Tip: Highlight text to annotate itX
Senior cut day was planned to perfection. It would be at Logan's beach on May 19, but on May 18 the principal called me into her office, and using very underhanded methods, she guilt-tripped me into spilling the beans. Needless to say, the senior class was not happy, and even though my locker was vandalized and my car and the sidewalk in front of my house, I don't regret coming clean because no matter what happens in my life, no day will ever be as bad as that day. Plus, I learned a valuable lesson-- ignore feelings of guilt. So Yeah still working on that. You had every right to ask him not to date her. He's your friend and she's a cold-blooded snake. That's redundant; Snakes are cold-blooded. She's a plain old snake. She doesn't deserve him. Ignore feelings of guilt. Has Joyce Barnes checked in yet? Joyce Barnes-- that's how we refer to our mother? Let me see. Joyce Barnes is not checked in. Like cancer. And car accidents. What's so funny? Oh, do you remember that article in the Atlantic a while back about how women can't have it all? We were thinking that we kind of had it all. Cancer. Car accident. You were in a car accident? No, no, e-Emily was. Yeah, just a little one. She left a note because she's a good girl. I'm a guilt-ridden girl. Would this be a good time for me to take my mom to her extremely important ct scan? 'Cause I could always come back if you two need some more time to chitchat. Did he just say "chitchat"? Male chauvinist pig. You're gonna be late to rounds. I'll come see you later, Joyce. Hey, so, actually, I wanted to put you on my mom's case today. Great, give us more time to chitchat. Hey, you guys can't gang up on me, right? No, we'll chitchat about it later. Good morning. Good morning. Morning. Do you spell "monocle" with an "O" or an "A"? An "O." Told you. Good job, Sammy. Loquastic. Still not a word. So, are the tests back? Yes. Unfortunately the hepatitis is causing Sam's liver to fail. We can't reverse the damage. He will need a partial liver transplant. It's going to be okay, pal. So, what happens next? Well, we will test you both to see if you're a donor match, assuming that you want to donate. Yeah, absolutely. Of course we do. I want to be tested, too. Whoa, not so fast. Well, what are the risks? They're common surgical risks-- pain, bleeding, infection-- but we have extremely qualified physicians, and everyone will be in good hands. Okay. Okay. Well, Dr. Owens and Dr. Collins will do blood draws, and we will proceed from there. Okay. Thank you. Can you do mine? Yeah, sure. So, Sam, right? Bet you're an old hand at getting your blood drawn. This arm's better. I used to play bananagrams with my friend in med school. We had this epic fight about the word "loquastic". is that a word? No. Yeah. It's definitely not a word. Definitely a word. What do you think-- "loquastic"? Is it in the dictionary? We play "No dictionaries allowed". not a word. See? I knew I liked you. I'll drop these at the lab. Ugh, Gina gave me a narcoleptic copder. Guy's never going to wean off the bipap. Snore. That's me, not him. You're so lucky you've got the kid with the liver transplant, Emily, but, I mean, you, like, totally deserve it. You're so great with kids. What's up, Cassandra, why are you being nice? What? Oh, fine, I need a favor. Something bizarre is happening with will. Everything was great, he was obviously really into me, and then, out of the blue, he just started blowing me off. Act surprised. Wow, that is really bizarre. Right? You're his friend; Did he say anything to you? No, no, not a thing, absolutely nothing. I have to get this. Could you ask him what happened? I'd really rather not get involved. Please, it just-- it doesn't make any sense. I keep going over what happened-- if I did anything. No, stop feeling guilty. She's mean. Get her to say something mean. Cassandra, do you like my shoes? No, they're awful. Why? No reason. Thank you. And, like I said, I just don't want to get involved. What? I got your page. What's the emergency? My boyfriend's here. What? What are you talking about? My fake boyfriend-- his name is Rick. We used to smoke weed together in high school. The passed-out guy? No, the cop. I ran into him six months ago at a deli and I ended up telling my parents that we were dating to get them off my back 'cause of, you know, them not knowing I'm gay. You see the problem? Well, there are just so many. Rick doesn't know he's my beard. No, of course not. So we have to keep him away from my dad. No, there is no "we," and maybe this is a sign that you should tell him the truth. What do we