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00:01Previously on Doc.
00:02He's back.
00:03I made mistakes.
00:04Actually, you leveraged an incredibly painful situation to your advantage.
00:08And how are things with Nora now?
00:11Over.
00:11I found a lump.
00:13Please don't tell anyone about this.
00:14Do you have a minute?
00:15I'm in radiology right now with a patient.
00:17What if she's sick?
00:18I guess she's trying to hide it.
00:19It's progressing quickly.
00:20I suggest you reach out to Ethan.
00:22Get a support system in place.
00:24You went into her desk?
00:25We had no other choice.
00:26I'm afraid that you might be sick.
00:28We gotta talk about Joan.
00:44Dr. Ridley.
00:45Oh, they're here?
00:46Heading up now.
00:47OR3 is clearing the blood banks on standby.
00:49Good.
00:50Then we are ready.
00:53Bay 4.
00:54Breathe me in.
00:54Penetrating abdominal wound.
00:55Initial stabilizing surgery on site, but multiple retained foreign bodies could not be removed.
01:00Open wound pack for transport.
01:01How do you do on the flight?
01:02Hypertensive and tacky.
01:03Started norepi and fluid recess en route.
01:05Conscious?
01:05In and out.
01:06I'm asking for you.
01:08On my count.
01:09Three, two, one.
01:13Hang TXA to a bone egg.
01:14I want him on the table in half an hour.
01:17Ridley?
01:19Is that you?
01:19If you missed me this much, you could have just called.
01:24You know I left to make an entrance.
01:27Well, you are here now, Javi, and I am gonna take care of you.
01:31I don't know.
01:39I thought you were coming in later.
01:42Well, so did I.
01:44But I gotta review all of Amy's cases by end of day.
01:47Is she doing the same for yours?
01:48She handed hers in already.
01:49Not that it matters anymore.
01:51Okay, why do you say that?
01:52Don't you think Joan's gonna figure out we were the ones who told Jake about her?
01:55She was hazing me yesterday as if she already knew.
01:58I'm pretty sure Jake passed that baton to Amy today, so I'm sure you're on equal footing now.
02:02I heard she's prepping another surgery, and clearly she hasn't invited you to audit.
02:08We did the right thing.
02:10Can't overthink the consequences.
02:14This should hold him for now, but prep the team for massive transfusion protocol.
02:19Damn generator exploded.
02:21We worked medical missions together for 22 years, but why don't you go ahead and say what you need to
02:26say?
02:27Uh, I thought maybe we could step away.
02:31Is your boyfriend hiding out there somewhere to double-team me?
02:34Joan.
02:36It's MDS.
02:39Oh, God.
02:40Please, don't.
02:42I was diagnosed a few weeks ago.
02:44It's mostly indolent.
02:46I haven't had a chance to tell Michael yet, so I'd appreciate it if you let me do that.
02:50Yeah, of course.
02:51And before you ask, Javi knows he came here anyway.
02:54He has Addison's.
02:55He needed a surgeon he could trust.
03:00Does he know that your hand's been shaking?
03:06That happened once, Amy, after a very difficult surgery.
03:09Which this will be.
03:17I'm medicated and I'm fine.
03:21You could use an extra set of hands to manage his cortisol and electrolyte levels.
03:25Is that you offering?
03:27I'll get him started on a TTE.
03:34Thank you, Ray.
03:36Mr. Boyd.
03:36Who are you?
03:37Supposed to be seeing Dr. Ridley.
03:38Dr. Ridley had an emergency, but I can assure you...
03:41And Dr. Humda was supposed to be joining us as well.
03:43Uh, his whereabouts I can't speak to.
03:46But I'm Dr. Miller.
03:47First name?
03:48Uh, Richard.
03:49And you are...
03:50Fiona, Xander's COO.
03:52And my wife.
03:53You're an internist?
03:54Ford certified in oncology as well.
03:55Pulmonary subspecialty.
03:57Where?
03:57St. Ejuricus.
03:58And he used to be chief of internal medicine here for just two months.
04:01I didn't love the admin.
04:03So I took a little hiatus and I came back to work with patients, which is what I do love.
04:08Okay. Continue.
04:09I understand you have a suspicious mass in your right lung.
04:12I get regular full body scans in Palo Alto, but I was here at a conference when the Apollo DX
04:16flagged it.
04:17It's an AI diagnostic program.
04:1917% better than humans at early cancer detection.
04:22It's also far more likely to give you a false positive.
04:25Well, that's the hope, but I won't wait to get home to find out.
