-[door opens] -Good morning.
Admissions percentages at top colleges have dropped to record lows.
-You thinking about going back to school? -No.
No, I'm thinking about our son's future.
As in, starting a college fund for the peanut?
No, I have put the peanut on a waitlist for pre-kindergarten at McClelland Hall.
Isn't McClelland Hall that snobby private school in Menlo Park?
It is one of the top three feeder schools for Stanford University.
So, you've not only decided he's going to college,
you've also picked out which one.
Given our son's genetic makeup, he will probably be very intelligent
and will require a challenging academic curriculum.
Or he may not even enjoy academics.
Whatever he ends up doing will be his call, not ours.
Whatever pre-kindergarten he ends up attending
will be our call, not his.
Hmm.
Oh. No coffee.
Glassy still in his room?
No, I heard him leave at 6:14.
He's been so sad about losing his house.
How can you tell he's sad?
Have you noticed how quiet he's been?
Yes. It's been nice.
Guess he's just throwing himself into his work.
Hmm.
[car alarm chirps]
Dr. Murphy, little help here?
Hmm.
Give tetanus booster, clean the wound with Betadine, administer--
No, we got that. It's--
We wanted a second opinion.
Uh, Victor did.
Before these young pups take a saw to our son's foot,
I'd like to talk to a supervisor.
The nail's bent.
I am their supervisor,
and we need the saw to cut the nail, not his foot.
Are you good, Ricky?
[saw whirring]
You all know my angel for the past 11 years, Dr. Lim.
Oh. Hey, Roses. And this is my resident, Dr. Jordan Allen.
Hi!
-Roses? -My website's called "More than 65 Roses."
It's what I called it when I was diagnosed at five.
Sixty-five roses, cystic fibrosis.
Okay.
And welcome to vlog number 458,
going out all around the world.
And what does DLT stand for?
-[cell phone dings] -That'd be "double lung transplant."
-[imitates air horn] -[both whooping]
[chuckles] Your new lungs just arrived.
Oh.
[theme music playing]
I never should've agreed to let him go.
You didn't. You just stopped fighting with me about it.
He's running a mild fever, 100.4. Go where?
Church camping trip, less than an hour away.
Camping can be very dangerous.
Thank you, Dr. Murphy.
You know, I had my first fire-roasted s'more last summer,
so camping can also be very fun.
Thank you, Dr. Wolke.
Be careful, please.
Victor, he's a doctor. Just try to trust--
"Trust that things will work out." Yep, I know.
[sighs]
You're a Warriors fan, huh? You like Steph Curry?
[wincing] I like Draymond.
A rebel. I like it.
Huh. Look at this beast.
Nice job, Ricky.
[thermometer beeps]
His temperature just jumped two degrees.
Let's get a CBC, blood cultures, and a CT of his foot
to check for damage to the bones and muscles.
[knocking on door]
Dr. Park, how kind of you to join me.
You paged me.
Have a seat. And, yes, they're Herman Miller.
Cappuccino, mochaccino, espresso, latte?
None of those are for you.
Okay, I was wrong.
This is the perfect job for you.
Your first study has, what, 800 patients?
But since you've had four whole days
to hire all the clinical trial nurses you'll need,
should be easy.
I may be a little behind, and may already have 13 patients waiting,
but I'll handle it.
With a lot of cappuccinos.
Thanks for your support.
Do you want me to give you a hand?
I have 90 minutes before my next surgery.
In exchange for unlimited use of your espresso machine.
We'll see.
[CT machine whirring]
[Asher] Poor Ricky.
He probably just has a minor infection.
I meant, the parents.
They went to two very different schools of thought on child rearing.
It's hard on the marriage but harder on the kid.
Everyone has different opinions, Dr. Wolke.
Yeah, which they really need to sort out before having kids.
[Asher] My college roommate, was Jewish, married a wonderful Catholic woman.
They had three children in quick succession,
started fighting about how to parent them non-stop.
See, my parents never fought about us because my dad didn't care,
as long as my mom got me and my brother dressed and out in time for chores.
Well…
No hematoma or abscess.
No explanation for the fever.
[groans] My neck, it really hurts.
Okay.
[vomiting]
Hey. I got you.
[vomiting continues]
He has tick bites on his back.
Pink, plump, and spongy.
What's that?
Pneumonia?
In both lungs.
[Jenn and Brecka laughing]
She's lucky if she has another week.
Ex vivo lung perfusion.
Maybe we can make the lungs heal themselves.
That's usually used in cases involving pulmonary edema.
Get the lungs. Meet me in the procedure room.
Tick bites?
