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[ SIREN WAILS ]

-- Captions by VITAC -- www.vitac.com

CAPTIONS PAID FOR BY DISCOVERY COMMUNICATIONS

SHOCK ADVISED.

THESE ARE THE REAL STORIES OF THE E.R.

THAT DOCTORS NEVER TALK ABOUT.

RUTHIE!

I THOUGHT SHE WAS GETTING SOME SORT OF SCAN.

SHE WAS. SHE IS!

HE'S NOT HAPPY WITH ME

BECAUSE I'M NOT GIVING HIM DEFINITE ANSWERS.

I'M GONNA BE SHUNNED.

MY FATHER WILL DISOWN ME.

I SEE COMPLETE PANIC IN HER EYES.

I MIGHT AS WELL BE DEAD.

CODE BLUE.

HI. I'M DR. GARVIN.

THIS IS MAXINE. I'M MELANIE.

I'M MAXINE. THIS IS MELANIE.

I'M GUESSING YOU'RE TWINS.

Together: WE'RE MIRROR TWINS.

I'M RIGHT-HANDED.

I'M LEFT-HANDED.

MY HEART FEELS LIKE IT'S GONNA JUMP OUT OF MY CHEST.

SHE JUST KEEPS GETTING WORSE.

OH, MY GOD!

I TOLD YOU...

Together: WE USUALLY GET SICK AT THE SAME TIME.

WHAT IS GOING ON WITH HER?

[ SIREN WAILING ]

-F.D.G.B. -FALL DOWN, GO BOOM.

HE'S GOT NO PULSE.

HEY, SIR, I'M DR. BAKER. CAN YOU HEAR ME?

SO I PUT MY STETHOSCOPE ON HIS CHEST...

[ WHIRRING ]

WHAT IN THE WORLD?!

...AND HEAR A STRANGE WHIR, LIKE AN ELECTRIC MOTOR.

[ WHIRRING CONTINUES ]

WHAT IS THAT?

I HAVE NO IDEA.

Narrator: THESE ARE THE...

♪♪

DR. BERNICE SESSA IS THE DAUGHTER OF IRAQI IMMIGRANTS.

OKAY, NANA, I GOT TO GO.

AND SHE GREW UP LEARNING TO ALWAYS RESPECT HER ELDERS.

WE WERE RAISED IN A VERY STRICT CATHOLIC BACKGROUND.

SOME PEOPLE DO REBEL AGAINST THAT...

YEAH, I WILL CALL HIM. I PROMISE.

...BUT NOT ME.

I TRIED TO FOLLOW MY PARENTS' RULES.

LOOK, I HAVE PATIENTS I NEED TO SEE.

I WILL CALL YOU LATER.

OKAY? ALL RIGHT, LOVE YOU.

BYE.

[ WOMAN SPEAKING INDISTINCTLY ON P.A. ]

18-YEAR-OLD FEMALE WITH ESCALATING BACK

AND ABDOMINAL PAIN, BAY THREE.

OH, AND SHE'S AMISH.

WELL, IT'S KNOWN AT THE HOSPITAL

THAT THE AMISH CAN BE

VERY SKEPTICAL OF MODERN MEDICINE.

HELLO. I'M DR. SESSA.

I'M ISAAC MILLER.

THIS IS MY DAUGHTER RUTH.

SHE'S BEEN IN PAIN LIKE THIS FOR A FEW HOURS NOW.

I'M QUITE WORRIED ABOUT HER.

RUTH, CAN YOU TELL ME A LITTLE BIT ABOUT YOUR PAIN?

UM, AT FIRST, IT STARTED IN MY BACK,

BUT NOW IT'S IN MY STOMACH,

AND IT'S HURTING MORE AND MORE.

SHE'S A GOOD GIRL, MY RUTHIE.

NOT ONE TO COMPLAIN.

RUTH, DO YOU HAVE ANY MEDICAL CONDITIONS

THAT I NEED TO BE AWARE OF?

Dr. Sessa: WE TALK ABOUT HER HISTORY.

SHE'S A PRETTY HEALTHY GIRL.

I'M GOING TO NEED TO EXAMINE YOU.

MAYBE WE CAN STEP OUTSIDE WHILE SHE GETS UNDRESSED.

