Morning. Admissions percentage is out. Top colleges have dropped to record lows.
- Thinking about going back to school? - No, I'm thinking about our son's future.
As in starting a college fund for the peanut?
No, I put the peanut on a wait list for prekindergarten at McClellan Hall.
Isn't that a snobby private school in Menlo Park?
It is one of the top three feeder schools for Stanford University.
So you've decided he's going to college, and picked out which one.
Given our son's genetic makeup, he will probably be very intelligent
and will require a challenging academic curriculum.
Or he may not even enjoy academics.
What he ends up doing will be his call.
Whatever prekindergarten he ends up attending will be our call, not his.
No coffee. Glassy's still in his room?
- I heard him leave at 6:14. - He's been so sad about losing his house.
How can you tell?
- Have you noticed how quiet he's been? - Yes, it's been nice.
I guess he's just throwing himself into his work.
Dr. Murphy, little help here.
Give tetanus booster, clean with betadine.
- Administer-- - We got that. It's...
We wanted a second opinion.
Victor did.
Yeah, before these young pups take a saw to our son's foot,
I'd like to talk to a supervisor.
The nail's bent.
I am their supervisor,
and we need the saw to cut the nail, not his foot.
Are you good, Ricky?
You all know my angel for the past 11 years, Dr. Lim.
Hey, Roses. And this is my resident, Dr. Jordan Allen.
Hi.
-"Roses"? - My website's called "More Than 65 Roses."
It's what I called it when I was diagnosed at five.
Sixty-five roses. Cystic fibrosis.
- Okay. - And welcome to vlog number 458.
Going out all around the world.
- And what does DLT stand for? - That would be double lung transplant.
Your new lungs just arrived.
I never should've agreed to let him go.
You didn't. You just stopped fighting with me about it.
He's running a mild fever. 100.4. Go where?
Church camping trip, less than an hour away.
Camping can be very dangerous.
Thank you, Dr. Murphy.
I had my first fire-roasted s'more last summer,
so it can also be very fun.
Thank you, Dr. Wolke.
Be careful, please.
Victor, he's a doctor.
- Just try to trust-- - Trust that things will work out.
Yep. I know.
You're a Warriors fan? You like Steph Curry?
- I like Draymond. - A rebel. I like it.
Look at this beast.
Nice job, Ricky.
His temperature just jumped two degrees.
Get a CBC, blood cultures and CT of his foot
to check for damage to the bones and muscles.
Dr. Park. How kind of you to join me.
You paged me.
Have a seat. And, yes, they're Herman Miller.
The cappuccino, mochaccino, expresso, latte...
None of those are for you.
Okay, I was wrong.
This is the perfect job for you.
Your first study has what, 800 patients?
But since you've had four whole days to hire all the clinical trial nurses,
it should be easy.
I may be a little behind, may have 13 patients waiting,
but I will handle it.
With a lot of cappuccinos.
Thanks for your support.
Do you want me to give you a hand?
I have 90 minutes before my next surgery.
In exchange for unlimited use of your espresso machine.
We'll see.
Poor Ricky.
He probably just has a minor infection.
I meant the parents.
Two very different schools of thought on child-rearing.
It's hard on the marriage, but harder on the kid.
Everyone has different opinions, Dr. Wolke.
Which they need to sort out before having kids.
My college roommate, Jewish, married a Catholic woman.
They had three children quickly.
Started fighting about parenting nonstop.
My parents never fought about us. My dad didn't care.
As long as Mom got me and my brother dressed and out in time for chores.
No hematoma or abscess. No explanation for the fever.
My neck.
It really hurts.
Okay.
Hey, I got you.
He has tick bites on his back.
Pink, plump and spongy.
What's that?
Pneumonia?
In both lungs.
She's lucky if she has another week.
Ex vivo lung profusion.
Maybe we can make the lungs heal themselves.
That's usually used in cases involving pulmonary edema.
Get the lungs. Meet me in the procedure room.
Tick bites?
His fever, vomiting and sore neck could be neurological.
It's in his brain?
Possibly. The blood tests were inconclusive,
so we'd like to do a lumbar puncture to check Ricky's CSF.
This camp just keeps getting better and better.
Can we not do this right now?
- I want this to never happen again. - And I don't?
I care about our son as much as you.
And yet you keep prioritizing fun over safety.
Yes, I care about fun.
And socialization, self-esteem, self-expression--
None of which are as important as his safety.
I can't do this anymore.
After six, only one with a minor reaction.
- You? - Me too.
So we are 12 down, one to go.
Mr. Riggs?
Sorry.
I just drifted off.
My fault for keeping you waiting so long.
