01x02 - The Barrier

[bunniefuu]

PREVIOUSLY ON LENOX HILL-

The patient's a 41-year-old

police officer from Tennessee.

She has a big tumor in her neck.

These are risky operations.

No question about it.

You live and die for them.

To me, the ER is like the frontline.

You cannot chose what comes at you here.

I want to work with populations,

who, maybe medicine

has traditionally neglected.

Never know

what you'll get with brain surgery.

Let's roll.

As a surgeon, researcher,

I have to bring my best.

sh*t, man. Feel this.

f*ck!

I don't have cancer?

Well, that's what I want to talk to you

a little bit about.

It's a lot of juggling,

being a surgeon and a chair.

We are on the right path.

We're absolutely on the right path.

Growth hurts.

There's the baby.

When do we get to know the sex?

Remember, we're not going to know

until we deliver.

- We're pregnant.

- We are pregnant.

And it's good.

Oh-h*-h*!

A NETFLIX ORIGINAL DOCUMENTARY SERIES

Hey.

Two, one, okay. Let it out.

Again. One more.

One more. Give me one more.

Push through it!

There you go.

- Much better. Good. Good. Good. Yes!

- And let it out.

So close. We're so close.

Okay, don't push. Don't push.

- Okay, one more push, dear.

- Give me a push.

Good!

Look down. Look down!

- Hi.

- Oh!

Happy birthday!

And he's crying.

- Yeah.

- There you go.

- Congratulations.

- Okay.

Hello?

Boo.

Yes.

- What's up?

- Hey, I've I've been thinking

why didn't you call me back, babe?

Um, Kevin, when did you call me?

I called you about four hours ago.

Okay, yeah,

so I was probably working, boo.

Do I want to talk to you

or do I want to do work?

It's hard to know.

You should talk to me,

because you haven't talked to me all day.

Oh. Boo, did you get my email?

Did you make the, um, appointment

for this daycare or no?

Uh, did you read the pamphlet

I sent you, boo?

I did actually read the pamphlet

you sent me.

Huh. Interesting, because in that pamphlet

it would say that

they only give tours to people

who have an enrollment offer.

Would they have spots available

in September?

I just got the pamphlet, boo-boo.

I've been back-to-back busy, boo.

I have to leave every day at 6:00.

That's what that means.

- My homey's

- Hold on, hold on.

And he's like, "No, we gotta go."

And she's like

Which room is that?

- So she be trippin' when he's gone.

- Okay, thank you.

I was like

Oh, you know, Joe told me this sad story.

He said that, uh, he's looking forward

to the day

when he comes to pick up his girl

and she'll be happy to see him.

That's kind of sad.

Vocera.

Call Stephen Fisher.

- Finding

- What? Oh.

It's uh oh.

Speak at the tone. Message canceled.

- Vocera.

- Urgent call, Stephen Fisher.

- Urgent call to

- Stephen Fisher.

Why don't you just call the number?

Shh!

All right.

Sorry. Did I just hear

the emergency bell go off?

Yeah, it was an accident in room six.

Okay, but then I went out and I was like,

I don't hear it anymore.

So I wasn't sure, so

Yeah, it's fine. We already it's fine.

- Okay.

- Yeah.

She's not having an emergency. Okay.

Sounds good.

Thank you so much.

- Okay.

- Call from

Stephen Fisher.

What, Kevin?

I forget what I was saying, boo.

Mmm.

- Sherese?

- Yes?

Can you update me on Christopher?

- We looked at the images.

- Okay.

- So they look good. They look better.

- Did he get Avastin?

No, he got Cetux.

Really?

He's scheduled

for another dose Wednesday

- Oh!

- So I wanted him to get a scan in between.

This is exciting.

This is a clinical trial patient,

so I we we get excited

about clinical trial patients,

because we want to see new

and innovative things work.

He had a particular protein

on the surface of his tumor

and we targeted that with, um, a drug

that we give through an artery.

This is good

if his film was really good.

It looks better.

- Well, even any better.

- I know.

- So how's he doing clinically?

- Clinically he's much better.

That's bizarre, in a good way.

This really should work, right, Sherese?

Yeah.

That would

It seems like it's going faster.

It's reducing quicker than it was

the first time that we went through this.

I'm telling you, the tumor

looks like it's retracting a little bit.

Now, a little bit

is 'a lot a bit' in this disease, okay?

These tumors have a doubling time

of about 17 days.

But, actually,

what I'm most happy about is this.

- You see this storm cloud here?

- Mm-hmm.

That's the edema. That's the edema here.

It's actually completely gone.

- How's the strength on the right side?

- Great.

- Can I see you stand up?

- This is 'cause he's been doing yard work.

