"Come back next week, and we'll take out the sutures." "Have a Happy Thanksgiving, Dr. Holt." "Thank you." "Well, well." "Scrooge found a smile." "She's my last patient." "I'm done here for a week." "Oh, so we all have something to be thankful for." "Watch your back, Dr. Mike." "What's this?" "It's equipment for the new trauma room." "Got it from one of the ers that was closing... cheap." "Really?" "I'll find a way to pay for it." "Are you joining us for dinner?" "You and the hubby?" "No." "The first annual" "Anna Paul Thanksgiving dinner at clinica sanando." "Christina, after all your messages, we're not having dinner at your place?" "Mom canceled it." "What's up, Uncle Mike?" "Milo." "This clinic is such an inspiration," "I had to get involved." "Anton and I are planning the dinner, and Milo's going to help us cook." "Yeah." "Can't wait." "Anna gave people here a lot to be thankful for." "Have a good time." "You're not going to be here?" "Anna was your wife." "Ex-wife." "And I don't need to be told when and where to be grateful." "Come on." "Christina's a good cook." "And you've always been a yam fan." "She's back, isn't she?" " Don't start with me, Anton." " Anna's here?" " Now?" " I could drive a truck through the tear in your energetic body." "Anna!" "Anna, it's me, Christina." " So loud?" "Really?" " I miss you." "Happy Thanksgiving." "Are you really going to spend Thanksgiving by yourself?" "What, you, uh..." "Want to spend it together?" "No!" "Well, I mean, it would be nice, but..." "Right, but, uh, I would cook," "I'd eat, do all the dishes." "And that's, uh, if you'd show up from, uh... where is it?" "Have you ever noticed that your mood changes around the holidays?" "Maybe I'm not such a yam fan after all." "Or maybe Thanksgiving brings up bad memories." "Your sister said something about that once." "Oh." "Christina blab about any other deep, dark family secrets?" "This might be a great place to spend Thanksgiving." "And we're all so grateful to you for everything you've done." "Especially me." "Easy." "Hey, Dr. Holt." " Lenny?" " Hey." "Good to see you" " again, sir." " What is this "sir" crap?" " Thought you were in Afghanistan." " Yeah, they sent me home 'cause you can't shoot with a bad trigger finger." " What did you do, break a nail?" " Shrapnel from an IED." "Oh." "Wow." "Rita didn't tell me you were coming home." "Yeah, I didn't tell mom." "Oh, this is going to be good." "All right." "Morning." "Morning." "Bottoms up." "No, I don't want that drink." "I hate that drink." "You drink this stuff every morning." "No, no, no." "But today, I would like a..." "Root beer float with rocky road ice cream." "That's my boy's favorite drink." "Well, then, you better make two of them." "What?" "Oh, my God." "No." "Leonard Hall Junior." " Hey, mom." " You're not supposed to be back till January." "What on earth happened to your hand?" "That's my ticket home." "I report to Fort Bragg on Monday." "This is the best Thanksgiving surprise" "I could ever hope for." "If your father knows about this," "I'm going to kill him." "Dad doesn't know;" "Only Michael." "I just found out a minute ago." "Yeah, well, you're still a dead man." "When your father sees you, he's going to wet his breeches." "Let's go call him." "I'm going to go make my rounds." "If the clinic calls, tell them I am done till next week." " What is the problem?" " That guy's an idiot." "He doesn't like cranberry sauce." "I said I like fresh, just not that crap in a can!" "That's the best part!" "It's shaped like a can!" " You're a moron!" " All right, shut up, shut up!" "You, sit!" "Sit over here on this blanket!" "Sit down!" "Sit your ass down!" "And you, sit down and face forward!" "First one of you so much as looks at the other one, you're out on your ass!" "Little too much, uh, holiday spirit?" "Yeah, about 100 proof." "Well, at least they're lively." "Haven't had a patient under 70 all day, and most of them are depressed." "Oh, that always happens around the holidays." "Someone brings in granny 'cause they think she don't look too hot, and the only thing wrong with her is she's a year older than the last time they saw her." " I'm taking a break." " Thought you quit." "One day at a time." "And today's not the day." "Hey." "I got a guy in trouble back here." "Come on!" "I was about to head back to the depot, and I heard him wheezing back here." "I thought he got off at the last stop." "Tell me what's wrong, pal." "His name's Dennis." "He rides back and forth all day long." "Help me get him inside." "All right." "Hector!" "I need a room and an ambu bag!" "All the exam rooms are full." "Put him in the