- Previously on The Resident... - This is my son-in-law Derek.
He's been complaining of shortness of breath.
- Mom. - And my daughter Molly.
Derek has an aggressive B-cell lymphoma.
You have a 50% chance at being cured.
This is Dawn Long, the one from TV.
She's not getting better, but Cain wants her treated
and sent back to the LTACH.
Your patient had Candida auris.
- The superbug? - Once Candida auris
spreads throughout a building, it's nearly impossible to eradicate.
Anyone know what this is about?
- Logan Kim is gonna give an announcement. - These Red Rock speeches
are starting to drive me up the wall, man.
Why can't we just go back to paper memos?
Ah, okay.
As you know, ICU nurses
must chart patient data constantly.
This practice is inefficient, tedious
and expensive for the hospital.
Today is a new day.
As a trial run, these rooms are being retrofitted
with state-of-the-art automated patient monitoring.
The system is so sophisticated
that it could even tell if doctors and nurses
don't wash their hands before entering the patient room.
Chastain is taking its place
on the technological map in health care.
- Staff loves that guy. - Just wish I could hug him.
Good times.
Through and through. Inside there,
and the ceiling all around. In there.
As far as anyone's concerned,
we're just installing A.I. technology.
No one knows we're also eliminating a deadly fungus.
Candida auris is highly dangerous
in immune-compromised patients.
Half the people who get it die.
We're lucky it's not airborne
like the coronavirus. The staff is not at risk,
but the patients could be.
The protocol here
is gonna be to notify the state health authorities.
- We need to follow protocol. - You didn't mind
bending protocol to keep a vegetable on life support
just to protect your stats.
I kept Dawn Long alive for Red Rock.
It's because of me, you can have the Mother of All Surgeries
- in the win column. - No, you weren't helping Red Rock,
you were feeding your god complex.
As a result,
she brought a deadly fungus into this hospital.
And there was no way for me to know that she had the superbug.
It's common in nursing homes and LTACHs.
Even I know that. But you missed it.
You approved or demanded every step I took in this.
According to you.
I've got your back,
as long as you've got mine, and not a moment longer.
- Are you threatening me? - Get on board
and help to fix this mess or I'll tell the world
what happened when you were an intern.
- Synced and corrected by Firefly - - www.addic7ed.com -
You need to be honest with me.
I haven't had any.
- I promise. - Look,
we can only treat your cardiovascular disease
without surgery if you quit smoking.
I haven't had a smoke since you last saw me.
Oh, so what were the cigarettes you had this morning?
Reformed addicts are the worst.
Yeah, I'm just looking out for you.
Look, there's a sign-up table over there
for a program that helps you quit.
Will you just walk over?
Maybe.
Uh, thanks for trying, Nic.
Are you feeling okay?
I'm good.
Well, let me just...
Your heart's racing, you're coughing.
Any muscle weakness, headaches?
Yes, to all of the above. But before you say it...
I think we should get you to Chastain.
I'm not gonna go. You know what my insurance deductible is.
Come on, people like me only go to the hospital
- as a last resort. - Right,
but I think this is one of those moments.
Come on, let's get you to a doctor.
Look at the all the people who need you to stay healthy.
Come on.
You rang?
We've got a case.
45-year-old female suffering from fever,
joint pain, chills and diarrhea.
Well, that's all painfully nonspecific.
She could have anything.
Yeah, which makes this the perfect medical mystery
and teaching tool for you.
You mean it's full of grunt work you don't want to do.
See? You're learning already.
Sophia, these are Drs. Pravesh and Dreyfuss.
They're gonna help me with your care today.
Great, 'cause I could use all the help I can get.
Sophia, it's nice to meet you. I've seen you around.
- You're an EMT, right? - Guilty.
I had to take the day off, though, 'cause I got this bug.
Good thing you did.
Your ketone and glucose levels are sky-high.
You're in diabetic ketoacidosis.
How does an EMT not understand how dangerous it is
to let her sugars get out of whack?
You'll have to forgive Dr. Dreyfuss.
He has an issue of his own.
His mouth moves before his brain catches up.