I CAN TELL BOTH THE PATIENT AND THE FATHER ARE UNCOMFORTABLE.

COULD YOU WAIT IN THE WAITING ROOM?

WHEN I'M DONE WITH THE EXAM, WE CAN COME BACK AND GET YOU.

SO, I GO BACK IN TO EXAMINE HER WITH THE NURSE,

AND I CAN TELL THAT SHE'S STILL UNEASY.

BUT I FEEL VERY PROTECTIVE OF HER.

MAXINE, CAN YOU HELP ME PUT THE BED DOWN, PLEASE?

I DECIDE TO TALK THROUGH WITH HER WHAT I'M DOING

BECAUSE SHE SEEMS SO NERVOUS.

I AM GONNA HAVE TO LIFT UP YOUR GOWN A LITTLE.

SO, I LIFT HER GOWN SO I CAN EXAMINE HER ABDOMEN,

AND ONCE I PALPATE HER BELLY,

I KNOW EXACTLY WHAT'S HAPPENING.

RUTH, ARE YOU PREGNANT?

[ GASPS ] NO.

SHE IS VERY PREGNANT.

SO I'M NOT SURE IF SHE'S IN DENIAL

OR IF SHE ACTUALLY DIDN'T KNOW,

BUT THERE WAS NO QUESTION IN MY MIND.

I CAN'T BE. IT'S IMPOSSIBLE.

WELL, I DO BELIEVE THAT THIS IS A VERY PREGNANT BELLY.

YOU'RE ABOUT TO HAVE A BABY.

I SEE COMPLETE PANIC IN HER EYES.

[ SIREN WAILING ]

Narrator: E.R. PHYSICIAN DR. RACHEL GARVIN

LOVES A MYSTERY.

HOLD ON.

WHAT ARE YOU DOING?

SOMEBODY STOLE MY LUNCH.

CHECKING TO SEE WHO SMELLS LIKE PEANUT BUTTER.

OH, SO NOW WE HAVE A LUNCH THIEF ON STAFF?

I WILL TOTALLY HELP YOU HUNT THEM DOWN.

BEING A PHYSICIAN, ESPECIALLY IN THE EMERGENCY DEPARTMENT,

YOU'RE PUTTING THE PIECES TOGETHER TO SOLVE A MYSTERY.

AND SO IT'S LIKE BEING A DETECTIVE.

WHERE'S HE BEEN HIDING?

OH, I THINK HE JUST GOT ON SHIFT ABOUT FIVE MINUTES AGO.

SO, USUALLY, I'M TRYING TO GATHER CLUES

TO SOLVE A MEDICAL MYSTERY,

BUT I'M UP FOR ANYTHING.

Greg: DR. GARVIN?

I JUST PUT A NEW PATIENT IN ROOM ONE FOR YOU.

THANKS, GREG.

SURE.

I'M GOING FOR LUNCH. PATIENT'S 18 YEARS OLD, FEMALE.

SHE LOOKS PRETTY SICK.

ALL RIGHT.

I'M GONNA GO SEE HER.

IF A NURSE TELLS ME SOMEONE'S REALLY SICK,

THAT MEANS I NEED TO GO NOW,

STOP WHAT I'M DOING, AND GO SEE THAT PATIENT.

[ MAN SPEAKING INDISTINCTLY ON P.A. ]

HI. I'M DR. GARVIN.

THIS IS MAXINE. I'M MELANIE.

I'M MAXINE. THIS IS MELANIE.

I'M GUESSING YOU'RE TWINS.

Together: WE'RE MIRROR TWINS.

I'M RIGHT-HANDED.

I'M LEFT-HANDED.

THAT'S WHY I PART MY HAIR ON THE LEFT.

AND THAT'S WHY I PART MINE ON THE RIGHT.

GOT IT. SO, YOU'RE MAXINE.

YES.

I SEE TWO YOUNG LADIES,

ONE OF THEM LOOKING VERY FATIGUED, VERY ILL,

AS COMPARED TO HER SISTER.

OKAY, WHAT BRINGS YOU IN TODAY?

I'VE BEEN FEELING A LOT MORE TIRED

OVER THE LAST COUPLE OF WEEKS.

WE'VE BEEN FINISHING FINALS,

AND I GUESS WE JUST FIGURED IT WAS THE STRESS.

