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00:06If you think choosing a college major is hard, wait until you have to choose your medical
00:11specialty.
00:12How late were you up researching treatments for that patient?
00:16Late.
00:16You need sleep.
00:18I'll get right on that.
00:19You have no idea how many emails you get until you come back from a three-month sabbatical.
00:24Delete all.
00:26Wait, what are some of those that are important?
00:27I'm practicing healthy boundaries.
00:29If they need me, they can pick up the phone.
00:34It's not just what medicine you'll practice.
00:36It's your whole life.
00:37Hey, should I pull the drains on Mr. Sherwood before we round?
00:40Uh, no, Adams can do that.
00:42Um, Toni Wright is down a resident, so I took the liberty of moving you to her service.
00:48I hope that's okay.
00:50Dr. Toni Wright.
00:51Yes.
00:52NIH grant recipient for research on myofibroblast for wound healing, pioneer in lymphedema, Dr.
00:58Toni Wright.
00:59Yes.
01:00Yeah, okay, yeah.
01:00I may have read up on it.
01:01Uh, play it cool.
01:03Yeah, yeah, I gotta go prep.
01:04Uh, Ben, why?
01:05Hey, hey, hey, come on.
01:07I was born cool.
01:10Okay.
01:10Okay.
01:11Oh, my God.
01:13I'm playing.
01:14I'm playing.
01:15I'm playing.
01:16Who you'll work with, whether you'll be home in time for dinner, or never see your kids.
01:21I love how they think we have time to go to the doctor.
01:24Last year, I had a dental student pull one of my teeth in the cath lab.
01:28Have you considered egg freezing?
01:30Have I considered giving myself a series of shots, and screwing up my hormones, and then
01:34going through an uncomfortable procedure, and then paying forever to store my eggs in
01:38a freezer, and the chance that I might want kids?
01:40You could have just said no.
01:43I might do it.
01:44I want to keep my options open.
01:46Why do they need to know when your mom had her first period?
01:49Oh, I hope they don't, because I have no idea and no way to ask.
01:53Oh, smoothies.
01:54The choice is yours, and so are the consequences.
02:00Hey.
02:01Hey.
02:04Hey, so my lawyer wanted to check in.
02:07I still haven't received any papers to sign.
02:10Yeah, I still have them.
02:12Your lawyer mentioned wanting to file before the end of the month.
02:16I just, I've been slammed with work.
02:18If we don't do it soon, they're going to make us pay additional retainers.
02:21I'm aware.
02:22I'm sorry.
02:23I have a consult, but I will get to them as soon as I can.
02:26Okay.
02:26Dr. Morales to the ICU.
02:28Dr. Martha Morales to ICU.
02:33Dr. Wright.
02:34Hey.
02:34Ben Warren.
02:34Thrilled to be on your service.
02:35Nice to meet you, Benson.
02:37Back on my service again?
02:38Yeah, can't get enough.
02:39And people call me blue.
02:40After the Joni Mitchell album?
02:42No.
02:42Oh.
02:43Well, that's too bad.
02:44It's one of the all-time greats.
02:46I applied to three colleges in California solely because I thought it'd be cool to sing
02:50that line about coming home there and literally mean it.
02:53Do either of you play guitar?
02:55Uh, not really.
02:57Well, yeah.
03:00So now, feel free to push me.
03:02You know, I like to work hard and I'm actually applying for a plastics fellowship.
03:06Good for you.
03:08You should have told her you play guitar.
03:14Five minutes to answer, Paige.
03:15The patient could have died in that time.
03:17Did somebody die?
03:17Well, that's irrelevant.
03:21What do we got?
03:22Randall Lutton, 62.
03:24He has scrotal swelling and severe pain after blunt trauma.
03:27BP is slightly elevated.
03:28Day two of morphine in route.
03:30Ah, God, it hurts like hell.
03:33Okay, we're gonna get you more inside, okay?
03:34You got up to use the bathroom in the middle of the night and walked right into the dresser.
03:38Yeah, I'm gonna need an ultrasound and some gel.
03:40Are you a doctor?
03:41Urologist.
03:42No need to comment on the irony.
03:44Okay, let's get him to trauma one.
03:51Hey, Cortman.
03:51Just double checking you're getting your IV antibiotics before rounds with Dr. Altman.
03:55Um, do you think you could slip me the staff Wi-Fi password?
03:59I know, the guest Wi-Fi is spotty, but ours is used for things like imaging and staff messaging, so
04:04they're pretty strict about it.
04:05Could you make an exception?
04:07I just, I really want to see my cousin get married in Big Sur today.
04:09Second cousin, second marriage, and he's not that great.
04:18You didn't get it from me.
04:22Somehow, I am always in the hospital for my friends and family's Big Life events.
04:26This is the second aortic graft to get infected in a year.
04:30No offense to Dr. Altman, but if this one doesn't take, we need a second opinion.
04:35Well, Dr. Altman's extremely skilled.
04:37She's even kind of famous now. She invented a new surgery.
04:40Yeah, but like a difficult one?
04:43Don't look at me like that.