It's all right.
I deserve the judgment.
I should be monitoring my blood sugar more closely.
Uh, your diabetes diagnosis is recent.
Lifestyle adjustments, they take time.
See what he did there?
So, what's the plan?
An X-ray and empiric antibiotics.
I'll go check on your blood and urine cultures, okay?
- Thanks, Dr. Hawkins. - You got it.
Now, Dr. Dreyfuss, what do you recommend
for her diabetic ketoacidosis?
An insulin drip until her anion gap closes.
Along with aggressive hydration and dextrose to keep her glucose
from dropping too precipitously.
And the kid redeems himself.
I love unicorns.
Excuse me.
Has this vent been used in the last 24 hours?
No, it's been down here for the decontamination process.
Okay, good. Clean it now.
Like, right now.
- Okay. - Hey.
I need to talk to you.
Lunch. Half hour.
What were you doing in there?
I'm making sure they cleaned Dawn Long's vent.
Don't want one more person getting the superbug.
It might be too late for that.
I had one of our I.T. guys ping any patients
who might have had contact with Dawn Long.
They got a hit with this new admit Sophia Masters.
She's one of the EMTs who brought Dawn here,
and she has fever, joint pain and diarrhea.
That could mean a number of things.
Health care providers aren't at risk
unless they have a compromised immune system.
According to her charts, she also has
poorly managed diabetes, which would check that box.
Who's her doctor?
Conrad Hawkins.
The whistleblower you let back into our house?
He finds out, he will definitely trace it back to Dawn.
You have to handle this.
If it gets out now that we have a deadly fungus at Chastain,
this hospital goes bankrupt.
Which is why I'll handle it.
- It's on me. - Oh, wow.
Thanks, Dr. Cain, but you don't have to do that.
Always here to help a struggling young intern.
Well, um, thanks again.
You've done so much for me, and my mom.
Well, no more than she did for me.
Hey, you got a few? Let's walk.
You know, your mother is one of the finest nurses I've ever met.
- How's she been? - Oh. S-She... Well,
she's-she's, uh, she's much better
now that you've, uh, recommended her for that new job.
Oh, good. Good. Do you know that
she helped me when I was an intern?
No, I didn't know that. How?
Well, nurses, they teach interns more than anyone,
and she was so generous to me.
- Oh. - She's why I wrote
the recommendation for you to match here at Chastain.
Oh, well, uh, I-I wouldn't be here without you.
Well, that's very true, very true.
Please, want to step in?
Mm.
I need a small favor.
Uh, sure. Uh, a-anything.
Now, I understand that you're working with Dr. Hawkins
- on an EMT patient named Sophia. - Mm-hmm.
I'm worried that she has Candida auris.
Candida auris?
That-that has a mortality rate above 50%.
Yeah, well, it's-it's just a hunch.
Sophia transported my patient Dawn Long here from LTACH.
What, did your patient have it?
I don't know for certain.
You know, but looking back, uh, I believe that could be
the reason why Dawn's final illness
didn't respond to the antibiotics.
Well, we need to tell Dr. Hawkins.
Well, no, that can't happen.
Because if I'm right about this, it all stems from my mistake.
I misdiagnosed a patient,
and let me tell you, I am beating myself up about that.
So my-my hope is to fix it,
but quietly, by making sure Sophia gets antifungals.
I just need to make sure
that you can treat Sophia without Hawkins finding out.
What... Are... You're serious? I, um...
Dr. Cain, what you're asking...
Is a big, big favor. I know that.
But it repays a pretty big debt.
And I know that you'll help me... because I helped you.
- Ezra. - What are you doing?
Did something happen to Sophia?
Her MRSA and VRE screens were negative.
Well, given her symptoms, I thought it could be
a-a C. diff infection.
- Why didn't you page us? - I should have. I-I'm sorry.
I just, I guess I... my-my OCD got the best of me.
I started thinking about the germs and then... uh, you know,
I had no idea that, uh, sending stool for C. diff
would trigger isolation protocols.
Look, interns overcall
C. diff all the time.
Since when are you the good cop?
When it's not my intern.
