01x05 - Undercurrents

[bunniefuu]

PREVIOUSLY ON LENOX HILL

I'd rather be here, though,

than be at home.

I know that's gonna happen after I have

the baby. I'm gonna want to work.

Happy birthday! He's very cute.

- Is he?

- He's adorable.

It's one thing

to be proud, and independent,

and say you don't need your kids

and be strong for them,

but I think, at some point,

you have to be honest.

I'm lonely.

I'm scared.

I have cancer.

I could be gone in six, seven months.

We potentially are, like

naively optimistic.

We just feel

like she's gonna be okay.

And we hope that she is.

Thank you.

Right now,

I mean, that's all we have, kind of.

It's a girl!

I heard it! I heard it!

I heard it!

Look how healthy he is.

Look how perfect

How perfectly healthy he is.

You don't feel it. It happens really fast.

One minute he was fine

The next minute he was having seizures.

And it was just this tiny little blip,

and it grows really, really fast. Just

These are pictures of my dad.

And he had cancer.

My brother said, "Dave, you just

You do just what Dad did."

There's no question

I became a doctor because of him.

Yeah, it's no question.

He had a heart attack when was 42

and died when he was 45.

His stroke is what got me interested

in neuroscience to begin with.

Beautiful.

A YULARI FILMS PRODUCTION

EXECUTIVE PRODUCERS

RUTHI SHATZ, ADI BARASH, JOSH BRAUN

I still never told you about my dream.

It was about my dad.

I've had them before

where it's like he's alive again.

I find out that I can cure a stroke,

and he's there.

He's alive still, but he's had a stroke.

Then it like, stops right there.

Sometimes I wonder if I wasn't

close enough to my father, that I felt

emotionally connected

to him enough that it would drive me

to do something just about him.

Which I think I feel guilty about.

There's no question

that part of the reason

I went into neurosurgery was

to cure my father.

It really goes deep and and it's, uh

That that's what that dream is

a manifestation of.

It's the the undercurrent of what's

probably been in my head for a long time.

LENOX HILL

Just walked into this mess today.

What mess?

It's like there are two cases

added on. It's just madness.

I called Raf yesterday

to try to figure it out.

It's, like,

what the hell is going on over there?

But I feel great.

I feel amazing.

I want to talk

about Mitch a little bit.

So, I don't think

DAVID LANGER, MD

CHAIR, NEUROSURGERY

that he'll be back

for a couple of months.

So what I want to try to do is

be very proactive on the volume side.

Mitch is probably doing 20 cases a month.

He's about

Budgeted for around 200 cases.

Screw about the budget.

- What's he do in a month?

- About 20. Let's

I think if we could sh**t

for, like, 200-case volume,

but we have to just make sure

we support his practice.

And make sure our volume is

It's going to drop a little bit.

We just gotta do

as much as we can to keep it where it was.

He has cases scheduled already,

- so we need to reach out to patients

- He does?

- And talk to them.

- He has cases scheduled?

- Yes.

- Somebody has to do them.

Correct.

Let me manage Mitch's practice best I can.

I think if we divide it up

amongst too many of us,

it's not going to be a good idea. Okay?

Plus if they start freaking out,

that the fear the chairman's showing up,

that alleviates some of the

Like, "I'm not going to that doctor."

I don't want that to happen.

- Okay.

- Okay?

But I want to be the point person for this

and make sure it's done properly,

because I'm taking responsibility

for Mitch.

This must be your son.

- Yes, sir. Pleasure.

- I can tell.

- Jake. Nice to meet you.

- Good morning.

This is the area that we're going after.

And there's a significant volume

of residual that we're going after.

Okay? And it's right near

your motor strip, so this is the leg,

arm,

face,

as we go from the middle

down to this side.

It's really a long operation only

because there's a lot of us involved.

Myself, Dr. Chong, the epileptologist,

Dr. DeSanctis, the neuropsychologist,

and Dr. Constantino.

Okay?

It's the right thing to do.

There's a lot of tumor in there.

- Don't give them too much sh*t, all right?

- I'll try to be good.

All right, Timothy,

let's get the job done.

- I'll see you inside, okay?

- All right. Sounds good.

Thanks, Alison.

- Good morning.

- What's up, JB?

Good morning.

What kind of music you like?

Rock and roll.

Okay, so classic rock. Really?

Yep.

I'm gonna give you

some local anesthesia.

This is gonna be the worst part,

just the pinching.

And the burning. Okay?

Tim, what's your address at home?

Forty-six Chester Hill, Michigan.

Great.

Welcome to New York City.

I've gotta move quickly

in an awake surgery.

