Bell, yank that sucker, so we can get out of here.
Oh, the appendix hasn't burst. That's good news.
Slippery little fellow.
Did you guys know this is my first surgery with Dr. Bell?
No kidding.
We have to get a photo.
- Make it quick. - Get in, Chu.
That is totally inappropriate.
- Go back to your stations. - Oh, we're just having fun.
He's out cold, he'll never know.
Wait, I'm gonna take a quick selfie. Get closer together.
I wish we could do one without the mask.
Quit clowning, Chu.
Just one more. I think we got it.
I'm going to send this to my mother.
You'll get us all fired. Cameras aren't allowed in the OR.
He's waking up.
I need to up the sevo.
Oh, my God. Did you hit an artery?
- On an appendectomy? - You're losing blood fast.
I'm hanging two liters of normal saline wide open,
Call for four units of blood and 2 FFP stat.
I'm giving him Trendelenburg.
Packing, suction.
You have to clamp something.
He's lost at least two liters already.
Come on, come on.
We just lost the pulse. P.E.A. arrest.
All right, pressure, Cheryl. I'm starting compressions.
CPR isn't gonna put all that blood back into his body.
Don't die on me.
It's no use.
He is so dead.
Time of death: 12:03.
Dr. Bell.
Well, I think we can all agree it was the misdosed sevo...
...that led to this unfortunate situation.
What? You're kidding, right?
The patient woke up, his arm hit my hand.
You left the blade in the field. You nicked the artery.
- You all saw it. - Well, you never should've okayed
him for surgery in the first place. His INR was abnormal.
The upper range of normal. That's never gonna fly.
You know, I'm-I'm flashing back
to the time when you tore through
that old woman's oropharynx on a routine intubation.
Did that fly? I covered for you.
Not this time.
I'm chief of surgery, and he's at the end of a 30-hour shift.
What did you see?
Well, w-we're all on the same team here,
right?
Maybe he had a heart attack.
Yes. There's some family history of heart disease.
Uh, yes.
His left main clogged.
Sudden cardiac event.
We tried CPR.
He was unresponsive.
Yeah, that works.
Well, that's right.
That's exactly right.
There was no way to prevent this.
Who are you calling?
I'm erasing the photos,
Doctor.
- Synced and corrected by Shazi89 - - www.addic7ed.com -
- That's handicapped, pal. - Yeah, whatever.
This bone here is the acromion.
We have 206 bones, and I can name each one.
Here is the clavicular head.
The sternum.
I got to go.
No. Stay. It's early.
I don't want to be late on my first day.
You're gonna be an amazing doctor.
I know.
Every doctor needs one of these. It's part of the uniform.
- This is insane. I can't... - Well, you have to.
It can't be returned. I had it engraved.
"Dr. Devon Pravesh."
Keep it to remember this day.
Your first as a doctor.
Wow.
That's him.
Dr. Randolph Bell.
Chief of surgery. He's a legend.
Thank you very much for coming. I really appreciate you taking the time.
And, Dr. Shore, thank you...
Excuse me, Dr. Bell?
I just wanted to say that I really admire you.
And you're the reason why I chose this residency.
Well, you made the right decision. Good luck to you.
Thank you.
Okay. So that's pretty much it?
Did you see that?
I feel like I just got blessed by the Pope.
Oh, my supervising resident just texted me.
Oh! A winky and a smiley face.
- That's got to be good, right? - Yeah. Yeah.
Um, hey, man.
Know where I can find Dr. Conrad Hawkins?
Namaste.
You found him.
Take off that tie. You're not at Harvard anymore.
What are you into? White, black?
Brown?
Men?
- I-I don't understand what you... - Oh...
"I don't understand."
Were you affirmative action at Harvard?
I read your file, bro.
Yale, then Harvard.
Let's go.
19 first authors. Step 1 score: 267.
- I got 280 by the way. - Dr. C.
Top of your class, followed all the rules,
and you think that puts you at an advantage. It doesn't.
It just means you have more to unlearn
than the guys who weren't paying attention.
Over easy, no cheese, no mayo, breakfast sandwich.
Good man.
Second year.
I broke him.
Now he's a doctor.
You're not.
You got your little white coat, though.
Your stethoscope, your penlight.
You're all ready to play doctor, right?
No, no, no, no. It's not like that.
We're not laughing together.