Because of what you did, Ezra,
Sophia will have to remain in isolation
until her stool sample comes back negative.
Again, so sorry. I-I didn't realize.
Fine. OCD or not...
... you're going in there and checking in on our patient.
Hi, Isaac.
This is Dr. Austin, our very best cardiothoracic surgeon.
Oh, I need a surgeon now?
Woof. That can't be good.
- Or cheap. - Wow, Nic was right about you.
- You are a charmer. - Um, why are you here?
Well, you have some scarring and other signs on your CT
that suggest you have a lung disease
called pulmonary fibrosis.
It's the reason you've been having a hard time breathing.
I was homeless for a while myself when I was a teenager.
Did I get this from living on the streets?
No, not in this case.
In this case, it's more likely it's genetic.
Premature gray hair
is a rare genetic manifestation of the disease.
So... I got this from my family?
Wow, I've never seen a patient
so happy about inheriting a disease.
Probably because most of your patients
know where they came from.
My parents dropped me off at a fire station after I was born.
I was raised in foster care.
And, uh, I've waited my whole life
to learn any scrap of information about them.
So this is like Christmas for me.
Uh, tell me there's a cure
for pulmonary fibrosis under the tree, too.
Uh, I'm sorry, Isaac.
I'm worried the damage to your lungs cannot be repaired.
We're gonna try to ease your symptoms with medication,
- but, um... - But we need to take a biopsy
of your lungs to be certain.
What's wrong?
It's Derek.
I thought he was doing better.
He was.
But then one cough led to another,
and before we knew it, shortness of breath.
I discussed it with Conrad, and it's Derek's lungs.
He has diffuse bilateral crackles.
Pulmonary edema?
He thinks so.
Derek's gained five pounds of fluid since chemo,
and his kidneys still haven't bounced back.
Well, haven't they given him diuretics?
Yes, but that might not be enough.
And if that's the case...
They want to put you on a ventilator to help you breathe,
and hopefully allow your lungs to heal.
A ventilator?
For how long?
There's no way of knowing.
Will I be awake, able to communicate?
No, we have to sedate you.
And there's a chance you could develop other complications
that could prevent
the breathing tube from being removed.
So, when they p-put me under, there's...
... there's a chance that I might not wake up,
that I might not see my family again.
- Is that what you're saying? - Shh...
That's a worst-case scenario,
but it's the only way you recover lung function.
Kit, there has to be another way.
- There has to be another way. - No. Honey, honey.
I don't think there is.
If I do this,
I could die.
If you don't do this... you definitely will.
How long can I delay being intubated?
The way things are going,
unless something changes, it will need to happen soon.
Okay, well, I just, I have to see Josie one more time.
- Yes. - Okay, I know that we said
that she needed a day a-away from all this but...
No, I'll-I'll let the babysitter pick her up from school
and bring her here immediately.
This is a bag of antifungals.
- Yes, I'm aware. - How did you get this?
You don't get to where I am without making a few allies.
You know someone in pharmacy?
No, I have someone in pharmacy.
I have someone everywhere.
Is Sophia still being treated with the insulin drip and D5?
- Yes. - Here's a label for her fluids.
Put it on the antifungals and hang it.
Are you having doubts?
No, I want to help. I, uh...
Yes.
Chock-full of doubts.
I get it.
You know, when I was an intern,
I was faced with so many choices.
It was all confusing. I struggled, too.
But eventually, I learned to just do what I was told to do
by the people who knew better.
And I got rewarded for that.
I didn't climb up the ladder, I flew up it.
That could be you, Ezra.
Blood pressure 90/50, tachycardic in the 130s.
My heart, it's pounding.
Ezra, check her lungs.
Uh-huh.
She's burning up. Temp is 101.5.
Breathing sounds are diminished.
She's septic.
Two liters of normal saline now.
Dizzy. Hot. Turn down heat.
Should we start her on pressors?
Let's see how she responds to volume.
I'm putting her in Trendelenburg.
Squeeze the bag.
Her BP is rising.
It's working.
Something is causing her to deteriorate.