04:29Hi, I'm Dr. Coleman. I'll be assisting Dr. Miller.
04:32Uh, yeah, that's, uh, Theodore Coleman.
04:34He's an intern, Columbia Med School, Army Ranger Medic.
04:38He is highly skilled, very ambitious, and an extremely hard worker.
04:42Are we being interviewed?
04:43Vetted.
04:44It's gonna be on him anyway.
04:45Steiner vouches.
04:46Oh, I'm flattered.
04:47Great. I want the, uh, tissue removed and studied.
04:49So, how'd you do that, Dr. Coleman?
04:52Uh, bronchoscopic biopsy and a PET scan.
04:55Is that correct?
04:56It is.
04:57Then let's do that, huh?
04:58Stat.
05:01I want to thank you both for being here today.
05:04My role is not to judge or to take sides, but to facilitate a productive, respectful conversation.
05:12I'm so sorry. It's Max.
05:14Fine, Michael.
05:17I told you I had a personal matter to attend to today.
05:20You also told me Joan would be taking care of Xander Voight.
05:23Well, she has a patient who is a higher priority.
05:25Than a tech tycoon who can fund our entire capital campaign with what he makes while brushing his teeth?
05:31Well, Dr. Miller's on the case. I hear he's excellent. Why else would you have hired him back?
05:35Not funny, Michael.
05:36No, it's not.
05:37I'll deal with this in a few hours when I get back to the hospital. Goodbye, Max.
05:42So she took this job and she didn't tell Michael?
05:45No, she was diagnosed after she was offered the job.
05:49And she still hasn't told him?
05:51She's getting her head around it.
05:52And in the meantime, what, you're aiding and abetting, risking a patient?
05:55The patient knows, and he chose her anyway.
05:58Besides, there's no time to move him.
06:00I don't know if something doesn't feel right. She's working you.
06:03No, she isn't. You just don't know her the way I do.
06:07Yeah, you don't know her either. Not in the last eight years.
06:12I'm sorry, but that's the truth. And you know you can't justify any of this.
06:26How long has it been like this?
06:27Mom says a week. They thought it would heal on its own, but...
06:30No, she's too malnourished.
06:32Fighting in Goma cut off the food supply.
06:37Yeah.
06:37We're going to clean you a little bit and find something to eat.
06:41That's it?
06:42Yeah.
06:43So I got saline, degreedment kit, McPearson.
06:47Please trade with me.
06:49What's wrong with your case?
06:51Oh, Marcus keeps sending me lumps, bumps and dumps.
06:53That's what you get for sleeping with him and not calling him back.
06:57Dr. Ridley.
06:58Mm-hmm.
06:58It's your son.
06:59What?
07:00It's...
07:01It's 2am in Minneapolis.
07:05Ethan?
07:06Hey, what's wrong?
07:09No.
07:10No, no, no.
07:11Uh, forget the pediatrician.
07:12Get to Westside.
07:13Ask for Amy.
07:13I'll...
07:14I'll make sure she's waiting for you.
07:22Thank you for doing this.
07:23I'm here for you.
07:24But keeping this a secret won't do you or our patients any favors.
07:29You're giving me an ultimatum?
07:30I'm asking you to tell Michael today.
07:33We both know that this disease will take things from you.
07:37Your legacy shouldn't be one of them.
07:45We'll see you in there.
07:53I can't do dinner.
07:55I'm too tired.
07:59But we're still facing resistance from regulators on the new build.
08:03So find a new country or grease the wheels.
08:05I don't care which.
08:06Look, I gotta go.
08:07But one way or another, I want movement by next week.
08:09Hi, Mr. Boyd.
08:10Max Garner, CEO of the hospital.
08:12Just wanted to say that we will do everything in our power
08:15to give you what you need today.
08:17My test results would be nice.
08:23Unfortunately, I'm going to have to eat my words.
08:25The biopsy confirmed you have small cell lung cancer.
08:30Lung cancer?
08:31Yes.
08:31He hasn't smoked a day in his life.
08:33And he's meticulous about his health.
08:35Fiona, we're not going to argue this away.
08:37But I'm sure if you couldn't see the mass, we caught it early.
08:40Right?
08:42Yes.
08:43But genetic sequencing indicates it's an aggressive variant.
08:47And the PET scan shows micrometastases in your brain, abdomen, and bones.
08:52So it's already spread?
08:55So what now?
08:56Well, we can try chemo and molecular therapy, but those treatments are very painful.
09:01And even then...
