Three Rivers S1E10 - English Transcript

Good morning, Mr. Becker. Did you pass your drug test? With flying colors, nurse Acosta. Scott Becker, 19. First evidence of toxic effect on his heart: An MI at 17. That's a heart attack at 17 from *** use. This kid deserves a second chance. I am a serious screwup. I can't take this heart. It's just not right. You know what, Scott? Maybe the old you doesn't deserve this heart, but you do. We're taking you to the O. R. soon. You nervous? Kind of. I can understand that-- your new life starts today. Right. Well, that's exactly what I told Cece. I said you don't call a parent meeting unless all the committee chairs are gonna be there. Right. Hey, is it true that we can't send juice boxes with the kid's snacks anymore? Really? Right. So, anyway, how did Thanksgiving go with Rick's parents? Whoa! Bill! Easy, Hailey. Oh, my goodness! I gotcha. I wasn't looking, and Hailey, honey. If you want something, use your words and tell mommy. Oh, thank you, seriously. I should have belted her in. Here, uh, this should keep her busy. Nice moves, by the way. Not bad for a 40-year-old. Yeah, surprised myself. I'm still stiff from running the Philly Marathon last week. Candace got tired of me moaning on the couch, so she sent me out to try and be useful. Well, you were definitely that. Thank you. Don't worry about it. Hey. Take it easy, little daredevil. Mm-hmm. Bye-bye. Aw Just a few more minutes, Hales, okay? Okay. Oh, you're such a good girl. You scared mommy. Hey, Bill Bill! Oh, my God! Bill! Somebody call an ambulance! Bill! Morning. Hi. Doctor. Hey, people. How's it going? Yo, Andy. That's very funny. Since you're taking over for Dr. Jordan as Department Head while she's at the conference, we thought a gift was in order. Yeah, we all All pitched in. Try it on. Aye, aye, Captain. Nice. Whoo! Oh, oh, oh, I'm sorry, Andy, I forgot to tell you, um, Gilligan called. That's-that's hilarious. Seriously, there are, like, three people waiting to talk to Dr. Jordan, and I transferred them to your line. Great. And you have an HR meeting in ten minutes. Dr. Jordan told me that you would cover for her. I'm sure she did. Dude really? Hey! Scott! Ah How long do I have to keep coming here for these checkups? How's "for life" sound? Which I told you before the transplant. Tried to forget. Mm-hmm. So, how's it been living back with your folks? I know you guys weren't on the best of terms for a while. We're getting along. And I got a job. I'm working at a substance abuse program for teens. Check you out, giving back. That's great, I like it. It's a bummer about Brenda moving to Oregon, huh? She get her transplant, and her dad landed a new job. With her medical bills, they need the dough. We'll find a way to be together if it's meant to be. That's very Zen of you. Zen with a huge-*** text-messaging bill. Okay. How you been feeling? Good. Yeah? No aches, fever, coughs? Negative. I'm-I'm a picture of health. Okay. Whoa. Is that sore? Not really. I-I fell skateboarding last week. Other leg's swollen, too. I'll run some tests, check it out. Wait, isn't our president trying to stop unnecessary medical tests? You had a heart transplant six weeks ago. Trust me, it's necessary. I'll be back in a few minutes. Original Air Date on June 12, 2010 What do you got? name's Penelope Kirkell. Bystander CPR. We found her bradycardic and hypotensive. Gave her atropine, epi and intubated. Any respiratory effort? Not yet. Bp 90 palp, pulse 110, pulse ox 90. No breath sounds on right. All right, we have a possible hemothorax. How did she get a hemothorax from drowning? No clue. Let's get prepped for a chest tube, and get Andy down here. I don't like these breath sounds. Pulse is dropping fast. I'm sorry, I'm not quite sure I understand how a perfectly healthy man collapses in a grocery store with kidney failure. He ran a marathon last week. Well, it seems that the running has something to do with it. Now, what kind of training did you do? Uh, around five miles a day. I just figured I'd push it on race day, see how far I could go. I made it the whole 26. Wow. Well, it seems that the extra exertion caused your muscles to break down, and the by-products flooded your kidneys. It's called acute tubular necrosis. From running? Basically, yeah. Your kidneys shut down, and that's why you collapsed. Now, what do either of you know about dialysis? Oh, tell me that's not where we're headed here. Candace's brother-in-law's been on it for five years. It's taken over his life. Yeah, well, transplant is also an option. And we can get you listed immediately, but you both should