04:44I already know I'm becoming mom.
04:47Surgery's incredibly complicated.
04:49She's on a podcast. You can look it up.
04:52Told you. I just had bad luck.
04:54Well, hopefully the new T-bar gives your aorta a break, so the antibiotics can do their job.
04:58That's what you said last time.
05:01I'll be back soon.
05:08Welcome back, Dr. Shepard.
05:09Have you met our new classics attending, Dr. Tony Wright?
05:12Relatively new. Nice to meet you.
05:14We should get started. It's a Lafort fracture. I'm sure there will be questions.
05:19Did you see that?
05:20Uh, yes. Yeah, I don't know.
05:22I don't think she remembers me.
05:24Should she?
05:25Well, we went to med school together. We were in the same study group. She hated me.
05:28Well, maybe it's better she doesn't remember.
05:34Teresa Daniels, 49, post-op day 5 from a hemicraniectomy for subdural hematoma after auto versus pedestrian.
05:42Concomitant Lafort 1 fractures.
05:43Please say you're fixing my mom's face today.
05:46That's up to Dr. Shepard. She'll tell us if your mom's head bleed has healed enough for us to perceive.
05:50I'll do a neuroexam on her now and make sure the EBD is working.
05:54So, uh, what are you studying?
05:56Data science. I was going to major in it, but the intro course is hard.
06:00I'm a freshman at UC Davis.
06:02Do you have a study group?
06:05I haven't found the right people.
06:07It does make a big difference.
06:09My mom says to stick with it.
06:11I was complaining to her about it on the phone when she got hit by that idiot driver.
06:16That's awful. I'm so sorry.
06:18She'll be happy to see you when she wakes up.
06:19ICP is 12 and subdural is stable.
06:22Great. So we're good to go. Let's order a CT max face before bringing her to the OR.
06:34Hey, sorry I'm late. How was cousin Frank's wedding? Were you able to stream it?
06:40Still no contractions.
06:41Don't jinx it.
06:44Okay.
06:45Dr. Mead.
06:46Corbin Gregory. 28 year old male. Status post coarctation repair when he was two.
06:52He subsequently had two graft repairs. Both became infected.
06:55Has now developed a pseudo aneurysm and is here today for his second T-VAR.
06:59You made somebody a new aorta?
07:02He's stalking you online. I told him it was weird.
07:04And it said that the patient had two repeat graft infections too. Can I get this?
07:10A T-VAR is still a solution for you. It's less invasive and less risky.
07:14For me? Or for you?
07:17Corbin, the patient that you're reading about was much sicker.
07:20I don't want another band-aid if there's a permanent fix.
07:23I don't want to diminish what you're going through.
07:25You think you know what I'm going through?
07:27My favorite thing is running, but I can't remember the last time I had a runner's high.
07:31I won't be able to lift my baby nephew.
07:33I can't travel. I can't visit my friends.
07:36I have spent more time in the CCU than my own house in the last year.
07:38Is that not sick enough for you?
07:41Well, you just don't care?
07:43That's not true.
07:44Then why won't you fix me?
07:45I wish there was an easy fix.
07:48Just get out.
07:50Get out!
07:52Okay.
08:11It's a larger patient load than usual, but with two of you, Adams, please tell me that you are at
08:18the benefits fair or rounding or anything but late.
08:21Sorry, I was on the phone with Boise General. They don't have Katie Rogers immunotherapy either.
08:25Well, the government cut off funding. You're not going to find it.
08:28Okay, what about cytoreduction surgery with HIPEC?
08:31What about it?
08:32Well, could Katie be a candidate for it?
08:34I emailed you the case report.
08:36Okay, now I appreciate your initiative and I will look at it, but right now I need you to focus
08:41on patients that are currently admitted to the hospital.
08:44We're down two residents due to illness and a family wedding, so I need you and Spencer to get started
08:52on the floor, okay?
08:53Ms. Hayes needs a Dob-Hoff tube for tube feeds.
08:57Oh!
08:58Well, I've never inserted an NG tube on a real person, or a fake one, so...
09:03Well, um, Adams will help you.
09:05Hey, don't forget to check your email.
09:06I...
09:09Just keep taking deep breaths. New pain medication should kick in any second.
09:13Can I take a look?
09:15Yeah.
09:17Wow.
09:19That looks painful.
09:20Last I checked, it measured 20 centimeters.
09:22I suspect a bleeding testicular artery.
09:25Do you see anything?
09:26Uh, it looks like it's expanding.
09:28Let's get an ultrasound and paid urology.
09:30Was the dresser sharp?
09:31I mean, I do see a couple of small lesions.
09:33Must have just snagged a drawer pull.
09:35Okay.
09:36Well, let's get him some more fluids and a full set of labs.
09:40Okay.
09:41Well, the testicles are intact, and they're in the correct position.
09:44Okay.
09:44But I do see some free fluid in the scrotum.
09:48Oh, my God, Randall.
09:50Is it his heart?
09:51Uh, no.
09:52My heart's just fine.
09:53Doctors, this is my wife, Kimmy.
09:54Okay.
09:58Is that one of your...