Everything you thought you knew about medicine is wrong.
All the rules you followed, we'll break.
I have only one rule. Covers everything.
I'm never wrong.
You do whatever the hell I tell you.
No questions asked.
- Do you want me to speak now? - That's a question.
No, no, no, no, no, no, no. Don't do that.
Don't do that. Eyes on me.
My last resident had an attitude, too, and you know where he is now?
He's teaching eighth grade biology. I cut him.
Do you know what that means? It means I can end your career.
Just like that.
Remove you from this residency at any time, for any reason.
And if I do that, no other residency will take you.
All you'll have left from that fancy Harvard medical school degree
is a mountain of debt.
Now, let's meet your first patient.
This is Dobroslav.
He's Croatian, speaks no English.
He has severe cauda equina syndrome. What are we worried about?
- Early paralysis. - Hey, man.
What's the first sign of paralysis?
- Anal tone. - Stick your finger up his ass.
Normal procedure is to get an MRI.
Thank you so much for telling me about normal procedure.
An MRI would take hours and delay steroid treatment and surgery,
both of which might save Dobroslav.
A loose rectum means his legs may give out soon.
Tight means there's no paralysis.
So we need to know exactly how tight it is up there.
Good afternoon, we need to explore your rectum.
How tight would you say it is?
Compared to your prom date.
Stay like that until you can answer the question.
Excuse me, nurse? Devon.
Nic.
I need a new resident. Mine's impossible.
- You got Conrad. - Yes, I did.
And I need someone else, like, now.
Let's say your car has a rattle.
So you take it to a mechanic and this guy's kind, polite, eager to help.
For two days, he runs every test in the book.
And then he calls you and says it's gonna set you back a thousand bucks.
So you max out your credit card
and on your drive home, guess what.
What?
You hear the same rattle.
Or you could take the same car with the same rattle to another mechanic.
And this guy is rude, uh, dismissive, arrogant,
but he tightens a bolt, fixes the rattle,
charges you five bucks. Problem solved.
This is nothing like that.
No, because your car can't end up dead.
Watch and learn.
Conrad's the guy who tightens the bolt.
Four heart failure disasters.
Two went straight to the unit. One is dry and cold.
Now a new admission shows up with a bewildering array of symptoms.
You'd probably diagnose her by the type of dirt on her shoe.
Could you possibly do a quick consult?
I'm slammed.
- Ah. - I took that photo.
Mrs. Robinson, we're going to get you back to your room.
"No gamers, no slackers, no doctors."
That's pretty clear.
What did you do this time?
Tell me about the new admission.
Alopecia, discoid rash, rising urea nitrogen...
Lupus.
HR to Dr. Shaw.
You think you can just kiss me?
I will do whatever it takes to get you back.
Take off your shirt.
My shirt?
If we're gonna do this, we're gonna do it my way.
And your pants.
Nic.
Not funny. Nic.
Acute leukemic on chemo.
Fiancé called because she was shaking uncontrollably.
Uh, she spiked a fever this morning, 100.8.
Also, there was some vomiting. There's no blood in it.
Last chemo was a week ago.
- Hey. - You're here.
- I was scared. - Ah, you're running a fever.
It's just another infection.
Chemo is still crushing your immune system.
We'll get you started on broad-spectrum antibiotics again.
Acetaminophen to get your fever down.
Get cultures from both arms. Urine. She'll need a head CT.
- Okay. - Don't worry.
We'll get this under control. Get you both back home soon.
You're in good hands.
Guess where he went to medical school.
I think he went to Harvard Medical School.
Was it Harvard Medical School?
I'm pretty sure it was Harvard Medical School.
Lily means a lot to all of us.
She's been in and out of the ER so often,
we're all invested, but her diagnosis is a tough one.
I'm giving you a gift. From now on, she's your patient.
But if you screw this one up, I will wreck you.
- I got it. - Hey, Conrad.
What's wrong?
Your appendectomy patient who had surgery last night...
What about him?
Conrad, he's dead.
What the hell happened?
HODAD happened.
What was it this time, Bell?
- Pulmonary embolism? - Undisclosed heart condition.
Tragic situation, and naturally I covered for you.
You need to consider a change before you kill any more patients.
How dare you?
Go be one of those celebrity TV doctors. You look the part.
Make a lot of money, wear nice clothes.
- You'd be great at it. - You watch yourself, Conrad.