There's no time for dillydallying.

The patient's almost doing you a favor

staying awake

during a procedure like this.

Get in, get out, take the tumor out.

You're a robot.

You're a robot. You're a robot.

This brain tumor,

it's right in his motor strip,

which, in my opinion,

can be more aggressively resected

if it's done awake.

We're gonna talk to him

through the surgery.

We're gonna make him move his right side.

The rationale to do that is

can we take out more tumor

while sparing his function?

- You okay? It's Dr. Boockvar.

- Yeah.

I just put on some classic rock,

all right? Starting with Boston. Okay?

- All right.

- All right, enjoy.

Let's get this done.

So what teams do you root for in Detroit?

Well, unfortunately the Lions.

The Lions. I'm sorry.

Yeah, I know.

Tim, any song you want to hear?

Suction to me.

- How about some Tom Petty?

- Tom Petty?

Yeah, I took my son to see him

when he was, like, 12.

- What do you want me to do?

- I think they're good.

- Now now we're talking.

- Now we're talking.

Squirt.

And take your finger.

Half by three, Patty. Ready?

Could you bring the head up

a little bit, please?

Should I move my head?

No, you don't move anything.

- Okay.

- But thank you for asking.

- Just wanted to clarify that

- You're doing just enough.

You remember the, um

- what I call the snotty-like tumor?

- Yeah.

- See how snotty this is?

- Yeah.

So is a snotty tumor good?

- Yeah.

- Snotty tumor's great.

What a snotty tumor means is that

it's lower grade, which I like.

It's not a scientific term.

That's brain.

That's normal brain tissue down there.

Right?

Regina, just do a motor test for me.

Fingers. Okay.

Shoulder shrug.

Yep, um

He's having a little trouble

with the shoulder shrug.

Okay. I'm right at that margin.

Your shoulder's still not moving?

You can't move that shoulder yet, can you?

How's the leg doing?

Move your toes.

Yep.

All good.

So what we're doing with Mitch

he made the decision that he's going to go

to Houston for the surgery.

- Physician illness is a very unique thing.

- Yes.

Especially the decision making

and some of the stresses

because there's politics and there's ego

and there's what you want to do

for your health,

the value of being a VIP,

the bad things about being a VIP.

I don't think it's black and white.

I think when physicians are ill,

sometimes it works via their home base,

- and sometimes it works elsewhere.

- Yeah.

And this in particular, I think, it's much

better off that he's not here, uh

- I agree.

- And so

My father, when he got sick,

everything was hunky-dory

for the first three to six months,

- and then

- Until it's not.

All of a sudden it's like,

there's got to be an end to this.

And so I think what we have to do,

as a department and as a hospital,

is give Mitch the opportunity to decide

what he wants to do and when.

I think that'll be he'll determine that.

And I think it's not

He's not unable to move an arm or a leg

or unable to actually operate.

Really, a lot of this depends on Mitch

and what he feels like

coming back and doing.

You're handling it

as your closest friend and colleague.

- Yeah.

- That's how it needs to be handled.

We just need to protect it

as long as we need to.

Right. And we will support

the whole through.

- Everything okay?

- Yeah.

Here.

- I think I can feel it, actually.

- Hey, man.

Hey. Hey.

John is so good with the baby.

He doesn't mind changing diapers.

He's involved in everything

that involves Joaquim.

And I think that has helped me

tremendously in getting through

the ups and downs

after becoming a new mom.

That was paramount.

Because I did feel definitely

very early on

there was a lot of hormonal ups and downs.

I wasn't depressed,

but it was a blue-ish time.

Mommy.

Everybody at work

is asking me if I'm doing nights still,

but I don't know how the nights is

going to work with him.

We got a little routine going on,

him and I.

- You have some daddy magic?

- I have some Daddy magic.

You are.

You're going to be alone with Daddy

when Mommy goes back to work.

Yes.

I think I'll feel better

once I start working again, though.

It's been a long time.

I need to go back to work. Definitely.

I love him. I love this.

It's been super fun with him,

but it's time.

I need I need to get back in there.

I need to see people again,

talk to people again.

Because that's the thing about our work.

We get to talk to a lot of people.

We get to speak to people

we don't know, strangers.

That's what I love about the ER.

And I miss that.

It's going to be good for me to get back.

This has been

a little Disneyland vacation, actually.

Do you want to take a nap?

Take a nap.

I know you can put yourself to sleep.

I've seen you do it.

Just doing a final physical on 81.

Okay, I just need

Whenever you're finished,

bring it to recovery room,

'cause I need it to confirm presentation

for a C-section. Thank you.

