intern?
03:38Please, I have dignity.
03:39Don't knock it till you've tried it.
03:41Tried what?
03:42Vegan sloppy joes.
03:43You sleeping with an intern too?
03:45Who was sleeping with an intern?
03:47I am.
03:48Who are you texting?
03:49Nobody.
03:50Doesn't look like nobody.
03:51Nah, she's just a patient.
03:52Why are you texting a patient?
03:54Yeah, well, Bailey made me drive her an hour to get treatment,
03:56and now she's sending me dumb memes.
03:57It's nothing.
03:58Wear a condom.
03:59She's a cancer patient.
04:01Hey, did you see that I admitted Mr. Howard?
04:03You don't have to put your phone down.
04:05It's fine.
04:05Oh, sorry.
04:06My phone has been blowing off since the podcast dropped.
04:09Yeah, I listened.
04:09You sounded great.
04:10Well, now I've got doctors reaching out about their patients,
04:12and the department chief from Mass General has asked me to do grand rounds.
04:15Huh, sounds rough.
04:16Well, it's not like I'm getting a Nobel Prize.
04:19I mean, MGH asks everyone to guest lecture.
04:21Well, they never asked me, and I went to Harvard.
04:23Anyway, so, Mr. Howard, his EKG shows a conduction block.
04:26Do you want an echo?
04:27Um, uh, yes.
04:29Sorry, I have to take this.
04:30Hi, this is Altman.
04:32Hi, Janet.
04:34I'm, uh, Dr. Millen.
04:35I hear you're having some leg pain?
04:37Yeah, and some heaviness.
04:38I'm concerned it might be a DVT.
04:39I think she should have an ultrasound.
04:40I assume you want a full workup of CBC, D-dimer, and a duplex ultrasound?
04:46I'm Jules Millen.
04:47I'm a second-year surgical resident.
04:50You're internal medicine, right?
04:52Oh, no.
04:53Oh, I'm not a doctor.
04:55Sorry.
04:55Oh, we were role-playing.
04:56The more medical terms, the better it gets.
04:58Yeah.
04:59So, Hal does his homework.
05:02So, do you have, like, pain, or is this...
05:04Oh, no, that's real.
05:05The pain started this morning when we were trying to squeeze in a quickie before work.
05:09May I do an exam?
05:10Mm-hmm.
05:13Um, how long did the pain last for?
05:16Uh, a few hours?
05:18Yeah, we've been trying to spice things up lately, so we just want to make sure we haven't, uh, caused
05:22a problem.
05:23Well, um, DVTs usually occur with less, um, activity.
05:30But it is better to be safe than sorry, so I will order some tests.
05:35All right.
05:35And get back to you.
05:37Okay.
05:39Yes.
05:40Dr. Griffith.
05:4138-year-old female with a large mediastinal teratoma that has been resistant to chemotherapy,
05:48presents with progressive shortness of breath, orthopnea, and angina.
05:51That has to be at least 35 pounds.
05:53And, uh, 27 centimeters for the longest diameter.
05:56The tumor is displacing the heart and great vessels.
05:59The SVC is compressed, and it's also indenting the right lobe of the liver.
06:05Mm.
06:06How are the lungs?
06:06Compressed, with near total collapse of the mid-right and lower lobes.
06:09Has anyone tried to operate on the thing?
06:11Her name is London, and yes, there have been two attempts at Seattle Prez.
06:16They had to abort both times because she arrested on the table.
06:20But you believe you would have a different outcome if you tried?
06:23Well, I have removed extremely difficult tumors before, and this one is benign.
06:29So if we can successfully remove it, then she resumes a normal life.
06:34Even if you convinced anesthesia, you could still encounter catastrophic bleeding.
06:39And that is why I'm here at the tumor board, where people help their colleagues to come up
06:44with a plan.
06:45If anyone here thinks this remotely is a possibility, please speak up.
06:51Yes.
06:57It's a tragic case, Dr. Bailey, but it's a lawsuit waiting to happen.
07:05I'll do it with you.
07:10The alternative is hospice, right?
07:14Dr. Hunt, it just can't be done.
07:15Yeah, well, you don't know what we are capable of.
07:23I knew you'd have an idea.