10:00Yeah, I walked into the dresser.
10:03Probably just a hematoma.
10:04Is this gonna jack your fertility?
10:06I ovulate next week.
10:08We're going to give you some privacy.
10:17You've been back three hours,
10:19and you've already requested a new 3D microscope with AR tech?
10:23Why are you reading emails?
10:24When you are supposed to be on leave.
10:26The captain finally left the house.
10:27If that woman makes me take one more nap,
10:29I'm gonna lose my mind.
10:31Um...
10:32When did you hire Toni Wright?
10:34A few months ago.
10:35I'm surprised we got her.
10:36Jackson says she's the go-to for facial reconstruction.
10:39Well, yeah.
10:40Jackson is the go-to for facial reconstruction.
10:43Is there a problem?
10:45I just spent the last few months getting to a really good place.
10:47I took scout camping.
10:49I went to the grocery store during normal hours.
10:52I slept.
10:52You need to get to the point.
10:54Wright and I...
10:56have a history.
10:58In that historically, she...
11:01pushes my buttons.
11:02If I hired people based on whose buttons they push,
11:05no one could work at this damn hospital.
11:07And your request for a microscope is denied.
11:21You know, I, uh...
11:22I read that you won the Goldstein Award for excellence in teaching.
11:26Hmm?
11:28I...
11:29I...
11:29Um...
11:30No.
11:30Heh.
11:38So...
11:40You must be an excellent teacher.
11:42That's the name of the award.
11:47She is all set.
11:49Okay.
11:58Yep.
12:00Well, her nasal frontal and zeal sutures are broken.
12:04Good. What else?
12:06Her zygomatic arch is comminuted.
12:08And it's a Lefort 3, not a Lefort 1.
12:10Man, this just got a lot more complicated.
12:12Should I call the OR?
12:14Let them know that we're gonna push the surgery.
12:16And our daughter's gonna be crushed.
12:17No, we're not pushing anything.
12:19Every day that she's intubated, it makes it tougher for her to recover.
12:22We're just gonna have to come up with a new plan.
12:26Quickly.
12:32Is he asleep?
12:34Just resting.
12:36Did you get my scans back?
12:38Everything looks stable, so you're all set for the T-bar.
12:42Corbin!
12:44He was hoping you'd say that he got worse, so he could get that new aorta business.
12:50The T-bar really might work.
12:52A new aorta would definitely work.
12:54If you survive it.
12:58I wanna talk to the other guy.
12:59The doctor that did the new surgery with Dr. Altman.
13:02Dr. Ndugu.
13:03You could give me a second opinion, right?
13:05Dr. Altman should be in shortly.
13:06You can ask her any questions or you could check-
13:08I'm asking for Ndugu.
13:09This is my life.
13:10I'm not gonna ask permission to hear about all my options.
13:14Would you?
13:15Just give me ten minutes with him, please.
13:19I'll talk to him. No promises.
13:23Catherine, I didn't know you were here today.
13:25Oh, I had to get out of that house.
13:27For ten days I've been taking care of my husband.
13:30I don't know how these nurses do it.
13:32All right, where's my consult?
13:35Randall?
13:37Randall, what are you doing here?
13:39Good to see you.
13:39Oh, we missed you at the last AUA conference.
13:42We were on our honeymoon.
13:44Oh, that's right.
13:45So, what brings you in?
13:49You have more important things to do.
13:50I can see a resident.
13:52Nonsense, I am here.
13:53Dr. Hunt, what have we got?
13:55Blunt trauma, now experiencing severe scrotal swelling.
13:58It's the size of a coconut.
14:00Thank you, Dr. Millen, for that wonderful assessment.
14:02Randall, may I?
14:06You don't have to be here for this.
14:07Why don't you just go eat?
14:08I'm sure you're starving after Pilates.
14:11I am not leaving your side.
14:13How does it look?
14:14Well, for blunt trauma,
14:16it doesn't seem to follow the typical injury pattern.
14:19Will this mess up his sperm count?
14:21Yes, it will.
14:22From walking into a dresser?
14:24How is it this bad?
14:25I'll let Dr. Lutton answer that.
14:31I didn't walk into anything.
14:36Okay, please don't hate me.
14:38I gave myself a vasectomy last night.
14:43While I was at book club?
14:46What the hell?
14:47I will page psych.
14:48Mm-hmm, yeah.
14:57Keep swallowing.
14:58Mm-mm.
14:58It pushes the tube down your esophagus to your intestine.
15:01Okay.
15:03Does that look right?
15:05Yeah.
15:05Keep going until you hit the mark we measured on the tube.
15:08You sure you know what you're doing?
15:10Uh...
15:11She does.
15:11Keep sipping.
15:13Chin down.
15:13Is that mine?
15:15My cats are just supposed to be calling.
15:17Excuse me.
15:18Hi.
15:19It's Dr. Adams.
15:20Yeah.
15:21Actually, I'm with a patient right now.
15:23Can I call you back?
15:28Okay.
15:29I'm done.
15:30All right.
15:30Looks good.