- Hi.

- Hi.

Hi. How are you?

- We're very well.

- Good.

You're the husband?

You're both doing well?

- Yes.

- Yes.

- Excited to meet your little one?

- We are so excited.

- Are you having a boy or girl?

- Boy.

Boy? You have a name?

- Not yet.

- We didn't decide yet.

That's okay.

- You ready to rock and roll?

- Yep.

- Let's rock and roll.

- Okay.

Thank you, Tina.

Can we get suction?

I see Daddy's here.

I'm going to call Pete.

Perfect. Nice.

Yes, you can come in.

Where have you been?

I waited outside.

I started residency in 2015.

Thank you.

It's crazy that I've been at this hospital

for three and a half years

and that it's almost done.

Clear fluid.

As I come to the final year,

I'm, like, trying to make sure

that I'm capitalizing on all the things

that residency offers me

before I go out on my own.

Okay, we got a baby!

- That's a first-grader.

- Yeah!

- It's a scary step.

- Marianne was right.

- Big baby!

- You got a big kid.

He looks like you?

I hear him cry! Look at him.

Oh! Oh!

Hi, Mama!

There we go.

It would be really hard to have imagined

going through this process

without my family.

My dad definitely is a big reason

I became a doctor.

- Okay.

- All right.

All right. Congratulations again.

Thank you so much.

I'll see you very early tomorrow

morning, probably earlier than you like.

Thank you, everyone.

- Okay.

- You're welcome.

So this is the area in his brain

that has the residual tumor,

and we've been hitting this thing

with chemotherapy.

He's got a bad tumor,

but we see a lot of good response.

It's called keeping John's thought process

about delivering

the chemotherapy locally

rather than systemically.

All right, rock and roll.

Let's get the mannitol, please.

John Boockvar conceived of this idea,

because of what happened to his dad.

His father had a lymphoma

and had a side effect

of a high dose of chemotherapy

that ultimately he passed away from.

In order to get drugs into the brain,

it's challenging.

Our usual chemotherapies don't pass

through the vessels very easily,

so what winds up happening is you have

the systemic toxicity of the medication

without the local effects of the drug.

So the idea is

create the pathway to access the brain

through these openings

and the tight junctions.

And John's really been a leader

in the idea

of it in the business,

and it's proven to be effective.

It's really our obligation to do something

that's potentially valuable but safe.

Because, frankly,

there's not many other options for them.

Whatever life the person has left,

the last thing you want to do is

make them live with a deficit.

We just did two weeks of radiation,

and these three procedures and that's it.

Um, it's harder in one way,

because of the speech issue.

And all the high steroids are

really destroying his muscles.

But on the other end,

it's not a year of maintenance chemo.

It's over now.

Now after today he just builds back up.

Hopefully, you know, it worked,

and we don't have to worry

from this point on.

Is the foot moving?

No.

The toes not working now?

All right. No.

I can feel it.

Yeah. The sensation's there.

I'm gonna start stimulating your brain.

You may feel some movement, okay?

- Okay.

- Right. So it's going to be normal.

So we want you to relax

as much as you can,

and he's going to activate a certain

neuron in your brain, and it will fire

- Pull it tighter, please.

- And it will move automatically.

We're just putting

back on the grid now to make sure

- you're not having a seizure, okay?

- Okay.

- You want to do leg?

- Yeah, I'm trying.

How about now?

Okay, that's a huge antiv

and two feet muscles.

And you're getting good amplitude?

Good amplitude.

Yeah, much better amplitude.

- The good news is it's intact.

- Right.

It's intact, right?

- He just couldn't generate

- Right.

The command,

but it's there obviously, so

Turn the room lights up.

That's fine. Take the scope out.

Good job, Tim.

All right, good job, everyone.

Excellent job.

- I'll let you go back to sleep, okay?

- All right.

We're going to hustle through

and get you out quickly.

It was smooth.

- Yeah?

- Very smooth.

I literally got out everything.

- Awesome.

- Okay?

He's having a little trouble

His arm is fine. His leg is a little weak.

But it stimulates fine.

And we were explaining this to him

while we were

And, by the way, we were joking.

We listened to Tom Petty.

- Awesome.

- He had a blast.

He may start getting weaker

over the next couple of days,

and if he has a seizure,

he may go out entirely.

The tumor's out.

- All of it.

- Wow.

- Okay?

- Thank you.

- Thanks.

- So much.

Okay. Please.

Nice seeing you guys. Meghan, thank you.

All right.

- Happy, bud?

- Yeah. Thanks.

Today is Mitzie's big day,

and we've waited for this

for three months.

