"What's going on?" "I don't know." "You gotta be kidding me." "Hello?" "Anybody there?" "Hello?" "This is Dr. Tyler Wilson." " What the hell?" " Who is this?" "I'm Hospital Corpsman Jacob Gold." "So this thing actually works?" "Uh, yeah." "And just by turning it on, you paged me." "I'm a medic, I'm the only one here, along with H.N. Susan Wheeler." "We're near to the end of the drawdown that..." "I-I have a patient here, my best friend," "Who set off some kind of IED and " "Hey!" "Come on!" "Okay!" "Don't hit the robot." "I need help here!" "Uh, okay, corpsman, listen to me." "I'm a private doctor." "I'm a neurosurgeon." " I'm in Portland, Oregon." " Oregon?" "!" "Can you tell me everything that happened, right from the start?" " Okay, can you do that?" " We were walking." "We're getting ready to leave." "We're moving out." "Alex tripped an IED." "It blew up." "He got thrown." "He went unconscious." "He then regained consciousness and seemed fine." "About a minute later, he just slumped over." "I carried him back to the tent, and Wheeler's bagging him right now." "Okay." "I'm gonna take a closer look." "That's in Afghanistan?" "And as of right now, so are we." "I do a little independent contracting with the military." "Okay, I can see him fine." "Talk to me." "Uh, Alex Kimura, 22 years old." "He is unconscious." "Had agonal respirations." "His pulse is slow, but his pressure is through the roof." "At first, I-I thought he was dead." "No movement." "I couldn't even feel a pulse." "He was dead." "And then he woke up and seemed fine," "Talking as if nothing had happened." "He was clear, lucid, completely focused." "After a few minutes, he slumped over and went back to this." "How long after the explosion did he wake up?" "I ran over to him." "I checked his pulse and was trying the radio." "I looked up, and he was gone." "A few minutes." "Maybe ten?" " He actually got up?" " Yes, yes." "He got up." "Is there any way of getting a scan of his brain?" "You're looking at everything i've got." "We're in a tent." "Practically everyone's gone." "We're moving out." "And this is all with a robot?" "Unbelievable." "Keep me posted, will you?" "And good luck." " Unbelievable." " You're our baby." "Yeah, she thinks sugar packets are funny." "Honestly, she thinks everything is funny." "Don't you?" "Don't you?" "Sorry, i know it's a little loud for the hour." "Oh, no problem." "She's so adorable." "Aw, thanks." "Well, aren't you just the happiest little girl?" "Is she always so happy?" "Yeah." "She just laughs, night and day." "She's pretty much either feeding or laughing." "Aren't you?" "See?" "There you go!" " How old?" " 10 weeks." "Wow." "Congratulations." " Thank you." " Beautiful." "Um..." "I think there's something wrong with her." "Excuse me?" "Babies don't typically laugh" "Until they're at least four months old," "And they definitely don't laugh like that." "Wait!" "Hold on!" "I didn't mean to offend you." "Oh, really?" "You didn't mean to offend us?" "I'm actually a doctor." "And there's something wrong with this baby." "Noah Garret, 32, married," "Collapsed this morning in his hotel room." "No spontaneous breathing, intubated en route." "Pupils are reacting, but no response to physical or verbal stimuli." "I don't know what happened." "We were leaving our hotel room," "We're here on a rock-climbing trip." "He just dropped." "Is he on any prescriptions?" "Any drug use, bumps to his head?" " No, nothing." " Oh, my God, what happened?" " No, no, ma'am, please step back." " Are you his wife?" " No, I'm his sister, Kara Bishop." " And you?" "I'm his husband." "We're visiting from Massachusetts." "Okay, we're going to take him back, run some tests to see exactly what we're dealing with." "I want you two to stay here." "Julie." "Yes?" "Julie is going to ask you a few questions." "We'll come get you once he's settled." "Let's move." "He's unconscious." " Ran a C.T., and clearly..." " A.V.M." "Catastrophic bleed." "Mid-Brain, thalamus." "He dead." "Gone." "He's not dead." "No sensory, motor, language -- All gone." "How old?" "32." " Good God." " Exactly." "How old?" "10 weeks." "So " " So let me understand, you run into these people in a cafe, and somewhere between the croissants and the creamer," "You detected a brain tumor?" "I