His fever, vomiting, and sore neck which could be neurological--
It's in his brain?
Possibly, but the blood tests were inconclusive,
so we'd like to do a lumbar puncture to check Ricky's cerebrospinal fluid.
This camp just keeps getting better and better.
Can we not do this right now?
I wanna make sure this never happens again.
And I don't?
I care about our son every bit as much as you do.
And yet, you keep prioritizing fun over safety.
Yes, I care about fun,
and socialization, self-esteem, self-expression--
Yeah, none of which are as important as his safety.
[scoffs]
I can't do this anymore.
[hesitates] Come on.
[Victor sighs]
Got through six so far. Only one with a minor reaction.
-You? -Me too.
So, we are 12 down, 1 to go.
[knocking on door]
Mr. Riggs?
[inhales] Sorry.
I just drifted off.
[chuckles] My fault for keeping you waiting so long.
[groans softly]
So, how are you feeling? Aside from tired.
Uh, just a bit achy. [sighs wearily]
Especially my knees and elbows, hips.
And some mild jaundice.
Other than that, I feel pretty good.
[speaking indistinctly]
-Hello. -Oh.
We should sort out our differences about child raising.
If this is about McClelland Hall, it's not a big deal.
Oh, no. I have made a list of 37 other potential differences.
And I'd love to discuss them all, but Andrews just approved new EMR software
and wants me to run a beta test on it in the next 24 hours.
-Have you talked to Glassy? -No.
He didn't come to work today, but I got a text.
He says that he is okay.
So, where is he?
[clattering]
[Dr. Lim] It is not over yet.
Lungs are remarkably resilient organs when they are in a body.
Which is why we have to convince them they still are.
We give them a blood supply by hooking them up to a perfusion machine,
an air supply by hooking them up to a ventilator,
IV drips to feed them antibiotics,
and we might just be able to con them back into viability.
The next six hours are crucial.
How will you know if they're viable?
Our main indicator is a calculation called the P/F ratio.
When that reaches at least 400 millimeters of mercury,
those lungs are good to go.
Mom, relax. It's Dr. L.
[machine beeping]
Palpate to find the L3-4 interspace.
Maybe Lea and I'll not be able to sort out our differences about child raising
and become angry like Victor and Shelley.
[Asher] You and Lea are nothing like Victor and Shelley.
[Daniel] They come from completely different worlds,
have vastly different outlooks.
Lea and I are very different too.
Insert the spinal needle.
[Asher] And who knows how much they love each other.
You and Lea, on the other hand, I know you do. A lot.
And that's all that matters.
At least, according to the Hallmark Channel.
I'm in.
[squirting]
Whoa, whoa. Whoa, whoa, whoa.
The infection has elevated his intracranial pressure.
Intubate and load him with levetiracetam and dexamethasone
before his brain herniates.
CSF confirmed a very rare infection called Naegleria fowleri.
It's a brain-eating amoeba that's caused serious cerebral swelling.
We need to put Ricky in a barbiturate-induced coma
and surgically place a port into the center of his brain.
Then we will flood it with antibiotics, which will hopefully reduce the edema.
And he contracted this from a tick?
Oh, no, it's contracted via contaminated water through the nose.
So… So, he got it from the swimming hole at camp?
That's a good guess.
But Ricky's way too anxious around water to ever put his head under,
let alone get water up his nose.
Naegleria fowleri has also been found in untreated swimming pools, nasal rinses,
-water heaters-- -Nasal rinses?
If unboiled tap water is used.
I gave him a nasal rinse the morning he left for camp.
He had a runny nose.
That is a better guess.
Excuse me.
Riggs has fatigue, joint pain, impaired mental acuity,
tachycardia, and mild liver failure.
-Thanks. -Maybe he has a pre-existing condition.
He should've been eliminated by any remotely competent screening process.
Those protocols were in place before you came on board.
I'll remind the CRO of that when I tell them, on my first day,
that their $4-million trial needs to be trashed.
How about you save the doomsday predictions
until after the blood panel results?
Lab is on the way to the OR.
[door opens]
It hasn't been six hours yet, has it?
Six and a quarter.
[beeping]
[monitor trills]
You want company?
Thanks.
Hello. Where is Victor?
Beating himself up somewhere.
I… I just wish that made a difference.
Do you love each other?
Yeah.
[chuckles softly] Of course.
We've always been oil and water.
That's how my dad describes us.
Victor grew up in Belgrade, I grew up in Berkeley.
Different religions, politics, socio-economic status.
But when I got pregnant,
we knew we had a lot of issues to work out.
And we did.