15:31Pull out the stylet, secure the tube, and start trickle tube feeds.
15:34Then we gotta do research for Dr. Bailey.
15:36She didn't mention anything about research.
15:38It's for her patient.
15:39Oh.
15:40Well, she's in luck.
15:41I'm really good at research.
15:43In med school, I presented a poster.
15:45Great.
15:46Finish up here, and I'm gonna get started.
15:48Where are you going?
15:49I'll text you.
15:52I'll text him.
15:57Hey, how's it going with Wright?
16:00I have no idea.
16:02Did you change services?
16:03No.
16:04I'm just getting zero vibe.
16:06Because you're over-vibing?
16:08No, no, no, no, no.
16:10Okay, I've been cool.
16:11No excessive praise, no impulsive moves.
16:13Well, just give it time.
16:16Hey, if it makes you feel better, I hear your residency director is very impressed.
16:21It does.
16:24Psych is on their way.
16:26That man doesn't need a psychiatrist, he needs a marriage counselor.
16:29You think he was successful doing it on himself?
16:32We'll find out.
16:33I gotta get him in an OR and evacuate that hematoma.
16:36Can I scrub in?
16:37I've never operated on a DIY vasectomy before, and it'll be my second.
16:41Wait, you know somebody else who tried to do their own vasectomy?
16:44Another urologist said he was embarrassed.
16:47I don't know why these boys don't just pick me for fun and call me.
16:50It's just a hollow tube filled with sperm.
16:53In fact, if you ever want one...
16:54I'm good down here.
16:56Go scrubbing.
16:57Ah, wait.
16:58Just let Kimmy get in another few rounds, then go prepping.
17:06Can't even count how many fractures she has.
17:08Yeah, the number doesn't matter.
17:10Okay, so how do we plate her zygomatic art?
17:12It's like tempered glass.
17:14There's nothing solid to screw into.
17:16Warren, any ideas?
17:18Uh, create a scaffold of cadaveric bone paste and BMP.
17:22You've studied this.
17:23No, I saw it once.
17:24Years ago.
17:25I was an anesthesiologist before I went into surgery.
17:29Interesting.
17:30Okay, so our first step is going to be to wire her jaw with her bite in the proper place.
17:35We won't be able to have her orally intubated for anesthesia, Warren, trach, or submental intubation.
17:41Oh, trach.
17:42It's a straight shot into the airway, less risky than going through the chin and the mouth.
17:45Spoken like an anesthesiologist.
17:47A plastic surgeon thinks it'll take her three months to heal from a trach.
17:49A submental incision will heal in a week.
17:52Quan, what are the steps of a submental intubation?
17:57You make an incision under the chin and honestly, I don't know.
18:03Of course not.
18:03You're a Gen Surge resident.
18:04You'll learn today.
18:06Cool.
18:06It is.
18:07Take a look at this.
18:11So we would create a large segment of aorta with a synthetic graft, rerouting it from your chest to your
18:17abdomen.
18:18And then we would staple off the infected piece here and remove it at a later time.
18:21So then no more T-bar procedures?
18:23If the surgery is successful, yes. That's the idea.
18:26And you really think this could be a success for me?
18:28I would need to further study your case before I could answer that.
18:31So shoot me his latest imaging.
18:32And I want to do another echo before we...
18:35Dr. Ndugo, excuse me. May I have a word, please?
18:37Sure. Yeah. Excuse us.
18:47Someone talk fast.
18:48Orban S for a second.
18:49Not you.
18:50You're talking to my patient behind my back about a procedure that I've already said no to.
18:55Okay. I assumed you were aware.
18:57Don't do that.
18:58Don't put it on the resident to have the uncomfortable conversation with her attending.
19:02The patient asked if he was a good candidate for ventral aorta.
19:04I simply explained what it was.
19:06No. You got his hopes up.
19:08And if you had come to me first, I would have explained that unlike Nora,
19:12Corbin has major scarring from a previous esophageal reconstruction.
19:15He is a bad candidate for it.
19:17How do we know who's a good candidate? We've done this once.
19:19And that might be all we ever do if we kill Corbin with it.
19:22Nora hasn't even hit the six month mark. We need more time to see how she does.
19:27Okay. All right.
19:31Dr. Alvin, I'm sorry. I wasn't sure.
19:32How did Corbin even know about the ventral aorta in the first place?
19:36If you shut me out again, you are off this case.
19:45I'm her boss.
19:47Didn't she make you chief while she was chief?
19:51Okay. Well, so what did I owe her?
19:53If I made someone chief and they gave my patient a second opinion behind my back,
19:58I would blow my sack too.
20:00Yeah. Yeah. That part was bad, but I'm not wrong.
20:03This surgery could cure all kinds of aortic disease.
20:08Okay. Tonya Wright just gave me the cold shoulder again.
20:12It's okay. I was pretty much done.
20:14Okay. She can do a super micro surgery in a 30 X magnified field, but she can't say hi to
20:19me.
20:19Oh, Amelia, don't. I can't watch this. Nope.
20:26Hi. Hi.
20:28We went to med school together. You hated me.
20:31How?