07:25Yeah, I got nothing.
07:41Well, look who's here.
07:44How was your flight?
07:45Most quiet I've had in months.
07:47Great.
07:48Dr. Weber, it's a pleasure.
07:51I've heard a lot about you.
07:52All good things.
07:54Katherine's thrilled you joined the team in Boston.
07:56She's thrilled she poached me from Sloan Kettering.
07:58You are at the forefront of urologic oncology.
08:01And that lecture that you gave to the American Urological Association last month brought the house down.
08:07And she is developing a program that uses AI to study biomarkers.
08:12We just received another grant for it yesterday.
08:14You bet you did.
08:16Now, tell us about my husband's prostate.
08:19Katherine, please.
08:21If now's not a good time.
08:23Don't be ridiculous.
08:24Come on, everybody.
08:24Sit down.
08:25Have a seat.
08:26Come on.
08:29Good news is you caught it early.
08:31Gray Group 2 of 7 Gleason.
08:32He knows all of that.
08:34So tell us, what do you suggest?
08:36Well, given the cancer's localized and you're generally in good health, I recommend a radical prostatectomy.
08:42I couldn't agree more.
08:44If you're worried about side effects, urinary incontinence, erectile dysfunction, they are a risk.
08:49But for many men...
08:51What about infection?
08:52It's unlikely, but possible.
08:55Blood clots.
08:56Stroke.
08:57Injury to the rectum, bladder, nerves.
09:00They're all possible too, right?
09:04Yeah.
09:07Thank you for your time, but I've already selected an option with my own doctor.
09:12Watch for waiting.
09:13I've got patients to see.
09:21I'm not seeing abnormalities.
09:23What's that lung called?
09:24An ultrasound probe.
09:26Write that down.
09:26Okay.
09:28All right, the ultrasound is negative.
09:31So, she doesn't have a clot?
09:33Not that I can see.
09:34Sounds like maybe there still might be one.
09:36Well, your D-dimer was slightly elevated, which is the marker we look at for clots.
09:40It doesn't necessarily mean anything, but it is reason to come back if you have any more pain.
09:44Maybe I just need to stretch before I go to the doctor.
09:47Oh.
09:48Stretch?
09:48I don't ask any questions.
09:49I'm going to start your discharge paperwork.
09:52What was that all about?
09:53I like to rope the doctor and patient in bed.
09:56Good for them.
09:59But they're so cute.
10:02Rustic cute.
10:03Five of you said those rockers broke within a year.
10:06How's the lake house?
10:07We've moved from arguing over tile to arguing over porch chairs.
10:12How was the tumor board?
10:14Uh, unfortunately, they are concerned about the risks and recommend that we don't proceed.
10:21So, naturally, I call them reinforcements.
10:25This is Dr. Owen Hunt.
10:27He's one of our trauma surgeons.
10:29If it's okay with you, I'd like to work with Dr. Bailey to make sure that we've explored every possible
10:34option.
10:34I want to help.
10:36I like him.
10:38If everyone else has reservations, why do you think you can do it?
10:42Charlie, we've actually found surgeons that are not giving us a hard no.
10:48I've almost lost you twice.
10:50I'm definitely not ready to lose you today from some botched operation.
10:54Neither are we.
10:55Hey, I'm still here.
10:57They're just asking if they can go work on a plan.
11:00If their plan leads to us growing old together, looking at the water from shoddy but very cute rocking chairs,
11:11I'm in.
11:13Aren't you?
11:18You really think you can figure out a way to keep her heart from stopping when she's on that table?
11:22Look, if we can't figure this out, we won't proceed.
11:25That was our deal when you two came to me.
11:29Okay, work on your plan.
11:31Okay.
11:32We'll be back.
11:33Okay.
11:42Hi, my beauties.
11:46They look bigger.
11:48Did they get bigger?
11:49Hattie's put on a full ounce in the last 24 hours, and Peyton isn't far behind.
11:53That's right.
11:54Lincolns know how to bulk.
11:58Hey, I gotta go to PT.
12:00You sure you're okay?
12:00Okay.
12:01You sure?
12:02Yeah.
12:04All right.
12:05Okay.
12:07See you soon.