- Yeah. Work.

- Okay, good.

What kind of yard work are you doing?

- Well

- We have a new house with no

- It's completely empty yard.

- No trees.

He likes to garden,

so he's been putting in.

- And he's been

- And Yeah.

He's out there

I'm praying my hydrangeas come in well

this year.

Yeah.

I'm really optimistic

for what I expect from you.

Yeah.

And just remember, if this fails,

- we have a lot a lot of good drugs left.

- Yeah.

- Okay.

- Thank you.

Yeah. Bye, guys.

- Okay.

- Thanks, Chris.

Well, I hope I'm right about that.

That was good.

Yeah. Really good.

- That was a good promise.

- I know.

You know?

- I know.

- It's much smaller than the last time.

Yeah.

Will you rub my arm?

MITZI & TONY.

Sure I will.

I'll rub your leg.

So her head goes here.

This is the renal artery graft here,

- and I'll be over here.

- Okay.

This screen has to sort of be

where Peter's going to work.

Mm-hmm.

So what I would do is

He has to do the opening, too,

because he wants to make

this combined opening.

I'll start the crani you know, up here.

Just do it

Mitzie arrived to us

after living with this tumor

in her skull base and neck

for about ten years.

At the end of the day,

no one near her was really

willing to operate on her.

It was just too difficult.

Knowing she's a mom to a daughter,

has a family, a son who needs her,

this is the major drive that made me

ultimately decide to take the risk

and try to save her life.

You had some nausea at home,

right, though?

I had the nausea spell after.

- You throw up a little bit?

- A few times.

I think it's probably where the tumor is.

And now it's still pushing on

some of the spots in your brain

that can cause nausea.

I'm just glad you're fine this morning.

You can talk and move your right side.

That's the most important thing.

What should I expect

when I come out of surgery

for the next 24 hours?

What should you expect?

It's possible that you could have

a neurological deficit

from a new blood flow.

It's not a stroke.

Um, we're always concerned about it,

because there's no way for us to tell.

So we end up getting

a lot of scans really quickly.

And nine times out of ten,

there is no stroke.

It's a little unpredictable,

what could happen.

The most important thing is you have

a working graft and it looks good.

You're not going to have a stroke.

The graft will protect you.

I met my husband

a long time ago through a friend of ours.

And I went to medical school with him.

And we reconnected four years ago

and got married.

But there was a time before I met him

that I thought,

"'I'm just going to have

a child on my own."

Now I'm 39 and I'm having my first child.

So.

It's comforting

that now we're living in a time

where women can have children

at an older age.

There was all this family pressure.

I come from a big Latino family.

So all my sisters have

already had their children.

Everybody's been anticipating this,

so it's just a lot of pressure.

My main importance right now

is to have a healthy pregnancy.

And I definitely stressed about it

in the beginning,

given the nature of my work.

It's making me nervous. We good?

125 over 90.

Oh, perfect. Okay.

Pressures have been great

since that last visit.

Oh, good.

So how are you feeling otherwise?

I'm feeling okay. Just tired.

That's normal.

- And Dr. Stephens will be right in.

- Awesome. Thank you.

- You're very welcome.

- Okay.

So, your blood pressure's borderline

again today.

So, I thought like 125 was okay.

- Your 125 is fine, but the 90 is not.

- Ah.

I want you to check

your blood pressure every day.

- I have been, actually. I got a cuff.

- Okay.

- And they've been good.

- Good.

For gestation hypertension

I can just put you off for the rest.

- Yeah.

- It's two more shifts.

They have backup,

so they can find coverage.

- Yeah.

- I'm assuming so.

There's other people who can do it.

- Yeah.

- It's okay.

- Okay?

- I'm sad to leave work, actually.

Yeah, I'm sure. I'm sure.

Okay, let's take a look.

Heartbeat looks great.

Yeah.

Okay, baby looks perfect.

Yay.

And then, you know,

if you're feeling off at work,

even if you're feeling anxious, shaky,

anything like that, I want you to leave.

Okay.

- Okay?

- I haven't been.

- And you'll call me.

- Yeah, I mean, I'm used to the busy

The busy environment.

- I I haven't been

- I know.

All right.

I'm still so skeptical,

because my blood pressure's been fine

at home.

- Completely fine.

- I know, but she just said that.

And, all right, like she said, so you had

a really stressful night at work.

I just wanted to work until the very end.

Yeah, you did.

She's coming in right now.

We had to deal with one room,

and he's coming right now.

Who is that for?

Four, but they have it.

Four? Wait, Rachel, what?

I don't feel

like I'm tired because I'm pregnant.

I feel I'm tired because of residency.

Hello. Oh, my God.

I'm not very good

at taking my prenatal vitamins.