know that, because of your condition and the fact that dialysis is still an option, you will be low on the priority list. Can I give him one of my kidneys? Yeah. We just have to make sure the blood type and tissues match. We can send a nurse in to do samples, if you're really interested. Candace, I Stop it. Yes. We're interested. Okay. Okay, doc, what do we got? This kid, who we transplanted a couple months back Yeah, Scott Becker. Cardiac enzymes are elevated. Bnp and chest x Ray confirm congestive heart failure. Okay. Gonna have to do a myocardial biopsy, and we'll go with pulse steroids, see if we can reverse this. Andy, Lisa needs you in the E. R. okay, thanks. Thanks, doc. Please tell me that look on your face isn't about Scott Becker. His body's rejecting the heart. Well, you were right-- she's definitely got a bleeder in her chest. Okay, let's advance the chest tube. Hooking up to pleurovac. Okay, people, she's got a massive arterial hemorrhage-- we're not gonna be able to stop the bleeding down here. Let's get her up to the O. R. Why is a drowning victim bleeding like this? If you figure it out, please let me know. Okay, come on, here we go. Okay, talk to me, Dr. Lee. Bleeding in the right chest is continuous and diffuse, with no specific site. Pre-op labs? PT and PTT are both normal. Bleeding time's a bit elevated. A little water here, please, Pam? Mm-hmm. So what's your call, doctor? I think we load her up with platelets and plasma. So do I. Let's do it. Do we know if she's on any blood thinners? Uh, University police haven't given us any information on her yet. Do we know anything besides her name? Anybody? Pam, help a brother. This bleeding's not stopping. Andy needs A fresh joke. Well, little buddy I have some news for you. Call me "little buddy" again. Li Sorry. Candace Dula isn't a tissue match for Bill. So he can't have her kidney. The Struckmeyers. The Struckmeyers. What? The Struckmeyers. Heather and Darren Struckmeyer. She's on dialysis, and he wanted to donate, but he's not a match. However, Candace Dula has the same blood type and HLA profile, which makes her the ideal donor. So what are you proposing? It it's something called a daisy chain. If you were to donate your kidney to Heather, her husband would donate his kidney to someone who matches his criteria, and so on. That's how you find a kidney for me. Exactly. Now, you both should know this hasn't been approved by the hospital just yet, but I do plan on bringing it up at the transplant committee meeting. How many couples will this take? If we're lucky, only one. But it most certainly won't be that easy. I'm in. I'll do it. But, honey, think about this. You you're gonna go through surgery for a stranger. If it means you're gonna get a kidney, yes. And I'm praying that somebody'll do the same thing for you. Okay. We'll give it a shot. I'll keep you posted. Great. I can't believe this-- I showed up at work, and the campus cops were there asking questions about Penelope. Where do you work? At a medical research lab on campus. We're in the biochem Phd program. Do you know of any medications that Penelope was taking? She has asthma. She carries an inhaler. Any recent injuries that you know of? No. She works out all the time though. She's been getting ready for her wedding. Oh, she's getting married? Well, she was supposed to. I'm not sure what's going on now. She flew out to California last week to visit her fiancé, but they got into a big fight, so she came back early. Do you know how to get in touch with her fiancé? I'd like to ask him a couple of questions. Sure. His name's Jared. He was in the undergrad program with us. Hey, Pam? Do you have a second? Excuse me. Hey. How's she doing? Well, we did what we could, but she lost a lot of blood. So, whoever her people are, get them down here asap. Come on. All this for a sprained ankle? Your ankles aren't swollen because of skateboarding. Your heart is not pumping adequately, so fluid is collecting at the low point. It's a sign of congestive heart failure. I've been feeling fine. Yeah, but that could change overnight. We're going to need to take a biopsy of your heart, then we're going to hit you with a high dose of steroids. We've stopped rejection with them before. Look, I swear, I've been totally clean. I mean, no smoking weed or anything like that. I know that, Scott. But this is not about lifestyle. Rejection can happen at any time. But you're young, you're in good health, so there's no reason why we can't turn this around. Here come my folks. Take it easy with the medical info, all right? They get scared real easy. All