12:11You're Peyton and Hattie's mom?
12:14Mm-hmm.
12:18Sorry.
12:19It's just that, um, that's the first time that somebody's called me their mom.
12:25Here.
12:28Oh, wait, that one's not clean.
12:32Here.
12:33I'm an OB-GYN, and I talk to my patients all the time about postpartum hormone drops,
12:40but I had no idea it was this intense and just random.
12:44Yesterday, my boyfriend and I were buying diapers for me, not the baby, and the guy
12:49ringing me up said, will that be all?
12:51And I burst into tears.
12:53It's nice to know that I'm not alone.
12:58What?
12:59You're my first mom friend.
13:02Oh.
13:03I'm honored.
13:04Did you tear?
13:06Can I ask you that?
13:07Yeah, you can ask me anything, but, um, no, I didn't tear.
13:11I, uh, I had something called a crash C-section.
13:15Oh, tell me everything.
13:19I'll be back.
13:20Richard, what the hell are you doing?
13:23I'm about to check Mr. Tolley's wand back.
13:25You said you would hear Kaplan out.
13:27I did.
13:29Is this because you're worried about the bedroom?
13:31Because you know we'll figure that out.
13:43I'm not having this conversation here.
13:45Is this because you prefer a male doctor?
13:47Now that's insulting.
13:49Well, I'm just trying to understand why you would dismiss a top urologist like she's an intern.
13:54I moved mountains to bring her here for you.
13:56I didn't ask you to.
13:58Now my cancer has a metastasize.
14:00Watch for waiting is a perfectly reasonable option.
14:03I respected your healthcare decisions even when I didn't agree.
14:07I need you to do the same for me.
14:14Who is the surgeon in Seattle, Prez?
14:16Collins.
14:16Yeah, uh, he actually did his residency here a couple of years behind me.
14:20When his chief wouldn't let him try again, he sent London to me.
14:23If she codes the minute she lays on the table, why didn't he try a reverse Trendelenburg,
14:27keep her an incline to take the pressure off some of the cardiac vessels?
14:30Uh, look, they didn't.
14:31Uh, but see how compressed they are?
14:33It wasn't enough.
14:34Okay, what about conscious sedation instead of general anesthesia?
14:37She'd continue to breathe on her own, which would help blood return back to the heart and minimize airway collapse.
14:42I mean, it might help some.
14:44The tumor's matured into its own ecosystem.
14:47You can see the calcifications, that, the cystic components.
14:52What if we drain it, shrink the mass before we go in?
14:54It's a good idea, but the location is just too risky.
14:57We can't risk the contents of the tumor spilling into the chest.
14:59It will just regrow.
15:00Yeah.
15:01I gotta run to a consult in the pit, but I will keep thinking on this.
15:04No promises, though.
15:07Adams, Griffith, let's look up every case report published on mediastinal teratomas.
15:12Research patterns, cross-reference solutions, okay?
15:15We all just listened to a podcast this morning about how our hospital pulled off a miracle.
15:18Who's to say we can't do it again, right?
15:20Go.
15:24You're going to come up with something.
15:28Hey.
15:29Hi.
15:30Are you done with that tablet?
15:31Nope.
15:31Get your own.
15:32Bailey and Hunt have a massive mediastinal teratoma.
15:35If you sweet-talk Bailey, you can get in on it with us.
15:38Looking for ideas.
15:39I'm too swamped down here.
15:41Hey, I'm sorry about this morning.
15:44Jo's crying about everything these days.
15:45It's fine.
15:46But she loves Iris, so she'll be happy if you two were a thing.
15:57Why are you acting weird?
15:59I'm not acting weird.
16:00Yeah, you are.
16:02Help!
16:02Help, my wife!
16:03What the?
16:04How?
16:04You might want to button that.
16:05Oh my god, Janet!
16:10I'm getting weak pulses.
16:12Okay, Janet, look at me.
16:13I'm going to take care of you, okay?
16:15We need a gurney in here!
16:24The plane won't be ready for another couple of hours.
16:26Catherine said I could work in here.
16:28Not a problem.
16:32I owe you an apology.
16:34I was led to believe that you were the one seeking a second opinion.
16:37You couldn't have known.
16:39I should have at least suspected.