20:32I didn't hate you.
20:35So you do remember me?
20:37Yeah.
20:42I should have thought this through. I don't really know what happens next.
20:47Why did you think I hated you?
20:49You ran out of your own birthday party when I showed up uninvited.
20:53Oh, my God.
20:53You changed study groups and actively avoided me in labs.
20:58Because I liked you.
21:00What?
21:01I tried to kiss you in the mission during orientation.
21:04You were drunk. I thought you stumbled into me.
21:09No. I had a huge crush on you.
21:12I mean, I thought you were queer, but then I wasn't sure. So I didn't want to get burned. So
21:16I kept my distance.
21:18But you have nothing to worry about. This is all way in the past. And frankly, you're not my type.
21:27My OR is ready.
21:31For some reason, I froze when I saw you earlier. I'm glad you cleared beer.
21:38I'm pretty sure Altman hates me.
21:40Yeah, if she didn't kick you off the cage, it's probably fine.
21:42Let's talk about something else.
21:44Uh, my patient tried to give himself a vasectomy.
21:47Wow, we will always have jobs.
21:49Everyone thinks they can do anything themselves. They watch enough videos on social media.
21:53Are you the board-certified urologist?
21:55You know what? That actually seems doable with some lidocaine and a mirror.
22:00Our OR is ready.
22:01I'm out.
22:05How come women in their 20s have to shell out big bucks to preserve their fertility,
22:09but men in their 60s are so worried about pregnancy they are giving themselves vasectomies?
22:14Evolution failed us.
22:16Do it with me.
22:17Our future and less fertile selves will thank us.
22:20So we can both be hormonal at the same time.
22:22It's a hard pass.
22:23But I will do your shots.
22:25I am very good at giving injections.
22:28Don't ask why.
22:36You can have the other half of my sandwich if you're hungry.
22:39I brought it from home.
22:40Yeah, I'm good.
22:41Did you email me the results for the immunotherapy study from San Francisco?
22:45I included it in the Chicago study at the bottom.
22:48Okay.
22:48I like to cook.
22:49Do you?
22:50It makes me happy following directions and...
22:53I wonder if we could file a compassionate use application for her meds?
22:57Or maybe we could get it off-label directly from the manufacturer.
23:02Why is this particular patient's research so important?
23:06I mean, I just meant, weren't there others in the trial?
23:09What about them?
23:10Look, I care about all the patients.
23:13I do.
23:13I just...
23:15How Katie...
23:16She's in her late twenties just like us.
23:19She feels like a classmate.
23:20Or more like a friend.
23:22We've just spent a lot of time together.
23:25So she is now kind of a friend.
23:28I get it.
23:30It's like when you meet someone and you feel like you've already met them before.
23:35Like...
23:36They're supposed to be in your life.
23:42Oh, no.
23:43It's Wendy.
23:50Hey.
23:50May I come in?
23:57She wanted me to apologize?
23:59Unbelievable.
24:00It's okay.
24:01Can we have a minute?
24:03Sure.
24:05Don't say anything stupid.
24:07You're stressing me and the baby out enough.
24:13If you want Dr. Nduga to replace your aorta, I won't stand in your way.
24:17But I do need you to hear me out first.
24:20Okay.
24:21Talk.
24:21Okay.
24:26We have done this once on a person with very, very different anatomy who could have a complication at any
24:33moment.
24:34So it's not just a risk.
24:35It's a complete unknown.
24:37There is no way to know what will happen if we staple your aorta shut.
24:41And it's irreversible.
24:43If the staples don't hold and you hemorrhage, you'll die.
24:50I don't want to do this surgery on you because I want you to be able to meet your nephew
24:54and see your sister become a mom and go running again and visit your friends.
24:59And I know the idea of going through this again is infuriating, but at least, at least you'll still be
25:08alive.
25:18I'll give you more time.
25:25Thanks.
25:34Nice.
25:35You didn't skive at all.
25:36And now I will lift the scalp flap to expose the face.
25:43Hold up.
25:44What have you got there?
25:45A beaver blade.
25:46What are you trying to keep us here all day?
25:47Plastic surgeons use this to make delicate decisions.
25:49Yeah, sure, if we're working on a cleft lip or somewhere where every millimeter counts.
25:54The scalp's robust.
25:55Get him the 15 blade.
26:03Make sure to stay in the same plane.
26:07Good.
26:09Oh, there's some fluid.
26:17Give me a specimen tube.
26:25Paper towel.
26:34It's a halo sign
26:35Dammit, she's leaking CSF
26:37We need Neuro now
26:46What happened?
26:47She was fine
26:48I started the trickle feeds
26:49And her sats dropped
26:49What's wrong?
26:50Hold on, we're gonna find out
26:51Just don't move
26:55The tube is in her lung
26:56Wait, you didn't see that on the x-ray?
26:58What x-ray?
26:59Let me see
26:59Look, you have to get an x-ray
27:00After you insert a doll pocket
27:01And most importantly
27:02Before you start feeds
27:03Okay, let's pull it out
27:04Quickly now
27:05I'm sorry, this is my first one
27:07I didn't know
27:07No, it's okay
27:08And we can fix this
27:10Prepare for a bronchoscopy
27:11To suction the feeds out
27:12Okay
27:19Suction?