So, how are you feeling, aside from tired?
Just a bit achy,
especially my knees and elbows, hips.
And some mild jaundice.
Other than that, I feel pretty good.
Hello. We should sort out our differences about child-raising.
If this is about McClellan Hall, not a big deal.
I've made a list of 37 other potential differences.
I'd love to discuss them, but Andrews just approved new EMR software
and wants me to run a beta test on it in the next 24 hours.
- Have you talked to Glassy? - No.
He didn't come to work today, but I got a text. He says that he is okay.
Where is he?
It is not over yet.
Lungs are remarkably resilient organs
when they are in a body.
Which is why we have to convince them they still are.
We give them a blood supply by hooking them up to a profusion machine,
an air supply by hooking them up to a ventilator,
IV drips to feed them antibiotics,
and we might be able to con them back into viability.
The next six hours are crucial.
How will you know if they're viable?
Our main indicator is a calculation called the P/F ratio.
When that reaches at least 400 mm of mercury...
those lungs are good to go.
Mom, relax.
It's Dr. L.
Palpate to find the L3-4 interspace.
Maybe Lea and I won't be able to sort out our differences
about child-raising and become angry like Victor and Shelly.
You and Lea are nothing like Victor and Shelly.
They're from completely different worlds, have vastly different outlooks.
Lea and I are very different too. Insert the spinal needle.
Who knows if they love each other.
You and Lea, I know you do, a lot, and that's all that matters.
At least according to the Hallmark Channel.
I'm in.
The infection has elevated his intracranial pressure.
Intubate and load him with levetiracetam
and dexamethasone before his brain herniates.
CSF confirming a very rare infection called naegleria fowleri.
It's a brain-eating amoeba that's caused cerebral swelling.
We need to put Ricky in a barbiturate-induced coma
and surgically place a port into the center of his brain.
Then we will flood it with antibiotics, which should reduce the edema.
And he contracted this from a tick?
No, it's contracted via contaminated water through the nose.
So he got it from the swimming hole at camp.
That's a good guess.
Ricky's too anxious around water to put his head under,
let alone get water up his nose.
Naegleria fowleri has also been found in untreated swimming pools,
- nasal rinses, water heaters-- - Nasal rinses?
If unboiled tap water is used.
I gave him a nasal rinse the morning he left for camp.
He had a runny nose.
That is a better guess.
Excuse me.
Riggs has fatigue, joint pain, impaired mental acuity,
tachycardia and mild liver failure.
- Thanks. - Maybe he has a pre-existing condition.
He should have been eliminated
by any remotely competent screening process.
Those protocols were in place before you came on board.
I'll remind the CRO of that when I tell them, on my first day,
that their $4 million trial needs to be trashed.
Save the doomsday predictions until after the blood panel results.
Lab's on the way to the OR.
- It hasn't been six hours yet, has it? - Six and a quarter.
You want company?
Thanks.
Hello. Where is Victor?
Beating himself up somewhere.
I just...
wish that made a difference.
Do you love each other?
Yeah.
Of course.
We've always been oil and water. That's how my dad describes us.
Victor grew up in Belgrade. I grew up in Berkeley.
Different religions and politics, socio-economic status.
But when I got pregnant,
we knew we had a lot of issues to work out.
And we did.
Then Ricky was born and...
we suddenly started arguing over...
When can he safely eat tree nuts?
How high should he climb on the jungle gym?
When can he stay with a babysitter?
Those little things were the ones we could never work out.
But, yes, we still love each other.
It's just that...
I'm not sure love is enough anymore.
Still waiting.
Still hoping.
That's kind of what we do, isn't it, Roses?
And the wait is over.
I'm sorry.
We've put you back on the list.
You're at the very top.
I deserved this.
I wanted those lungs.
I wanted someone to die.
Brecca.
Honey, should we finish?
No.
Hello, Dr. Glassman.
Shaun.
You might try knocking next time,
although, you know, it might be a little tough.
- What are you looking for? - You know...
My life.
Just my life.
Not yet.
I think I'm gonna keep at it for a bit.
- Okay. - No, this is on me. You can head home.
Thanks.
I will miss your big screen LED TV.
It was old and had a pixel line down the right side.
Did you love Alana?
What?
Did I love Alana? Yeah, of course.
Did you love Debbie?
Yeah. I loved Debbie. Where is this going, Shaun?
That wasn't enough for you to get over your differences.
How do I know if love will be enough
for me and Lea to get over our differences?
You won't know.
I mean, how can you know? You can't know.
I do not like worrying about this.
I mean, Lea had some doubts just a little while ago.
- You both got over that. - Yes.
- Because I was very supportive. - There you go.