And then Ricky was born, and…
we suddenly started arguing over
when can he safely eat tree nuts?
How high should he climb on the jungle gym?
When can he stay with a babysitter?
Those little things were the ones we could never work out.
But, yes, we still love each other. It's just that
I'm not sure love is enough anymore.
[slow indie pop song playing]
[Brecka] Still waiting, still hoping.
That's kinda what we do, isn't it, Roses?
And the wait is over.
♪ Gave you things to ease your pain ♪
♪ So don't walk out on me this way ♪
I'm sorry.
We've put you back on the list.
You're at the very top.
I deserved this.
I wanted those lungs.
[sighs] I wanted someone to die.
Brecka.
♪ Baby, if you're depressed ♪
♪ Can't leave it up to you ♪
Honey, should we… should we finish?
[voice breaking] No.
[objects clanking]
-[Shaun] Hello, Dr. Glassman. -Geez! Man!
Shaun.
You might try knocking next time,
although, you know, that might be a little tough.
-What are you looking for? -Oh, you know,
my life.
Just my life.
[object clattering]
Not yet.
I think I'm gonna keep at it for a bit.
-Okay. -No. This is on me. You can head home.
Thanks.
I will miss your big-screen LED TV.
It was old. It had a pixel line down the right side.
Did you love Ilana?
What?
Did I love Ilana? Yeah, of course.
Did you love Debbie?
Yeah, I loved Debbie. Where is this going, Shaun?
That wasn't enough for you to get over your differences.
How do I know if love will be enough for me and Lea to get over our differences?
Well, you won't know.
I mean, how can you know? You can't know.
I do not like worrying about this.
Well, look, I mean, Lea had some doubts a little while ago, right?
-And you both got over that. -Yes, because I was very supportive.
Okay, well, there you go.
But differences about child raising seem to be bigger than normal differences.
Well, yeah. I mean, having a child, that's big. That's huge.
That's a shift. It shifts everything. Marriage, everything.
I do not want a shift in our marriage.
Well, maybe it'll shift for the better.
Aardy's eye.
The first thing I ever bought Maddie was a stuffed aardvark.
Back in the day, I performed a 21-hour surgery.
I removed an astrocytoma from the medulla of the brainstem.
It was heroic. It put me on the map.
My elective surgeries were booked out for a year.
I was in a zone, like playing scratch golf.
And then, Ilana got pregnant.
She didn't wanna stop working.
She had a real-estate thing. She was doing very well.
I didn't wanna stop working. I wanted to stay on the map.
And then, we brought Maddie home. That first night…
everything changed.
Hmm.
Go talk to Lea.
I tried.
She had to run a beta test on new EMR software.
Well, then, you'll have to wait until she's done.
[monitor beeps]
[machine beeping]
[door opens]
All I had on my DVR was a marathon of Shark Tank.
Can't say I was in the mood to be staring at Mr. Wonderful's bald head.
So, why not entertain myself by watching some hot lung-perfusion action?
I'm not one to kink-shame.
Coffee and cronuts from Chaz's Bakery.
I'm happy for the company.
Noomie's not much of a conversationalist.
-Noomie? -My pet name for them.
From the Greek word for lungs "pneumonas."
I thought it was better than "Lungie."
-Yeah, I may be losing it. -[whispers] Cronut.
[chuckles]
-Mmm. -Any progress?
Negligible.
I keep doing the same thing over and over, hoping for a different outcome.
Yeah, I'm definitely losing it.
Then do something different.
Okay.
Doubling up on antibiotics, and we can add steroids.
This will either hammer out the infection
or the lungs.
[keyboard clacking]
How's Glassy?
Very sore and very sooty.
-Mmm. -[door closes]
We need to talk.
About our 37 differences?
I thought of two more.
Shaun, as you know, I'm kinda busy right now.
So you'll have to settle for agreeing that we'll have many, many differences,
but in time, we'll be able to work them out and--
That's what Victor and Shelley thought, and now they are talking about separating.
I don't know who Victor and Shelley are.
But in any event, I have at least two more hours of work to do tonight.
-[keyboard clacking] -Okay.
-You're waiting, aren't you? -Yes. I am very patient.
You are very patient and very understanding.
And you were so good with me on our babymoon.
If you could just channel some of that--
On our babymoon, I thought love was enough.
That's kind of a big thing to drop on me this late at night.
You were too busy to discuss it in the morning,
so I talked to Dr. Glassman about it,
and he said having a child will shift our dynamics.
And if it does, we can talk about it then.
So, if we can't talk about our dynamics now,
how about our differences?