27:23Is it weird operating
27:25On your friend's scrotum?
27:26Oh, my dear
27:27You've seen one testicle
27:28You've seen them all
27:30But asking me if I think
27:31The man has a screw loose
27:32Ooh
27:33He must really not want kids
27:35Of course not
27:35He's a grandfather
27:36That's when all the fun starts
27:38Raising a child is hard
27:40This coming from the chairwoman
27:42Of the National Hospital System
27:44I don't know how you did it
27:45Me neither
27:46But I will tell you this
27:47As proud as I am
27:48Of all my accomplishments
27:49The best job I've ever had
27:52Is being Jackson's mom
27:54And the biggest surprise
27:56I didn't think I wanted
27:57To be a parent
27:58I just never had that pull
28:01But life is full of surprises
28:05I just asked Kimmy
28:06No
28:06She's gonna make sure
28:07That lawyer's looking
28:08Over that prenup
28:09Okay, let us finish
28:10This vasectomy
28:11In the right way
28:12I've palpated
28:13The vas deferens
28:14And isolated it
28:15Now
28:15What is next
28:17Exteriorize
28:18Legate both ends
28:19Then divide
28:19And send a path
28:22After you
28:254-0 Vicro
28:32All right
28:32What happened?
28:33She has a CSF leak
28:35Can you show me
28:35Where the fluid's coming from?
28:37Do you think it's
28:37From the cranial base?
28:38I can't see
28:39Let's light it up
28:40Dilute fluorescein
28:41Please
28:42Inject it into the EVD
28:44And clamp it
28:45Injecting now
28:46All right
28:47Now we wait
28:48Lights please
28:49For what?
28:50The drain is in her ventricle
28:52Which is filled with CSF
28:54If this is a leak
28:55We should see
28:56Yeah, the fluorescence
28:58Is coming from the location
28:59Of the dural tear
29:00Is it weird
29:00That I think that's beautiful?
29:02Not at all
29:03All right
29:04Let's sew this up
29:055-0 Nylon
29:07Actually, the dura is friable
29:09It's not gonna hold a stitch
29:11And the pericranium
29:12Is too scarred
29:13To harvest for a patch
29:14You want some fasciolata?
29:15I think that might be
29:15Our only option
29:16Put the thigh
29:17Not the only option
29:18Instead of another incision
29:20I can harvest fascia
29:21From the existing field
29:23You think it'll have enough
29:24Bite to hold the dura?
29:25Give me three minutes
29:25I'll show you
29:27Scalpel
29:35Okay, mom
29:36Whatever
29:38I'll let you know
29:38When I know
29:39What he's decided
29:40Hey
29:41Everything okay?
29:44Everything's fine
29:45I'm just
29:46A terrible person
29:47I have a hard time
29:48Believing that
29:49You're spending
29:50Your third trimester
29:51With your brother
29:52In the CCU
29:53My mom's a wreck
29:55Because her son
29:56Is having another
29:57Big surgery
29:58While she's recovering
29:59From pneumonia
30:00And I just
30:01Yelled at her
30:02Because she didn't
30:02Have an opinion
30:03On the paint color
30:04Of the nursery
30:05Yeah, you want
30:06Your mom's help
30:06It doesn't make you
30:07Terrible
30:10I'm just overwhelmed
30:11Of course you are
30:12There's a lot
30:13Going on
30:14I'm not so stupid
30:16I am 36 years old
30:18I'm about to have a kid
30:21But I still
30:22Just want my mom
30:25I know the feeling
30:29I should call her
30:30And apologize
30:32I'll see you up there
30:47Hey Corbin made his decision
30:49He wants a T-bar
30:50Great
30:52I paid someone else
30:54But we're down residence today
30:55I'm good
30:57Do you need a minute?
30:58Not at all
30:59I'll go prep him
30:59Okay
31:05Dr. Bailey
31:05I am so sorry
31:06I take full responsibility
31:08I should have told Spencer
31:09To check the KUB
31:10Before starting fees
31:11Yeah, damn right
31:12And you better have
31:13A good reason you didn't
31:14Yeah, a pharmaceutical company
31:15Called with a lead
31:16On Katie's infusion
31:17So I just wanted
31:18No, the last time I checked
31:19I asked you
31:20To focus on your patients
31:22Admitted in the hospital
31:23I only picked up long enough
31:24To let them know
31:25That I was serious
31:26Wendy could have died
31:27Of chemical pneumonitis
31:28Or pneumonia
31:29She didn't
31:29And Katie could die
31:31If we don't fight for her
31:32I know
31:32I am fighting for her too
31:34Are you?
31:35Because what options
31:36Have you found?
31:37What research have you done?
31:38Have you exhausted
31:39Your contact list?