09:02So, how long do I have?
09:04Best guess, we can get you four to six months.
09:10Personally, I'd consider palliative care.
09:12I'm getting Dr. Steiner.
09:14We'd be happy to interface with any of your own specialists.
09:17Well, we've already conferred with our chief of oncology and he agrees with our assessment.
09:21Well, of course he does.
09:22He works in a bureaucracy and can't think out of the box.
09:25I wish we could do more.
09:26We could try CAR-T.
09:29No, we cannot.
09:30What is CAR-T?
09:32Chimeric antigen receptor T cell therapy.
09:34It reprograms your white cells.
09:36And has absolutely no efficacy on this type of cancer.
09:39I don't think anyone knows that for sure.
09:40There's not enough data.
09:41Steiner is fielding second opinions and wants to teleconference in an hour.
09:44The plane will be ready to take you to Sloan or Hutch or Oxford if we have to.
09:48Wait a minute.
09:49Anything any of those places can do, we can do and we'll be completely transparent with your team.
09:55Your team is not even on the same page.
09:57We will get there.
09:58I assure you.
09:59Then come back to me with a plan.
10:00Like, if I'm still here, I'm all ears.
10:05One centimeter fragment in segment six.
10:09Two suture repair.
10:15Hey, any news?
10:16No.
10:17I'm freaking out.
10:19Listen, I told you.
10:20Just because they're taking longer to get the results, that doesn't mean anything.
10:23I know, I know.
10:23I thought I'd be okay with this, but I am really not.
10:26Maybe stay away from work today and just try and distract yourself.
10:29Funny you should say that.
10:31Because I'm kind of at the cafe around the corner.
10:34Uh, from the hospital right now?
10:36Look, is there any way you can come down for a minute?
10:38I'm really not handling this well.
10:40Yeah, yeah.
10:40Be right there.
10:44BP's dropping.
10:4491 over 59.
10:45Amy.
10:46Imagine 100 had a cortisone.
10:48Normal saline, wide open.
10:49What's this?
10:50Sodium?
10:50It's fine, 134.
10:52It's not me.
10:53You have a bleeder.
10:54My field is clear.
10:56Unless...
10:57Damn it.
10:58Suction.
10:58Lender sees things lost already.
11:01You're counting?
11:02I can't clear the field fast enough.
11:04Want another clamp for a Pringle maneuver?
11:05No time.
11:06I'll do it blind.
11:07Micro switcher on a needle driver.
11:09I can't hear you.
11:11I can't see you now.
11:30Jesus is here.
11:34that was amazing
11:36piece of cake
11:57yeah
12:00we're here with Amy now
12:02she's checking his lungs
12:03stop
12:04I can't hear anything you're saying
12:06you have to find someone
12:08with a better seat
12:10mom
12:16so the albuterol
12:18is working but his oxygen
12:20is still low
12:21if it drops anymore
12:23don't tell me you have to intubate
12:24no we're not there yet
12:26let's just try to stay calm
12:30I never thought I'd say this
12:31but I wish my mother were here
12:33there's nothing she would do
12:34that I'm not already doing
12:35you think I want her here
12:36for medical expertise
12:38no
12:40you know when I had meningitis
12:41in college
12:42she at least offered to fly home
12:44Ethan
12:44she's doing the best
12:46don't defend her Amy
12:47alright please
13:06John?
13:08yeah?
13:09you okay?
13:11I'm fine
13:13I just had to
13:15splash a little water on my face
13:16I'll be right out
13:29okay let's bump his methamazole
13:31up to 20
13:31and then recheck his TSH
13:32and can you have Dr. Park
13:34give me a call on labs
13:35come back on 6-12
13:36okay
13:37thanks
14:06I'll be right back
14:08all handled?
14:09yeah
14:10I think they can survive without me
14:12apparently I can't
14:13hey
14:14it's fine
14:15okay
14:16I'm not going anywhere
14:17until the labs come back
14:18thank you
14:19what is this?
14:21this is the Mia treatment
14:22and you thought this would
14:23distract me from my impending doom?
14:25I've seen you around a Sunday
14:33I want primary custody
14:35for as long as I'm breastfeeding
14:36absolutely
14:37I'll take regular visitation rights
14:39for the first year
14:40and after this first period
14:42we'll transition to the 50-50 custody
14:45yes
14:46agreed
14:47now on to assets
14:49first the family home
14:51it's in Michael's name
14:52I'm prepared to sell it
14:53and give Nora
14:54half the proceeds
14:55I can't let you do that
14:56Michael
14:56why not?