You know, I'm remembering a pretty, young resident
that reported a fatal chemo overdose a couple years back.
That good deed... that led to a lawsuit
that cost the hospital millions.
You tell me, Conrad, where is she today?
...with cutting-edge research.
At this moment, our patients are involved
in over 100...
Not here.
How'd you get that cheeseburger, Chad?
Delivery app.
It looks like you haven't been following your diet.
Diets don't work.
Have you been taking your insulin?
I don't want a lecture, Nic.
I'm here 'cause my toe's killing me.
Severe gangrene.
The toe was already dead. I just touched it.
- He broke my toe! - His toe fell off.
Chad, buddy, we are amputating the whole foot.
You knew this was coming. Devon.
What do you think they got for dessert?
You can't keep me here!
- You need to settle down. - Calm down.
New admission. 21-year-old girl, history of IV drug use.
Likely endo.
She was trying to steal Dilaudid. Now she wants to leave AMA.
- She's been spiking fever, vomiting. - She's using again.
She took all my money and spent it on oxy.
Oy, listen to me.
- Whoa, whoa, whoa, whoa. - Please, stop.
Hey, hey, hey. See these? See these? These are Osler's nodes
caused by bacteria swarming in your blood
and moving throughout your body. Classic for endocarditis,
an infection of the heart valve.
Happens to drug users all the time.
If you walk out of here without any antibiotics, this will kill you.
If you give us a chance, we can save your life.
I'll stay if you give me three milligrams of Dilaudid.
Two.
If you calm down and you get back in bed right now.
Chloe, baby!
- Get a crash cart. - Chloe, baby!
- I'm not getting a pulse. - Code Blue in ED alpha!
- Get them out of here. - No, no!
- Baby, no! No! - You need to give them space.
Start compressions. You're running the code.
- I've never run a code. - Do you want an amp of bicarb?
He's in charge.
Page Anesthesia.
What is the first question you ask in a code?
Rhythm.
What's her rhythm?
P.E.A.
- Should we shock? - No, we can't.
Her rhythm's not shockable. Get me one of epi. Make those compressions
harder and faster. Prepare to intubate.
It's been 24 minutes. It's time to call the code.
No!
This is my code. You gave me this code.
She's 21 years old.
Harder, man. You need to feel the ribs crack.
That's enough.
No. Move.
I'm not giving up.
I said that's enough.
We got a pulse.
You saved her life.
Her end tidal CO2 was less than 15 for the entire code.
- That doesn't necessarily mean that... - Yes. Yes, it does.
She's been without oxygen to her brain for 26 minutes.
Congratulations, you got her heart beating again, but she's brain-dead.
You came in here all bright-eyed and bushy-tailed,
ready to save lives, but today you didn't save a life.
You saved a brain stem because you didn't listen to me.
Now the repercussions on Chloe's family will be catastrophic.
There's no way they'll accept this.
Chloe looks alive. They'll think she can wake up.
So they will hover over her, tend to her for days,
weeks, maybe years, waiting for a miracle to happen
that's utterly impossible.
What was rule one, Devon?
Do whatever you tell me to do.
No questions asked.
All we want to do is help our patients,
but what they don't teach us in medical school
is there are so many ways to do harm.
As you can see, the Titian is an amazing piece
of medical technology.
We've nicknamed it the "Hand of God"
because it does what no human hands could accomplish.
Even yours?
Yeah, even mine.
The finest surgeon in the world
would benefit from the Titian.
It's capable
of movements that are incredibly steady and precise,
virtually eliminating human error.
Chastain Park Memorial
is the first hospital in the country
to have this miraculous machine,
thanks to Dr. Bell, who spearheaded
this fund-raising campaign,
and, of course, to you, our very generous donors.
Thank you.
"Serious complications may occur, up to and including death.
Individual surgical results may vary."
I've trained for months to do this. Results will not vary.
Until Bell gets his hands on it.
- Over my dead body. - I'm sure HODAD could manage that.
I heard a nurse call him HODAD.
What does it stand for?
Hands of Death and Destruction.
You're kidding. Does that mean everyone knows
about his complication rate?
All the nurses, some of the doctors.
The ones who pay attention.
Poetry.
But none of the patients. They're clueless.
You've got the best hands in the business,
but he's still the most requested surgeon in the hospital.
Have you seen his reviews online?