16:41I think your wife broke contract laws to ensure my employment at her hospital.
16:45Don't feel bad.
16:46You're not the first to fall prey to her ways.
16:49Well, guessing I won't be the last.
16:52She does it because she cares.
16:54That's what makes it infuriating.
17:01Feel free to say no.
17:03But I've got a patient with a retroperitoneal tumor, and I would be remiss if I didn't ask
17:09Fox Hospital's chief of chiefs for a consult.
17:12No.
17:13Got a little time.
17:15How about we get a couple pastries to go with this coffee?
17:20That would be great.
17:2222-pound teratoma in the abdomen.
17:25San Francisco, 2018.
17:28They started with a CT-guided drainage.
17:29Yeah, but look at the picture of the CT.
17:31Nowhere near the heart.
17:33Another dead end.
17:36Another dumb meme from your patient?
17:38She's asking for movie recs.
17:40She's stuck at home.
17:41Not exactly a doctor-patient conversation topic.
17:45She's Bailey's patient, and she has stage 4 gastric cancer.
17:48She can ask whatever she wants.
17:49And Michelle, you keep it professional?
17:51Do you have no idea where you're talking about?
17:53I'm just saying you're young, you're single, you look like you.
17:56You might be leading her on.
17:59I'm her doctor.
18:01And she's a vulnerable patient.
18:03I don't need this right now.
18:05No, I'm just trying to look out for you.
18:06Yeah, try less.
18:10Hunt's asking for an update.
18:14Okay, anything?
18:15Not yet.
18:20Why'd you join this case when everyone else dismissed it?
18:24It's like you said.
18:25It's benign.
18:26Once it's out, she moves on with her life.
18:27There's no worry of Mets or recurrence.
18:34I might be feeling a little uninspired lately.
18:37Uh-huh.
18:38Wouldn't have to do with other people solving cases at weddings and doing podcasts, would it?
18:44I see you at drop-off.
18:47I know everything's falling on you right now.
18:49She's lecturing and you're packing lunches.
18:52I'm happy to do it and she deserves all the attention.
18:56I just think this tumor was...
19:00I don't know.
19:01My patient cannot be the fix to get you out of this slump.
19:05What do we got?
19:06Ten cases, at least half of them considered inoperable,
19:10and none of the masses are nearly the same size.
19:12There's one case that reported a similar arrest in the OR,
19:14but the team never tried it again because they couldn't safely find a way around the heart and lungs.
19:18Which is exactly what happened with London.
19:21As difficult as this is for me to say,
19:25I think we're out of options.
19:27What about ECMO?
19:29What about it?
19:30We need to bypass the pulmonary system, so why don't we use ECMO?
19:33The machine oxygenates and pumps the blood so her heart and lungs don't have to.
19:38There is no arrest if the machine is acting as her heart.
19:43Don't say no yet.
19:45I'm going to go find and do them.
19:50Almost there, Janet.
19:51If this is a clot, you can fix it, right?
19:55Blood clots are treatable if you catch them in time, so it's a good thing you were here.
20:00Weird, but good.
20:02I should probably be embarrassed, but I'm proud of us.
20:05All my friends got bored of their spouses and filed for divorce, but we got creative by coming to the
20:12hospital and having sex.
20:14Don't be jealous.
20:15I'm sure other people aren't getting any either.
20:17All right, let me see.
20:21Looks like there's a left iliac vein thrombosis.
20:25How is right, DBT?
20:26If you look closely, the iliac artery is compressing the vein.
20:30May Fender Syndrome.
20:31Mm-hmm.
20:32All right, let's book an angio suite for a thrombectomy and iliac vein stunting and start practicing.
20:37I am going to supervise you doing the procedure.
20:41Me?
20:41She means me.
20:43I don't care who it is, as long as you guys are prepped and ready to go.
20:50Do you really think this will work?
20:52The challenge, right, has always been the pressure that your tumor is putting on your heart, your lungs, and major
20:59arteries when you're positioned for surgery.
21:01The ECMO machine makes that irrelevant because it oxygenates and pumps your blood for you, so no matter what happens,
21:06your body will receive oxygen and blood flow while we work.
21:11I can't believe you actually figured it out.