14:57I know what it means to you
14:59and what about Katie?
15:00she's fine with it
15:01she's off to college soon
15:03and I think it's the least
15:04I can
15:04oh god
15:05don't you dare be kind
15:06to me right now
15:08what else would I
15:13I need to hate you Michael
15:15and you need to let me
15:21hey
15:22hey
15:22how's our patient?
15:24well
15:24strong vitals
15:26no sign of infection
15:27emptied his drains
15:28on post-op antibiotics
15:31wow
15:31could have put our nurses
15:32out of business
15:34I can handle post-op
15:36if you just want to
15:37sit with him
15:39that's a hell of a
15:40bedside manner
15:41you've got there
15:44you alright?
15:45Amy
15:47hey
15:49I'm good
15:51I
15:52I have another patient
15:54I should check on
15:55but Hottie needs
15:56post-op lights
15:57and hourly labs
15:59I'll take care of it
16:06we talked about this
16:07I don't want you back in that chair
16:08until we have
16:09I know
16:09until I've had two months
16:10of normal EEGs
16:11I know
16:13but I've had four clean studies
16:15and I need this memory now
16:17look I know you're going for chief resident
16:18and recovering your medical knowledge
16:20is important
16:20no it's not that
16:21when my brain does this
16:22it's because
16:24it's trying to tell me something
16:26my friend needs help
16:27and this memory may be the only way
16:29that I can help her
16:32any headaches or nosebleeds
16:33and I'm pulling the plug
16:35of course
16:37I want to be clear
16:38that the treatment protocol
16:39that I'm proposing
16:40will be risky and painful
16:41pain is irrelevant
16:42will it work?
16:43I found one successful case
16:45but as your team will tell you
16:46cancer involves many mutations
16:48the treatment
16:49has to be as unique
16:50as a disease
16:51that is where CAR T comes in
16:52we take your own T cells
16:54and re-engineer them
16:56to target the specific markers
16:57of your illness
16:58which antigen will you use?
16:59his cancer cells exhibit
17:00a large number
17:01of DLL3 surface proteins
17:03and which viral vector
17:05for delivery?
17:05the case I'm referencing
17:06used a lentivirus model
17:07the case he's referencing
17:08was so much less aggressive
17:10it shouldn't even be
17:10considered a comp
17:11Mr. Voight's immunoresponse
17:13will almost certainly
17:15be catastrophic
17:16there's a very good chance
17:17this treatment will kill you
17:19by tomorrow
17:20or it could add years
17:21to his life
17:21team
17:22some feedback
17:24would be nice
17:24give us a moment please
17:26I thought you were getting
17:27on the same page
17:28so did I
17:30okay
17:31the only other option
17:33we can see here
17:34is Ludo's team in Zurich
17:35they have a vaccine model
17:37that's had some
17:37limited success in mice
17:38limited and only with mice
17:40no
17:40that's out
17:41what else?
17:42I'm sorry
17:43but there's nothing
17:43we can stand behind
17:44so Dr. Coleman's idea
17:45is the best option?
17:47it would be
17:47yes
17:48Elise?
17:49with more time
17:50we could dig deeper
17:51but
17:52big things don't happen
17:54overnight in the cancer game
17:55okay
17:56so
17:57we have no choice
17:58okay then
17:59let's get the ball rolling
18:01with whatever we need
18:02to do next
18:02I'm sorry
18:03but clearly
18:04these people on your payroll
18:05don't know how to say no to you
18:07Dr. Miller
18:07and I gotta say
18:08if you were anyone else
18:09this hospital wouldn't even be
18:11considering this course of treatment
18:12Mr. Voight has an appetite
18:13for risk
18:14an appetite for risk
18:15is one thing
18:16this is trying to kill
18:17a lion
18:18with a toothpick
18:24sometimes we
18:25fly too close to the sun
18:27but we get nowhere
18:29if we don't try to fly
18:31right Dr. Coleman?
18:34well I sincerely
18:35hope this works
18:38but respectfully
18:39I won't be a part of it
18:52I uh
18:54I didn't mean
18:55what I said
18:56before
18:57I mean
19:00I don't want to hate you
19:01I wouldn't blame you
19:02if you did
19:06I hope
19:07that selling the house
19:08will be a fresh start
19:10for you
19:12I think you really need that
19:15okay
19:16I've drafted an agreement
19:17why don't we give it
19:19A once
19:19over
19:23and focus
19:25ground yourself
19:26in the memory
19:27what can you smell
19:28hear
19:29see
19:36okay
19:37let it rip
19:48so just stay out of it
19:49what are you not telling me
19:51it's MDS
19:53so there's a good
19:54chance it'll turn into
19:56leukemia
20:00what is it Amy?