got? Systolic is 70 and dropping. Get him into a trauma bay. One of you, deal with that. If you can't get him up, give him naloxone. Go, go. I can't let Rick see me. How long has he been nodding off? Uh, under an hour. Can you hear me, sir? Do you know his name? Conor, Conor McCall. Conor, Conor, can you hear me? OD'd during a visit to his probation officer. No track marks. Probably some kind of ***, pills. He's totally unresponsive. Give me .8 milligrams of naloxone. Be prepared-- naloxone, I've heard, is pretty dramatic. It reverses the effects of the opiates, but it prevents the pain receptors Hold him down, officer! Help, somebody get his legs! I've got this arm. Hold him down! Hold him down, officer! Hold him down, officer! Oh, my God, I pulled s-- s-something came off. You pulled off his ***, Dr. Owens? No, it's I mean, it's, it's obviously not a real one, it's Although it is really lifelike and it's big. It's actually called a doppelwanger? Yep, helps these guys get around drug tests. They're watched when they urinate, so the, uh, fake, uh It's okay, I'm a doctor. Right, well, the fake *** is attached by a tube to a patch of clean urine. That's pretty industrious. Please, can't you give me something for the pain? No pain meds for junkies. I'm not a junkie. Right, right, no one's a junkie. Parking him in 531. It's going to be a little while till you can book him. We have to monitor him until the naloxone wears off. I'll hang around. This hospital has pretty good vending machines. Yeah, I know, right? I had a chicken potpie a couple months back that was great. You eat from the food ones? I'm telling you, it was delicious. I'll take your word for it and I'll let you know when he's in better shape. Here in slice 16 you see an ill-defined hypodense solid tumor. The tumor is present in the uncinate process of the pancreas. Now, I don't appreciate direct involvement of the SMA, as you can see from the absence of the fat plane, and here in the axial cross section, we see that the tumor remains at 42 millimeters. So it hasn't shrunk at all? No. Okay, well, we're just gonna have to get more aggressive. I'm thinking a combination of oxaliplatin and gemcitabine. Well, we can try Good, let's do it. Hey, are you okay? Me? Yeah. Because if you want to No, I'm fine. Is Rick still here? I think he's in the waiting room. Shoot. If I text the word "fire alarm," you know what to do. You're eating from the food ones? Tyra, I forgot you worked here. You know, after we ran into each other, I wanted to stay in touch. I know, I know, me, too, but, you know, life happens, we're all busy, so, you know, we'll catch up sometime, just not now 'cause, you know, you got to get to work and I do, too. Okay, wait, what's going on? Why do you want me to leave? I don't. Okay it's not a huge deal, but I need your help. After we ran into each other at the deli, I told my parents that you and I started dating. Uh, because they keep trying to fix me up because they don't, um, know that I'm gay. You haven't changed since high school, have you? That's not fair. Elaborate lies to your parents? Rick. Rick Malone. Hey there! It's been a while, sir. Only because you keep canceling my dinner invitations. Well, you know, things have been crazy at work. Hey, I understand. We'll try again. My wife and I would really love to have you over. Looking forward to it as well, sir. I so owe you. If there is anything, anything you need You told him I'd go out with him? It's not that big of a deal. You don't have to put out or anything. I mean, I'm sure he'd appreciate that, but that's totally up to you. No. I-it's not happening. Please. It would mean a lot to me. He just helped me out with my dad. You do not have to do this. So what if you know that her dad is having an affair and you haven't told her? Ignore feelings of guilt. One cup of coffee. Blood test for that family. Thank you ooh. Yeah, so the parents aren't a match. At least the sister is. No, well, look at the alleles. Luke and Karen are a positive, Sam's a B. Well, that doesn't work. That means he can't be the fa Oh. Aw, geez. You think he knows? I looked at the intake form, and he's listed as the biological father. She must know, right? She had sex with the other guy. She could've had sex with her husband around the same time. Guess we're gonna find out. Oh, come on! Seriously? Unfortunately, you're not a match. Neither of us? I'm afraid not. But Tracy is a match. You don't have to if you don't want to. Are you kidding me? Of course I'm gonna do it. Is this our only option? Unless you have another close relative who might want to get tested. No. Our Only