21:13Have you done this before?
21:14How common is this ECMO?
21:16Charlie, you said you were in if they figured it out.
21:19How common is it?
21:21It's not common for this, and it can be hard to wean off ECMO after removing something that's compressed your
21:26lung for so long, but her heart is healthy.
21:28I don't anticipate that being a problem.
21:30But it could be a problem.
21:35You almost lost me twice.
21:38If we do nothing, this thing just keeps growing inside me until it squashes all my organs.
21:45And I'm definitely gone.
21:48I don't want to live like that.
21:51I'm slowly suffocating.
21:53And I don't want you to have to watch me live like that.
21:58We ask them to come up with a solution.
22:04I'm taking it.
22:05Okay.
22:06Dr. Griffin and Dr. Adams will get you prepped.
22:07We will see you in the OR, okay?
22:14Is it weird that he's not blinking?
22:16Newborn tear ducts aren't fully developed.
22:19It's so cool that you know all this stuff.
22:21Is it bad if I'm not, like, feeling anything?
22:25You mean you don't feel a bond?
22:28I'm already a terrible mom.
22:30No, no, it's completely normal.
22:32And you're exhausted and your hormones are all over the place.
22:36And to be honest, newborns are kind of just flops.
22:39In a few weeks, he'll be laughing and smiling.
22:42And it just, it gets so much better.
22:44You're a really good doctor.
22:47Are you taking new patients?
22:49Wow.
22:50Hey, how are my girls?
22:51Hey, well, we made a new fret.
22:54Whoa, whoa.
22:55Someone call a rapid response.
22:57Right away, doctor.
23:06She's still seizing.
23:09Someone give me I.M. midazolam.
23:11She's seven days postpartum.
23:13Check her blood pressure is probably eclampsia.
23:15She needs mag now.
23:16Does she have any symptoms before she started seizing?
23:18No, she seemed completely fine.
23:19It came out of nowhere.
23:21We'll need to get her up to OB.
23:22Will you go up with her?
23:23Whatever you want.
23:25Call me when you get up there, okay?
23:31Scissors.
23:34Put two units of blood on standby.
23:36Lap pad.
23:39All right, I secured the cannula.
23:41Adam, are we ready to remove the clamps?
23:43Yeah, ECMO's ready.
23:50Okay.
23:50We have dark dwell.
23:52We have full flow.
23:54Let's try lowering her down.
24:02At least that worked.
24:03We're going to make all of her work.
24:05Griffith Adams, you may never see another case like this again, so keep your eyes on the field.
24:08If you see any signs of hemodynamic instability, speak up.
24:12This is not a race.
24:13Our goal is not to finish fast.
24:15It is to keep her safe.
24:18Understood?
24:21Okay, London.
24:23Let's intubate.
24:29It's a hormonally active adrenal mass, so you need to watch out for sudden hypertension.
24:34I'm planning to use alpha blockers.
24:36Oh, good.
24:36Well, I assume you're going to do this open, given the size?
24:39That's the plan.
24:41My colleague will actually do it.
24:42I usually stick to robotic procedures.
24:45Whoa.
24:45You got something against the old-fashioned way?
24:47No.
24:50No.
25:16I have MS.
25:17Symptoms, muscle pain and leg weakness, and I thought, if only there was a way to operate
25:23while sitting down without having to hold the scalpel.
25:29Was it a difficult adjustment?
25:31Adjusting to living with a chronic illness is never easy.
25:34But over time, I just turned MS into a pivot.
25:39Not an ending.
25:42Well, you seem to be managing well.
25:44Oh, well, I have my ups and downs, believe me.
25:48But Catherine Fox is flying me around on her private plane and paying me more money than I know what
25:53to do with.
25:56And I still get to do what I love, even if it is in a different way.
26:02Yeah, they're going to go ahead with Bailey's giant teratoma and OR2, and Dugu's going to have to recycle.
26:08Can we just focus, please?
26:10It's a fake patient.
26:11Calm down.
26:12Oh, don't tell me to calm down.
26:13What is wrong with you?
26:15Is it about Simone breaking that dumb pact?
26:19No, and stop asking.
26:21I'm fine.
26:22No, you don't seem fine.