He has got five stars.
Top patient review: "McDreamy is real."
- You want to hear yours? - Don't care.
You got one star. "Steer clear of Dr. Okafor.
She told me my uterus sucked."
It did suck.
I just had hernia surgery with Dr. Bell.
The man has magic hands.
Dr. Flores, dial 182...
Hey.
Randolph, I'm so glad you're here.
Where else would I be?
You better finish up those smoked oysters.
There's no food after midnight.
All right. They're absolutely delicious.
This whole VIP floor is spectacular.
It's nothing more than you deserve, my friend.
If it hadn't been for your generous donation,
there would be no new cancer wing.
- Well... - So...
I hear you're gonna be the first patient to benefit from the Titian.
Yeah, it's quite the honor.
I hear the damn thing practically operates itself.
Have you met your surgeon yet, Dr. Okafor?
Nope, not yet.
She's Nigerian.
Yeah, here on a visa.
Very promising young resident.
What do you mean, "young resident"?
Well, second year, I believe.
Randolph, I spoke directly to the CEO...
I mentioned you... but she told me
that Dr. Okafor was the best
possible person to remove my prostate with the Titian.
- She'll be fine, I'm fairly certain. - I want you.
You're the chief of surgery.
Don't you think I deserve the best?
Yes.
And I'll make sure you get it.
Thank you.
Lisa brought this back to you, baby,
your honey bunny.
I'm so happy you're with us again.
I'll be right back, my darling.
Dr. Pravesh,
I never thanked you for saving my daughter's life.
Thank you.
You're wonderful.
I'll be in the cafeteria if she wakes up.
You okay?
Nothing like this has ever happened to me before.
They'll do an investigation, right?
Are you kidding me? The hospital will probably give you a medal.
Every day Chloe's in the ICU, they bill thousands of dollars.
It's a huge payday for them.
Medicine isn't practiced by saints, Devon.
It's a business.
Yeah, but this, all this, just isn't what I imagined.
Then you're lucky.
When I was 13, my mom went in for her routine physical.
They did some tests, and they...
they found something small on her lung.
So they cracked her chest,
and her lung collapsed.
She got pneumonia, and five days later, she was dead.
She was 38 years old.
I'm so sorry.
This happens all the time, Devon.
Medical error is the third-leading cause of death
in the United States after cancer and heart disease.
They don't want us talking about that.
But you still show up here every day.
'Cause it's personal to me.
And there are still plenty of good
doctors and nurses trying to do the right thing.
I'm just trying to be one of 'em.
Lily.
You look like you're feeling better.
Yeah, yeah. Conrad's a miracle worker.
Well, good. Let's get you back in bed. You need to stay warm.
Where's your fiancé?
Oh, he... he left a few hours ago.
I was still in the ER.
I bet he's just exhausted. He'll be back tomorrow, I'm sure.
No, he won't.
I got diagnosed a month after I got engaged.
It's not his fault. He didn't sign up for cancer.
I mean, maybe if I just let him go sooner...
I was selfish.
Didn't want to die alone.
Do you have to go right away?
No.
No. We can talk.
Come on, man.
Status?
We pushed adenosine six milligrams, then 12.
- She's still tach'ing away at 180. - Try verapamil.
That won't work, Dr. Bell, she's gonna have a heart attack.
I think her heart's had enough AV blockade.
Normal rhythm. Her heartbeat is back.
Ice water stimulus.
Prompts vagal tone, restores normal rhythm in SVT.
Called the Diver's Reflex. That was my next step.
Two in one day would have been a bit excessive.
Tightening the bolt.
You saved my life, Dr. Bell.
Thank you so much.
Nothing to it.
I don't have time to give updates on how the surgeries
went one by one. Are the families all assembled?
Dr. Okafor, you have to talk to them each individually.
- There are rules about this. - I get it.
Luis is doing fine. He's in recovery.
Raj is in the ICU. It's touch and go.
Prescott's dead.
What? Huh?
Dr. Okafor! A word.
Sorry, I'm on my way out. I need to rest
for the first robot prostatectomy tomorrow morning.
Well, that's actually why I'm here. The patient has requested
- a last-minute change in the lineup. - The lineup?
Lyle's always been my patient. He's asked me to step in.
Does he have a death wish?
I hear you're applying for an O-1 visa.
You'll need a letter of recommendation from your supervisor.