I'm like a bad OB patient.

Just tell me what the to-dos are.

- Okay.

- I'm pretty sure I know. Just tell me.

The only person

that needs the sono is.

- I already called.

- Okay, thank you.

She needs to be on insulin.

- I know. I started her.

- Well

I mean. Okay, speak Okay.

Hi. Yes. Hello.

- Hi. Laura?

- No.

- Okay. It's Ellie.

- Yes.

Okay. Thank you.

Okay.

- Amanda.

- Yes.

I have an appointment

scheduled for my own ultrasound,

which now feels like

extremely inconvenient.

I don't know if I can go to it.

Said, and anesthesia

are ready to go back.

Give me 30 seconds. Is Woo here?

Woo is here.

Okay. No problem.

I'll find somebody who can go.

- Thank you.

- Thanks.

- They're gonna pick it up.

- Tomorrow, yeah. On the side.

Wait, you're not here tomorrow, Forzana?

No.

We're f*cked.

It's hot in here. I'm thirsty.

Okay.

I'll get it. It's probably OB.

I'm like

Hi. It's Amanda.

It started as a migraine, okay?

I used to get migraines all the time.

Um, I couldn't

Uh, I I didn't resist the light.

It was just it was so bad.

Um, and then I fainted.

I fainted on a Saturday.

Then on a Monday, I went to to my doctor

and, um, I said to him,

like, "You have to send me for an MRI,

because I can't really deal with this."

And he sent me for an MRI.

And I came back to his office

and he called me to the back,

because I guess they had

called him already,

that I had a tumor in my brain.

Um, the tumor was about, you know,

this this big.

I got operated.

The year passed, and I was in remission.

And then I got it again.

Tamika. Lucas. Lieutenant.

How are you?

- How are you?

- I'm okay. Thank you.

So who made these shirts?

I made them.

They say my team in the back.

- I know.

- Yeah.

They're so cute.

So, you understand what we're giving.

We're giving you

a little piece of a bacteria.

- Okay.

- To elicit immune response in your body.

In the bacteria is a drug

that we hope gets it

into your brain tumor,

into your glioblastoma.

And the way we want it to target

your glioblastoma is through

a surface antibody, or a targeting

of what we call a honing device.

Okay.

I gotta talk like police stuff.

Yeah, I know.

It's like a drone,

it's going right into the tumor.

And it's using

the antibody called Cetuximab.

That's the drug

that got Martha Stewart in jail

- for insider trading.

- Oh, yeah. Oh!

You're the eighth patient in the country

to get this treatment.

- Yeah, I know.

- So you're a special girl.

Yeah.

So thank you for your patience

and your courage

and to all you guys

for being so supportive.

Thank you for considering me.

Yes.

Okay. I need to

They're pushing me aside,

- so I need to

- Okay.

I can't

Every day I see patients that

I feel like

we're making a dent in the disease.

It's just

It's a very challenging disease.

I go to the lab on Wednesday,

and I come back so inspired.

And I have these scientists telling me

great new things.

And

new viruses, new bacteria, new everything.

But we're making

just incremental progress.

You know, in five decades, we've improved

survival in glioblastoma five months.

So, frankly, I should be devoting

my whole life to research at the bench,

but there are few people like me

that can take it from the bench,

where you have these brilliant scientists

who don't really understand medicine.

And then there are a lot of people that

treat the disease clinically

who don't understand the science.

They're calling me upstairs

to the operating room.

I'll come back

and see you in a little bit, okay?

- Thank you.

- Good luck.

Thank you.

When I was at Penn

as an undergraduate,

there was a guy named Steve Fluharty.

He was

my neuropsychopharmacology professor.

He changed my life.

He piqued an interest in me

that I didn't even know I had,

which is in neuropsychopharmacology.

I started looking at stem cells in cancer,

and I started looking in glioblastoma,

and that's when it took off for me.

It is human's

most aggressive cancer.

You can see by these patients,

they're all so different.

It's a devastating disease.

- Hi. John Boockvar.

- Nice to meet you.

- How are you?

- Good.

So I'll be working with Dr. Langer.

So I run our brain tumor program,

where we take tissue

and we grow it in mice

and then we propagate it.

It's of no cost to you.

It's so we can do some basic

science research on this material.

You have no obligation to do it.

We get the tissue back

in about six months.

And then we have genetic information

from your blood and from the brain.

And that's maybe important

for not just you, but for the next person

- and the next person.

- Absolutely.

I have no financial interest in anything.

I don't get paid a cent

whether you do it or not,

but it is important

for biomedical research.

So the good news is,

we know it's a low-grade tumor.

In this location,

we're going to be aggressive.