knew something was wrong." "I just figured it was neurological." "Where are they now?" "Exam room." "Scared to death." "As they should be." "It has to be an E.D.H." "Classic lucid interval." "Who is that?" "This is Dr. Ridgeway." "She's... also on call." "Check his pupils for me." "Okay." "I need a line in." "Are you two able to intubate him?" "Yes, sir." "How quickly can you get a medivac?" "I called Kabul " " They said it'd be at least an hour, maybe two." "Okay, Jacob." "Listen to me." " Alex has an epidural hematoma." " How can you know that?" "I know that from what you've told me, and from what I'm seeing." "140 00:06:09,428 -- 00:06:11,729 The initial blast knocked him out completely, but it also severed a blood vessel in his brain." "He regained consciousness." "He was confused." "That's when he got up and he walked around." "The problem is, the blood vessel was and probably still is continuing to leak, putting pressure on his brain." "Which is why he lost consciousness." "Yeah." "He had a lucid interval, wide awake, but just for a few moments." "But he's in trouble." "But we need to get that pressure off his brain." "Okay." "Where is it?" "I don't know." "Typically, it's on the same side where his pupil is dilated, but it could be on the other side." "We need to make him experience some pain." " He's unconscious." " Jacob, I realize that." "But if I'm right, we may be able to break through." "We may be able to make him experience enough pain for him to tell us something." "Now, listen to me." "I need you to do a sternal rub." "Get your knuckles" "And rub them as hard as you can on his chest." "Right now." "Come on, Jacob." "Right now." "There you go." " You need to do it harder." " A lot harder, Jacob." "You're not his friend." "Okay?" "I need you to be his doctor right now." "Harder!" "Okay, stop it." "Got it." "There." "I need to make a list of things we need." "Can you stay with them?" "Uh, Corpsman Gold." "Alex's epidural is on his right side." "The left side of his brain controls the right side of his body, and he appears to be moving that side pretty well." "So that means the right side of his brain is being affected." "All right, corpsman, you're gonna need three packets of vicryl sutures, a ten-blade, and as many little clamps as you can find." "At least several sterile cloths," "And whatever you can lay your hands on for draping." "What's over here?" "Jacob, I think we got a drill in the supply cabinet." "Can you get it, please?" "A drill?" "!" "You're going to perform a craniotomy." "What?" "I'm a medic." "You're a medic who's about to do a craniotomy." "Okay." "Got everything." "Now what?" "You need to trim his hair." "Do you have surgical clippers?" "I'm not even sure we have a razor." " We do." " Would you get it, please?" "Here you go." "Okay, now shave the right side of his head." "Arteriovenous malformation." "Artery deep in brain." "Connected to veins, no capillaries." "All one." "Uh...what?" "Most likely, he was born with this condition." "It's been asymptomatic until this morning," "When the artery ruptured." "Noah suffered a severe stroke." "The damage to his brain is extensive." "Oh, my God." "Are you saying he might die?" "He has no cognitive function," "And he won't be able to speak again." "Is he brain dead?" " Vegetative state." " That's impossible!" "He's in perfect shape." "He's 32." "He's a runner!" "He's the most healthy man I know!" "We're out here to rock-climb!" "So " " So he has no other options?" "You can't operate?" "Could try evacuate blood from brain." "Maybe vascular repair." "Is not likely." "Do it." "Can never return blood supply to dead cells." "So if you operated, what would you accomplish?" "Chance reflexes slight improve." "Maybe moan." "Without the surgery?" "Keep him breathing." "On ventilator." " Only other option..." " Is what?" "Disconnect." "Let go." "Done." "Now what?" "Okay, you see that bottle of hibiclens over there?" "It's behind you in the supply cabinet." " Yeah." " Get it." "Pour it all over his head." "And then, Nurse Wheeler, one gram of ancef in the I.V." "Just hang it there." "And you both need to disinfect your hands." "Yeah." "Do we have enough time for all this?" "An infection will kill him, Jacob." "Meningitis, encephalitis." "Clean your