Apparently we've 39. We're gonna need a serious chunk of time,
and I'm pretty sure they'll keep,
because we're committed to having a kid together,
whether love is enough or not.
Shaun, I'm just… I'm way too tired
to have a productive conversation about this right now, okay?
-Okay. -[door opens]
[beeping]
[monitor trills]
[sighs]
It's time to call it.
I had half an hour left on my call when she first came to the ER,
coughing blood and vitals on the floor.
[scoffs softly]
When we opened her up,
her lungs looked like they belonged to a 70-year-old.
Didn't think she'd make it through the night.
She was eight.
[sighs] I couldn't go home. I stayed with her that night.
And then, the next morning, she just
opened her eyes, looked at me, and told me she liked my French braid.
Once I call it…
I have to go up there and tell her I failed her.
[sighs]
Got Riggs's latest test results.
Turns out he did have a pre-existing condition.
Hemochromatosis.
So, the jerk lied about it to get into the study.
That's your assumption?
He got 3,500 bucks to participate. I think it's a pretty sound assumption.
But whether he lied or not, it means the screeners are incompetent.
That's gotta take a toll.
Expecting the worst of everybody.
I'd rather be pleasantly surprised than bitterly disappointed.
And that's the worldview you wanna impart to your future child?
"Assume the worst of everyone"?
-[monitor alarm blaring] -Help! We need help in here!
What's happening?
Add a milligram of lorazepam. He's seizing.
Because his ICPs are in the 40s, his cerebral edema's gotten worse.
If we don't open up Ricky's skull immediately, he will die.
[monitor beeping steadily]
Removing large hemicrania skull flap.
Performing wide dural opening.
[flesh squelching]
[Daniel] Look at the monitor.
EEG's all over the place. He's still seizing.
[Shaun] Place an additional EVD and increase propofol to burst suppress.
[Asher] Uh, but he's maxed out.
If we give him any more propofol, we could kill him.
If we don't, the seizures will definitely kill him.
[monitor trilling]
Oh. We can remove the damaged cortex in the left anterior temporal lobe
using ECoG and pre-op imaging to guide us.
[Daniel] Cut out part of his brain? That's extreme.
[Asher] It is the area that's causing the seizures.
It'll just be a tough sell to his parents.
Which is why you will help.
Okay, please keep him stabilized with iced LR to the cortical surface.
[Daniel] Uh…
[doors sliding open]
[Jenn] "The country flew past as if they were seeing it
"from the windows of an express train.
"Faster and faster they raced,
"but no one got tired or out of breath."
We can save the last chapter for later.
[slow pop song playing]
There is no later.
♪ Even after it's gone, it's all going wrong ♪
♪ Every hour is too long ♪
♪ Tell your heart to hold on ♪
Where's Dr. L?
She wasn't ready to give up on your lungs.
There's still a chance?
Dr. Lim thinks so.
Let's finish.
♪ And tell someone you love How much you need them ♪
♪ To be strong ♪
♪ Hold on ♪
"Chapter 16.
"Farewell to the Shadowlands."
[Asher] We would cut out a small piece of his cortex.
It's already been damaged by the infection.
Removing it may be the only way to keep him alive.
But, uh, how would that affect him?
Oh, there are areas of the brain that are significantly less essential than others.
This part only impacts his speech and memory,
probably not long-term.
So, he might not be able to talk or know who we are?
We wouldn't be able to fully assess him until he wakes up.
[sighs]
[sighs softly]
Ricky's skull is opened.
[inhales]
We should do it.
Uh, this is a very good hospital. These are very smart doctors.
And someone very wise once told me that, uh,
"Sometimes you just have to trust that things will work out."
Okay.
[Riggs] Hemochromatosis?
You never noticed the symptoms until now?
Joint pain, fatigue, mental fuzziness?
Well, I turn 58 next week.
I mean, I haven't felt a day over 30 until now.
It is very unlikely your hemochromatosis went from 0 to 60 in a week.
Is it possible you gave the screeners someone else's blood?
[chuckling] You think I cheated for the money?
No, Mr. Riggs, I'm just trying to…
You're a blood donor in the 20-gallon club?
Yeah, regular donor, last 30 years.
When was the last time you donated?
Two months ago, just before I started this trial.
And you're not allowed to donate while you're in the trial.
Well, see, that's the downside. I actually enjoy those cookies.
[chuckles]
I'll make sure you get all the cookies you want, Mr. Riggs.
[footsteps approaching]
Don't you think it's time to come home?
No.
[chuckles softly]
In that case…
I wanted to make you something delicious like you've made us.
But I'm not a very good cook, and everything's closed.