20:01I have to go
20:08you can't perform surgery
20:10anymore
20:17place a vast cath
20:19prepping for temporary
20:20human dialysis
20:21what happened?
20:22BP spike
20:23acute renal failure
20:25but that makes no sense
20:27Addison should prevent
20:28BP spikes
20:28and his renal function
20:30was normal pre-op
20:31well clearly
20:32we're missing something
20:33blood cultures
20:34auto antibodies
20:35and a pan CT scan
20:37that's a good idea
20:38it was even better
20:38when Dr. Matra
20:39had it five minutes ago
20:40where were you?
20:43I was in TMS
20:45I love your sense of timing
20:47I remembered
20:49you were diagnosed
20:50months ago
20:51and the disease
20:51certainly wasn't indolent
20:53so you're off
20:53chasing unreliable memories
20:55while our patient's
20:56life hangs in the balance?
20:57you're gonna look me
20:57in the eye
20:58and tell me
20:58that was a false memory?
21:00it was a bad day
21:01I was emotional
21:02and I'm fine now
21:04you took this job
21:06knowing that you
21:07couldn't handle it
21:08I am handling it
21:09really?
21:10where did you get
21:11this bruise?
21:11and what about
21:12the edema
21:12in your wrist?
21:13how much prednisone
21:14does it take
21:15to get you
21:15through a shift?
21:16you know what?
21:17Dr. Matra and I
21:18will take it from here
21:22I would never
21:23do anything
21:24to jeopardize a patient
21:25and I don't need
21:27you
21:27to tell me that
21:51let me ask you something
21:52when you went up
21:53against Dr. Miller
21:54was that for my sake
21:55or were you just
21:57pandering to your CEO
21:59come on
22:00don't pretend
22:01you don't have a lot
22:02riding on this too
22:03I don't do anything
22:04I don't believe in
22:05man of conviction
22:06I guess I'm not surprised
22:08four years in Afghanistan
22:10took a bullet
22:11during that hostage crisis
22:12okay you guys
22:13gotta ease up
22:13on the background checks
22:14it's getting weird
22:16honest too
22:17look
22:18this idea
22:19is out of the box
22:20but you push boundaries
22:22for a living
22:22controversial
22:23but necessary
22:24to a society
22:28I've just
22:31never been the lab
22:32rat before
22:51Dr. Ridley
22:52he has tuberculosis
22:54I saw some
22:55non-specific areas
22:56lighting up on CT
22:57figured they were artifact
22:58but his sed rate was up
23:00so I ordered
23:01an ultrasound
23:02with Doppler
23:02and found a cavitus lesion
23:04in his hepatic artery
23:06add that to his
23:07chronic inflammation
23:08milky drain fluid
23:09travel exposure
23:10extra pulmonary TB
23:12explains it all
23:12even the Addison's
23:14he must have a lesion
23:15on his adrenal gland
23:16and who knows where else
23:17we need a full body MRI
23:19with contrast
23:20and surgery
23:21to remove infection
23:22good
23:23I'll take him to radiology
23:25you can grab a few
23:26protein bars Dr. Maitre
23:27we're going back in
23:32feeling okay
23:34I feel like crap
23:35I guess that's
23:36what we want
23:37alright
23:38it means it's working
23:40yeah
23:41well your BP's a little low
23:42I'm going to start
23:43your oppressors
23:46Mr. Voight
23:46Mr. Voight
23:49two milligrams
23:50IV lorazepam
23:51stat
23:51when did you inject
23:53the CAR T-cells
23:53an hour ago
23:54it's a cytokine storm
23:56but I premedicated
23:57with Benetrile
23:57and Methopeniculum
23:58well it wasn't enough
24:18what else we got
24:20dinner
24:20oh no
24:21I'm going to eat later
24:22you can't help them
24:23if you can't stand
24:24Ridley
24:25eat
24:32can we talk about
24:33the real reason
24:33you won't slow down
24:34have you had
24:35Terry's moambe
24:36your grandson's
24:39going to be fine
24:40from everything you
24:41said about Amy
24:42he's in the best
24:42possible hands
24:45not mine though
24:47you can't be everywhere
24:51when Harry and I
24:52were first married
24:54I tried to stay
24:55but be the doting
24:57wife and mother
24:58and have a regular
24:59nine to five
25:02the truth is
25:03I just
25:04wasn't cut out
25:05for it
25:09maybe you were right
25:10to never settle down
25:12or maybe
25:13I just never found
25:14a man who could
25:15put up with me
25:17well it makes