31:40Because it feels
31:41Like you've given up
31:43Oh, so
31:44You think after
31:45Katie sobbed
31:46In my arms
31:47I shrugged
31:49And said good luck
31:51And I gave her a goodie bag
31:52And sent her on her way
31:53She's dying
31:54Okay
31:54And I think about it
31:56Every single day
31:58And I also think about
32:00My 65 year old
32:02With decompensated cirrhosis
32:04Who's treatment resistant
32:05And the 17 year old
32:07That's septic
32:08And I can't figure out why
32:09Don't forget about John Doe
32:10In the ICU
32:11Whose abdomen
32:12I had to leave open
32:14Yeah, he's also
32:16Keeping me up at night
32:17And now I guess
32:18You can add Wendy
32:18To my list
32:20See, I haven't given up
32:22On Katie
32:22But I also haven't given up
32:24On the rest
32:25Of my patients
32:26And that
32:27Is where you and I
32:29Are different
32:31Get it together
32:53Hi
32:54Randall did great
32:55He is recovering now
32:57And they will call you
32:58When he's ready for visitors
32:59Is it bad if I don't answer?
33:01No one would hold it
33:02Against you
33:04I really do love him
33:06That's what makes us
33:07Hurt so much
33:09I mean, it's his body
33:11And he can do
33:11Whatever he wants
33:14But if I want to
33:15Stay married to him
33:17I don't get a say
33:18In whether I have a baby
33:19Well, you could always
33:20Ask him to reverse it
33:22What's the point?
33:24He obviously doesn't
33:25Want to have kids with me
33:27Uh
33:29Well, can you get a puppy?
33:32I'm allergic
33:34That's unfortunate
33:41Hey
33:42Hey
33:43I did Corbin's T-var
33:45He did great
33:46His numbers are improving
33:49Okay
33:49Look, I'm sorry
33:51If I came across
33:52As harsh earlier
33:55I still maintain
33:56That the ventral aorta
33:58Wasn't the right call
33:59For this patient
34:00What about the next one?
34:02You were more than happy
34:04To talk about this surgery
34:05On podcasts
34:06Publish abstracts
34:07Present it
34:09You were the one
34:09Who came up with it
34:10What's the point
34:11If you never do it again?
34:12It's a break the glass
34:13In case of emergency surgery
34:15But does it have to be?
34:17Think of the number
34:18Of people suffering
34:19From aortic disease
34:20With no options
34:21We might have something
34:22That could help them
34:23Why don't you want to use it?
34:34She looks terrible
34:37She'll look more like herself
34:38When the swelling goes down
34:39And we'll keep monitoring
34:41Her brain function
34:41To see what's intact
34:42Her intracranial pressure
34:43Is stable
34:44And she's not re-leaking
34:45Any fluid from her nose
34:47That's good
34:49I think I have to drop
34:50Out of school
34:51I can't leave her like this
34:54It's always been me and her
34:57Have you thought about
34:58Contacting the school
34:59Maybe take a leave of absence
35:01Or do your coursework remotely?
35:03You think they'd do that?
35:05Yeah, you worked really hard
35:07And if you stop now
35:08Then it's gonna be a lot harder
35:09To start back up again
35:10Never hurts to ask
35:15You know, um
35:15Excuse me
35:19Uh, Dr. Wright
35:20Um, I ordered Teresa's
35:21Post-op imaging
35:22But it probably won't
35:23Happen overnight
35:23So I'll make sure
35:24It's done for first thing tomorrow
35:25Good
35:26Thank you
35:28All due respect
35:28Uh, I don't want to be
35:30Just good
35:31I want you to see me
35:32As excellent
35:33So I'm asking
35:34What would that take?
35:35Tell me what you need me to do
35:36And I will do it
35:38There's your problem
35:39That I'm not anticipating
35:40You well enough?
35:41You're trying to anticipate me
35:43When you should be trying
35:44To anticipate the medicine
35:45Look
35:46Over the years
35:47I've found that
35:48The most successful residents
35:49Focus on patient care
35:50And surgical technique
35:52Mm-hmm
35:52They're confident
35:53In who they are
35:54Which translates
35:55Into them being confident
35:56In what they do
35:56And that
35:57Is what leads
35:58To excellence in plastics
36:00I didn't see that
36:02From you today
36:03Maybe next time
36:12Hey, did you update
36:18Miss Cahill's output for Baxter?
36:20He's on tonight
36:23You okay?
36:25You okay?
36:26Look, Bailey was mad at me
36:28Not you
36:28And she was way out of line
36:30Bailey?
36:31Bailey wasn't the problem
36:35Spencer
36:35I thought you were gonna apologize to me
36:37For what?
36:39Look, you might have taken the heat
36:40Because you're the second year
36:41But I fed the tube into Wendy's lungs
36:43And if you told me to get a KUB
36:45I would have taken a damn x-ray
36:46And not initiated feeds
36:47Okay, but we managed it
36:48She's fine
36:49She had food in her lungs
36:55Oh, okay
36:56Thank you
36:58Thank you
37:01I wasn't cool
37:04Oh, you're being hard on yourself
37:05Oh, she said in no uncertain terms
37:08That she did not see excellence in me today
37:12I'm sorry
37:12You know what makes it worse?