Finally, we're taking her tumor out.

All set?

- I think I am.

- I think you are too.

- It's about time, right?

- Yeah

- I just want to be able to get this done.

- I know, I know.

- And get home and be with my

- You're becoming a New Yorker.

- No. Negative.

- How about we just be a little.

Negative.

Nice toenails, dude.

- Thanks.

- Where'd you do that?

- We went and had a pedicure done.

- That's a serious pedicure.

It looks more like

a fricking goat rodeo pedicure.

Well,

we are from Tennessee,

and we do rope goats.

That's awesome.

Anyway, no,

I think the biggest risk of the operation

you've kind of already overcome.

Um, you actually suffered a small stroke

from a combination of factors,

but I think the chances of you having

another stroke is really low.

All right?

Let's just get in here,

and let's get this done.

Let's get it done.

Let's get your consent form.

I hate knowing the patient so well.

That's why you don't operate

on your family or your friends.

Especially things

that are really dangerous.

It's the rare patient that has something

that really is dangerous and difficult

that you sit on and get to know them

for a year or

The problem is we all got to know

and love Mitzie and her husband

and the craziness, and then

she went through this complication,

you felt emotionally her pain,

and then she got better

and how happy we were.

So when you go in and operate on somebody

like that a second time in,

it's different.

You know? When It's such a hard tumor,

you can't help but be a human being

and think about it.

Come here. Give me some love, baby.

Come here.

- Going to be all right.

- Love you. Forever and always.

- We'll see ya.

- Always.

- See you. Thank you.

- You got this.

Do your thing.

- I wanna see some rock and roll.

- She's going to do great.

Hi. How are you? You guys are so cute.

Oops. What I'm Don't

I always do that.

Ran into it.

- How's the baby?

- Hi, how are you, Rosalie? Good.

- I'll pull out some pictures later.

- Okay, good.

What's up? What's up?

I got some gyozas.

This used to hold, uh

This used to hold breast milk,

and now it doesn't.

Oh Oh, my God.

- Wanna see him with a haircut?

- He's really changed. Yeah.

Where's his hair?

His hair his hair's gone.

He just turned four months on Monday.

Hi. What's up? How are you?

Good. This is my first shift back.

And and this is my first patient.

Where's his wheelchair?

All swooped up.

Hi. Terry, how are you?

I'm not good.

I haven't seen you in so long.

This hurts.

That hurts?

My chest

How long? How long with the chest?

- About a week, maybe.

- Move your hands

- A week?

- I'm gonna

What happened tonight?

- Fell.

- You fell?

- You fell.

- In my room.

- I fell in my room.

- Terry, did you drink today?

A beer.

A beer. No more than one, right?

- Hold still, all right?

- No.

Okay, let's check.

Stick out your tongue for me. Say "Ah."

What's that stuff on your tongue?

Did you eat something weird?

- Yes.

- What was it?

It's normal.

- What was it?

- A hamburger.

A hamburger? Oh, okay.

Terry, we're gonna give you some aspirin,

and put you in a hospital gown,

and give you something

for the chest pain, okay?

Whatever you say, do.

Okay. But we're going to put you

in a room. Is that okay?

Whatever you say, do.

All right. And then we're going to do

some blood work. Is that okay too?

Whatever you say, do.

Okay. You're not gonna say no

to the nurse, no?

I'm going to say, "Whatever you say."

Okay. Let's get you into a room.

It's all right, buddy. I promise.

I had a nanny for the last

six weeks, but we fired her yesterday.

- Really?

- Yeah.

I never knew how complicated

the whole nanny situation is.

Like, they have to have a chemistry

- with you and your family.

- Yep.

So it wasn't the right fit.

I feel a lot better mentally,

because I I was like,

"I can't go back to work

and deal with that, with the stress."

And then I started work today,

and I was, like,

I felt I was ready and everything

was going in the right Then

It's going to be very challenging.

I miss him right now.

- How are you?

- I'm good. How are you?

How's your patient? Doing much better?

- No problems.

- I'm glad. Okay.

Oops.

I have to buy some more.

We need the vitamins.

My goal is to finish

all my case requirements for graduation

before I give birth.

Maybe two more cancer cases.

And I need eight more

laparoscopic hysterectomies.

What did I do last night?

Joanne and I did obstetrics.

I did obstetrics.

If I finish

those kind of residency requirements,

that would be a load off my shoulder.

When I come back from maternity leave,

I can just work, not be doing extra work.

So the more productive I am now,

the better.

Going to take a second.

Maybe I'll set a timer.

Take ten minutes.

Catch up on my celebrity gossip.