25:18two of us
25:25hello
25:26it's me
25:28albuterol and
25:29high full oxygen
25:30are keeping his
25:31numbers in the 80s
25:32so no need to
25:33intubate
25:34no he's stabilized
25:35but they've got
25:36an intense recovery
25:37ahead of them
25:38if you could come
25:39home
25:40I would
25:44I'm trying to do
25:45my job
25:46at what cost
25:47Joe 60 milligrams
25:49at that rate
25:50you will flame out
25:51in weeks
25:51that's my choice
25:52does Javi know
25:53what you're doing
25:54I'm not killing
25:54myself Amy
25:55I am trying
25:57to make the most
25:58of the time
25:58I have left
25:59and he would
26:00respect that
26:01well what does
26:02Ethan think
26:04I don't know
26:06he doesn't know
26:07he doesn't return
26:08my calls
26:08what
26:09how long
26:10have things been like
26:11you know what
26:11I think
26:12you've drenched up
26:13enough bad memories
26:13for one day
26:14and if you'll
26:14excuse me
26:15I have a patient
26:16who needs me
26:20what do we got
26:22granulomas in the liver
26:23kidney
26:24adrenals
26:24bowel
26:25they're everywhere
26:32tell the on-call surgeons
26:34to drop what they're doing
26:34and meet us in the OR
26:36we're going to need
26:36all the hands
26:37we can get
26:38I commend you
26:39my dear brother
26:41to almighty God
26:42and entrust you
26:43to your creator
26:44may you return
26:45to him
26:46who made you
26:46from the dust
26:47of the earth
26:49may holy mary
26:50the angels
26:51and all the saints
26:52come to greet you
26:53I am
26:55so sorry
26:56Mrs. Voight
26:59I never should have
27:00let him go through
27:01with this
27:03excuse me
27:17you care to explain
27:19how this went
27:19so wrong
27:22we tried
27:22cartoon
27:23I read the report
27:24I know what was attempted
27:25I'm wondering how
27:25that was allowed
27:26to happen
27:26you'd have to ask
27:27the CEO
27:28about that
27:30he was pushing
27:31medical decisions
27:32we could have
27:33used you here
27:36so what are you
27:37proposing now
27:37I'm thinking
27:38IL-6 blockers
27:40the COVID treatment
27:42CAR-T triggers
27:43a similar
27:44inflammatory cascade
27:45and I don't think
27:47that the standard
27:48protocol will get
27:48the inflammation
27:49under control
27:50he's been right
27:50all along
27:54we should follow
27:55his lead
27:59your patient
28:00your call
28:04okay
28:06our Thailand trip
28:07you got boot
28:07off the karaoke stage
28:08Bohemian Rhapsody
28:09yes
28:13for the record
28:14it wasn't my performance
28:15that people hated
28:16it was just that
28:17that song is too long
28:29they in
28:33I can't let you do it
28:46it's negative
28:47I don't have cancer
28:49don't have cancer
29:04saddle up everyone
29:05for the next 11 hours
29:07we're doing
29:08an ex vivo
29:10that's right
29:11the thing you learned
29:12about in med school
29:13but never thought
29:14you'd actually do
29:14we're removing
29:15every damaged organ
29:17repairing it
29:17and then putting it
29:19back where we found it
29:20we'll run two full
29:22operating fields
29:23side by side
29:24my team will be
29:25the one removing organs
29:26and keeping Javi alive
29:27that means controlling
29:29bleeding
29:29managing perfusion
29:30oxygenating his heart
29:32and brain
29:32team two
29:33is on ex vivo
29:35work
29:35when we pass
29:36off an organ
29:37you strip
29:38the granulomas
29:39and adhesions
29:40repair what you can
29:42then it comes straight
29:43back to us
29:44in working order
29:46precision is everything
29:47we lose focus
29:48we lose an organ
29:49we lose an organ
29:51we lose the man
29:56no mistakes
29:58let's go
29:59god I cannot believe
30:01I'm seeing this
30:02alright I brought
30:02nourishments
30:03yeah great
30:04thank you
30:05thanks
30:07did she just do
30:08a rapid artery
30:09reconstruct on the fly
30:10yeah
30:11it's unreal
30:12she's a friggin rock star
30:14she's something
30:15that's for sure
30:17you wonder why
30:18I didn't want to tell you
30:18look the way she's
30:20managing everyone
30:20she's like a maestro
30:23okay so what exactly
30:24is her end game here
30:25is she just going to
30:26keep operating
30:26until she drops
30:27I can't believe