Because if we get the whole thing out,

it could be, essentially,

it'd never come back again.

One of the reasons why I told him

he should come here

is because I knew we had not only

sophisticated guys like John with us,

but just kick-a*s monitoring.

And having a guy like John with me

makes both of us because we can

You know, you talk

and we make these hard decisions.

Because what happens today could have

implications for quite some time for you.

Okay. All right.

We'll do a good job, okay?

Okay, buddy. Good to see you.

I'll see you later.

Hey, Ben, it's Dad. Just calling to see

See how you're doing. Love you.

Call me when you get a chance

this afternoon.

Love you, bud. Bye.

Okay. I have to do an angiogram

that morning it looks like.

Just tell Alex I need to get

an early start on Friday, if possible.

I used to just get so stressed.

Because I was just worried about being

I wanted to be a good dad.

There's just so much, um

you know, emotional energy

that goes into doing this well.

And then, actually having

a piece of yourself

that you can share

with your wife and your kids.

It's there,

but because of the intensity of this

I'm just a person who looks inwardly

and, like, "I'm not doing enough."

And, look, I love what I do.

It's not a sacrifice.

When you're doing what you feel like

you're cut out to do, it's great.

You have to accept the fact

that you give up something

to get something, I suppose.

Ah. There's plenty of room in here.

Whoever set the room,

this actually really looks good.

- I'm very impressed.

- Good.

Darwin, you want to step in here

and get this screen hooked up

so Sherese can see?

Keep his head Stop.

Let me have the head.

That's how you want the head.

Is to be horizontal, okay?

You can do nothing surgically

if you're not comfortable.

If you're leaning over

and you're not in a good position,

you're never gonna be able to operate

or do anything.

That's right in the center of it, right?

So the tumor is here.

I like to prep my own patients

because it's the last time

you see the patient uncovered.

So.

It's a valuable time.

I know you love this.

Okay, so Kevin's 28.

He works at a restaurant in Brooklyn.

His mom and sister are here.

They're from Detroit.

Uh, he presented with a seizure

to King's County.

Uh, they found a tumor that's right here.

You see that?

But, uh, with JB here, we're going to be

aggressive and take the whole tumor out.

Either way,

because his prognosis will be best

as removing all this if we can,

which I think

we oughta be able to do, okay?

All right, ten second time out.

Deep breath. Eyes closed.

Let's get our eyes on the work.

Let's do a good job for this guy.

Where's the blood gonna go?

- It's gonna come this way by gravity.

- Yeah.

You pull it tight okay?

Little things

make your surgery perfect, okay?

Do you have another one of these

or just one?

I'm not getting a good contact.

This is that electrode

we're putting on the surface of the brain,

and he's watching electrical activity.

How about here?

- No, not there.

- How about now?

It's gonna be tumor there.

We're gonna be fine.

You shouldn't hit anything.

Yeah. All right. We're good.

- All right. I need 3D glasses, please.

- Something like this.

No, look, how there's tumor right here.

All this has to go.

All of it.

- Want to come on the inside here?

- Yeah.

- Want to preserve this vein

- Exactly.

Well, I think that's a tumor vein,

but it's the vein on top of it.

Yeah.

- Right there.

- Scissor.

- You see it?

- Yeah, I see it.

- Right there.

- That's it. That's all tumor.

It's all tumor.

It's gotta go.

It's behind our motor strip.

This is what we call

supramarginal resection

from low-grade gliomas.

It's like the first offer

you get on your house

when you put it on the market.

It's probably your best offer.

You get one chance to cure this disease

in a low-grade glioma.

Nice.

That's gorgeous.

- It's gorgeous.

- Come here.

There's the tumor.

Pretty cool, right?

For whatever reason, this is hard.

The tumors just grow infiltratively

into the adjacent brain.

And that's why it's

Gliomas are essentially incurable.

Here's the surface

where the patient had a previous biopsy.

And all the tumor's underneath.

Now we're going to send some for frozen.

We're going to grow

a large chunk of this in mice.

Do some experiments on it.

Yeah, divide that one in half.

That was awesome.

That's how we do it, baby.

It's perfect. It's a perfect operation.

- That was great.

- We saved the veins.

See how we preserved the vein?

He's still going to wake up weak,

but he's going to get better with time.

Another tumor,

defeated by the crew, baby!

David, great job.

You too, brother.

Always clean your shoes.

Families don't want to see

blood on your shoes.

Come, come, come.

- Leave everything there.

- Okay.

We got it all out. We did what's called

a supramaximal resection.

Meaning we took out the tumor

and then some.

- And that

- Okay.

You know, remains to be seen.

So, look, this is what I study.

This is what keeps me up at night.