trauma room." "It's not finished yet." "It's got an exam table." "Find me Kate now!" "And O2, and a monitor!" "Hurry up!" "Who's our guest?" "Dennis... no I.D., can't breathe, ambu bag's not helping." "We're going to lose him if we don't get him on a ventilator." "Lucky him... an intubation kit and a vent turned up an hour ago." "Somewhere in these boxes here." "Well, you take over bagging." "I'll look for it." "Yeah." "Here's our new blood count machine." "What's this?" "Ultrasound." "Hurry up." "I'm losing him." "Found the intubation kit." "Great." "Charisse, push meds." "Thanks." "Find the vent." "Vent, vent, vent..." "Okay, I see the cords." "Endotracheal tube." "Okay, I'm in." "Okay." "Zeke, where's my vent?" "Kate, there is no ventilator in here." "Maybe you didn't order one." "Delivery guys must have left it on the truck." "I'm looking at the packing list right now... it's not on here." "Okay." "Well, we'll just have to keep bagging him until we get him to a hospital." "Bus driver found this on the floor of the bus." " Says it's your patient's." " Thank you." " Call 911 for us, please." " I'm on it." "Sats are on the way back up." "Here we go." "What'd you find?" "Medical bracelet." "Got a last name on it?" "Dennis Jones." "That's not all." "He's a DNR." "We just saved a guy who didn't want to be saved." "Now what the hell do we do?" "A Gifted Man 01x08 In Case of Missed Communication November 18, 2011" "What a mess." "Wish we knew Dennis had a DNR before we intubated him." "We know now." "We can't take it out." "That's euthanasia." "That'd be what he wants." "He didn't want us to save his life, but ending it is a different story." "Even though he had this?" "Clasp is broken." "Might have fallen off." "Or maybe he changed his mind about the DNR, took it off, forgot it was in his coat pocket." "I told Autumn to run down every Dennis Jones in the phone book." "Maybe he's got a next of kin who's his proxy." "Good idea." "Hey, what happened to that ambulance?" "EMS is too jammed up with emergency runs to spare a bus for a patient transport." "Then we'll pay for a private ambulance when we find a hospital to take him." "In the meantime, we got to keep bagging him unless he dies or wakes up and tells us to take the tube out." "Want me to start calling hospitals?" "No." "You know what?" "My hand is tired, and, uh, I have better phone manners." "Like I said, we didn't know that he was DNR until after we intubated." "Yes, ma'am, we're idiots." "And you're a bitch." "It's official." "No hospital in the five boroughs will take Dennis." "No one has a spare ventilator for a patient who's DNR?" "Nope." "They don't want to get sued when he wakes up." "Any luck finding his family?" "I called every Dennis Jones in the book..." "All 18 of them." "No one knows him." "Well, we saved him, we own him." "Okay, so there's no crackling in your lungs, which rules out pneumonia." "What is your story, Dennis?" "How come you don't want to be saved?" "Are you sick, or you just run out of gas?" "You must have some reason to live." "I know, it's none of my business." "Sorry." "Just have to grab some stuffing mix." "Stuffing mix." "Think I saw a few boxes under the X-ray film over there." "Don't worry about it." "I'll find it." "You just keep breathing life into him." "Yeah." "Hey, you know, you could help me actually breathe life into him for a minute while I get this machine hooked up to try and see what's wrong with him." "Are you sure that's okay?" "Yeah." "As long as I'm here, it's legal." "Then I would be honored." "Yeah, it's just an easy in and out here." "Just a little, gentle squeeze." "Keep it going." "That's perfect." "Your friend's carrying some pretty dark energy." "Is that your shamanistic diagnosis?" "Hard to miss a soul in pain." "And where do you think his pain might be coming from?" "Well, all of his chakras are pretty blocked, but the fourth is definitely the worst." "The fourth." "Which one was that?" "It's right there." "It's his heart." "Well, nothing's showing up on his echocardiogram." "Ticker's not dilated." "He's got a good ejection fraction." "That rules out congestive heart failure." "Maybe it's spiritual." "Maybe it's neurological." "Zeke, I'm off the clock till next week." "Oh, sorry." "Didn't get the memo." "But I did get an African-American male in respiratory failure with no other cardiothoracic findings." "If you think it's neurological, then send him to a hospital for an MRI." "Come on." "This is your kind of patient." "He's an unconscious head case with a tube down his throat." "He can't even talk back." "You want me to drop everything the day before