right. Thanks. Hey, mom. Dad. Hi. Honey, are you okay? Yeah. I'm fine. This is Dr. Yablonski. George Becker. How do you do? This is my wife, Ronda. Pleasure. Nice to meet you. So, uh, we thought he was just coming in for a checkup. But, uh He called and said he needs to stay for a couple of days. Yeah. Don't worry. We, um, we got it under control. We have a plan now, don't we? We do. Uh, did you guys bring the Backgammon? Oh. Yeah. Mom's got it in her bag. If you hear screams from in here, don't be alarmed. It's just the sound of victory. Okay. It's very nice to meet you both. Dr. Yablonski? Yes? I should have, um, called you or sent a note or something to thank you for everything you've done for Scott. I apologize. There's no need. I'm a huge fan of your son's. We are, too. But there were some years there where we lost him. And when you went in and put the new heart in him, it was like It's like you went inside and flipped a switch and you turned him back into the Scott that we knew. Well, I'm glad to hear that. I'll check back soon, see how he's doing. Great. Thank you. You're welcome. Okay. Hey, there, Penelope. I'm Pam Acosta. You're in Three Rivers Hospital. Can you understand me? You can just nod, okay? You had an accident yesterday morning, when you were swimming. You were bleeding internally and needed surgery. Do you know what could have caused that? I fell on my bike. I was riding to the pool. I lost my balance. Good. That could be what caused your injury. Can you tell me what medication you've been taking? Ambien, for sleeping. Okay. I have an inhaler for my asthma. Um Aspirin. A lot lately, for headaches. The aspirin could explain the bleeding. Your doctors infused you with platelets. That should help your body regain its ability to clot. The doctor's going to come talk to you. We're going to keep you here for a few days. I need to talk to Jared. Is that your fiancé? Your friend Jeni got a hold of him. She said he was flying out today. I can't believe he's going to see me like this. I'm sure he'll be happy just to see you alive. That's him. Oh, thank you. Dr. Lee? Yes? I'm Andrew Gold. Penelope Kirkell works in my lab. I was told you could tell me how she's doing. Um, well, she made a big turnaround overnight. All in all, she's doing a lot better than I thought she'd be. Did you determine why she passed out in the pool? I really can't discuss that. Of course not. I understand. We're all just really worried back at the lab. Well, I can show you to her room, if you'd like. Um no. That's okay. She probably needs her rest. I'll, uh No. I'll call back later. Okay. Thank you. Food services, call 316. Food services, call There you are. Can't a man enjoy a meal alone? You're in a hospital. We make it our business to invade your space. Where are your parents? Out on a walk. Hey, so the, uh The results of your biopsy came back. You're having what's called an antibody-mediated rejection. Well, that doesn't sound good. It means you won't respond to the steroid treatment. We're going to put you on a drug that's going to help boost the contraction of your heart. And then we should start talking about another transplant. Scott, listen. You really need to let your parents know what's going on here. You know? Yeah. I wish I had better news, buddy. Hey, I had a freakin' heart transplant. These things happen, right? Yeah. I'm late. I got to go. Scott. You okay? I'm good. Go. Leave me in peace. Please. Wow. You're early. Yeah. Leading by example. Jordan would be proud of you. I'm proud just to know you. You, too, Dr. Lee. Let's get started. First up, Scott Becker. Received a heart transplant six weeks ago. Lab and echo suggest CHF. Biopsy shows acute antibody-mediated rejection, so we added ATG. I think we should relist him, in case we can't stop this rejection. Anybody object? Good. On to the next order of business. Miranda? Okay. Patient's name is Bill Dula. Age 43, current diagnosis is ATN as a result of a marathon he ran last week. Another reason not to move to Philly. Bite your tongue. His kidney function studies, his bun and creatinine are extremely elevated, and he's not making any urine, which means that he'll have to go on long-term dialysis if things don't improve. But you want to list him anyway. Yes, I do. But he's a low priority, which is why I am suggesting an alternate approach. Okay. His wife has offered to donate her kidney, but she is not a tissue match. However, we have found someone here who is, so we've constructed a partial Daisy chain. With altruistic donors? Yes. The board vetoed daisy chains because of the surgical risk to altruistic