So, I hope you like hot-dog-flavored potato chips
and Nutty Buddys.
Mmm.
Yeah.
Nail polish?
Father-daughter time.
Maddie insisted that she paint my fingernails a sparkly rainbow color.
[chuckles]
And, the next day, my first patient was very uncomfortable.
That's when I realized I forgot to remove the nail polish.
That's a nice memory.
Oh, sit. No, sit, sit, sit.
[exhales sharply] So many memories.
At Halloween, Maddie wanted to go as a ham
because we'd just seen To Kill a Mockingbird.
But… [chuckles]
She wanted the ham to be made out of an actual ham.
And then, one night, the wind was blowing so hard,
it blew her bedroom door shut.
She was convinced
that her grandmother's ghost had come back to visit her.
Wanted to sleep in our bed for the next two weeks.
You didn't come here just to feed me junk food, did you?
I thought you might need someone to talk to.
I'm fine.
Hmm. I know someone you should talk to.
I know.
But this was easier.
[Dr. Glassman] Mmm.
Hot dog should not be a flavor.
[slow acoustic song playing]
"All their life in this world and all their adventures in Narnia
"had only been the cover and the title page.
"Now, at last, they were beginning chapter one of the great story
'which no one on earth has read,
"which goes on forever,
"in which every chapter is better than the one before."
♪ Coming home with your song in my heart ♪
Checking in. Need me to up your morphine?
Couldn't hurt.
♪ Ooh, ooh ♪
♪ Coming home with your song in my heart ♪
Hey, I changed my mind.
About the vlog.
Wonderful.
♪ Restless wolves cry out in the cold ♪
♪ Chasing hours… ♪
Go for it.
[breathes deeply]
Hey, Roses.
I'm back.
The DLT didn't really work out, so
this is gonna be my last update.
I wasn't even gonna do this.
I was gonna flip off Dylan Thomas and go gently into that good night.
But…
I couldn't leave without saying good-bye.
And that
it's okay to be hurt.
I am…
that my life's been cut short.
But the upside to all of this
is that I feel something I never thought I would.
It's gratitude.
I'm grateful to my sweet mother.
And… [wheezing]
to the people who keep hope alive…
Like Dr. L and… [wheezing]
[monitor alarm blaring]
Crash cart!
She's in full respiratory failure.
-We need to intubate her. -No.
We need to let her go.
[gasping]
[monitor beeping]
[monitor trilling]
Noomie hit 402. Get Brecka to the OR.
The lungs are good.
We should intubate.
Yes.
[monitor trilling]
-Ricky? -Dr. Murphy!
Ricky, can you hear us?
Hello.
Do you know where you are?
Do you know your name?
I'm Ricky Pavlovic.
I'm in the hospital
because I stepped on a rusty nail at church camp.
But I would still like to go back there next year.
[chuckles]
[monitor beeping steadily]
Welcome home, Noomie.
So, Riggs is a lifelong blood donor.
Which totally eliminated his symptoms.
Until he started this trial.
And he's not allowed to donate till it's over.
So, there was nothing wrong with the protocols,
nobody was incompetent,
and Riggs isn't a big fat liar.
In fact, he's a legit hero.
Maybe my worldview does need a little adjustment.
I prefer Italian roast.
Noted.
Ready to take Noomie for a test run?
That's what she named your lungs.
It was a weird night.
[slow indie pop song playing]
Start small.
♪ I see all the light that lifts us ♪
♪ Hitting on the edges of our wings… ♪
[exhales]
[shuddered breathing]
♪ Choirs of stars gathered before us ♪
[breathing deeply]
♪ To light the path beneath our feet ♪
♪ Ooh ♪
♪ Hey, courage, be my compass ♪
♪ Start a fire deep within ♪
♪ 'Cause I run with everything And nothing ♪
Thanks for coming.
We should talk.
♪ Even when I don't know where to begin ♪
♪ We fall ♪
♪ We fly ♪
♪ We'll all be, we'll all be We'll all be all right ♪
Number 39.
-Dietary restrictions. -Hmm?
-Other than breast milk-- -[gasps]
Oh, I felt a kick.
Oh!
I felt…
Very exciting.
[all laugh]
Come here.
Think of all the new memories waiting to be made.
♪ We fall ♪
♪ We fly… ♪
Hey, let's go home.
♪ We'll all be, we'll all be We'll all be all right ♪
Number 39. Other than breast milk,
I don't think that Peanut should have any dairy products before six months.
Easy peasy. Number 38?
♪ We'll all be, we'll all be We'll all be all right ♪
[closing theme music playing]