30:28what she's doing
30:29to herself
30:30I know that you
30:31don't want to go
30:31behind her back
30:32but I don't think
30:32she's really leaving
30:33as many options here
30:35just give me a couple
30:36hours
30:37till the end of the day
30:48Ethan it's Amy
30:50give me a call back
30:51when you can
30:52there's
30:53there's something
30:53going on with your mom
30:55okay liver's coming out
30:58subhepetic space is clear
30:59put a retractor in there
31:00carol
31:01sponge
31:04okay
31:08that granuloma's wrapped
31:09around the inferior
31:10vena cava
31:11we can clamp
31:12take it out
31:13then reconstruct
31:13with dacron graft
31:14no we've made enough
31:15compromises today
31:16I'll dissect it off the wall
31:17leave the vein intact
31:18scalpel
31:20uh
31:21isn't it safer
31:22to do a graft
31:23one slip
31:23and he could bleed out
31:24in seconds
31:25I know
31:25I wrote that chapter
31:27in your vascular surgery
31:28textbook
31:29suction doctor
31:30matra
31:32clamp ready
31:33in case it goes south
31:47mats
31:49i'm securing the vena cava
31:51now dr matra
31:52get that lump
31:52out of my hair
31:53please
31:58you know what they say
31:59about me
32:01hands of stone
32:08hi
32:09hi
32:10what are you doing here mom
32:11i wanted to check on robbie
32:13i came as soon as i could
32:15well we both know that's not true
32:16okay okay
32:17i came as soon as i could
32:19responsibly leave
32:20and why is it you feel a greater
32:22sense of responsibility
32:23to a group of strangers
32:24than your own family
32:26robbie was fine
32:27he didn't need
32:28no i needed you
32:32you know for once
32:33i actually let myself
32:34believe that you'd be here
32:35i was on my way
32:37and and what
32:38then we got the call
32:38fighting broke out
32:39in sake
32:40we were inundated
32:42it's always something mom
32:47and what would you have me do
32:49let those people die
32:50so i can come and hold your hand
32:51no you're right
32:52no you had to do
32:53what you thought was right
32:54and now i have to do the same
32:56so you know what i'm i'm done
32:59what does that mean
33:00you're done
33:01that means i'm just i'm done
33:02you know at some point
33:03i only have myself to blame
33:05for letting you disappoint me
33:12if you can't see
33:13i made the only choice i could
33:15in that moment
33:16then i didn't raise the man i thought
33:22you barely raised me at all
33:39welcome back
33:42it must have been a close one
33:44turns out
33:47your addisons
33:48was a symptom of indolent tb
33:51you had a lesion on your adrenal gland
33:53along with 14 others
33:55but we cleared the damage
33:56and you'll make a full recovery
34:00but so
34:00so no more addisons
34:04no more addisons
34:10you saved my life
34:13i wish there were more i could do for you
34:15are you kidding
34:17that was a career making surgery
34:19you begged me
34:20i'm gonna live forever in these halls
34:24so um
34:27when can i get back out there
34:29well in the last 12 hours
34:31most of your organs have been
34:32outside your body
34:33so maybe you want to give it a few weeks
34:37hey
34:37we go where we're needed right now
35:01we go where we're needed right now
35:04hi stranger
35:24come on
35:25unfortunately
35:27the car t hit you harder than your cancer
35:30we've retested your blood
35:32and your small cell tumor markers only dropped 3%.
35:35Meaning it didn't make a dent.
35:38Right.
35:40Well, then, what's next?
35:43We're back where we started.
35:46Chemo and molecular therapy.
35:48So you're right.
35:49My yes-men almost killed me for nothing.
35:53I'm just glad you're still here.
35:55I'll be dead by the end of the year.
35:57I'm sorry, but there's plenty you can do
35:59with the time you have left.
36:00No, I won't slowly degenerate.
36:03If you can't cure me, I will wait.
36:06Xander, no.
36:07What better time to do it than now?
36:08I'm sorry, what are we talking about?
36:10There's a Swiss cryogenics company
36:11that will freeze me until further notice.
36:13When there's a cure for this in 10, 20, 30 years,
36:16I'll be first in line.
36:17If they find a way to reverse the freezing process.