- We took her internal carotid.

- Right.

And we tried to put a bypass in,

and the bypass didn't work,

because she has

competitive extracranial flow.

- Okay.

- Then she had a stroke after surgery.

- Peter's part is

- He's going to be here for three hours.

The bulk.

Most of the tumor's in her neck.

It goes all the way up to the skull base,

up into posterior fossa.

- Okay.

- All right?

Yeah. Thanks.

I don't want you to get too yeah.

No, no, I'm not.

The website is a little tricky.

There's a lot of functionalities

that I don't want to mess with,

so whatever we can do to make it

look nice, that's how I want to do it.

- I don't want to reinvent the wheel.

- 100% agree.

If we got this health bridge thing,

rather than finding it buried somewhere,

and then it takes it off our website.

Let me move it.

Let me see what I can do.

And then you can see the basics here

that we agreed upon on the bottom.

Home, pictures.

As long as it's ordered

by the most recent at the top, it's fine.

- Yeah. It's the way Instagram

- Correct.

And then, did you have

You realize the computer in your home,

you can use it for literally anything?

Yeah.

Okay, just

Not that you need more work, but

There's a ribbon-cutting ceremony

at the today?

- Yeah. You're going? What time?

- Evening.

Eleven o'clock.

How many ribbon cuttings can you

possibly have? For one place?

I think I been

to three ribbon-cuttings there.

I can't make it. Just go and wear your

"Lenox Hill Neurosurgery" hat.

Okay.

Yes, I gotta run to a case.

Can I do it with you in about an hour?

Are you are you

Yeah, I'm sorry. My window just closed.

That's good.

That's a jugular bulb right there, right?

- Yeah, right.

- Yeah.

Take any more of that tumor out?

- Took everything out of the neck.

- Oh, great.

I think the nerve's responsible.

Awesome.

I can go from there, bud.

My hand's hurting right now.

Yeah, it's really It works you, right?

Even the CUSA is, like uh!

Can we turn the room lights down?

- Yeah.

- Oh, I'm so happy.

I'm back in my zone, dude.

This is my total happy place.

Hey, how you doing?

Long time no see.

Yes, it's been a while.

So how we doing on the right side?

This one's going good.

TIM

Okay.

Squeeze.

- Wow. That's good.

- Yeah. Started out

where I couldn't

Where I couldn't do nothing with it.

My leg, though, is a problem.

Okay.

Look at your foot.

Wiggle.

Oh.

Okay. How about bending the knee?

Try to move the leg again.

I stimulated up here,

- right on your brain.

- Yep.

- And we got recordings down here.

- Right. I felt it.

That means the neurons, the axons,

and the peripheral nerves are all working.

- Okay.

- But, for whatever reason,

volitionally or voluntarily,

you can't move the leg right now.

I want you to keep trying to stimulate it.

Right. I'll keep practicing that.

Yeah. Little things like that.

Plus, it'll make your wife

and daughter cry.

Yeah.

- You remember surgery at all?

- Yeah.

- Not bad, right? It's just brain surgery.

- Yeah.

- I'm very glad we did it awake.

- Yeah.

Because it allowed me to take out

the whole tumor, actually.

Yeah, that's that's huge.

Yeah.

We don't push treatments

that are not going to improve quality.

If there's ever a treatment that I think

is going to hurt a patient, I never do it.

The right operation is to be

a little bit more aggressive.

Although, look, you know,

he came to me with a good leg

and a good arm, and if I'm

If I took out his leg

that could impact his quality of life.

Even though I took out the whole tumor,

which will extend his life.

So you have to balance extension of life

with quality of life,

and I hope that his leg comes back

so he gets both.

When my dad got cancer,

he never told me.

He had two sons

who were doctors, and he never told us.

He's a doctor.

I don't know

if he had involved me earlier

in the course of his battle with leukemia,

had it, um it altered

his ultimate course,

because he had a complicated course

that may or may not have been altered

by his early decisions,

and so that is a frustration

that I live with.

He died from complications related to

an aggressive chemotherapy regimen.

So.

Do I think, you know,

we could have altered his course?

The answer is probably yes.

- [BEEPING.

- I don't have to worry about it.

Can I move that screen

closer to me? Hit "3D."

Hit hit the button again. It's at 2D.

Call somebody who knows

what's going on, please?

Don't use the screen

for anything else except the exoscope.

You can't start mixing up

the technologies.

That's not what that screen was built for.

Okay?

I spent a lot of effort

in making this work.

- There should be

- Red, green, blue, white. Exactly.

It is connected

This is a big deal.