I know I know the biology

of this disease as much as one can know,

and I'll treat it the way I would want

my family member to be treated.

Right. Right.

There's some controversy

about best treatments,

and we are still understanding

what is the best treatment,

but given his age

and the extent of resection,

I expect good survival from him.

You're gonna ask me exactly

how many years he has left to live,

I can't give you that.

Kevin, you're all done, brother!

- Sorry.

- It's all right.

Okay.

- This went really well. A little too well.

- Strong guy.

Everything went great!

Okay?

I think we're good.

All right.

- Good job.

- Good job.

John Fehling, Senior.

I'm a lieutenant in the NYPD.

My uncle passed away in 9/11.

I said the "P" names,

and then I said my uncle's name at last.

And my uncle, Pedro Francisco Checo.

Tio Frankie, we miss you, we love you,

you'll never be forgotten.

We will miss you and get to heaven.

I wanted to be a civil engineer, you know?

I was in Hartford University,

and I got into John J

because I wanted to be a cop.

When he passed away.

Thank you.

- I'm so proud of you.

- You're welcome, mom.

Today's two.

And then next week is our max dose

at eight times ten to the ninth.

Yeah, you know,

your body got introduced to it last week,

and you did well.

Now we're sort of doubling,

and then we're going

up to eight times ten to the ninth.

So it's a lot of bacterial particles.

Okay.

We took the same pieces of bacteria

and we put them in mice.

We cured some of the mice of cancer.

The problem is

you can experiment a little bit more

Take a little more risks in mice

than you can in humans.

You see how carefully

we're titrating up her dose

from one to two to eight.

If I get to eight too quickly

and she dies,

the FDA will shut down the trial,

you know?

And so we're very, very cautious.

The courage that a patient like that has

to be the first or the eighth patient

in the nation to do something,

it's incredible.

It's almost it's almost unfathomable

the trust that she has in the team,

and just say, "Hey,

I'm going to take this risk."

LENOX EMERGENCY ROOM GREENWICH VILLAGE

We can just order it. Okay.

Borderline.

Borderline but not terrible.

Not positive.

- Hi.

- Let me say hi to the baby.

Hi, boo-boo. Hi.

- I know, I'm like too big.

- Your blood pressure good?

- Don't scratch.

- Uh, borderline.

I know. I don't want those stretch marks.

- Don't scratch. Just rub.

- Just rub. Okay. Okay.

Yes, I'm a little bit swollen.

- Yeah, my rings

- What about your feet?

- My feet are, too. They are swollen.

- Try and take it easy.

Yeah, everything is swollen,

but later it'll go away.

- It's momentary.

- Now I'll go eat and it'll go away.

We're having ham and cheese.

And my mom is like ridiculous.

She washed all the clothes,

- she's putting everything away.

- She's nesting?

She's nesting for me.

I'd rather be here than be at home.

I know that's gonna happen

after I have the baby.

I'm just going to want

to come back to work.

So why is the last day today?

My husband's like, "That's it."

Yesterday I was breaking down boxes

and taking them downstairs.

He's like,

"Can you stop what you're doing?" Like

- I just can't sit on the couch.

- I know.

I heard you're not feeling well.

I think I've seen you before, haven't I?

Yeah.

- Yeah.

- Your face looks so familiar.

Why does it look familiar?

What's going on today?

- Chest hurt.

- Your chest hurts?

Okay, what were you doing when it started?

Sleeping.

Sleeping?

- What?

- It hurts.

- What hurts?

- My chest.

Here?

Okay.

- You having a boy?

- Mm-hmm.

- Mm-hmm.

- How'd you know that?

I'm a mother.

- You're what?

- I'm a mother.

- You're a mother?

- Mm-hmm.

- Oh, so you know.

- Mm-hmm.

- How many children do you have?

- Just one.

- How old?

- Eleven.

- He or

- She.

She. Where is she?

At my sister's.

- In New York?

- Brooklyn.

In Brooklyn.

What's your daughter's name?

- Jamia.

- Jamia.

- Yeah.

- That's pretty.

How often do you see her?

I don't.

- You don't see her?

- No.

How come?

I don't know.

But she's with your sister.

How long has she been

with your sister for?

Two years.

- Okay.

- I miss my baby.

Yeah?

I think about her every day.

She's an honor roll student.

Is she?

Mm-hmm. Gifted and talented,

and she's on student council.

Wow.

She's very intelligent.

- Are you allowed to see her?

- Mm-mmm.

No?

How come?

Me and my sister don't get along.

- And you're not doing any drugs right now?

- Mm-mmm.

Okay.

I'm a good girl.

- Yeah?

- Mm-hmm.

All right.

Trust me, my life,

I should be doing drugs.

But I'm not.