hands, and then if you've got a gown, put it on." " Ty, who are we kidding here?" " Shh, he can hear you." "I'm just saying, this is crazy." "The man's life can possibly be saved, Tina." "What do you want to do?" " Okay." "Ready." "Now what?" " Okay, look at me, Jacob." "I need you to do exactly what I say." "First, take a deep breath." "Good." "I need you steady." "Now... take the ten-blade." "Oh, God." "A brain tumor?" "I'm afraid so." "The fits of laughter are gelastic seizures." "Are you okay?" "No." "No." "I'm anything but okay." "Is it, um..." "Is it serious?" "I mean, of course it's serious." "It's -- it's a brain tumor." "And she's a two-month-old baby." "Yes." "It's serious." "Look, the hypothalamus controls everything" "From body temperature to breathing, emotions." "This is very dire." "So, what do we do?" "Operate?" "Or..." "Operating on a child this young... it is extremely risky." "I don't see any alternative," "But we've never had a case quite like this before." "She's just been the happiest little girl." "And you're telling me" "All this time she was having seizures?" "Can you tell us, what are the surgical odds?" "Futile." "He gone." "No." "No, he's a fighter." "You of all people know that he is a fighter." " This is a fight that he won't win." " You don't know that." "Not for sure." "There are medical miracles all the time." " We cannot just give up on him." " No, no, Kara." "Kara, no!" "We don't want him to suffer." "He would never want to be kept alive as a vegetable." "No, don't say that." "Don't even..." "We need to save him." "So, is there any chance with surgery?" " Not much." " But there's some?" " Ms. Bishop..." " Let's do it." " Kara." " We need to try, Mike." "Kara, look at him." "Look." "With the scalpel, you're gonna make" "A reverse-question-mark incision on the side of his head." "That's the zygoma." "You start there." "Cut back to the occiput and then forward to the hairline." "You got that?" "Okay, go ahead." "Oh!" "Oh, wow." "Great." "You're doing great." "Keep going." "All right, now flip the skin back." "There you go." "Now take the drill." "Is this gonna hurt him?" "He feels pain." "The only thing that would hurt is the skin." "There are no nerve endings in the bone." "And what about the brain itself?" "The brain itself has no sensation." "Jacob, buddy, not to pressure you, but time is of the essence here." "Get in there." "How will i know when to stop?" "The drill will stop automatically." "Okay, you see the tip?" "You see that?" "Push it in." "Now, when that releases, the drill stops automatically." "Now, look at me." "You need to start right here." "Okay?" "Steady." "Promise me it will stop." "It will." "Tough kid." "Tell me about it." "You thinking anterior or posterior?" "I don't know." "Maybe we wait till she gets older." "Let her grow a little." "No." "The seizures are battering her brain." "She won't develop properly." "The hypothalamus controls that, too." "Harding, we have a little situation." " You got a second?" " Not really." "Where's Dr. Wilson?" "Is he in yet?" "No." "Well, find out when he will be." "I'm scheduling a procedure." "Ten weeks old?" "Dr. Wilson doesn't specialize in peds." "Well, perhaps not," "But he's the best pair of hands we've got." "What's your situation?" "God, there's so much blood." "That's good." "That blood... that's what was causing the pressure on his brain." "How's the ventilator running?" "Is it still okay?" "So far, still good." "All right, two more holes," "And then we can take this bone completely off." "Am I doing this right?" "You're doing great." "Soft hands." "Soft hands?" "What?" "Yeah, no forced movements." "If you're doing it right, it should feel easy, effortless." "Good." "Now, you see that package?" "That's the router." "Fix it to the end of the drill." "And then just connect the dots." "You mean cut?" "Dot-to-dot?" "That's right." "Cut." "I'm the last person on earth that wants to see him die." "Clearly, you're not." "That would be me." "Sweetie, you know your brother." "His life was active." "It was physical, it was rock-climbing " "Lives change, Mike." "You don't believe me?" "Look." "Lives change." "And miracles happen." "I assume there's no advance directive." "Look." "I'm the spouse." "Therefore his legal guardian, and