WE THOUGHT WE'D BOTH GET SICK.

Together: WE USUALLY DO AT THE SAME TIME.

BUT I WAS THE ONLY ONE WHO DID,

AND [COUGHS] THE LAST COUPLE OF DAYS HAVE BEEN REALLY BAD.

AND THEN SHE JUST STARTED TURNING YELLOW.

Dr. Garvin: TURNING YELLOW IS WHAT WE TERM JAUNDICE.

JAUNDICE IS USUALLY THE SYMPTOM OF SOMETHING.

A LOT OF TIMES, IT'S RELATED TO LIVER DISFUNCTION,

BUT SOMETIMES IT CAN BE CAUSED BY PROBLEMS WITH THE BLOOD

THAT CAUSE THAT PERSON TO TURN YELLOW.

WHAT ABOUT TRAVELING OUT OF THE COUNTRY?

Together: WE WISH.

WHAT ABOUT EATING ANYTHING OUT OF THE ORDINARY?

NO, I DON'T THINK SO.

Dr. Garvin: SO WHEN WE SEE SOMEONE

THAT PRESENTS WITH JAUNDICE,

WE KNOW THAT SOMETHING VERY WRONG IS HAPPENING.

WHY DON'T WE GET AN I.V. STARTED?

LET'S GET A CBC, CMP, COAG PANEL,

AND A LACTIC ACID. -OKAY.

Melanie: WHAT DO YOU THINK IT IS?

I DON'T KNOW YET, BUT, HOPEFULLY,

THE TEST RESULTS WILL GIVE US SOME ANSWERS.

Dr. Garvin: WE ORDER A BUNCH OF DIFFERENT LABS

BECAUSE WE HAVE TO CAST A WIDE NET

SO WE CAN TRY TO FIGURE OUT

WHAT'S GOING ON WITH THE PATIENT.

ANY OTHER SYMPTOMS, MAXINE?

MY LEGS HAVE BEEN ACHING THE LAST FEW DAYS.

IS IT OKAY IF I TAKE A LOOK?

OH, WHERE'D YOU GET THOSE BRUISES?

I DON'T KNOW.

Dr. Garvin: SO, SEEING BRUISES ON HER LEGS IS CONCERNING.

IF IT'S RELATED, I'M DEFINITELY CONCERNED

ABOUT A PROBLEM WITH THE BLOOD.

ANY OTHER SYMPTOMS?

UH, MY FEET FEEL SWOLLEN THE LAST DAY OR TWO.

I'M GONNA TAKE THESE OFF SO I CAN GET A BETTER LOOK.

SHE HAD SWELLING JUST ON THE TOP OF HER FEET ON BOTH FEET,

AND THAT'S A REALLY UNUSUAL PLACE FOR SWELLING.

OH, MY GOD!

[ COUGHS ] MEL!

Dr. Garvin: SO, NOW I'M THINKING,

"IS IT SOMETHING CONTAGIOUS?

IS IT SOME TYPE OF INFECTION?"

I TOLD YOU...

Together: WE USUALLY GET SICK AT THE SAME TIME.

Dr. Garvin: NOW I CAN REALLY PUT MY DETECTIVE SKILLS TO WORK,

'CAUSE THIS IS ONE MYSTERY I TOTALLY HAVE TO SOLVE.

Narrator: LIKE ALL PHYSICIANS, E.R. DOCTOR JAY BAKER

MUST CONTINUALLY UPDATE

HIS KNOWLEDGE OF HIS NURSES' ABBREVIATIONS.

HEY, CATHY, WHAT'S THIS YOU WROTE

ON THE CHART -- "NPS"?

OH. THAT'S A TECHNICAL TERM --

NEW PARENT SYNDROME.

THE KID HAD THE HICCUPS.

OH. RIGHT.

ACUTE HICCUPS.

RIGHT.

Dr. Baker: WELL, IT'S IMPORTANT TO KEEP THINGS LIGHT IN THE E.R.

WE WORK LONG HOURS.

WE ALSO DEAL WITH, SOMETIMES, SOME GRAVE SITUATIONS.

BUT IT'S WHAT MAKES US A TEAM

AND HELPS US COME TOGETHER

AND TAKE CARE OF OUR PATIENTS.