donors. Well, there's also a risk of our patients dying, waiting for a kidney. Have you done psych evals on all your donors? This isn't 1972. These are consenting adults who'd like to help. How do you know the family members aren't being coerced? Because when a family member doesn't want to donate, we tell the family that they're not a match. What about children? Are any of your donors under the age of consent? Like I said, we have eight consenting adults who would like to save some lives. And I don't think anybody here should get in their way. So, Dr. Acting Department Head, how would you suggest we proceed? Well, with Dr. Jordan absent, I'm not sure this is the best time to reverse our policies. I can't believe I'm hearing you say this, considering you'd be making the exact same argument if you weren't sitting in that chair. All I'm saying is dialysis is a safe option. Temporarily. Okay, so let's agree to disagree. Let's agree to vote. Okay. All of those in favor of enacting the daisy chain procedure here, raise your hand. Good news. The committee approved the daisy chain. But I have to say, finding a donor for you was the hardest part. Until we found DA, DA, DA, DA. There he is. Mr. Wilkinson. See, Mr. Wilkinson wanted to donate to his son Kevin, but they weren't a match. However, we did find someone for Kevin through the chain, and Mr. Wilkinson agreed to donate to you. What do you think, hon? You know, my grandfather was a labor leader. A switchman on the railroad. He was always talking to me about the greater good, and how one guy had to not just think about himself, but about the bigger picture, and how we'd all be better because of it. I was such a knucklehead back then. Didn't think much of what he was saying. When do you want to do the surgery? You may be feeling better, but you're not out of the woods yet. Don't blame me. She told me to bring her work. And my favorite robe and some of my things. Most people use major surgery as an excuse not to work. Those people don't have tenure track positions. You know what they say, "publish or perish. " You push it too far, and the perish part might actually happen. Your boss came by. Dr. Gold? Mm-hmm. He spoke to Dr. Lee. Sounds like he had to run before he could see you. What's going on? Dr. Gold had this minor obsession with Pen. His wife got wind of it, and now he just skulks around, barely talks to her. It's creepy and uncomfortable. Well, for now, you can hide out in here with us. Ten more minutes, then it's pencils down. Chaplain to room 802. Chaplain to room 802. Dr. Foster said there's some paperwork to fill out about my surgery. Candace Dula. Mrs. Dula? I'm Rick Wilkinson. I'm going to be your husband's donor. Oh, my God! Thank you so much! It's so nice to meet you. You, too. Can you believe this thing? Bunch of people you don't know giving kidneys to each other. Well, kind of makes all the sense in the world though, right? I'd do anything to get my boy back on track. His kidneys started failing when he was 13. Affected his growth, his height. I mean, he was a teenager and his life just stopped when he went on dialysis. I wish I was the one helping your son. You are. We all are. Hey. Did Penelope Kirkell mention anything about taking digoxin? No. There was no reason to run the screen when she was admitted, but when I ordered the new chem panels, it popped up. Her levels are through the roof. She doesn't have a heart condition, so I don't know why it would be in her system. It's Penelope. She's in fib. All right, call a code! Code Red. Code Red ICU. Amp of epi is in. Okay. Everybody clear. You got a rhythm. Good carotid pulse. Now let's make sure she stays that way. Hang an amiodarone drip. Repeat blood count and chem panel. What is going on with this girl? That's a good question, Pam. I mean, an internal bleed wouldn't cause the v-fib, right? The digoxin would. And it would also explain her bike fall. She could've had an arrhythmia from the high dig level and blacked out. But how's it getting into her system? I don't know. Excuse me. Is that Penelope? Sorry, sir. W-who are you? I'm Jared Douglas. I'm her fiancé. What's going on? Dr. Yablonski? Yeah. I need you to sign off on the organ donation for Dr. Foster's kidney patient. Uh, yeah. Yeah. Okay. Where? Uh, right there. That's it. That's great, thanks. Okay. This is Ryan Abbott. Hey, Andy. Yeah. Let's clear the air about this afternoon, please. Yeah, if I sounded annoyed, that's because I am. That's fairly obvious. It's not you. I I could never do Jordan's job. I spend half my day in stupid HR meetings and signing forms and making calls. I