I..." "Your marriage is domiciled in Massachusetts." "It is not legally recognized in Oregon." " It's my decision here." " Kara." "Look, I know how much you love him." "And I am beyond grateful that my brother found you." "But I'm his sister." "You need to let me love him now." "All right, you're almost done." "We're done?" "Just need to take care of that bleeding." "You see that blood vessel right in the center there" "That's pumping away?" "Cauterize it with the bovie." "You see it?" " Yeah." " Okay." "That's it?" "I just did a craniotomy?" "Yeah." "Just don't tell anyone, okay?" "Save the bone." "Wrap up his head." "Okay." "Then what?" "Just listen." "Listen?" "Listen to what?" "Shut up." "Listen." "I think your ride is here." "Thank you, God." "You just walked a medic through a craniotomy... in Afghanistan." "You helped." "The sister wants the surgery, but the husband does not." "Yes." "I'm afraid Ms. Bishop's right," "Which I confirmed with Attorney Scott Henderson." "Under current federal law, same-sex unions cannot be recognized across state lines." "I have a lovely pamphlet that lays it out quite wonderfully " "Thank you." "The sister has control." "She does." "That's not to say that the spouse cannot sue should you go ahead with the procedure." "Nothing's ever to say that, Fran." "You know, they teach that in medical school now." "The hippocratic oath has been amended." "It now reads "Do no harm, but expect litigation just the same."" "♪ When the day breaks..." "Think he'll make it?" "Depends on where they take him to." "But he can survive, I don't see why not." "That kid's hands weren't bad for a 20-year-old medic." "Ty, can you really process what just happened?" "No." "♪ you suddenly know" "♪ you suddenly see" "♪ you've been asleep so long" "♪ you might as well be gone" "Nice that you two could finally make it in." "Two months old?" "She's being prepped now." "Scans are in radiology." "I'm scrubbing in, too." " Because?" " Because I am." "Fine, but stay out of the field." " Two months old?" " Yeah." "Come on." "Seriously?" "It's heavily surrounded with delicate nerves and blood vessels." "I'm just not even sure we could get to it." "You better." "You're supposed to be such a big shot." "You better." "Maybe with the Nico." "Have you ever used it?" "Not on a baby." "It's a fairly new device called the Nico-Myriad." "It's especially designed" "For hard-to-reach areas of the brain." "It kind of works like Pac-Man." "It gobbles, sucking up tiny pieces of tumor." "It doesn't emit any heat, preserving the surrounding tissue." " And you've used this before?" " Yes." "But Chloe would be the youngest patient ever treated." "And if we don't operate?" "Well, the tumor is in a critical area of Chloe's brain." "It's affecting her development right now." "If it were my daughter, I would operate." "But you're telling us she might not survive the procedure." "That is a risk," "But we are not gonna let her die." "Mr. and Mrs. Newton..." "I don't have children." "I cannot even imagine what you're facing here." "But here's what I can tell you." "There's nobody on the planet who has more gifted neurosurgical hands than this man." "And looking at your daughter's scans, that tumor really should come out." "Futile." "He gone." "Surgery not help." "I understand, but since we can't exclude the possibility of a miracle, the sister wants us to attempt one." " He gone." " Dr. Park." " If i could just..." " No." "Gone." "The sister controls, Sung." "It's that simple." "If we disconnect," "We've got a wrongful-death lawsuit on our hands." "And if we don't disconnect, while it's possible the spouse will sue for pain and suffering, at least that claim is much more tenuous." "Let me ask you this." "Suppose you do operate, what's the likely outcome?" "Dead." "That might be our solution." "We try to save him in accordance with her wishes." "Should he die, well, at least she's at peace, knowing she tried." "The spouse is satisfied that his husband's not a vegetable." "In an albeit morbid way, it's win-win." "Schedule the procedure." "Mr. And Mrs. Newton." "Chloe has just gone in." "The procedure should start any moment now." "As Dr. Wilson said, it should take between two and four hours." "I know that seems like an eternity now," "But