Yeah, but there's nothing in her labs that's suggesting
- what that could be. - Well, something's changed.
We need a new set of labs.
And broaden her antibiotics, just in case.
- I'll put in the orders. - We'll have the nurse
come check on you, Sophia.
Hey. Ezra, what are you doing?
- Hey. - When I said, "Put in the orders",
- I meant you would. - Yeah, right. Coming.
We got the results from your lung biopsy.
I'm so sorry, Isaac.
You need a transplant.
Well, what are my chances of getting a new lung?
Well, you're a good candidate.
You're young, otherwise healthy.
But in order to be eligible for a transplant,
all patients must have a support system.
Two people who can take care of you after the surgery,
take you to appointments, administer medication
for as long as necessary.
They'll have to commit to your recovery,
which can be a long process.
Yeah, I am the support system for other people.
I don't have one of my own.
Well, surely there's someone who can step up, right?
Old foster parents, friends?
It's my own fault.
Growing up, I had a huge chip on my shoulder.
Anger cost me every relationship in my life.
I found my companionship in drugs.
I lost my job and then my home.
I've lived my life alone.
Now it sounds like that's how I'll die.
Okay.
Why don't you give us some time,
see if there's something that we can figure out, okay?
You know, I do have a contact
in the pulmonary fibrosis community.
Maybe they have some resources that could help Isaac?
Never thought I'd say this,
but silence is not a good look on you.
What's up?
I was thinking about Isaac.
He was abandoned by his parents,
never had a real home or people who cared about him.
And how he just ended up living in the streets.
Do you think that could have been you if you weren't adopted?
Look, I was dealt a good hand. He was not.
He can't think of one person that can help him?
I have worked with Isaac for over a year.
He spends all of his time helping those
who aren't equipped to help themselves.
He really doesn't have anyone.
You know, he's not gonna live long post transplant
without a lot of help.
But come on, who's got the capacity and the willingness
to take responsibility of a 20-something-year-old man?
Me.
I wanted to give them a moment alone before Josie arrives.
Derek's parents are trying to get here,
but I'm not sure they'll make it.
And Molly's dad? Is he on the way?
Brett's in Denmark for work.
He's trying to get home,
but... we're not together anymore, it's complicated.
I... That's none of my business.
And I... and I can... I know I have no standing here.
But I... had to do something
for you and your family.
And this is just... the best I could come up with.
What is it?
I approached our palliative care people for advice,
and they suggested this. It's a legacy book.
So, a guide that helps patients
facing a dangerous procedure with an uncertain outcome.
It helps them organize their memories and, um,
put their wishes in order.
Just in case the...
And if, and if this is... if I'm intruding,
if this is the wrong thing,
- I'm... - It's perfect.
Derek needs to feel like he has some control.
Thank you.
Sorry. We got trapped in the ER.
How's Sophia?
She became more acidotic and hypoxic,
so I had to intubate her.
And she's still spiking a fever
despite being on new antibiotics.
Her latest set of labs show an acute liver injury.
Right.
What if she doesn't have an infection?
You did a detailed patient history.
Tell us more about Sophia.
Well, her mom suffered from lupus
- and her dad had MS. - Both are autoimmune disorders.
They could run in families.
Acute liver injury, joint pain, and Sophia's other symptoms,
she may have adult-onset Still's disease.
Ezra, what is the treatment for adult-onset Still's?
Steroids. But we can't give her that.
That absolutely can't happen.
Why not?
Because... W-Well, there's no test to confirm
adult-onset Still's, so we'd be treating Sophia blind.
That's not ideal,
but if we do nothing, Sophia could get worse.
I'm gonna check on Sophia.
And then I'll order the steroids.
Uh, uh, aren't-aren't there risks in giving her steroids?
Yes. Why don't you tell me what they are?
Death.
If you give high-dose steroids to a patient
with Candida auris,
you'll exacerbate the fungal infection
- and kill her. - Look, we can't let her die.
Her death won't make sense.
We could trigger an investigation.
We can't let Sophia die because she's a human being
- and we could prevent it. - Of course.
Of-of course, that's the first priority here.
Let me think, we have to fix this.