Thanksgiving?" "This guy's hanging on by a thread here." "Are you gonna help me or not?" "Yeah, I'll be there in a few minutes." "Sorry to break up the party." "Oh, Michael, I'm sorry, we'll get out of here." "No, no, no, no, it's fine, sit, sit, sit." "Good to see you, Len, it's been a while." "It's not every day my wife calls and tells me to get my butt over here." "Hey, how crazy did she go when she saw him?" "Oh, Rita?" "Oh, just her usual demure self." "Well, I'd better get my demure self to the grocery store and see if they have any decent-sized turkeys left." " Yeah." " You coming over for dinner?" "Hey, we'd love to have you." "You know, I would, but, uh, I've got other plans." "Get me a 20cc syringe filled with water." "Any clues?" "Well, it could be a stroke or a brain stem hemorrhage." "Yeah, peripheral reflexes are normal." "All right, let's take a peek here." "Pupils are equal and reactive." "Testing his vestibulocochlear reflex?" "Yeah." "That's normal, too." "So you got nothing." "My advice..." "Send him to an ER for a chest X-Ray and a head CT." "We tried;" "Nobody wants him." "Well, somebody has to take him." "Not under these circumstances." "Dennis is a DNR." "You're joking." "It was an accident." "He accidentally swallowed an endotracheal tube?" "I carried him off a city bus in respiratory distress and we intubated him." "His DNR bracelet wasn't on his wrist." "It was in his coat pocket." "So not only did you resuscitate someone who didn't even want it, you brought me here to diagnose somebody that I can't even treat." "Are you suggesting that we take out the tube?" "No, but didyou stop and think about what you were doing?" "If he lasts a few more days, you're gonna have to put a feeding tube in his stomach." " Did you think of that possibility?" " We're dancing as fast" " as we can here." " Ugh, and kicking my ass" " in the process." " You would have done exactly the same thing if you had been in our shoes." "You don't know that." "Rita, what's up?" "It's Len." "Rita's on the phone with the police." " She told me to call you." " What happened?" "Lenny's been in a motorcycle accident." "All right, have her tell the cops to bring him over to Holt." "Well, first they've got to get him out from under a car." "Where's the accident?" "Michael wants to know where he is." "Avenue D and East Fourth." "All right, that's close." "Uh, tell her I'm on my way." "What's wrong?" "Rita's son is hurt." "Hey, you can't..." "The guy on the bike..." "I'm his doctor." "Okay." "How'd it happen?" "Motorcycle swerved, hit a cab, which struck a parked car." " Only your guy on the bike got hurt." " Did he lose consciousness?" "For a couple of minutes, and since he came to, he's been talking kind of crazy." "All right, I'm his doctor, guys, what are his vitals?" "A little tachy and he's vasoconstricting, so I'm having trouble getting this iv in." "All right, I got it." " Get outta the way." " Radio J-Tac." "Lenny, it's Michael Holt, buddy." "You're, you're in New York, you're not in Afghanistan." "Fire on my six." "Nobody's under fire." "You need to stay still, okay?" "Michael?" "Yeah, it's me." "You're gonna be fine." "Cycle another BP as soon as we get him from under the car." "Can we get a little help with the car?" "Okay, ready when you are." "All right, soon as this thing comes up, we pull him out together, keep his spine in line." "All right, we're ready when you are." "Okay, bring it up." "Ready?" "One, two, three, go." "Okay, Lenny, do you remember what happened?" "Yeah, I almost hit an IED." "Well, you took, uh, took evasive action, you saved a lot of people." "Can you lift it?" "Okay." "You're okay now." "Wait, take us to Holt Neuro." "Do you have orders for me, sir?" "Yep, we're gonna do a drill." "Wiggle your fingers and toes." "I can't, sir." "Can you feel this?" "Feel what?" "How about this?" "I don't feel anything." "Am I okay?" "You hang in there." "Lenny." "We're right here, son." "What are you guys doing in Afghanistan?" "Was he altered at the scene?" "Yeah, his arms and legs aren't responsive to painful stimulation." "Just get him upstairs." "You're saying he's paralyzed." "Is he going to walk again?" "You got to stay calm." "I'll know more after I do the CT." "All right." "The brain's not bleeding." "That's a good sign." "That's not." "Jefferson fracture..." "Circle these..." "With burst lateral mass and bone fragments." "His brain isn't bleeding." "Thank God." "Then why does he think he's still in Afghanistan?" "Severe post-concussive syndrome from the head trauma." "His thinking will clear up in the next few days." "We sedated him so he won't move