We have, in some ways, an incurable tumor.

We've got her through the first stage

of this with a bit of a setback,

but now we have a second chance.

It's so important

that we don't f*ck anything up.

And that this goes as smoothly

and as well as possible

to give her her quality of life

and get her back to Tennessee.

Uh-oh

One second.

It's back. It's working.

Move the screen closer to me, please.

Okay, good.

Ready? Get it done already.

- All right.

- Please.

Don't know what that is.

Yeah, it looks like a nerve.

I think it's a nerve.

It's just kinda, like, filled with tumor.

That's the vein right there.

You could k*ll somebody tearing that.

Every time you go into the,

you're taking some risk.

- Right.

- Even though it's risky,

it felt like it was pretty loose.

Just I didn't really feel like

there was a ton attached to it.

Even though it was dangerous.

Call Peter, please.

Yeah.

Very challenging.

I'm going to have to come top down.

Yeah.

There's a big chunk of tumor right there.

On.

- How's it look, Dave?

- Pretty much all out.

So it just looks Yeah.

I think there's tumor

in the condyle itself.

Want to drill it out? I mean,

the other option's radiate the damn thing.

I can only say if it was my head,

I'd rather be rid of tumor completely.

That's aggressive, though.

I think it's going to be hard to cure,

this every morsel of disease.

It's in the muscle.

Even what I saw when I got in here?

What a frickin' mess.

- Yeah.

- Ugh!

Stacey Stacey who's Stacey?

Oh, I see. I need, like, an orientation.

Maybe I should do a meet and greet

with the new nurses.

Is there a new nurse?

- There is. Stacey

- Stacey.

And then we have

the two fellows off orientation.

I don't know anybody. What happened?

Hi. I'm Mirtha. We haven't met.

I'm the I'm I'm back. I've been away.

I'm here at nights.

I think you have a patient in room seven.

November 3rd, 1953.

We have the same birthday.

Oh. That's why you so beautiful.

Oh, is that why?

You were 1953. I'm 1978.

Oh, look at that.

Yeah.

Look at that.

We'll probably have to scan him, so

Hmm. There's a new one in 14.

- You want me to talk to him first?

- Yeah.

Okay, I'll do it right now.

- Okay.

- Okay.

Mr. Vasquez,

we're going to give you that stuff,

a shot of something to help you calm down.

Is that okay?

Yes. Can I get Thai food?

Why don't we talk

about what's going on today?

I'm hungry. Can I get Thai food?

And then I'll talk to you.

I need you to lie down. Okay?

I need you to relax a little bit.

You're very upset. Just relax.

We're going to give you that shot

of medication we talked about, okay?

Can I get Thai food, please?

- I'm hungry for Thai food.

- Okay.

I'm going to give you a shot

in your bottom right here, okay?

Okay. Just hold on to your money.

Hold on to your money first, okay?

I'm not gonna do anything

with your money right now.

You need to get some rest, Mr. Vasquez.

- Mmm, my head hurts.

- Oxygen.

And if we have a pulse ox,

just put him on it. I don't think he'll

You want full monitor,

or just pulse ox?

No, just a pulse ox.

I'm going to put up

a relaxation video for him.

Can I get, like, maybe, um, Vietnamese?

That sounds fantastic right about now.

Can I get, like, a turkey sandwich?

Sure. We'll work on that.

With mayonnaise?

And Dijon mustard?

And do you guys have pickles? Like, dill?

That all sounds very good.

I think the best thing

with patients like this

is just to make them comfortable

and give them some time to do

a decompression.

Literally, let them sleep on it.

I definitely assure them that

they're going to be taken care of

in whatever they need.

I can't exactly get him Thai food

But we'll take care of everything else.

Mom, don't

wake him up tonight to give him his milk.

Let him sleep until

whatever time he wants.

Okay, we gotta go for this food now, guys.

- We got 30 minutes, so let's roll.

- k*lling it.

Um, sorry. And then we're gonna

all come back here

- and work and study.

- I have so many notes.

You have four notes.

It's like the whole sixth floor came down.

Yeah. And it's so good.

Is it? Is there still food?

Hey.

Hey, guys.

I want to dance too now.

- Wanna take our pictures first?

- Let's do it.

Let's do it.

That's a good one.

Oh, wait. Okay.

Residents are

the backbone, for sure, of our department.

Someone said,

"You're bonded to your co-residents,

because you've gone through w*r."

And I think it's true.

You know, we see each other more

than we our husbands

and our partners,

so if we don't like each other,

then it's a big issue.

Guys, get a picture with us.

We really do have a lot of teamwork,

you know?