26:24It's because you are bothering me.
26:27Well, that can't be it.
26:28I always bother you.
26:30I'm just...
26:32I'm just tired.
26:35Every day is the same.
26:36It's the same people and the same rooms and the same conversations, and I'm just sick of it.
26:43Well, I am sorry we are not good enough for you.
26:46I didn't say that.
26:48Yeah, you don't have to defend yourself.
26:49We all know you're aloof.
26:59You're leaving?
27:00Yeah, I've already had an arthrombectomy.
27:03You can have it.
27:04Dr. Cardenas to the ICU.
27:06Dr. Maria Cardenas to the ICU.
27:10What's happening?
27:11Who's the doctor?
27:12Uh, John Burnett.
27:15An intern?
27:16Let's get a CT.
27:17They're getting a CT.
27:18No, she has eclampsia.
27:20Tell him she needs magnesium.
27:21Really?
27:22Tell him.
27:25Excuse me, I've got Jill Wilson on the phone, and she says it's eclampsia and you should start
27:29her on magnesium.
27:30Her BP is only 143 over 91.
27:32It could be an intracranial hemorrhage.
27:33Put me on speaker.
27:37Um, you're on speaker.
27:39I understand your concern, but postpartum eclampsia doesn't always present with a really
27:43high BP.
27:44Neither does her brain bleed.
27:46Barnett?
27:47It's, it's Barnett.
27:48Whatever.
27:48I may be only, but that doesn't mean that I can't schedule you to work every holiday and
27:52make your life miserable.
27:53So trust me when I tell you to start the mag now.
28:00Should I be magnesium?
28:07Your mom's gonna be okay.
28:11All right, we're gonna have to take part of the lower lobe.
28:13Adams, you want to staple the lung?
28:14Yep.
28:15Stapler.
28:15Bailey, you ready to start resecting the adhered diaphragm?
28:18I'm ready when you are.
28:19Griffith, what should we be careful to avoid?
28:22Hepatic veins and a retro hepatic IVC.
28:24Good.
28:24Let's get the next stapler ready.
28:26London thought.
28:27Fixing up a summer house was a lot of work.
28:30It's got nothing on fixing up a torso.
28:32Reload, please.
28:35Uh, BP is bobbing out.
28:37Damn it.
28:38I don't see any bleeding.
28:39I don't know why.
28:39The staple line looks clean.
28:40Well, if something's got to be causing this, what the hell is it?
28:43Does the ECMO say anything?
28:44There's a suction event alarm.
28:46Okay.
28:46Since we took pressure off the lung, could there be volume shifts?
28:50That's definitely possible, yeah.
28:51Okay, we need to up her pressers and flood her with fluids.
28:54If you don't get flowed back right away, she's done.
29:02Push fluids as hard as you can.
29:04I am.
29:04BP's still dropping.
29:05She can't take this much longer.
29:07I should have listened to that board.
29:09If I lose her...
29:10This is not on you.
29:11Come on, come on, come on.
29:12Come on.
29:14BP's coming back up.
29:17Well, that was close.
29:18Okay, folks.
29:20There's still a lot of tumor left.
29:23Griffith, you're on the livery section.
29:25Adams, you're on the superior mediastinum.
29:27If that's okay with you.
29:31Do what we say when we say it.
29:33Stay prone.
29:39Contrast?
29:42There's the occlusion and the iliac vein.
29:45Advance more.
29:47Okay, pin the guide wire and turn on the thrombectomy catheter, please.
29:53It's a shame Jenna isn't awake to see this.
29:55It would really turn her into a passionate fan of biological science and anatomy.
30:03Okay, I'm going to turn it off.
30:05I don't get it.
30:06If you have to pretend to be someone else for your partner to want to sleep with you, maybe
30:09you shouldn't be together.
30:10I've learned you never know what's going on in another person's relationship.
30:15Ready.
30:17Contrast?
30:22Thrombus is gone.
30:23The vein is patent.
30:25Great work.
30:27Now to stent.
30:31Thanks again for the consult.
30:33I see why Catherine calls you legendary.
30:35Oh, she is prone to exaggeration.
30:38I know.
30:38But in your case, it's true.
30:40Well, you live up to your reputation as well.