INCOMING.

-F.D.G.B. -FALL DOWN, GO BOOM.

WELL, FROM THE START, THIS WAS AN UNUSUAL CASE.

HEY, SIR. I'M DR. BAKER. CAN YOU HEAR ME?

HE WAS MOVING HIS EXTREMITIES

AND HAD SOME LEVEL OF CONSCIOUSNESS,

SO WE KNEW HE WASN'T DEAD.

SO WE PICKED HIM UP, AND WE TOOK HIM RIGHT BACK

TO THE RESUSCITATION BAY.

HIS AIRWAY LOOKED LIKE IT WAS OPEN.

I MEAN, THERE WAS NOTHING THAT SEEMED TO BE OBSTRUCTING IT.

HE ALSO HAD SOME RESPIRATIONS,

AND HIS BREATH SOUNDS WERE NORMAL.

SIR, DO YOU KNOW WHERE YOU ARE?

YOU'RE IN THE HOSPITAL.

WE'LL NEED A 12-LEAD EKG, PLEASE.

LOOKS LIKE HE'S HAD HEART SURGERY.

-BUT SATS ARE 95. -HE'S GOT NO PULSE.

GOT NO PULSE?

Dr. Baker: NOTHING'S ADDING UP AT THIS POINT.

I CAN'T GET A BLOOD PRESSURE.

GO AHEAD AND DO THAT MANUALLY, PLEASE.

THE PATIENT HAD A NORMAL HEART RHYTHM ON THE MONITOR,

HE HAD A NORMAL OXYGEN SATURATION,

BUT WE COULDN'T GET A BLOOD PRESSURE.

SO I PUT MY STETHOSCOPE ON HIS CHEST...

[ WHIRRING ]

WHAT IN THE WORLD?!

...AND HEAR A STRANGE WHIR, LIKE AN ELECTRIC MOTOR.

NEAL, LISTEN RIGHT HERE.

[ WHIRRING CONTINUES ]

WHAT IS THAT?

I HAVE NO IDEA.

[ SCREAMS ]

Isaac: RUTHIE, ARE YOU OKAY?!

OH, GOD, IT'S MY FATHER.

Dr. Sessa: HER FATHER MUST HAVE HEARD

AND CAME BACK TO CHECK ON HER.

IT'S THE MOST DREAD I'VE EVER FELT.

♪♪

SHE JUST STARTED TURNING YELLOW.

Narrator: DR. RACHEL GARVIN IS TRYING TO DETERMINE

WHAT'S CAUSING HER PATIENT'S JAUNDICE

AND BRUISING...

OH, MY GOD!

...AND IF THE PATIENT'S TWIN SISTER

HAS THE SAME AILMENT.

Dr. Garvin: I DON'T SEE A LOT OF TWINS,

BUT I KNOW THAT ONE OF THEM IS OFTEN FEELING

WHAT THE OTHER ONE IS FEELING.

SO YOU HAVE TO WONDER, "IS THAT SOMETHING

THAT COULD BE HAPPENING IN THIS CASE?"

WHERE DO YOU THINK THOSE CAME FROM?

I DON'T KNOW.

ANY RECENT HOSPITALIZATIONS OR SURGERIES?

Together: NO.

THIS IS THE FIRST TIME EITHER OF US

HAS BEEN TO THE HOSPITAL IN YEARS.

AND YOU'RE SURE YOU HAVEN'T BEEN EXPOSED TO ANYBODY

WITH AN ILLNESS OR INFECTION?

NO.

I DECIDE TO FOCUS ON THE SICKER SISTER.

SHE HAS REALLY MORE SYMPTOMS RIGHT NOW.

LET'S GET A PORTABLE CHEST X-RAY FOR MAXINE.

SO I DECIDE TO ORDER A CHEST X-RAY,

'CAUSE I'M TOTALLY AT A LOSS AS TO WHY THIS PATIENT

IS AS SICK AS SHE IS RIGHT NOW.

MAYBE SHE HAS A PNEUMONIA.

MAYBE SHE HAS SOMETHING

THAT CAN POINT ME IN THE RIGHT DIRECTION.

MAXINE, YOU'RE NOT DIABETIC?

NO.