36:21We can do it with embryos.
36:23It's only a matter of time,
36:24and I won't exactly be in a rush.
36:35She knew who she married,
36:36and I still have way too much to do in this world.
36:41The man needs a psych consult.
36:43We should put him on a 72-hour home.
36:45On what grounds?
36:46He's not depressed or pathological.
36:48He's got a God complex.
36:51And I flew too close to the sun.
36:54The CEO's watching.
36:55You got a billionaire setting you up to be a hero.
36:58You got carried away.
36:59You're right.
37:01Sorry.
37:03I know you think
37:04I don't have a leg to stand on here,
37:06but what happened with Mr. Voigt was unethical.
37:09And there isn't always going to be
37:11someone more senior around to push back.
37:13You're not a rookie anymore, TJ.
37:15Time to start acting like it.
37:25Hey.
37:27Oh, hey.
37:29So,
37:31I need to tell you where I was yesterday.
37:35Okay.
37:37Rachel had a mammogram,
37:39and they found a mass.
37:40Oh, no.
37:41Is she okay?
37:42Yeah, yeah, she's fine now.
37:44The biopsy results finally came back negative,
37:45but the past week has been kind of tough,
37:49so I just, I wanted to be there for her.
37:51So that's why you left early?
37:54Yeah, yeah.
37:54She was spiraling.
37:57And that patient you were with
37:59in radiology last week
38:02when you didn't want to talk,
38:03that was her?
38:05She asked me not to tell anyone.
38:10when I see the look on your face,
38:12and clearly I went about this all wrong.
38:14No, you were in a tough spot.
38:17I'm just glad she's okay.
38:19Yeah?
38:20Yeah.
38:25Yeah.
38:28Okay.
38:31It was pretty sneaky
38:33you calling Ethan.
38:36Dare I ask how it went?
38:39Well,
38:41we have a lot to clean up,
38:43but
38:45he's here,
38:47so thank you.
38:49There's one thing this year has taught me.
38:52It's that family finds a way to forgive.
38:56Let's hope.
38:59He certainly thinks I have a lot to answer for.
39:06We need to figure out what you're going to do, Joan.
39:10Oh, I know what I'm going to do.
39:14I didn't think it could get any worse
39:16than being schooled by Richard Miller
39:18and knowing he was right.
39:20Try this.
39:20I spent all of last week
39:22trying to sideline Dr. Ridley
39:23and the second
39:25she asked me to scrub in
39:26for a big operation,
39:28I leap at the chance.
39:30So we're hypocrites?
39:31Or maybe we're just
39:33doing the best we can
39:34in a job that has
39:35a lot of gray areas.
39:38Maybe we are.
39:40So?
39:42Want to give our date another shot?
39:44Dinner?
39:46That.
39:47Italian place on the corner?
39:49Or we could just go to mine.
39:51For dinner?
39:53That too.
40:07Dr. Ridley would like all of internal medicine
40:10to report to the office
40:11for an all-hands.
40:16Excuse me.
40:20Any idea what this is about?
40:22Uh, no, no idea,
40:24but I guess we'll both find out.
40:26Oh.
40:36Wow.
40:37That was fast.
40:39Am I that scary?
40:40Yes!
40:44Uh, this is, uh, not a conversation
40:47I ever wanted to have, so
40:51forgive me if I'm not exactly sure
40:53where to start.
40:56I know there's been
40:58concern about my health,
41:00and I truly appreciate it.
41:03Uh, it turns out it was warranted.
41:08I have MDS.
41:09It's advanced,
41:10and it's time for me to accept that
41:16it's not something I can outrun.
41:18So,
41:23last night
41:26will be my final surgery,
41:29and next week will be my last
41:32as your chief.
41:37I've spoken to Dr. Hamda,
41:39and he has agreed to facilitate
41:41a smooth transition,
41:43and never fear,
41:45you will all receive
41:46your long-awaited evaluations
41:48before I go.
41:51I like to think, um,
41:53that I,
41:54I still have some wisdom
41:58to impart on the next generation.
42:02Even you, Peter.
42:06So, um,
42:08as my friend reminded me today,
42:11uh,
42:12we go where we're needed.
42:15And right now,
42:16there are more important places
42:18for me to be than inside an OR
42:19or behind a desk.
42:25Being a doctor
42:28has been the privilege of my life.
42:33being your chief
42:37has meant more to me
42:38than I expected.
42:47All of you.
42:53And I'll see you tomorrow.
42:55and I'll see you tomorrow.
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