30:43Oh, but not enough to consider my recommendation.
30:48I'm sorry.
30:49I shouldn't have said that.
30:51That's okay.
30:53Can I ask you about something?
30:56Eurosynfacil fistulas.
30:59They are an extremely rare post-op complication of radical prostatectomy.
31:03But the odds aren't zero.
31:05They're close.
31:06What if it happened?
31:09Chronic pain, which often leads to difficulty walking, possibly warranting the use of opioids.
31:18I can treat complications.
31:21But if your cancer grows and metastasizes, that's when my hands are tied.
31:29If you change your mind, or if you just want to talk more, Catherine has my number.
31:48Done resecting the liver.
31:49Good.
31:51Excellent hemostasis.
31:56No bleeding on this side.
31:57Okay.
31:58We are in the home stretch.
32:00Let's get ready to get this tumor out.
32:03Hold on.
32:03Hold on.
32:05Did you hear that?
32:06What?
32:09Okay.
32:09We're going to need more lap pads and hang blood.
32:12Adams, quickly pack her.
32:14God damn it.
32:15All right.
32:15Keep the suction coming.
32:17Oh, wait, wait.
32:18Ah, okay, there's a tear where the IVC passes through the diaphragm into the chest.
32:24I'm trying to secure...
32:26Let me have a clamp.
32:28Okay, I need visualization.
32:29Put the suction on the lap pads.
32:31Not too harsh.
32:32Gentle, steady pressure, okay?
32:39I think I got it.
32:43Ah, she's stabilizing.
32:46Okay, everyone.
32:48On the count of three, everyone needs to help with this specimen.
32:50Okay, ready?
32:52One, two, three.
32:56Turn it in.
33:00Okay.
33:03Oh, okay.
33:07Oh.
33:07Okay.
33:09How do you all feel about getting the hell out of here?
33:11Yeah, you don't have to ask me twice.
33:13Bobby.
33:14Two O'proline.
33:23It's not here.
33:24Iris.
33:26Hey, what are you doing up here?
33:27So, a mom from the NICU is being treated for postpartum eclampsia.
33:31Can you look up her chart?
33:32Her name is Gina.
33:34I don't know her last name.
33:36I'm sorry, I can't.
33:37You're not her doctor.
33:40I just want to check on her.
33:42Do you want me to call Marcus?
33:44No, what I want is my friend's chart.
33:47I'm sorry.
33:48Stop saying you're sorry.
33:49Sorry doesn't help me.
33:50I'm this woman's only friend right now,
33:51and the person in charge of her care has been a doctor for about 90 days.
33:55So, if you could just please remove the stitch.
33:58All I want right now, no, we're not going to go.
34:00I, no, you cannot move me against my will.
34:04Stop!
34:06I, this is not okay.
34:09Can you give me a minute?
34:10Hey, hey, hey, hey.
34:11Look, I know you're scared.
34:13Okay, but maybe she's just trying to do her job.
34:35It will take a few days to wean her off, Ekmo.
34:37She does have a long recovery.
34:39But she's going to come home.
34:41Eventually.
34:41That is the plan.
34:43I don't know how to thank you.
34:45I think you just did.
34:50She's always been able to see what I can't.
34:53Her mind is filled with these big ideas that always seem impossible.
34:59Our wedding, this lake house, getting this tumor removed.
35:05But she knew you could do it.
35:09And she was right.
35:12I almost tried to stop her.
35:17But I'm glad I stayed out of it.
35:21We'll let you both get some rest.
35:29Great work today here with you and Adams.
35:32You really stepped up.
35:34I really appreciate the opportunity.
35:36I learned a lot.
35:41We did a good thing today.
35:46Some might call it inspiring.
35:49Might be even something you could lecture about.
35:53Hey, I hope I didn't overstep, you know, jumping in with the residents.
35:57Oh, no.
35:58I mean, if I'm the only voice that's teaching them, they'll wind up tuning me out.
36:03What do you think about having the residents do an ambulance ride along or EMS training?
36:07Something that could really get them thinking on their phone team.
36:10How it could help them in the ER or in situations like today in the OR.
36:15I think you should write up a proposal and send it to me.
36:23The surgery went well.