All right.

I'm just really hungry.

I haven't eaten in two days.

All right. Well,

how about we bring you some food?

How about that?

Hey, bud.

How are you, man?

Are you doing okay?

You sure?

You seem a little off.

Is everything okay with Mom?

It's all going to work out.

It's your first year.

I think you just have to

This is the way the world is.

I know you think

you're the master of the universe,

but it's competitive.

And you're going to do fine, but this is

There's a lot at stake

in everything you do. And that's why,

if I give you a hard time a little bit

about some of that stuff at school,

it's because I know what the potential

for the pitfalls of this are.

Well, don't keep it under your hat.

You should talk to me.

Okay? I've actually been through

some stuff before.

All right, I'll check in with you later.

Love you.

All right.

I'm late, I'm late

for a very important date.

Hi, Phyllis.

How was your night?

You want to go home?

Maybe that would be a good idea.

I think it would be a good idea.

And can you tell me a little bit

what's going on in there?

I took off one of the plates.

And growing up from under it was a cancer.

And I can tell

There was just this purplish

substance.

And so I took pieces and sent it upstairs

and I looked myself at it.

- Okay.

- It's a little unusual,

but it's all out.

Everything's been unusual with me.

The question will be is

if there's no other sites,

what do we do with this site

that's already gotten radiation?

And that's a question for the oncologist

and my radiation doctors as well.

So my take is do nothing.

It's not worth it.

It's not worth it.

I'm gonna get myself a nice pill,

so whenever that moment happens

happily, I'll say good night.

That's my plan.

And I told my husband,

if he wants one too,

I'll give him one too,

if he thinks he'll miss me too much.

We're going to talk about in the office

when you come back.

- All right.

- Okay?

Yeah.

Saul is home with you?

- Yes.

- Okay.

He'll be happy I'm home.

Yeah, I'm happy you're going home.

Okay.

All right, thank you.

- I'll see you next week, okay?

- Okeydokey.

You know, each of us have to

think about what we would want.

I'll never forget my dad.

When he had cancer,

he was very explicit about

what he would do if he lost consciousness.

So at the end of the road,

when all the doctors said

his case was terminal

he said, "Don't unplug me.

Just give me six months

in case I make a miraculous recovery."

I can come home early tomorrow and help

from the lab.

I have four kids, right? So every time

If you have cancer

and you get chemotherapy,

you can't be around children.

So he couldn't be around my kids.

He actually succumbed to not the disease,

but the treatment that he had gotten

for his disease.

And that shouldn't happen.

Everyone else good?

I don't know. I got two big cases,

and I'm not exactly sure what time.

My experience with my dad

changed me forever.

- He's doing pretty well, huh?

- I think he looks great.

Again, thank you so much.

No problem. Let me see your head.

That looks great.

Awesome.

And he had something else to say.

What else did you want to say?

Uh, I think you just saved my life.

- You look awesome.

- Thank you so much.

- You really look great.

- I appreciate it.

- He's not going to even need you.

- He's not going to need me.

And that And guess what.

Isn't that the best thing

you could say to me?

- Yeah, absolutely. See you soon, okay?

- Thank you.

- All right.

- Thank you, Dr. Langer.

You're not going to need me.

I know, John. I'm just I'm so happy.

It's it's better than I could've

Okay.

I know. Yeah.

I've never been so happy

my child doesn't need me.

Ah!

Kevin actually he moved to California.

So we're doing a little bit

of long distance right now.

So he's coming every other Friday,

so we have this whole process.

- Okay. Okay.

- Yeah.

Should I stay here, or over there?

Well, this is the ultrasound,

so where do you want to be?

Okay, my my pride and joy right now

is that no one can tell I'm pregnant.

You don't know gender or anything.

I'm trying not to know.

- Oh, good for you.

- We have debate within the household.

- Actually, no, it's cool.

- Oh, wow!

All right.

Your baby's in a perfect position

for the nuchal translucency.

Little big I feel like big

Oh, look at that little heartbeat.

Got a little heartbeat.

Nice and strong.

Good!

- Oh, moving.

- Hold still, baby.

It's awesome that you don't want to know.

Yeah?

I feel like there's not

that many genuine surprises in life.

- Right.

- And I feel like

when I'm in those deliveries

where the parents don't know the sex,

- it's like even more joy than normal.

- Yeah.

That's amazing.

Mmm!

Did you meet in California?

- No.

- We actually meet at the club.

That's why

you can't predict life like that.

And then he didn't know

what he was getting into

- by dating someone who was in medicine.

- I did not.

She did not tell me.

Oh, look at that. That looks good.

Can you stop the video

for a second, or no?

I was just going to say something, but

Generally speaking,

eventually it's going to be your decision.