immediate relatives are Luke's parents, Right. Well, they wouldn't be viable. That's too old. It's fine. I'm doing it. What do you mean I have a break-bad-news face? You just do. Well, I'm not telling them. It's not our place, and What is so break-bad-news-y about my face? Well, don't obsess about it. I'm not obsessing. Clearly obsessing. What is it? What's so funny? My face, basically. No. Uh, we were actually We were just discussing a case. So Oh, uh Yeah, sure, um of course. See you guys later. I know I asked you not to date her, and I'm very grateful, but, uh You don't have to be rude. Seriously? You asked me to blow her off. Now you want to manage the way I do it? Now I just feel really bad. Yeah, well, you know, it's Sort of an awkward situation. But if I'm too friendly, she's gonna get mixed signals, which I don't want her to get, so Just let me handle it. Dr. Owens, your addict's in trouble. Come on. Peaked ts. Sine waves? Saw it on the monitor. And with him being diabetic It's hypokalemia. He's going into V tach. Give me an amp of bicarbon, amp of calcium chloride, ten units of Insulin, and an amp of glucose, stat. Talk to me, Dr. Owens. He was mentating fine, and then his rhythm degenerated. Okay, I'm guessing he's not one of your more Responsible diabetics. It's probably DKA. Amp calcium chloride. Okay, let's go. Bolus it. Insulin. He's about to flatline. Let's get that Insulin in. Should I start compressions? No. Glucose. Glucose and the Insulin in. Amp bicarb. He's back in normal sinus. Apparently our diabetic was not taking his Insulin. Why didn't we catch this? He's an addict. Non-compliant symptoms were masked by drug use. Okay, well, we need to get his blood chemistry back in order. Dr. Owens, next 12 hours are critical. You need to monitor him closely. Cue one hour chem sevens initially. Don't forget to correct for a sodium concentration. Replete potassium before he gets hypokalemic, not after. Keep a close eye on his fluid status. You need to be on top of it but not too aggressive. Last thing we need is for this joker to get cerebral edema for some kind of Overzealous fluid repletion. Okay. Yeah, got it. And remember, his drug addiction's not your responsibility. You're only here to treat the medical issues. Mrs. Ballard? Can I help you? No, I Yes, I, um Are you okay? Yes, yes. These, uh. These are the consent forms for Tracy. Do you want to sit For a minute? Thank you, I I just I feel like I'm a little Overwhelmed by all this. Yeah. I I understand. It's a lot. I mean, I was just processing Sam's surgery, and Now Tracy's going in, too, and She says she isn't scared, but I know her, and I just I just wish I could do something, and there's nothing I can do, and Well, there is Maybe something. The blood test showed that your husband is not Sam's biological father. Maybe the man who is would be willing To donate? It was one night You don't have to One night 12 years ago, a Coworker Matt Porter. How am I gonna tell my husband? Can't wear a lab coat on a date. You did the right thing by telling her. Yeah, but now what does she do? And it's not a date. It is coffee. She's got to choose. What would you do? You can make nice conversation, right? You're not gonna be all dull and "Which movies do you like?" And "I think Greek yogurt's overrated," right? I can improve on that. I would tell. You? Yeah. Hey. Well, what do you know, you think you know someone, then you find out she keeps a *** in her locker. Seriously, could Albagetti be more immature? I'm no expert, but the detail work is Stunning. Hmm. Have fun on your date. It's not a date. And where did you go to undergrad? Uh, the university of Illinois. You? Boulder. For the skiing. You ski? No. I'm really uncoordinated. So, you booked Conor, and, uh, wh-what else do you have Going on today? Okay. Getting the sense that Tyra might have exaggerated when she said that you were totally into me. She has a way of putting me into very uncomfortable situations. You, too, huh? I just thought Something good might come out of it this time. You never know how you end up meeting Your person, right? Oh, how sweet. Maybe you should consider him. Are you ready to meet y-your person? Uh, yeah, I want the whole deal-- house, picket fence, kids. Aw, that's so nice. I mean, that's why I proposed to Lauren six months ago. And cue the other shoe dropping. But what do you know? She upped and cheated on me. So, I was hoping that you Maybe you could take my mind off of her. You a Tequila girl? - I'm out. - Twice in one day, Rick. What luck. Where's mom? She said she needed some air. Oh, come on. What's with the gloom? Tracy, there's