I'm going to miss them

as individuals a lot.

Oh, my God. My belly.

Hi. What's up?

Through room one?

Okay, thanks.

Emergency room

I think that's it.

What a crazy case.

I mean, seriously.

All right. Nice job.

I'll call my wife.

Hello.

Finishing in the OR. I'm done.

I'm going to go change.

I'm going to get out.

All right? I'll get you the exact address.

I love you. Bye.

No, she had a great operation.

I mean, we got out all the tumor

we could get out.

So now really what it comes down to

how much fatty tumors we left

in the post-op image

and what to do about it.

If there's any left,

- it's going to be a very small piece.

- Okay.

And we'd probably just follow it

and not rush.

Took her ten years

- for this thing to grow this big.

- Yeah.

The chance of it growing to this size

ever again is low.

- As long as we keep an eye on it.

- Now we know.

You just do an MR once a year.

And I I really doubt there's going to be

anything of significance left.

Get you some rest.

Do whatever you got to do.

I'll see you in the morning.

- Absolutely.

- All right. Thanks.

Oh! That was a long

Another long day.

Now, where the hell am I going?

And my wife doesn't really want to go

to dinner because it's so late, but I

My, uh, father's experience in healthcare,

his death, you know, taught me how bad

medicine can actually be.

When he got his stroke,

the hospital basically

threw him out.

My medical tuition which they were paying

was gone

and all of a sudden my parents had

no money. He had no insurance.

They totally screwed him,

because the contract was all screwed up.

And I probably could have gone

one way or the other at that point

and become really angry at the world

and said that, you know, people are jerks.

I'm just going to go off on my own now,

and f*ck everybody, you know?

That would have been a reasonable option.

But, um

I didn't do that.

Do you know if I can get a BLT anywhere?

I can get you crackers. Ginger ale.

I want, like

I don't want to say "want,"

because that sounds demanding.

I would like a sandwich. Like, now.

I didn't get to eat my dinner.

And I'm like

Yeah. I'm going to go home and have

a big breakfast.

Maybe a hash brown or two.

Mr. Vasquez, you want to go?

Yes, please.

You're okay to go home?

I'm going to catch a cab and then probably

go get a big old sandwich.

Let's see what's going on.

Good morning!

You want some breakfast?

Yes, ma'am.

Okay, we're going to get you

some breakfast.

- Yes, ma'am.

- We called the BRC, okay?

Your shelter's coming to get you

at 8:00 in the morning.

- Uh, okay.

- They're gonna come get you, okay?

- Yeah.

- We did do blood works, okay?

Your alcohol level is a little up.

- Uh, yeah

- More than a beer.

I drank.

- You drank. Okay.

- I drank.

And you also had some cocaine on board.

- What?

- Yes. You had cocaine in your urine.

I didn't know that. I don't do drugs.

- No?

- It's my old girlfriend.

- Your old girlfriend.

- Yeah.

What about your old girlfriend?

No, she gave me tje cigarettes.

Ah, so you think

they were in the cigarettes?

Had to be, because I don't do drugs.

She should have told me

it was in the cigarettes.

- Okay.

- I'm going to tell her off this morning

when I get back there.

You're gonna tell her you're gonna

blame it on your old girlfriend?

She younger. I called her old girlfriend,

but she's young. She's 40.

Okay.

I've been assured that I'll start

feeling better about leaving baby.

We shall see.

I also haven't gotten a call or a video.

What's going on here?

- What's up?

- Not bad.

- Not bad.

- How did she do?

- Yeah. Ah, you know.

- Oh, she did fine. Yeah.

- Get some sleep.

- All right.

- I'm happy you're back.

- Me too.

- You survived the first night.

- I did.

- You're in good hands.

- All right.

- Bye.

- See ya.

Is there a Mitzie Brooks-Hensley in here?

No, no. She she's not in here.

She's not in here.

What's up?

You did it.

She did it.

- You look awesome.

- Absolutely.

I feel awesome.

- Her speech is so much louder.

- Really?

Oh, yeah. It's stronger from what

it was yesterday, when she come in here?

But we got the whole tumor's out.

I told your husband,

if there's any kind of tumor left,

it's going to be little schmutzy stuff,

but I'm super happy with the result.

I think Peter is also.

I am too.

Yeah, well,

we're going to do an MRI before you go,

but if you look this good, she can

probably get out of here by the weekend.

- Yeah.

- I haven't had any new problems.

You're barely out of the OR 12 hours.

- Let's just see how you do.

- This is phenomenal.

- Yeah.

- It just blows my mind.

- We're thrilled. I'm so happy.

- Thank you for everything.