So, if you look here,

it's the fetus, this is the profile.

And the area behind the neck,

it's the skin fold.

It's this area we measure

and the larger the measurement,

the likelihood

of an abnormality is higher.

Also, there's a slightly increased risk

for birth defects.

Not that I can see one.

That's why we may have a fetal echo.

At this point, I would say

CVS makes more sense,

because we can get you the results

- within a few weeks.

- Mm-hmm.

An amnio means that you wait

for at least another month to do it.

Yeah.

Again

some patients may decide

that they don't want

Yeah, I didn't know

So basically what he's saying is

It's a little bit thicker

than it should be.

- Thicker

- But it's on the borderline of being

It's not like if it was four or five,

they'd be like, "This is done."

Like, this is 100% abnormal pregnancy.

But like, it's just a little bit

over the border,

but more

than they're willing to be like

Some people would definitely not do

a diagnostic test

and, like, have a high percentage

of having a normal pregnancy

but I think it's worth it

for us to do CVS.

And CVS is?

Chorionic villus sampling.

It's really kind of sampling the placenta.

Looking at the fetal genes

and the placenta.

- So they take a needle and they go in

- In my belly.

Oh.

I don't know. I've never seen a CVS.

I've actually only seen amnios.

- You've never done it before.

- No.

- Oh. Is that something you should do?

- Yeah, but I do.

It sounds like I'm very busy,

but are you okay? Are you okay?

I'm all right. I'll be all right.

- Come here.

- Okay.

I think it's going to be fine.

I don't think you need to change

your flight, actually. I really don't.

Actually, the more I think about it,

I don't need someone here.

I'm just going to get a resident to come.

I'll get a fourth-year.

- Okay, I'm going to talk to you later.

- All right.

This is not how you leave.

You can't go this way.

I'll talk to you later.

What Oh

Go that way.

Oh, this is

I'll see you up here

before you leave, okay?

- All right.

- See ya. I love you too.

I was running around

like a chicken with my head cut off

between cases.

I sent the lady down for a CAT scan.

No one could see the CAT scan

for literally an hour.

I don't mean to be shrill,

and I do get emotional, admittedly,

and I apologize for that,

but in general,

it's when things get really bad.

I just want to be a voice of reason.

I want to make this

the best damn place in the world.

And I believe that IT is

a huge component of that.

So, I'm about to start a big case.

I have got to focus on this,

but I can't tell you how much I appreciate

you guys reaching out.

I need to do this for myself

and my patient and my team.

Okay? All right, guys, loving you.

Thanks so much.

Okay. Bye.

All right, ready? Sorry about that.

We'll try not to cut her hair.

I think he's going to do

something like this.

And then he's going to come behind the ear

and like that.

You can feel it. That's the tumor.

- Yeah?

- Feel it?

We have to be able

to get to the middle circle.

This will be good.

How is everybody today?

It's a big one, guys.

I don't have

I don't have a signal on the screen.

He's coming down.

I see him. Give me one second, please.

Love it!

I f*cking love the exoscope!

That move is so hard

with a microscope, dude.

That's like when you hit

that three-pointer.

The reason

why she's getting the bypass is that

there's a large blood vessel passing

through the tumor.

If we just take the tumor out

with the blood vessel,

we think she would have a stroke

based on the testing.

We want to put a bypass in first

to bypass the tumor

so that we can remove the vessel

along with the tumor specimen.

I'm gonna cut a little bit more,

you think?

That's just perfect.

You couldn't have asked

for a better match.

Good.

It's a good graft.

That's really nice, dude.

That's varsity.

Somebody just walk down

and tell the family

I'll be out to talk to them in a half

an hour, but everything's going very well.

And John has his final exams.

He has finals?

The week I'm due.

- So if it happens, it happens, but

- Don't feel bad.

Actually, if it happens a week before,

then he can take the finals a week later.

Um, yeah, I know. No control.

I'm starting to feel

the weight of my, uh my work

on my body and my mind.

Give me one minute.

I'm going to have to bring a chair

to see these people.

My legs are my legs are tired, Jennifer.

Put them up.

What if I just get pushed

over to the other side?

I'm pushing myself, actually.

This this past week was pretty tough.

So, Mr. Munn, what's going on?

You were just here 24 hours ago.

Yeah, so I'm having the same issue again.

Just like a swollen throat.

- Yeah.

- Like my tongue is sore.

Um, I've not done any drugs

or eat anything different.

So I don't know what's happening.

So when's the last time

you did the crystal meth?

- Three days ago.

- Three days ago.

- I don't do that.

- Okay. Okay.

That's okay. I'm just asking.

- She has a bed.

- Okay.

- I told her everything that's going on.