a fine-looking young man right here, and you haven't even flirted with him. Dad! Oh, my God, dad. You are so embarrassing. Good! There are my kids. Well, everything looks great. Your brother's lucky to have such a healthy donor. Luke. I need to speak with you. What's wrong? Nothing. Grown-up stuff. Luke. I'll get you another blanket. Hey, is my brother out there in the waiting room? Tall guy, salt and pepper hair. No. I don't think so. Good. I-I told him not to come anyway. I don't want him to see me like this. God. What's with the itching? Why am I itching so much? It's the drugs working their way out of your system. I didn't even take that much. It must have been a bad batch or something. Do not get involved. It's a mistake. His addiction is not your responsibility. I got popped one time for possession. I took a few pills. Totally forgot that I was supposed to see my P.O. that day and God, I'm hot, too. How am I hot and cold at the same time? Your pain receptors are firing in overdrive. Can you do something about the light, please? Yeah. It's so bright. Yeah, definitely a bad batch. What does that mean? No metastasizing means that the tumor hasn't grown. Which is good news. Definitely. That part is good. What part isn't? There's no good or bad, really. We don't like to classify things that way, because w-we're looking at the whole picture. Oh, did the tumor shrink at all? Okay, it's not just about shrinking. What we need to do right now, is we need to find the exact right combination of meds. Because the first ones didn't work? It isn't that mom. It's just that we have even more effective ones in our arsenal. So a lot of this is trial and error. The good news is that we have a lot of medications to choose from. Wow. That's a lot of good news. Dr. Owens? We've talked it over, and we want to try to get in touch with Sam's With the biological father, Matt Porter. I-I think I can track him down. Okay. We'd just need an answer by the morning. And give him the number of the nurses' station. There's always someone here to pick up. Yes, okay. Thanks. The junkie's driving me nuts. Okay, I'll check on him again. Good luck. Anyway, I'm still here at the hospital. And I'm feeling pretty bad, bro. If you wanted to drop by, that'd be okay. Heard you weren't feeling too good. Can't you give me something, please? Just to take the edge off? You're almost through the worst of it. I know it doesn't feel that way. Conor. Conor! Conor! I need naloxone in room 531, and men-- lots of big men! Come on back. I need 4.2 milligrams. First dose must have worn off. Where are the men? Coming. Brace him. Now. Hold him down! Hold him down! I got your page. Is everything okay? Close the door. Please? What's going on? I don't know. No one will tell me anything about my scans today. You didn't talk to Micah? I did. He keeps saying things are good, things are good. But I know my son, and the more he says things are good, the more I know things are not good. Let me go get him, okay? No. He won't tell me anything. And I called the oncologist and he's off for the weekend, and I I need to know what's going on. I need to know What did the ct scan show? Um, if Micah You're my doctor, too. Don't you have an obligation? This is my life, and nobody will tell me what's going on. I deserve to know what's going on. Please Tell me. Did the tumor shrink? No. Thank you. Have you seen Dr. Barnes? No, not recently. My father said he saw you and Rick getting all cozy in the cafeteria, so now I have to fake break up with him. Or you could just tell your father the truth. Since you tried to steal my man, you and I'll have to pretend we're not talking. Perfect. We can start now. Micah, I wanted to talk to you about something. I'm running late for an ex lap; I'll catch up with you later. Any word from the biological father? No, not yet. Hope he shows up. Dr. Owens! Yeah? It's me. I'm Dr. Tavana from urology. I was told you needed a consult. Something about a dislocated ***. Ha-ha. Very mature. If you laugh, our friendship is over. I feel like I'm gonna die. I never felt like this, like I was gonna die. You're not gonna die. You did have more opiates in your system, though, than we originally thought. Bad batch? It wasn't a bad batch. Conor, you have a very serious drug addiction. So serious that your high outlasted the medication that we gave you to block it. You don't even know me. You look at me and you think "addict," but that's not all I am. I'm a graphic designer. I'm a really good graphic designer. My aunt was a fantastic photographer And a really great cook. But when I think of her, I think "alcoholic," because Her addiction got in the way of everything else. But everyone partied. When I was in college, all my friends, we got wasted, that's all we did. We got wasted So I'm guessing your friends stopped. So why can't I stop? We don't know what makes some people more prone to addiction than others? Sometimes it's family history, and sometimes it's just random. My brother-- he's not coming-- he, uh The last time that I saw him, he said that he didn't want me around his kids, so I mean, I don't even know where I would go. Like Like, a rehab? I don't have any money or anything. Do you want to go? Yeah. I'll look into it. No, he let his insurance lapse, so I was hoping that a state rehab might have a bed. You do? No. He can't wait four days. No, ma'am ma'am, no, he's being discharged tomorrow, and if he doesn't start treatment, he's gonna start using again, and I Hey, take the bed. Issue a 21-70 on the guy. That's a good idea. Thank you. No problem. I'm sor Yes, I'm here. Um, we will take the bed. What's a 21-70? It's the Colorado state institutional code for involuntarily confining someone who might do harm to themselves or to others. The bed at the facility is not available for another four nights, but I can't keep you here unless you feel like you might Do harm to yourself Or to others. Well, I-I have been Feeling really bad about my life. Really, really bad? I'm sorry to hear that. If you still feel that way tomorrow, I'm gonna have no choice but to keep you here. You're the doctor. "Anticipate," as in-- "They did not anticipate that will would play such an awesome word". "Peel." "Peeling." What's the matter over there, can't make sense of your letters? Will you shut up? I can't think. Just ignore him. That's his, uh, signature move. Yak, yak, yak. Has anybody got a "P"? One more, and I can spell "doppelwanger." Why don't you spell "loser"? It's a good one. What are you guys playing? Bananagrams. Why don't you talk to will, distract him? You know what, actually, why don't you, um, go ahead and take my spot. I should probably I should probably go back. Check and see if Matt Porter called, all right? Okay, I'm not crazy. You guys saw that, right? He doesn't even want to be near me. There's no "I" in "obfuscate." There is, too. You sure he didn't say anything? Sorry. No, you're spelling it wrong. No, I'm winning-- so you're trying to distract me. It's a "U." Look I know you have no reason to want to help me She took credit for your work. but I'm really at a loss. She's tormented you since you were ten. So if there's any way you could find out anything You are such a ridiculous person, pits. Why the hell am I being so nice to you if you can't do me one simple favor? Cassandra How is it that you always know just what to say? I need to speak with Emily. Alone, please? I tried to find you, but you'd already gone You are in no way qualified to assess a cancer patient's prognosis. She asked that For her test You crossed a line! No one would talk to her, and I-if it wasn't your mother But it is my mother! It's my mother! And you had no right telling her that she might die. I didn't say that. Well, she's gonna think you meant that. And she's gonna give up fighting. That happens to patients; I've seen it. They give up fighting-- and I'm not ready for her to give up fighting, 'cause It's it's not her time. I know I'm a doctor, and And I see death all the time but this is my mom. I know. Good morning, Dr. Owens. Hi. Chipper. You clearly slept. Like a log. Good for you. Um can you do me a favor and get papers ready for a 21-70? When I checked on my addict a couple of hours ago, he was pretty unstable. Oh, he's better. Checked himself out. What? Let me guess. He told you, while he was shaking and sweating in the middle of the night, that he wanted to get help, so you tried to get him into rehab. Yes, I heard, and I told you not to get involved in his addiction. I had to try. And maybe it-it didn't work, but maybe, at some point it will, and I couldn't live with myself if I didn't try. Dr. Owens? He wants someone on the Ballard boys case. His name's Matt Porter. Yes. Great. Thank you. Hi. This is Dr. Owens. I'm one of the doctors caring for Sam Ballard. Did you hear from him? I did. I'm sorry. He doesn't want to donate. So We're right back where we were before. No, we're not. What are you doing up here? I just, uh, needed some air before my surgery. Oh. I have to make a call. Is that? It's fine. Go ahead. It just seems like something's wrong. Is something wrong? Cassandra, I'm not in the mood. What's wrong? I'm not giving you intel on will. Yeah, I know. You're lame. What's