37:14She wasn't even mean about it
37:15She just said it like it was a fact
37:17Yeah
37:19Well, you think it's a fact?
37:20Oh, no, no, no
37:21I was thinking about how I yelled at Adams
37:24Oh, what do you do now?
37:26Well, his concern for one patient
37:29Got in the way of his care for other patients
37:32Katie Rogers
37:32Yeah
37:33I mean, truth is
37:35If she was our only patient
37:37His dedication would be admirable
37:40I hope I wasn't too hard on him
37:42Well, I guess we gotta have thick skin
37:45If we're gonna do this thing
37:47Wanna go home?
37:48Let's go home
37:57Hey
37:59Everything okay?
38:04I haven't signed the papers yet
38:09But getting a divorce was your idea
38:11I know
38:13I know
38:15You have any second thoughts?
38:18No
38:20I keep taking the papers out to sign
38:22And then I don't do it
38:23And now they're just sitting in my bag
38:25With crumbs and crayon marks on them
38:30Just because it was my idea
38:32Doesn't mean that I'm not scared
38:36What are you scared of?
38:38I don't know
38:39That everything will just explode
38:40And fall apart
38:43But doesn't that happen already?
38:56But you don't do them right now
38:58I mean, I'll take out another retainer
39:00We don't have to watch this
39:00I have to do it sometime
39:11My sixth grade teacher said
39:12Your actions plus your choices
39:14Equals your life
39:16This is mostly true
39:18I can do a whole vasectomy
39:20Start to finish
39:22It's pretty straightforward
39:23Why are you looking at me?
39:28Why did you change your mind?
39:30Yeah, today looking at questions about my mom
39:33Thinking about being a mom
39:34She brought up a lot of old feelings
39:35I don't have time to deal with
39:37I need to focus on work
39:40What if I did it with you?
39:42I don't have to be here for this, right?
39:43No
39:45What? You didn't want kids?
39:47I don't think I do
39:49But I also don't want to wake up one day
39:51And my eggs are all shriveled and dusty
39:53And realize that I do
39:56And it's too late
39:57And then if we do it together
39:59I could be there for you
40:01If you think about your mom
40:04You'd do that?
40:06Yeah, yeah
40:06And then I can tell you about my mom
40:07Which would make you feel better
40:11Fertility friends?
40:13Don't call it that
40:18No, no
40:21But what it doesn't account for
40:22Is luck
40:22What is going on?
40:24Leticia, you have to wait outside
40:25Someone tell me what's going on
40:26Get her out, please
40:26It's gonna be okay
40:27No
40:28It's gonna be okay
40:29What happened?
40:30I got him back after one round of epi
40:31But he's still hypotensive
40:32With a narrow pulse pressure
40:33Did you get an x-ray?
40:34I'm right here
40:35Good work
40:37We just started widening
40:38The leak is expanding
40:39Paige Altman
40:40We need to get him back to the angio suite
40:47Let's go
40:49Sometimes we encounter
40:50Unexpected twists of fate
40:54Hey
40:54Hey
40:56Thanks for today
40:57You're the only neurosurgeon
41:00That's ever responded to my page
41:02In under an hour
41:03Yeah, well
41:04It was my first day back
41:05So I didn't have a lot going on
41:08I'm not
41:09Not to say that
41:10I'm not always prompt
41:11Right
41:12Meet me again
41:13I will come just as fast
41:15Okay
41:18I made it weird
41:20No
41:20I swear to you
41:22The crush is all in the past
41:23I've had many crushes since then
41:25Succeeded at several
41:26Changed programs
41:28When others have failed
41:31You used to laugh more
41:37I also had a crush on you
41:40I mean
41:40I didn't understand
41:41What I was feeling
41:42But
41:42I wish I had known
41:46Sorry
41:47That is
41:48I'm not hitting on you
41:50In the attendings lounge
41:51Sorry
41:52This is work
41:54Do you want to
41:55Go somewhere
41:57Get a coffee
42:01And the best things in life
42:03Fall out of thin air
42:16All you have to do is catch it
42:23Look steamy, right?
42:25Mark Sloan
42:26Oh
42:27This is awkward.
42:29We're the dirty mistresses.
42:31I suppose we are.
42:33I'll show you the slow method.
42:35How many nurses have you slept with this week?
42:37That's not a problem, man. That's an adventure.
42:39The Plastics Posse?
42:41Kicking surgical ass and taking names.
42:43The Plastics Posse.
42:44People don't come to me to fix what's on the outside.
42:46They come to me to fix what's on the inside.
42:48If that means giving someone a straighter nose or a bigger breast.
42:51If that helps a person get by.
42:53I don't run. I don't hide. I don't take space.
42:56I'm a dad.
42:57We're fair.
42:59I'm a baby.
43:00Why are you telling me to give a time when there's no guarantee that time is gonna be there?
43:05If you love someone, you tell them.
43:08Even if you're scared that it's not the right thing.
43:10Even if you're scared that it will burn your life to the ground.
43:14You say it. You say it loud.
43:21Don't waste one single minute.
43:26Forget the world.
43:28Forget the world.
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