But differences about child-raising seem to be bigger than normal differences.
Yeah. Having a child, I mean, that's big, that's huge.
It's a shift. It shifts everything. Marriage, everything.
I do not want a shift in our marriage.
Maybe it'll shift for the better.
Ardie's eye.
First thing I ever bought Maddie was a stuffed aardvark.
Back in the day, I performed a 21-hour surgery.
I removed an astrocytoma from the medulla of the brain stem.
It was heroic, it put me on the map.
My elective surgeries were booked out for a year.
I was in a zone, like playing scratch golf.
And then Ilana got pregnant.
She didn't want to stop work. Had a real estate thing, doing well.
I didn't want to stop. I wanted to stay on the map.
And then we brought Maddie home that first night.
Everything changed.
Go talk to Lea.
I tried.
She had to run a beta test on new EMR software.
Then you'll have to wait until she's done.
All I had on my DVR was a marathon of Shark Tank.
Can't say I was in the mood to be staring at Mr. Wonderful's bald head.
So why not entertain myself by watching some hot line perfusion action?
I'm not one to kink shame.
Coffee and cronuts, from Chaz's bakery.
I'm happy for the company.
Pneumi is not much of a conversationalist.
- Pneumi? - My pet name for them.
From the Greek word for lungs, pneumonas.
I thought it was better than "Lungy."
Yeah, I may be losing it.
Cronut.
- Any progress? - Negligible.
I keep doing the same thing over and over, hoping for a different outcome.
Yeah, I'm definitely losing it.
Then do something different.
Okay.
Doubling up on antibiotics, and we can add steroids.
This will either hammer out the infection or the lungs.
- How's Glassy? - Very sore and very sooty.
- We need to talk-- - About our 37 differences?
I thought of two more.
Shaun, as you know, I'm kind of busy right now,
so you'll have to settle for me agreeing that, yes,
we'll have many differences.
But in time, we'll be able to work them out.
That's what Victor and Shelly thought.
And now they are talking about separating.
I don't know who Victor and Shelly are.
In any event, I have at least two more hours of work to do.
Okay.
You're waiting, aren't you?
Yes, I am very patient.
You are very patient and very understanding.
And you were so good with me on our babymoon.
If you could just channel some of that...
On our babymoon, I thought love was enough.
That's kind of a big thing to drop on me this late at night.
You were too busy to discuss it in the morning.
So I talked to Dr. Glassman about it,
and he said having a child will shift our dynamics.
If it does, we can talk about it then.
If we can't talk about our dynamics now, how about our differences?
Really? We have 39,
so we need serious time, and I'm sure they'll keep
because we're kind of committed to having a kid together,
whether love is enough or not.
Shaun, I'm way too tired
to have a productive conversation about this right now.
- Okay? - Okay.
It's time to call it.
I had half an hour left on my call when she first came into the ER.
Coughing blood, vitals on the floor.
When we opened her up,
her lungs looked like a 70-year-old's.
Didn't think she'd make it through the night.
She was eight.
I couldn't go home. And stayed with her that night.
And then the next morning, she just opened her eyes,
looked at me and told me she liked my French braid.
Once I call it,
I have to go up there and tell her I failed her.
Got Riggs' latest test results.
Turns out he did have a pre-existing condition.
Hemochromatosis.
So the jerk lied about it to get into the study?
- That's the assumption? - He got 3,500 bucks to participate.
I think it's a pretty sound assumption, but whether he lied or not,
it means the screeners are incompetent.
That's got to take a toll.
Expecting the worst of everybody.
I'd rather be pleasantly surprised than bitterly disappointed.
And that's the world view you want to impart to your future child?
Assume the worst of everyone?
Help. We need help in here.
- What's happening? - Add a milligram of lorazepam.
- He's seizing. - Because his ICPs are in the 40s.
Cerebral edema's gotten worse.
If we don't open Ricky's skull immediately, he will die.
Removing hemicranial skull flap.
Performing wide dural opening.
Look at the monitor. EEG's all over the place.
He's still seizing.
Place an additional EVD and increase propofol to burst suppress.
But he's maxed out.
Giving more propofol could kill him.
If we don't, the seizures will definitely kill him.
Okay.
We can remove the damaged cortex in the left anterior temporal lobe,
using pre-op imaging to guide us.
Cut out part of his brain? That's extreme.
That is the area that's causing the seizures.
- Might be a tough sell to his parents. - Which is why you will help.
Okay. Please keep him stabilized with eyes to the cortical surface.
"The country flew past,
as if they were seeing it from the windows of an express train.
Faster and faster they raced,
but no one got tired or out of breath."