suck as an administrator. It's a good thing you only have to suck for a few more days. Yeah. Oh, God. If he's got another form for me to sign, I'll kill myself. Just go, just go. What? UNOS just called with an offer for a kidney for Bill Dula. It's in Carbondale. We can send a team now. What are we going to tell him? We tell them a kidney became available. His wife won't need surgery if he takes it. That's right, she won't. Then for sure he's gonna take it. And that's gonna mess up the whole daisy chain. And what about all those people we signed up? They're not his problem, Ryan. Oh, s-so th-that's it? That's it. This is crazy. She doesn't have heart problems. She's super-healthy. We found a heart medicine in her system called digoxin. Did she ever mention taking it? No. But to be honest, she hasn't been speaking to me. She came out to visit. We got into a stupid argument. It started with the wedding invitations. She wanted a card with glitter, I didn't. I mean, literally, it was that stupid. All the stress just came out. Then she left. That's the last time I talked to her. Look, what if I'm the reason why she's Don't Don't go there, Jared. I'm not gonna lie to you, she's definitely not out of the woods. You need to stay positive. I've been where you are, sitting in a room like this, waiting for news. And what happened? It just made me grateful for every second the two of us had together. He told us about the heart rejecting. And he said that you feel positive about the options. I do. But I was coming to tell Scott that I'm not liking his blood pressure. It's too low. And it's probably an indication that the inotropic agents aren't working the way I'd like them to. Is there something else you can do? Yes, there's a treatment where we attack the white blood cells in Scott's lymph nodes by exposing him to high doses of radiation. It can help stop the rejection. And if it doesn't? Well, I think the best hope for him then is a new heart. Will the the people who control the organs hold it against him that he's already had a transplant? No, it's actually the opposite. The chance of Scott getting a new heart is better now, considering how sick he is. We just got our little boy back, doctor. Please don't tell me that we're gonna lose him again. Hey, it's gonna be okay. We can still turn this around. Okay? I'm gonna do everything in my power to make that happen. Thank you. Thank you. Hey, Pam. Mm-hmm? Want to get Penelope to Radiology, get a CT of her pancreas. How is her pancreas causing a heart problem? Oh, I just got her blood work back. She's got a blood sugar of 15. It's probably what caused her to crash. Oh. Why are her Insulin levels so high? Could be a couple of reasons. Maybe a pancreatic tumor that's causing an increase in Insulin production. That's why I want to get the CT. What's the other? Look, we didn't give her digoxin, right? No. But the high levels we found in her system could have caused her to pass out in that pool. Now her Insulin is skyrocketing. Which we also didn't give her. But somebody did. While she's been in this hospital. Who would do that? I don't know. But if somebody's trying to kill her, it'd be a good way to do it. I'm a little surprised by this. Well, yeah. It usually takes a lot longer to get a kidney from UNOS. But you're a six-antigen match, and perfect matches get first dibs. The thing is, with the daisy chain, we already have a kidney, don't we? Absolutely. If you'd still like to go that route. Yeah, but if I take this kidney, then you won't have to go under the knife. What'll happen to the chain if we pull out all of a sudden? We'll try to find a couple to take your place. I'm going to take the kidney from the UNOS list. I can't let Candace go through major surgery if I can get a kidney another way. Well, I'm gonna let UNOS know, and we're gonna get you scheduled for surgery. And then you can schedule me. I'm sorry? I'm going through with the donation. Candace I can't let this fall apart. It's not your responsibility. Of course it is. Those people are us, Bill. We know the fear they're living with, how it's crippling their lives. I can help. And I'm going to. All right, listen. There are no bad decisions here. You can take the kidney from UNOS, and if you stayed on the chain, four lives will be saved. But if I stay in the chain and UNOS offers the kidney to the next person on the list Five lives will be saved. Let's do it. Let's stay with the Daisy chain. Okay. Okay. So no tumor. Pancreas looks clean. Did you go over her chart again? She wasn't given any medication that would account for her Insulin spike. All