if we can offer any help or support in the meantime..." "Just went out to get some formula and ran into this doctor at the store, you know." "They say everything happens for a reason." "But it's not true." "Scalpel." "Wow." "Talk about a small target." "Definitely a hamartoma." "Okay, first step disconnect the intraventricular component of the tumor." "The middle cerebral artery looks good." "Good flow." "What?" "Syd, you sneak off and become a neurosurgeon when i wasn't looking?" "What you do isn't so hard, smart boy." "Actually, it is." "Okay, pass me the magic wand." "Drill." "We okay?" "Dr. Park?" "Not do." " Sorry?" " Not do." "Close." "Close him up?" "Futile." "Gone." "Not do." "Close." "Okay." "Looks pretty clean to me." " Dr. Ridgeway?" " I think so." "Can i see?" " No." " No." "I'm coming out." "There's no blood." "Everything's staying dry." "Looks like you can close." "You've had a day." "And it's only half over." "I take it back." "You're really good." "Oh, how dare you?" "Brother gone." "Surgery futile." " It was not your place..." " Ms. Bishop." "Cannot fix." "You don't know unless you try, which you didn't." "Please." "Know now." "Cannot fix." "Dr. Park, would you give us a second?" "I understand." "I do." "A week ago, my son came into the hospital." "He had been stabbed and was close to dying." "I stood over him just like you're standing over your brother, replaying all the conversations I planned on having with him but never did." "Thinking..." "I wish I could have helped him more." "He's your brother." "You want to be there for him." "And of all the ways of doing that, switching off his ventilator doesn't seem like one of the better ones." "But it is." "When he..." "when he first came out, my parents, they pretty much disowned him." "Not "pretty much." They did." "And I supported him." "But I never really fought for him." "You know?" "I never " "I know." "And you want to fight for him now." "It's my last chance." "He will never talk, walk, or even think." "I'm not a religious man." "But I do believe in God." "And I do believe that there's another side." "Now, what's on that other side, I couldn't tell you." "But we know what he's facing here." "Let him go." "Let him walk on the other side." "Thank you for coming," "Even though it was a rather last-minute page." "What an extraordinary day." "Well, it's certainly not a dull place, is it, Chelsea General?" "Now, where shall I start?" "Since Buck is on holiday," "I suppose I'll have to look elsewhere." "Dr. Park." "Doesn't really seem fair, does it, doctor?" "You know, looking at you now," "I can't help but think of a low-hanging piã'ata." "You began a procedure, sliced a man's head open," "And then abruptly did a big "never mind" and fled the room, leaving the man's head and this hospital somewhat exposed." "Surgery futile." "Not ethical do, just prevention lawsuit." "Patient gone." "Sister wrong." "If do, patient probably die." "Not do." "Not ethical." "Not apologize." "Well, that was very well put, Dr. Park." "Strunk and White could not have more eloquently made your case." "But if -- and let me see if I've got this correctly -- if "not ethical do, sister wrong, not operate,"" "Then why slice the man's head open?" "Start do." "Ask for drill." "Attack of conscience." "Not do." "I see." "Fran Horowitz has quite a few pamphlets you ought to read, Dr. Park." "Comments, anyone?" "Attaboy, Sung-Baby." "Any other comments?" "Well, let's leave it at that, shall we?" ""Attaboy, Sung-Baby."" "You're excused, Dr. Park." "Dr. Wilson." "Been playing with some fancy toys, I'm told." "Tell us about this new robot, would you?" "Well, it's called RP-7." "Basically, it gives the doctor a remote-presence capability." "It's one of the most successful telemedicine products that we use with the military." "So, is it like some big, giant Skype, is it?" "Well, except that with Skype, you have to rely on somebody else to aim and point." "With this -- with RP-7, I get to decide where to look." "I can move about." "It enables me to have dominion over the room." "It means I can examine, literally and remotely, the patient, like I did this morning when the call came in." "Oh!" "That must be so exciting." "Just imagine, you're sitting in your bed, and a call suddenly comes