- You want me to do it?

- I can walk over there.

- Okay, I can walk with you.

My sister

My sister's asking where the will is.

Why are you watching me

go down the stairs?

- Be careful.

- Do you think I'm going to fall?

Surprise!

Look at this!

You guys are so amazing.

Thank you so much, guys.

Eat, eat.

I'll eat.

I made a flan. I was like,

there's a potluck going on.

Oh!

That's right. You made something.

It's like my grandmother's recipe.

It's really good.

It has to be flipped over

or else it's not flanned.

This is your last night shift.

I'm going to miss you.

I know. I'm going to miss all of you.

Yay!

You'll have to send the photos to me.

Oh, boy.

Aw! Everybody's on here. Everybody.

The nurses. The techs.

You guys, this is honestly

the best place to work.

It's by far. It gets number one.

Right?

I mean, the people here are just

so amazing.

I'm really going to miss you guys

at nights.

I might come back before.

I don't know if I can make it.

Let me know. Let me know.

Four months is too long.

- Thank you, everyone.

- You're welcome.

You're welcome. Bye.

Go see what it looks like up there.

I'm scared to look.

Oh, boy.

f*ck me. What in God?

Look, it's not bleeding.

Heparin.

There's no flow.

Give me a scissor, please.

The stenosis is fine.

It was flowing fine for five minutes.

Now it's got no flow, though,

coming from the proximal side.

- There it goes.

- There it goes.

There it goes. There it goes.

Whatever clot was there

just opened up completely.

Right here.

This narrowing.

Get the exoscope on it.

Give me the pickups with the teeth,

the blue ones

and a brand new 15-blade scalpel.

Doesn't look right.

Doesn't look right.

Look at it up here, Pete. There's no flow.

You can see, it's just totally collapsed.

It's not bleeding all the way through

is what I'm saying.

You need more flow

for this thing to dilate up.

The only way to prove it

is an angiogram

and show the ACOM fills the MCA.

Let's do an angiogram.

It'll explain why it's not working.

That's why no one else does this stuff.

Yeah.

It's hard.

It's challenging.

She's going to do okay.

We'll get this tumor out.

She'll be all right.

Just going to stroke her in the process.

Oh, boy.

The graft worked for about five minutes,

and then it started slowing down.

And I think she may have collateral.

Because the graft is absolutely perfect.

- Yeah.

- Yeah.

Yeah.

That I could accept.

The brain's smarter than we are.

Yeah. That's, the human body.

Let's hope she doesn't have a stroke.

So there was some other source

that was competing against

the graft, basically.

Essentially, her right side

is filling the blood vessels to the brain

the normal way,

and actually through the face,

the right to the left side is feeding

these same external carotid branches

that we thought were isolated

and she couldn't tolerate losing.

There's no better way to study her

than we did.

And if it's my mom or my sister,

I would've done the same thing.

We'll go ahead with the tumor resection

next week.

I'm starving.

Things went well.

And, in fact, in a strange way,

unexpectedly, things went

better than we anticipated.

Because we have reserve redundancy

in the blood flow to her brain

that we didn't realize existed before.

And I think that,

it's likely that her brain will be safe

throughout this entire process,

- but I'll let Dr. Langer explain that.

- That's awesome.

There's no way that Dr. Constantino

could have gone in next week

and done this tumor resection

without knowing.

Absolutely.

And now even though it's

a 12-hour exercise

and it takes our technical thing

even though the graft isn't working,

we do know that she's safe and that

- he can safely take that tumor out.

- Yeah.

Well, you guys had a long, hard day, man.

We both, everybody appreciates

everything you've done.

- And you guys rock.

- Yeah.

- It's an art for what you guys do

- Y'all are famous in Tennessee.

One thing for sure,

- everybody in Tennessee knows you.

- I didn't have anything else to do today.

Yeah. I know you didn't.

She did a lot of background

on Constantino, and it led to you.

And seeing the positivity

between the both you guys,

and seeing how you managed, it means a lot

to people like us.

- Good.

- You know?

- All right, man.

- Get you some rest, man.

Let's hope she's okay.

Yes, let's hope she's okay.

- Okay.

- Tomorrow's another day.

So Mitzie had a stroke last night.

And I came in to see her at about

I was at dinner, and they called me

that she wasn't moving her right arm

and her

She was having trouble with speech.

I came and saw her and we're we're trying

to wean off pressers.

She'd been doing great in the afternoon.

But, you know, obviously, it's, um

very, very unfortunate.

And, um

complications are not

things that I take lightly,

and certainly in the vascular world,

it happens, but this was, um

just hard to take.

You have to think of yourself

as an arrow,

and that you you work

on sharpening your tip.