around and make his injury worse." "What kind of injury, Michael?" "Lenny has a Jefferson fracture..." "A break of the front and rear arches of the first cervical vertebrae." "Is his spinal cord intact?" "Yes, but bone fragments are compressing it and making it swell." "That's why he's paralyzed." "I put him on a steroid to reduce the swelling, but he has to have surgery to relieve the pressure and to stabilize his spine." "Four tours of duty... he almost gets blown up a dozen times and comes home with barely a scratch, and now this happens." "We'll get through it..." "All of us." "The critical window to operate is within 12 hours, but he is obviously in no shape to consent to surgery, so as next of kin..." "You've got our permission, Michael, do whatever it takes." "I'll get an MRI to give us a better look at the break, run some labs, and then we'll get him prepped for surgery." "You know, when I was a resident..." "This guy came into the er with the words "do not resuscitate"" "tattooed across his chest." "Now, that was definitive." "Dennis." "Kate, get in here!" "Kate!" "It's okay, let me explain what's happening here." "I'm Dr. Barnes, this is Dr. Sykora." "You came in here not breathing, we put a tube down your throat into your lungs to help you breathe." "It was the only way to keep you alive." "Uh, a pen, he wants a pen." "Okay." ""Stop this now."" "Mr. Jones, if we take the tube out, there's no guarantee you're going to be able to breathe on your own!" "Yeah, customer's always right." "Let's get him up." "Okay." "All right, hold still, hold still." "You ready?" "Yeah." "Can't you read?" "Where's my bracelet?" "We found it in your pocket after we put the tube in." "That's right, the damn thing broke." "You still shouldn't have done this to me." "We didn't know you were DNR when the bus driver brought you in." "Any doctor would have tried to save you." "I didn't want to be saved." "Get me my clothes." "You're in no condition to be leaving." "Lady, get your hands off me." " Calm down." " All right, then let me" " unhook your IV." " Aah!" "Okay." "Wow, you must really want to die." "Uh-huh, that's right." "You want to at least tell us why?" "That's none of your business." "Come on, you got to help me out." "I got to fill out a bunch of paperwork explaining why you refused medical treatment." "There's got to be a reason why you'd want to give up." "Write down "Nothing to live for."" "Really?" "No family?" "Wife died two years ago of lung cancer." "Daughter stopped talking to me." "Tried calling her;" "She moved." "Sounds like you wanted to talk to her." "Yeah, but Kelly didn't want to talk to me." "Now I got lung cancer, too." "I'm getting out of here and ain't nothing you can do to stop me." "Well, maybe you should wait till Kelly shows up." "You found her?" "You were out cold, so I tracked her down." "She'll be here in a few hours, tops." "You should stick around." "We'll look after you." "Come on." "There's no way you're putting that tube back in my throat." "Can I at least have a nurse put you on some oxygen so you'll be more comfortable while you wait?" "Yeah, all right." "Dr. Barnes, can I talk to you for a moment?" "What are you thinking?" " You did not find his daughter." " So you're fine with him dropping dead two steps outside our front door?" "No, of course I'm not, but it's his life." "He made a choice." "And if he's wrong?" "Look, he said his daughter's name is Kelly." "Maybe I can find her." "At the very least, those two should talk before he kicks the bucket." "All right, well, just get cracking." "He doesn't have a whole lot of time left." "You want an espresso?" "Yeah, make mine a double." " I just finished Lenny's pre-op images." " And?" "Something worse than a Jefferson fracture?" "Check out what's right below it." "It's an AVM." "Just look at that thing the wrong way and it'll rupture." "We'll have to operate on top of a land mine." "There's a new problem on Lenny's spinal cord that the MRI revealed." "Our son has an AVM?" "I'm afraid so." "Excuse me, but I haven't spent my whole damn life in medicine." "What the hell is an AVM?" "It's an arteriovenous malformation." "It's a tangle of arteries and veins." "And he got this during the wreck?" "He was born with it, hon." "The accident revealed it." "He's lucky it didn't rupture in the crash." "He could've died from blood loss." "Well, he's still in very serious danger, because the AVM is right next to the fracture I have to fix." "It's also very close to the innervation of respiratory muscles." "So I need to ask you:" "Does Lenny have an advance directive?" "You mean, has he said how far you should