We've gone too far already.
None of this would be happening if not for the liver injury,
and that is a known side effect of the antifungal I gave her.
Okay. I get it.
So what we have to do is we have to stop Hawkins
- from treating with steroids. - How do we do that?
I don't know!
- It's not just me? - No, it's not just you.
Oh, that's nice. Although, I'd like to be more of a...
Well, you two seem to be hitting it off.
Well, of course. I'm trying.
Or she's very easily impressed. I'm not sure which.
People like you are why I run
a pulmonary fibrosis organization.
We are in contact with more than two million people.
And I will absolutely put you in touch with survivors
who can talk to you about what it's like
to live with the disease.
Just know that you're not alone.
I-I love the sound of that.
Well, hopefully you'll like the sound of this, too.
Conrad and I have agreed to be your support system.
Wait, you're serious?
And with that assurance,
we got you on the transplant list.
My entire life, I've never had anybody
really stand by me.
I don't even know how to thank you.
Wait, wait!
Are those steroids?
No, it's an antifungal.
Sophia has Candida auris.
Candida auris? H-How did you go from diagnosing Sophia
with adult-onset Still's to Candida auris?
There is no test to confirm onset Still's disease...
- but you can rule it out. - I'm sorry, I'm a...
intern, still learning here.
- Sophia had a fever. Right? - Yeah.
The only telltale sign of Still's is...
a salmon-colored rash when a fever spikes.
She didn't have one.
When that happens...
... you go back to the well.
And you dig deep.
Have a look.
Otitis externa. She has an ear infection.
Which is how Candida auris was discovered in 2009.
Hence the name... auris is Latin for ear.
Seemed like a leap, but I ran the cultures
and confirmed it.
Dr. Hawkins knows.
He figured out Sophia has Candida auris.
I heard.
He already notified the health department.
It's over.
Get the bag of antifungals that you hung and it will be.
It's the only thing that connects us to this.
There's something I don't understand.
Why cover this up?
You're the most powerful doctor I know.
You could have survived this
if you'd just told the truth from the beginning.
Why didn't you?
Because Logan Kim would have destroyed me.
Over one mistake?
This isn't the first, Ezra.
When I was an intern, much like you...
something really bad happened.
We all make mistakes in the beginning.
Not like this one.
Laparoscopic instruments got infected by bacteria.
Patients got sick just from routine procedures.
Four of them ended up dead.
I suspected that the instruments were contaminated,
but... I never said anything.
Why?
Fear.
Red Rock covered for me, but that was all possible
because your mother took pity on me.
She helped them.
And I would not be here right now without her.
My mom wouldn't have stuck her neck out like that
if she didn't see something in you.
And with her sacrifice, I've done a lot of good.
A lot. And I hope to do more.
But there's just one more loose end...
What else should we put in our picture book?
My birthday party.
- Good idea. - There you are at the steamboat restaurant
with your cake and ice cream. Hmm?
Mm.
So this one for sure goes in the legacy book.
'Cause Josie and I, we love our ice cream.
Yeah?
I'll get a print made.
Here.
Why does Daddy have to wear the mask?
It helps him breathe.
- He's still very sick? - Yes.
But he's fighting to get better.
Honey? You and Mommy
are gonna be alone while I'm in the hospital.
I know this is all confusing and scary.
But will you promise me
you'll take care of each other?
That's my girl.
Thought someone might want a hot chocolate.
- What do we say? - Thank you, Dr. Hawkins.
Oh, you're welcome.
What's that for?
Uh, the vent will help your dad breathe.
They're just setting it up for later.
Code Blue, Room 54-17.
- Code Blue, Room 54-17. - I need a vent, now!
Go. I'll ask for another one.
Isaac. What's happening, man?
Sats in the 80s. BP's down to 70/50.
No, wait.
- If we wait, he'll code. - Well, his neck veins,
they're distended up to his ears.
He's hyperresonant on the left. There's air in there.
Chest tube is kinked.
What? You got to be kidding me.
That's what's causing the hemothorax.
Oh, yeah, there you go. Hey, hey, hey, you all right?