I really am.

You've been through so much.

You're such a great person.

I told them yesterday, I think the, uh

The hard part, sometimes,

is when you know somebody.

- Oh, man. Oh, my God

- I appreciate everything.

- No, seriously.

- I know, man.

We don't normally operate

on people we know as well.

It's harder. It took

Especially having gone through

what you went through

and feeling awfully responsible for you.

We know each other.

We're friends now. I can say that.

- Let's move back to Tennessee.

- I can say that.

All right, I'll see you later, Mitz.

You look great.

Thank you.

- This is it's unreal

- Yeah.

Dude, thank you so much.

And I'll see you again

- before we leave. Absolutely.

- Okay. All right.

I think that part of it is that, um

I I put a a lot of emotion

into this.

And

you realize what's at stake, you know.

And it's there's only so much

you can really do.

No matter how hard you work.

And sometimes

Most of the time, luckily, things go well.

But, uh

when they don't, it's it's not because

I've done necessarily I'm a bad person

or I don't care, but I still

It's still hard.

Still really hard.

And her the first, uh the first

surgery set me back a little bit.

And when things go well,

it's it's incredibly gratifying.

- Hi, whoever's on the laptop back there.

- His mom

- His mom and dad.

- Hi, Dr. Boockvar.

Hi. Hi.

- Where are you guys?

- They're in South Carolina.

Oh, okay.

It just feels warm where you are.

So in March of last year,

I guess you remember

your speech was pretty good

- at that point, correct?

- Yeah. Yeah.

And look, you can see relatively

little enhancement in that area

of that left posterior frontal lobe

and superior temporal lobe

where speech is.

You remember speech is

basically right here.

Yeah.

And now it's back again.

And it looks worse.

There is some nodular enhancement.

And nodules tend to be a little bit

more suspicious for tumor growth.

I can't be 100% sure.

It can still be radiation change

and treatment change.

I'm concerned that the tumor

is growing to a point

- that it's becoming untreatable.

- Okay.

And I'm going to tell you that.

And I think that based on your symptoms,

and if it is not responsive to Avastin,

then I'm going to tell you

that I think we should

no longer pursue treatment.

And because, at that point,

I think that the treatment side effects

may outweigh the benefits of treatment.

Right.

It's all right, babe.

You guys have been incredibly tough,

and obviously, um,

you've been through a lot.

I have to ask it. I'm sorry.

I have to ask something.

Because I need to mentally prepare

for something.

If it doesn't work.

How how much time

before you think it becomes

time for hospice, if it doesn't work?

The way that it's growing.

In other words, is it, like, a year?

- Is it six months? Is it

- Right. So

these are not always

easy things to predict.

And, um, I never want to say

I have a crystal ball and I can know,

but I have some philosophy as to how

to sort of give you guidance, and

First of all, in this disease,

one of the only positives

about this disease is that

it's not a painful death.

There are a lot of cancers

that are very painful

brain cancer

You know, how we all react

when we feel a punch,

you never really know.

Whether it's medically or family

professionally. When you take a punch,

you know, it's how you react

and how you get up again.

You always remember the patients

that you hurt

rather than the patients that you help.

And when things don't go well,

you have to find the strength

to keep going.

And it really is just a journey

throughout your whole career.

Mitch.

Mitch.

It's Dr. Malice.

I'm calling you from the great beyond.

- Everything okay there?

- Oh, it's amazing.

I did a T2 to pelvis fusion.

I did a, uh a sacrectomy. I did a

I might be slightly

out of commission for a little while,

so, you got your skill set out.

I don't know if I told you

I'm planning to do a number of

spinal replacement surgeries. Yeah.

- You're doing total spine replacements?

- It's a new technique

- I'm pioneering in your absence.

- With the exoscope?

- Yes, with the exoscope.

- Fantastic.

Is there any other way to do that?

Just take the spine out,

put an exoscope in.

There's no other way to do it.

He says, "Yeah,

I'm going to get this out of your head."

Since, you know, concern

because it's a cancer.

It's just like all cancers, you know.

Sometimes they spread.

And it's worth this big operation?

I really thought that from the beginning,

to go to Houston would be the best.

With your son there, you'll have family,

your daughter can go be with you and,

you know, you'll have you'll

I think that's the right thing.

All right. I'm going to get

some barbecue now

- and have a couple of beers.

- Good.

- All right. I love you, man.

- Okay.

I'll see you soon.

- All right. Bye.

- Bye.

I have got to go to the OR, man.

Slowing me down. f*ck.

All right, I'll be back. I just gotta do

a timeout, and I'm coming back.