go to keep him alive if something goes wrong?" "Yeah." "Nothing's gonna go wrong." "But no, he doesn't have one." "So any decision about life support..." "We'd make together, just like always." "Like Rita said, he'd want you to do everything possible." "Well, you know I will." "Is that the guy you saved accidentally?" "He's still pissed off about it." "You're Michael's sister, right?" "Mm-hmm." "And you're Zeke." "It's nice to meet you." "You, too." "You hungry?" "A new stuffing recipe I'm trying for tomorrow." "In other words, if it turns out to be crappy, at least I can get immediate medical care?" "Something like that." "So is he going to live?" "Good question." "Not having family here is tough." "Yeah." "I'm working on that." "Speaking of family, your brother..." "Has he always been such a..." "Hard-ass?" "Pretty much." "Kate thinks he's allergic to Thanksgiving." "Probably 'cause of the last one we spent together as a family." "Oh, that bad, huh?" "Pretty brutal, actually." "Michael was 11, I was nine." "Took me years to get over it." "Anton helped, actually." "Hmm." "Well, maybe he should take a crack at Michael." "That'll happen right after" "Michael takes up transcendental meditation." "I hope you find his family." "So if you are Dennis Jones's daughter, please call Clinica Sanando as soon as possible." "Thank you." "Wrong number." "Sorry." "Doesn't sound like you found her." "Google lists seven Kelly Jones in the tri-state." "But three have never heard of Dennis, one never picks up." "One's disconnected, and I just got my second wrong number." "So which one of you are going to stay with him tonight?" "'Cause we close in ten minutes." "Guess that'll be me." "No, I'll stay with Dennis." "You sending me home?" "No." "You are gonna go find the Kelly Jones who doesn't answer her phone." "Stop or get a face full of mace." "I'm not a mugger." "I'm just looking for someone that lives here..." "Kelly Jones." "I know Kelly, but who the hell are you?" "I'm Zeke Barnes." "I'm a doctor." "I work at a clinic in Manhattan." "I've been treating Kelly's father." "He's very sick." "Then he's getting what he deserves." "Oh." "So you're Kelly." "You know, he really needs you." "No, he doesn't." "And I don't need him." "Look, I know you two stopped talking after your mother died." "Did he tell you why?" "My mom was in so much pain, and my dad made her fight, even when there was no hope." "He made her suffer." "Well, he told me he tried to call you." "Maybe he wanted to apologize." "Well, that door closed a long time ago." "How long do you think he'll be under?" "Uh, excise bone fragments, stabilize his spine." "I'd say at least six hours." " I'll finish prepping." " Yep." " I can't believe this." " I'm not telling him." "Look, if you don't tell him, I will." "Are you threatening me?" "Tell who?" "Me?" "Sorry, Michael." "Um, family discussion." "Family discussion, my ass." "She lied." "To me and to you, Michael." "Leonard Hall, please don't do this." "Before Lenny shipped out to Iraq the first time, he and I had a long talk." "I told him about being in Vietnam, all the guys I saw maimed." "Lenny says, "Dad, if I have to be kept alive by a machine," "I'd rather be dead."" "He never would've said that." "So I was thinking about this a little while ago when I went home to get us a change of clothes." "I started nosing around the paperwork he sent Rita." "You had no right to do that!" "I found this." "Lenny's living will." "Rita, did you know about this?" "I saw it." "But I don't give a damn what's on that piece of paper." "That piece of paper says our son doesn't want to be kept alive by a machine." "It's all we got!" "He's all we've got!" "You just want him to die if something happens?" "Of course I don't want to let him die." "Then why'd you make him go to West Point?" " I never wanted him to go!" " Rita, that was his decision." "You know that." "Just like this is." "You have no idea what he wants!" "Enough!" "Lenny's an adult, and he made an adult decision, and I have to abide by it." "If something happens in that O.R., I can't put him on a machine to keep him alive just because you want me to." "Go to hell!" "It's terrible when a family can't talk to one another." "Especially on Thanksgiving." "Well, my most memorable Thanksgiving was when I was 11, and my dad went after my mom with a knife." "I knew your mother died, I had no idea your father..." "Killed her?" "No, he didn't." "Not that he wasn't trying." "We were screaming, and he..." "Cut her arm up pretty good." "She ran out the front door." "I followed the blood down the driveway, and..." "She was gone." "And that whole