going on? I told my patient something that Not only did it not help, it hurt them, so I feel bad, and Guilty. I'm trying not to feel guilty, so So I feel guilty about feeling guilty. That's what's wrong. Okay. First, there's nothing wrong with guilt. I mean, right now, I'd like to walk away and leave you here feeling bad because then maybe you'd mess up in the or or something. But I'd feel guilty about that, so instead, I'm telling you. Everyone knows you're a good person. It's incredibly annoying. So clearly, whatever you did, you had good intentions, because that's just who you are. Two kids going under the knife at the same time-- it's tough. I take it back. That whole anyone-but-Cassandra thing. I take it back. Why? Because the guilt is driving me crazy. Then don't feel guilty. I wish I didn't, but I do, and usually if something's driving me crazy like this, it's because it's just Not who I am, so I take it back. Ask her out. You're sure? Well, I appreciate it, Emily. What you just did. It's very loquastic. Good luck in there, Dr. Owens. You, too, Dr. Collins. Okay, Dr. Owens, medical record 52478, hepatic transplant. Right upper quadrant incision at 10:18. Dividing the peritoneal attachments to the left lobe. Left hepatic vein isolated Right on schedule. Let's get started on the left hepatic artery. Kelly clamp. Kelly clamp. Excellent. How are the vitals? Stable. Now I'm going to transect the parenchyma. Okay, get that retracted. Wait. Hold it. Okay, good. All right, let's ligate the proximal end of that portal vein branch. Perfect. I need suction. Now we're oozing too much. Owens, I need that thing tied off now. Very good. Looks like we won't have a problem with biliary outflow. Proximal end is ligated. There's hemostasis here. No. There's too much blood. Where is this coming from? Uh, BP is 70/30. We're crashing. You need to stop the bleeding. Come on, Tracy. Transfuse her four units wide open. Hemostat. Clamp the pedicle. Come on, Tracy. Not your time. Still bleeding. Must be the outflow. Perihepatic packing now. Come on. Wait. Owens, get in here. Right here. Here it is. Push there. Harder. Come on, Tracy. Fight. I need you to fight. Sutures? All right, Tracy, fight. BP's back to 100/60. She's stabilizing. Nice save. They're both gonna be fine. Thank God. Oh, thank God. Um when can we see them? As soon as they're out of the ICU. Okay. I'm gonna grab a coffee. Uh, Mrs. Ballard? No. Karen. Please. Karen, um I just wanted to say that I'm So sorry. I shouldn't have told you. It didn't help anything. Every day for 12 years, I've wondered when this would come out, because I knew it would it. It had to. And holding it in, you know, hanging over my head every day the guilt just Maybe this is best Now that it's out. So I've been a lousy doctor and a lousy son. It's okay. No. It's not. I didn't want to tell you the news because I was afraid that you would stop fighting. I know, but I need you to be honest with me. I'm strong, I can handle it. That's good. That you can. Oh come here. Um Come on! I'm not getting into bed with you. You may be a big shot doctor, but you're still my Micah mouse. Okay. Never say that out loud again. Get in the bed! Well, I I And this is just weird. Shh! Shh, shh. Hi. Yeah, this is Dr. Owens at Denver memorial. I had reserved a bed at your facility for a Conor McCall. Um, unfortunately, you can release it. Yeah, I know. Thank you. Okay, so, whole new plan. You and I are gonna stage a fight. I call you a ***, you apologize, I forgive you, proving I'm a bigger person. Tyra, think about what you're doing. I mean, all these elaborate lies, and pulling in innocent people. You trying to make me feel guilty? Is it working? A little. Look, I want to tell him, I do. I Rick said I was the same as I was in high school, which is true, and it's a really depressing thought. Yeah. I'm familiar. Well, maybe it's time. Yeah. Maybe. The truth is, guilt's not all bad. Sure it makes you do things you might not want to do, but it also serves as a moral compass. It keeps us on course. Come quick. What? What's going on? What the hell. Ladies, this is the look of a man who's just bitten into the business end of a doppelwanger. Yeah. Really funny. Let me have that. Not a chance. That was genius. It was genius! Ah, revenge I can do in my sleep. Later, guys. This is me. Hey, thank you. For what? Will asked me to go out for dinner, and I know it's because you put in a good word for me. So, yeah, maybe guilt keeps us in check. Ooh, looks like someone keyed your car. That sucks. That doesn't mean it's not a huge pain in the ***. Fine. Next time, I don't leave a note.