- You're breathing now, right? - Mm-hmm.
All right, all right, Isaac.
We got you.
Listen to me. Guys like Isaac,
if they go on the vent, they never come off.
Vents fall into the "last resort only" category.
- You got me? - Got it.
All right, all right. We got you.
You need this?
No, it's okay. Put it over there.
Well, because your fibrosis is genetic,
I asked Cheryl if she knew of anyone with premature
gray hair in their 20s.
Is she sure that this guy is my cousin,
not just some dude that recovered
from pulmonary fibrosis?
A DNA test will confirm,
but you cannot deny the resemblance.
Those are definitely my eyes and my nose and my chin.
And everything.
His name is Gabriel, and after hearing your story,
he thinks your mom is his aunt.
She got pregnant as a teen, and ran away from home.
And they've been searching for her and her child ever since.
Now, he's talked to the rest of his family,
and they have agreed to be your support system.
Even if you're not related.
I don't even know how to thank you.
You've been longing for this your whole life.
And now it's here.
He's ready.
As ready as he'll ever be.
I helped him write a beautiful letter
for the legacy book that Josie will have all her life.
Let's hope she never has to read it.
Yeah.
The legacy book was a great idea, Mom,
and made Derek feel like... like no matter what,
he was still taking care of me and Josie.
Oh, darling, it's okay.
Let it go.
Okay.
Remember this.
Derek can still make it through, and no one
is giving up on him.
Come here.
- Thanks. - Yeah.
It's gonna be okay.
Okay.
It's time for Dr. Bell to take you to get some food.
I don't want to leave Daddy.
Daddy wants you to go with Dr. Bell.
He's very nice.
Sometimes even a little bit funny.
I love you.
I love you, too, Daddy.
We'll be here when you wake up.
They'll be fine.
I'll make sure of it.
I know.
I love you, too.
It's okay.
- You good? - I'm good.
All right.
We're gonna give you a medication
that will put you to sleep.
All right, Kathleen.
There you go.
What happened to her?
Antifungals aren't working.
We've got her on four liters of normal saline.
Her systolic is still in the 70s.
She's going into shock. She needs pressors.
There's no access. Her veins are collapsed.
Then let's get an IO.
Ezra, grab one out of the code cart.
Where's that drill going?
Directly into the bone marrow.
Now you have your central access.
Okay, starting her on norepi.
Turn it up to 50 mics per kilo.
Higher.
- She's maxed out. - So what do we do?
Hit her with every antifungal in our pharmacy.
And if none of them work?
Then she dies.
I mean, how did Sophia even get Candida auris to begin with?
The health department will have to find the source.
If we would have found it sooner,
maybe that would have made the difference.
Hey, it's not your fault.
Candida auris is notoriously difficult to diagnose.
She got antifungals from the start.
Long before you knew.
What are you talking about?
I gave them to her.
- What? Why would you do that? - Dr. Cain told me to.
Why?
He knew she had Candida auris?
He suspected.
How?
It's been killing me keeping Cain's secrets.
You better sit down and tell us the whole story right now.
I assume you heard the EMT who brought Dawn Long here is dead.
Sophia.
Say something.
What do you want me to say?
That you regret going to Logan
instead of the state health board.
That you wish you would have come to me from the beginning,
'cause maybe we could've done something to save her.
That you regret using a scared, vulnerable kid,
saddling him with guilt
he'll carry with him the rest of his life.
Spare me your self-righteous anger.
You're no angel.
You've caused harm. You've made mistakes.
I don't willfully endanger my patients.
I told Kim and I warned him
to be straightforward about Candida auris.
I told him about that.
- He threatened me. - But you... you caved?
All that bluster, you bow down to a suit?
Why do you come in here?
So you can feel like a king?
Convince yourself you're not a coward?
Get out.
How could someone so brilliant and so gifted
throw it all away and sell their soul to Red Rock?
Is it just the money? The power?
Your name on a building?
What does any of that mean at the end of the day
if you can't look in the mirror?
Come on. It's okay.
Sleep tight, Daddy.
- Synced and corrected by Firefly - - www.addic7ed.com -