night, I just sat, staring out my window..." "Waiting for her to come back." "She never did." "Christina and I made a promise that we would never tell anyone what really happened." "And I got really good at believing that my mom was dead." "So, she's still alive?" "I don't know." "Michael?" "Lenny's in the O.R." "Then let's go." "That's the last bone fragment." "Lenny's spinal cord is intact." "Let's close the dura, stabilize his spine, and we're done." "How we doing, Victor?" "Ah, looks good." "Heart rate and BP are steady." "But his end title CO2 is climbing." "I'll increase his ventilatory rate." "Any idea what's causing that?" "Probably just underventilated." "Close the dura." "I need the hardware." "Michael, his temperature's going up." "What the hell's wrong?" "I don't know, but temp just spiked to 105." "He's going into spasm." "Spasm plus fever..." "It's malignant hyperthermia." "If he's having a reaction to the anesthesia, I got to wake him up." "Well, you can't." "Spine's still open." "Yeah, if I don't wake him up, his muscles will break down, or his brain will burn up." "And if I close him before I stabilize his spine, he's a quadriplegic on a respirator." "At least he'll be alive." "Respirator is not an option." "I am finishing the surgery." "Cool him down however you need." "Get me ice packs and chilled saline." "Putting him on a dantrolene drip." "Placing ice packs now." "His temperature is coming back down." "All right, done." "Let's close him up." "Temp's 102." "I'm waking him up." "All right, repeat blood chemistry and continue cooling measures." "Did you get his temp down before his brain burned up?" "I hope so." "Stay with me, Lenny." "Lenny?" "He's in recovery." "Bone fragments are gone." "Spinal cord is decompressed." "What happened in there, Michael?" "What took so long?" "Did his AVM bleed?" "Well, his AVM wasn't an issue." "Lenny had a reaction to the anesthesia." "I didn't know he was allergic." "Well, no one did." "He's never had surgery before, right?" "But we got it under control, and we fixed his spine." "You saved him, Michael." "You did what I asked." "Well, fortunately, I didn't have to make that choice." "But if I did, I would have done what Lenny wanted." "I know." "Do you want to tell Len?" "I'm not sure he'll even listen." "I think he'll be happy to know that his son's gonna make it." "Come on, Dennis, you made it through the night." "Don't leave now." "Why, so you can lie some more?" "My daughter was never coming." "Dennis, if you walk out that door now, you won't make it halfway down the block." " Fine by me." " Dennis," "I'm sorry, but I know you don't want to die." "You don't know, so save your apologies." "Because it's you who should apologize." "Kelly." "I spent all night thinking that if today means anything, it means family, so, yes, I came to hear your apology." "What?" "What do I have to apologize for?" "You're the one who left two years ago." "You lied to get me here?" " Like you lied to keep me here." " I didn't lie." "You said you called her, you wanted to talk to her." "For her to apologize." "Me?" "!" "You put mom through hell when all she wanted was to spend her last days in peace!" "Let me out of here." "Dennis, hold on." "Get your hand off me." "What's wrong with his eye and why is his voice messed up?" "Dennis, had you been feeling weak before you were brought in here?" "I always feel weak." "Seeing double, having trouble swallowing food?" "Yeah, it's all cancer, right?" "Did a doctor actually tell you you have lung cancer?" "No, but I smoked two packs a day for 40 years like my wife did." "I'm always tired and short of breath." "It's cancer." "I'm not so sure." "You need to stay here while we figure it out, okay?" "So I'd like you to go back to that room." "You can take your daughter with you." "What?" "I'm not going anywhere with him." "All right, enough of this crap." "You're going back to the room..." "You're going, too..." "Or I'm gonna reinsert that breathing tube, and this time it might not be down your throat." "That's what we call doctor's orders here at Clinica Sanando." "Let's go." "Milo, I need your help." "Kate, if this is about your DNR guy," "I am not coming over there again." "I am not asking you to, but he now has double vision, trouble swallowing, a droopy eyelid, and a fading voice." "Sounds like myasthenia gravis." " Great minds think alike." " All right, you need to do an edrophonium test to confirm the diagnosis." "You think we stock edrophonium?" "Okay, fine, send someone over." "Wow, that was fast." "Thank you, Michael." " Uncle Mike." " Yeah, I know, I know, I know," "Kate sent