- I believe that'd be me. - Dr. Bell,
you have never touched the Titian.
It takes many hours of practice to be proficient.
You cannot do that surgery.
As in, it's literally impossible.
You have no idea what's possible
for a surgeon with my experience and expertise.
The surgery is first thing tomorrow morning.
There isn't enough time to bring you up to speed.
I have to draw a line here. This can't happen.
It's too risky for you and for the patient.
Oh, then, I'm afraid you'll be heading back to Abuja.
And as you know, immigration to the States has become quite difficult.
We're shutting our doors.
Given the political unrest and the quality
of health care available in Nigeria,
you might want to reconsider.
If I help you, you'll get your visa. If I don't, you won't.
Your call.
Start with a simple maneuver.
Four-millimeter incision on the ventral surface.
Slow and steady.
I've got it.
What the hell's wrong with the machine?
It would be better,
for everyone, if I do this.
No. The patient asked for me.
I'm always there for my patients.
Just put that plum back on the table, and let's get on with it.
Round 11.
Oh, for crying out loud!
This is a new low even for you.
Is your pride really worth more than the life of a patient?
Get out.
I can't stop this train wreck, so I just wanted to let you know,
I've arranged for a very wide audience.
What are you talking about?
The hospital's gonna stream the robotic surgery live.
Not just to the donors who are watching here,
but to thousands of viewers online.
Unless, of course, you want to step aside.
Idiot.
I'll do no such thing.
The more witnesses the better.
This is going to be a flawless presentation.
Do you think you can sleep?
Uh, yeah, I think so.
Hey, can I ask you something?
Of course.
What are my odds?
I mean, is there a chance I can survive this?
I looked at your chart, and you're on an intense protocol.
The next few months will be rough,
but you can beat this.
How are you feeling, Lily?
A bit weak all of a sudden.
Your blood pressure is low. 80/40. It was 120/90 a minute ago.
Lily. Lily! Lily.
Lily!
Where's Conrad?
- He's in the ER. Why? What's wrong? - Lily's BP is 70/38 and dropping.
Can we please get rapid response now?
Get a CBC, CMP, LFTs, lactate. Is the IV wide open?
Systolic's fluctuating, but it's not good.
We're three liters in already. It's sepsis.
You want to give norepi peripherally?
No. Get a central line.
No. You've never done one. We wait for Conrad.
We can't. She'll die.
Prepare the iodine swabs.
We need norepi and vaso on the table. Get pharm here now.
I want 12 leads on her at all times.
Call for an ultrasound as backup.
Scalpel.
Have respiratory on page, please.
Oh, good. Her pressure's crashing. We need a central line now.
I can see that.
Go on.
- Do it. - Conrad, seriously...
- You heard me. - She's right. You should do it, not me.
Then why are you here?
Premed, med school, MCATs.
Was that just for fun?
Come on. Be a doctor, or go be something else.
Her stats are slipping. Pressure's 70/38 and dropping fast.
Okay.
Keep going.
So far, you haven't killed her.
Start at five micrograms. Titrate up as needed.
Don't look at him.
I'm right, and you know it.
What next?
When her pressure levels out,
wean her off the norepi and then drown her in fluids.
Congratulations. We just busted your cherry.
We are moments away from the maiden voyage of our new Titian.
And after having spent considerable time working
with it, I can definitively say
this is a miraculous machine.
And we expect it to be particularly useful for radical prostatectomies,
which is what we're doing today.
Tell me this isn't happening.
Oh, this is happening. The man is insane.
Only upside is this should be a career-ender.
I can't watch.
I can't look away.
The prostate has to be carefully peeled
off the bladder.
The risk of rupture and bleeding is high
in unskilled hands.
How is this possible?
As you can see, the robotic
instruments are smaller than your fingernails.
But that blade
is sharper than a #11.
This represents the union of human ingenuity and cutting-edge technology.
Man and machine are melded,
working as one.
Where's Chloe's family?
They just left for the first time.
The mom was sleeping in there in case she woke up.
You're done.
You can go home.
Hey!
I want to show you something.
Annabeth. Five. She had cancer.
I was a first year, just like you.
I gave her too much potassium.
She died.
From me, not the cancer.
If it were easy, everyone would be a doctor,
because this is the best job in the world. Despite everything.
Because of everything.
I'll see you tomorrow.
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