through from Afghanistan, no less." "Must have been thrilling." "Bet you wish you had someone there to share it with." "Did you?" "Oh, forgive me, I don't mean to go into my colleagues' bedrooms." "But to the extent that your bedroom has now become an outpost for you to practice medicine, did you by chance have anyone on hand for a quick consult?" "Dr. Ridgeway was with me." "Oh!" "Is Dr. Ridgeway your girlfriend?" "I'm not going to dignify that question." "I don't mean to indulge in gossip, but my intent is purely to safeguard our medical integrity." " Medical integrity?" " Yes." "As you know, I don't like to see" "The doctors of Chelsea General compromised." "A father may lapse in judgment when he treats his own children." "A boyfriend might be prone to show off for his girlfriend." "And what would occasion a Chief of Staff to show off?" "Power, perhaps?" "An audience and a glass of water?" "Yes." "Power can certainly render one a little giddy." "It's like having a new toy." "Especially when you're playing with it for the very first time." "You got to fiddle with your new robot for the first time." "You, too, Dr. Ridgeway, you both got to fiddle." "And you walked a 20-year-old medic through a craniotomy." "Now, some people might think that was exciting." "Others might deem it reckless." "Some others still might think it irresponsible." "I had no choice." "The marines had done a dedicated draw-down." "There was basically nobody left but the patient" "And two low-ranking medics." "The craniotomy was the only way to save that marine's life." "And did you?" "Save his life?" "I don't know." "Last I heard, he was air-vacked out." "Oh." "You didn't bother to follow up?" "I had a pretty busy day." "You then turned your attention to saving a small baby." "Quite a day, doctor." "Saving a baby." "Maybe saving a soldier." "We don't know because you never bothered to follow up." "Oh, I followed up." "Though not with a robot." "I don't have one of those." "But I do have my Skype," "Which I'm becoming increasingly fond of." "It can go almost anywhere." "Hey!" "Hey!" "There he is." "That's my co-pilot." "Hey, doc." "He looks like a kid." "Yeah, that kid assisted my brain surgery, bro." "Hey, doc." "As you can see, we made it back all right." "We're in Bagram." "Check out my handiwork." "Jacob here takes all the credit." "How do you feel?" "Sure as hell lucky to be alive." "Listen, hold out your hands for me, palms up, like this" "And close your eyes." "That's great." "Jacob, would you shine a light in his eyes for me?" "Okay, Alex, one last thing." "Just follow my finger with your eyes only." "Pupils are round, equal, reactive, extraocular movements are intact." "Congratulations, Corporal Kimura." "You look recovered." "This is Dr. Ridgeway." "She assisted." "Hey." "Hey." "You didn't tell me she was hot, man." "Sorry." "I didn't mean that." "No, it's okay." "I'm hot." "You look great." "Give her your serial number, dude." "Hey..." "Son, this is Dr. Hooten." "I'm afraid I'm going to have to prescribe some more rest." "How 'bout we check in with you tomorrow?" "Sounds good." "Thanks again, everybody." "A day, indeed." "Okay." "Do you want to leave before..." "No." "I want to be with him right to the end." " Ms. Bishop." " I know Dr. Park." "I know." "I love you, Noah." "♪ don't get lost but I feel like crying ♪" "♪ staring at the moon pulling at the tide ♪" "♪ feeling empty as the street beneath the city lights ♪" "♪ cold december dark pushing on the light ♪" "♪ now we're shuffling our shoes on the boulevard ♪" "♪ your eyes so soft in a world so hard ♪" "Hey, little girl." "How you doing?" "She looks great." "She does." "I'm gonna miss her laugh, though." "Oh, she'll laugh." "This little peanut's got a lot of smiles in her." " She's really gonna be okay?" " She is." "Can I hold her?" " Yeah." " Yeah?" "Hi, Chloe." "Oh!" "Wow." "Looking good here." "Doctor, words cannot express... how do we even begin to say "thank you"?" "She's actually a little hungry." "That's a very good sign." "Oh, here's her bottle." "How long will she have to stay?" "At least a few days, to be safe." "A precaution." "I mean, she's doing just fine." "Hungry little girl." "♪ everything I do is for you" "♪ everything I do is for you" "♪ everything I do is for you"