36:24We were able to clear the clot and put in a stent.
36:28You'll need to be on anticoagulation, but after a while, you'll be able to get back to life as usual.
36:34I'll get back to life as usual right away.
36:37Or when can I have sex is what I'm asking.
36:39Yeah, I know.
36:40You need to elevate your leg when resting, but other than that, it is good to move it around.
36:47I guess Trudy can still see the doctor.
36:49Trudy's always a good time, but honey, I love you most when you're just Janet.
36:59We'll give you some privacy.
37:12I checked London's labs before leaving.
37:15Thanks.
37:16Hey, I'm sorry about earlier.
37:18How you interact with your patients, your business, I'll stay out of it.
37:22I appreciate that.
37:24I do value your opinion, though.
37:28You do?
37:29I do.
37:30Just, uh, not about relationships for obvious reasons.
37:35What?
37:37Hey, look, I'm putting together a watch list for my patient.
37:41What am I missing?
37:43Well, she hasn't seen any of these.
37:57Hey.
37:59Hi.
38:00Did you make it through your busy day?
38:02Uh, I did.
38:04Uh, I did a thrombectomy and placed a stent.
38:08Nice, Mellon.
38:09You said it told me about that thoracotomy, by the way.
38:13I wasn't that very good deal.
38:14Uh, you saved a man's life with your hands.
38:18Doesn't get any bigger than that.
38:22Do you think I'm aloof?
38:25Aloof.
38:28Um, no.
38:31You're discerning.
38:32You don't suffer any fools, but that's not aloof.
38:36That's, um, that's protecting yourself because you care.
38:43It's funny you say that, because I, I have been, I had the worst day.
38:50I need the biggest vodka tonic that they have.
38:53Hi.
38:54I'm Iris.
38:55Uh, this is Jules Millen, uh, surgical resident.
38:57Nice to meet you.
38:58Nice to meet you.
38:59Um, I should go find my friends to, uh, thank you.
39:05See you later.
39:06It's jarring when your identity shifts.
39:09When you're suddenly a doctor, a partner, a parent.
39:13It helps if you focus on the things that haven't changed.
39:16I'm gonna have to change hospitals.
39:19I've cried in front of too many people at this one.
39:21They understand.
39:25I just feel like ever since I was admitted, I've just, I've just lost myself.
39:33I can't take care of our kids.
39:36I can't take care of my patients.
39:38I can't even shower.
39:40It's temporary.
39:42Your heart is recovering.
39:43I know, but for a few hours today, I got to be a doctor again and help this woman navigate
39:53a difficult time.
39:55But then when it really mattered, someone else got to help her.
40:02At least Gina's okay.
40:04And I would bet that she'd say what you did mattered too.
40:10Maybe even more.
40:14Oh God, it's happening again.
40:17No.
40:18Look at the dishes.
40:22Just.
40:27The comfort of old friends.
40:2935 pounds, that's like carrying four babies.
40:32Yeah, or four bowling balls.
40:34Who carries four bowling balls?
40:35People do weird things.
40:38I gotta go.
40:44Yeah, I'm out too.
40:47See you tomorrow.
40:56She's just a stop sign, not a roadblock.
40:59How did you?
41:01Doesn't matter.
41:03Wait, are you leaving me too?
41:05Um, sorry.
41:07Hey, have a drink on me.
41:14Anyone sitting here?
41:21The thrill of trying something new.
41:23Hi, I'm Sally.
41:24Because even though you may not recognize yourself.
41:27Catherine?
41:29I'm sorry.
41:30I am so sorry.
41:32I got scared.
41:34And I just called the best that I knew.
41:35I should have talked to you before I brought Laura in.
41:37Look, I thought a lot about letting fear cloud judgment today.
41:43Whatever you want to do, I support.
41:46I'm a surgeon.
41:48I'm a senior member of this hospital.
41:51If something were to go wrong and I couldn't stand long enough to do a simple appy, I'd feel weak.
42:00And I don't know how to lead like that.
42:02I don't know who I'd be.
42:05But people adapt.
42:07I want to go ahead with the surgery.
42:15It's been you all along.
42:46I want to go ahead with the surgery.
43:05I want to go ahead with the surgery.