right, so let's go back a few days. Let's say somebody did slip her digoxin. She gets dizzy, she wipes out on her bike. That causes a bleed, which later on takes her down in the pool. Then she comes to us and we fix her up. Then she crashes again because of high Insulin levels. So she recovers from the digoxin and someone shows up here and juices her with Insulin? It's a pretty ballsy move, right? All right, so who's been here? Who's come to see her? Hmm. Her friend Jeni, the fiancé, the boss. They all have biochem training. And they all have the medical knowledge to pull this off. They could have given her an injection, they could've shot it straight into her I. V. Yeah, but Penelope was awake. She would've noticed it. There's inhalable Insulin now, right? Yeah. Comes in little cartridges. Why? Because right after Penelope got here, her friend Jeni brought her an inhaler. Dr. Yablonski! You're never gonna believe this. Who's winning? My mom. The woman's a shark. I mean, she seems all sweet and everything, but she's beating me like a drum. Well, I got some good news. You've been offered a heart. Like, now? Yeah, like, right now. With your permission, I'm gonna send a team to Scranton to procure the heart. They should be back in a few hours. In the meantime, we'll get you prepped for surgery. When you wake up, you'll have a new heart. Seems like we've had this conversation before. Yeah, well, with any luck, we won't have to have it again. You think it's going to work this time? Dude, I thought it was going to work the last time. If it was just up to me, I'd probably let nature run its course. But then I think about my folks. It's been a good year. Let's go get a few more. Hey. All right? Thank you. I'll be back. Lay down my head by the wayside ♪ my worn out shoes ♪ quite why she went I can't decide ♪ yeah, but I sure could use ♪ one plate of food steaming and hot ♪ clean linen ironed ♪ on a fresh made bed, but I ain't got ♪ one salty dime ♪ one salty dime ♪ just close your eyes, it won't take long ♪ it won't hurt a bit ♪ I'm sure Mr. Dula would want you to do the honors. Telling myself I could be strong ♪ or some such brave ♪ trucks are roaring by, I'm a red ghost ♪ in their taillight gleam ♪ I'm a tumbleweed, I'm a spit roast ♪ just turning in your flame ♪ oh, my darling Kathleen. ♪ How we doing? Can't stop staring at her. I'm just so relieved she's okay. Was it really Jeni who did this? The police found digoxin and vials of inhalable Insulin in Jeni's apartment. But why? Penny, she was always jealous of you. She blamed you when she got passed over for tenure. She thought if you weren't there, she'd get the job. So she was poisoning me at work? Putting digoxin in her coffee. Once you were hospitalized and being monitored, she switched to a different poison and hid it in your inhaler. All of this over tenure? Yeah. You may want to rethink your career in academia. Go with something a little safer, like lion taming. How are my two favorite patients? I kind of feel like I got run over by a truck. After it ran over me. But I've never felt better. Me, too. We got a couple of days in bed, we got a TV, food coming to us three times a day. Well, I have to say, what you did-- what you both did-- was just remarkable. Thank you. No, no. Thank you. For the opportunity. It's probably the best thing we'll ever do. Well, listen. Do me a favor. I want you to take it easy with the running. Oh, don't you worry. From now on, he only runs when something's chasing him. I'll check in on you later. ♪ Okay, the new heart is in. Suturing. Cut here, please, nurse. Excellent. Excellent. Looks great. Okay, cross-clamp coming off. Kind of weak beats. Look, it's changing color. It's hyperacute rejection syndrome. He's in trouble! V-fib! Charge to 25. Amp of epi. Milrinone . 5 Mikes per kilo. Still in fib! Recharge. Recharge. Amiodarone 150 IV push. This heart's not going to work. Prime the heart/lung. We're never going to get him off bypass. Hurry up and prime that machine! We're going to have to anticoagulate. Charge again! Charge again! Thirty! Prime that machine! Damn it! Charge to 40. We're going to defibrillate again. Here we go. Oh, no. Oh, no. No. Oh, no! It's times like these when you wish hospitals served alcohol. I have a department meeting in three hours. I've lost patients before. You can't do this work and not lose patients. I mean, they're all so close to death. But Scott he was turning it all around. He was turning it all around, but he didn't get enough time. It makes me want to walk away and never do this work again. You should get some rest before your meeting.