you." "Have you noticed how hot she is?" "Have you noticed you're half her age?" "Are you really not coming to the Clinica for Thanksgiving?" "Is this you talking or your mother?" "She really wants you there." "Milo, your mother and I don't have the best track record when it comes to the holidays." "It's not like you can change the past." "Okay, that's definitely your mom talking." "Just seems like the two of you would have fun if you dropped by." "It's not like I care or anything." "I'll think about it." "Here you go." "Thanks, Milo." "He's your patient." "You run the test." "What are you testing him for?" "Myasthenia gravis." "It's an autoimmune disease that attacks the muscles, including the ones that help you breathe." "So that's what's killing me?" "Let's not get ahead of ourselves." "Take my hands." "There you go." "What the hell was in that needle?" "It was an enzyme inhibitor called edrophonium." "It proves you have myasthenia gravis." "That's why your breathing has gotten worse lately." "I breathe so much better." "Does that mean I'm not going to die?" "It's a treatable condition if you get on meds and you go to the doctor when you're supposed to." "Dennis, you need to decide right now if you really want to live 'cause these meds only last for a short while and if you go down again, we have to honor your DNR." "Kelly, you should say good-bye now, 'cause he's not going to last much longer." "Dad, please." "Mom fought till the bitter end because you wanted her to." "Why won't you fight like she did?" "'Cause if you don't forgive me for the way I acted," "I don't really have anything to live for." "I just needed your mom to stay with me so bad." "And now I need you to stay with me." "Meds are wearing off." "Pulse ox is down to 70." "Dad, tell them." "I won't fight you anymore." "Welcome back... again." "Mom, dad?" "Hey." "We're right here, Lenny." "Uh-oh, what happened?" "I was on my bike." "You had an accident, son, but you're okay now." "Michael operated on you." "Uh-huh, that IED in the street." "Is that what it was?" "No, it was a piece of garbage." "Looked like an IED." "Your son's mental status is normal." " What about...?" " Yeah." "All right, Lenny, can you wiggle your toes?" "I'll try." "Hey, hey, hey, hey, hey." "Excellent, now try the left." "Ah." "All right, so we're going to get you home, and once that spine heals, send you to rehab and, uh," " back on your feet." " And never on a motorcycle again." "Everyone up for Turkey?" "I ordered from the deli across the street." "Mm-hmm, sounds good, mom." "What about you, Michael?" "Actually, I'm gonna head out, thank you." "Happy Thanksgiving, guys." "Hmm." "Hey, Kate." "Hey, sorry for yelling at you yesterday." "You've done nothing but a great job ever since the moment you set foot in this joint." "Yeah, well, tell me that when I can't pay my credit card bills." "Zeke, here you go." "Happy Thanksgiving." "You, too." "Thank you, Christina." "Just, uh, you can't leave without telling me why." "Why what?" "Why you fought so hard to keep Dennis alive when even he wouldn't fight." "Guess I just hate to lose someone whose time isn't up." "Happy Thanksgiving, Kate." "Sure you don't want me to heat that up for you, mom?" "Oh, no." "Sit, sit, Zeke, sit and eat." "So how was today?" "Not so bad." "Looks good, huh?" "Oh, very good, yes, but next year I'm going to make" "Thanksgiving dinner myself, just the way you like it." "No one fights like you do, mom." "Michael, I thought you weren't coming." "Yeah, you either." "Not celebrating with the hubby?" "I, uh, told him that I had to work." "Oh." "Here." "So did your DNR guy have myasthenia gravis?" "He does, yeah, but he's better and he wants to live." "Good." "How's Rita's son?" "It's a tough road ahead, but he's alive." "You don't happen to have any forms for a living will lying around, do you?" "You don't have an advance directive?" "I'm not going to die." "All right." "I'll, I'll help you with your forms if you help me with mine." "Gentlemen." " Uncle Mike, you made it." " Yeah." "Mikey Mike, welcome." "Happy Thanksgiving." "Thanks... you, too." "Homemade tofu Turkey?" "That sounds terrible." "Sure." " Enjoy." " Thanks." "Save me a seat." "You got it." "Happy to see you here." "Yeah, me, too." "You okay?" "I've been thinking a lot about, uh, that Thanksgiving, uh, about the story we've been telling about mom leaving." "Why are you talking about this now?" "I think it's time to face the truth." "Come on, I'll get you a fork." "Thank you." "Maybe a knife." "Definitely a bunch of napkins for you." "A Gifted Man 01x08 In Case of Missed Communication November 18, 2011"