We can save the last chapter for later.
There is no later.
Where's Dr. L?
She wasn't ready to give up on your lungs.
There's still a chance?
Dr. Lim thinks so.
Let's finish.
Chapter 16.
"Farewell to the Shadowlands."
We'd cut out a small piece of his cortex.
It's already damaged by infection.
Removing it may be the only way to keep him alive.
But how would that affect him?
There are areas of the brain that are significantly less essential than others.
This part only impacts his speech and memory.
Probably not long-term.
So he might not be able to talk or know who we are?
We wouldn't be able to fully assess him until he wakes up.
Ricky's skull is opened.
We should do it.
This is a very good hospital.
These are very smart doctors.
And someone very wise once told me that
sometimes you just have to trust things will work out.
Okay.
Hemochromatosis?
You never noticed these symptoms until now?
Joint pain, fatigue, mental fuzziness?
I turn 58 next week.
I haven't felt a day over 30 until now.
It's very unlikely your hemochromatosis
went from zero to 60 in a week.
Is it possible you gave the screener someone else's blood?
You think I cheated? For the money?
No, Mr. Riggs. I'm just trying to--
You're a blood donor in the 20 gallon club?
Yeah. Regular donor the last 30 years.
When was the last time you donated?
Two months ago, just before I started this trial.
And you're not allowed to donate while you're in the trial.
See, that's the downside.
I actually enjoy those cookies.
I'll make sure you get all the cookies you want.
Don't you think it's time to come home?
No.
In that case, I wanted to make you something delicious like you've made us,
but I'm not a very good cook and everything's closed,
so I hope you like
hot-dog-flavored potato chips and Nutty Buddys.
Yeah.
- Nail polish? - Father-daughter time.
Maddie insisted that she paint my fingernails a sparkly rainbow color.
And the next day, my first patient was very uncomfortable.
That's when I realized I forgot to remove the nail polish.
That's a nice memory.
Sit. No, sit, sit, sit.
So many memories.
That Halloween Maddie wanted to go as a ham
because we had just seen To Kill A Mockingbird.
But she wanted the ham
to be made out of an actual ham.
And then one night the wind was blowing so hard it blew her bedroom door shut.
She was convinced that her grandmother's ghost had come back to visit her.
Wanted to sleep in our bed for the next two weeks.
You didn't come here just to feed me junk food, did you?
I thought you might need someone to talk to.
I'm fine.
I know someone you should talk to.
I know. But this was easier.
"Hot dog" should not be a flavor.
"All their life in this world and all their adventures in Narnia
had only been the cover on the title page.
Now, at last, they were beginning chapter one
of the great story which no one on Earth has read,
which goes on forever,
in which every chapter
is better than the one before."
Checking in. Need me to up your morphine?
Couldn't hurt.
Hey, I changed my mind
about the vlog.
Wonderful.
Go for it.
Hey, Roses. I'm back.
The DLT didn't really work out,
so this is gonna be my last update.
I wasn't even going to do this, I was gonna flip off Dylan Thomas
and go gently into that good night.
But...
I couldn't leave without saying goodbye.
And that it's okay to be hurt.
I am.
That my life's been cut short.
But the upside to all of this
is that I feel something I never thought I would.
It's gratitude.
I'm grateful to my sweet mother.
And...
to the people who keep hope alive.
Like Dr. L, and...
Crash cart.
She's in full respiratory failure.
- We need to intubate her. - No.
We need to let her go.
Pneumi hit 402. Get Brecca to the OR.
The lungs are good. We should intubate.
Yes.
- Ricky? - Dr. Murphy.
Ricky? Can you hear us?
Hello.
Do you know where you are?
Do you know your name?
I'm Ricky Pavlovich.
I'm in the hospital
because I stepped on a rusty nail at church camp.
But I would still like to go back there next year.
Welcome home, Pneumi.
Riggs is a lifelong blood donor.
- Which totally eliminated his symptoms. - Until he started this trial.
He's not allowed to donate till it's over.
So there was nothing wrong with the protocols. Nobody was incompetent.
And Riggs isn't a big, fat liar.
In fact, he's a legit hero.
Maybe my world view does need a little adjustment.
I prefer Italian roast.
Noted.
Ready to take Pneumi for a test run?
That's what she named your lungs.
It was a weird night.
Start small.
Thanks for coming.
We should talk.
Number 39, dietary restrictions.
Other than breast milk.
I felt a kick!
I felt...
This is very exciting.
Come here.
Think of all of the new memories
waiting to be made.
Hey. Let's go home.
Number 39, other than breast milk,
I don't think that peanut should have any dairy products before six months.
Easy-peasy.
Number 38?