ANY CHANCE YOU COULD BE PREGNANT?

NO.

NO.

ANY STREET DRUG USE AT ALL?

NO.

AND NOTHING OVER THE COUNTER FOR PAIN?

NO.

LOTS OF THINGS CAN CAUSE INSULTS TO THE LIVER.

SO THE LIST IS KIND OF ENDLESS.

THE LIVER IS SUPER-IMPORTANT IN MAINTAINING

OUR BODY'S NORMAL FUNCTIONS.

YOU CAN GO AHEAD BACK IN.

SO, I LOOK AT THE CHEST X-RAY, AND IT'S TOTALLY CLEAN.

NOTHING REMARKABLE.

HER BLOOD WORK IS BACK.

CHEST X-RAY IS TOTALLY NORMAL.

HMM.

SO, I GET HER HEMOGLOBIN BACK, AND IT'S 3.5.

AND I'M THINKING, "WHAT IS GOING ON?"

MAXINE, YOUR HEMOGLOBIN LEVEL IS REALLY LOW.

THIS PROBABLY EXPLAINS

WHY YOU'VE BEEN SO EXHAUSTED.

WHAT DOES THAT MEAN?

SO, HEMOGLOBIN IS WHAT MAKES UP RED BLOOD CELLS

THAT CARRY OXYGEN IN THE BODY.

IF THAT'S WHAT IT IS, HOW DO YOU TREAT IT?

IF YOUR HEMOGLOBIN LEVEL IS LOW, THAT'S A TERM WE CALL ANEMIA.

AND WHEN YOU'RE ANEMIC,

YOUR BODY DOESN'T HAVE ENOUGH OF THE CELLS IT NEEDS

TO CARRY OXYGEN EFFICIENTLY.

SO THAT'S WHY YOU HAVE ALL THESE SYMPTOMS OF BEING TIRED,

SHORT OF BREATH, CAN LOOK PALE.

OH, I FEEL DIZZY. OH!

Woman: HER HEART RATE'S STILL CLIMBING. 130.

B.P. IS DOWN TO 90 SYSTOLIC.

Dr. Garvin: SO, NOW MY PATIENT'S HEART RATE IS GOING UP,

AND HER BLOOD PRESSURE IS GOING DOWN.

I AM SUPER-CONCERNED.

WHAT'S HAPPENING?

I STILL DON'T KNOW WHAT'S GOING ON,

BUT IF THIS TREND CONTINUES, SHE COULD DIE.

RUTH, I NEED YOU TO TELL ME -- COULD YOU BE PREGNANT?

Narrator: DR. BERNICE SESSA IS CERTAIN

HER FRIGHTENED YOUNG AMISH PATIENT

IS PREGNANT AND IN LABOR.

YOU'RE ABOUT TO HAVE A BABY.

BUT THE 18-YEAR-OLD INSISTS SHE IS NOT.

I CAN'T BE. IT'S IMPOSSIBLE.

AT THIS POINT, I WANT HER TO UNDERSTAND

THAT SHE'S ACTUALLY HAVING A BABY

AND WANT TO MAKE SURE THAT THE BABY'S OKAY.

I ASK THE NURSE TO BRING ME AN ULTRASOUND MACHINE.

WHAT IS THAT?

IT'S AN ULTRASOUND MACHINE.

IT WILL ALLOW US TO LOOK AT THE BABY.

THERE'S NO BABY. THERE CAN'T BE.

AND THEN, OF COURSE, THE BIG PICTURE OF THE BABY

COMES UP ON THE SCREEN.

THERE'S YOUR BABY. YOU'RE GONNA BE A MAMA.

SHE BREAKS DOWN AND STARTS CRYING.

AT THAT POINT, IT HITS ME -- "OH, BOY, SHE'S REALLY AFRAID."

WELL, RUTH, I'M HERE FOR YOU.

YOU HAVE TO TRUST ME.

THAT'S WHAT HE SAID.

HE SAID YOU CAN'T GET PREGNANT ON THE FIRST TIME --

THE ONLY TIME.

AND THEN HE LEFT THE COMMUNITY.

THE BABY'S FATHER?

I'M SO SORRY. HE MISLED YOU.

I'M GONNA BE SHUNNED.

AND MY FATHER WILL DISOWN ME.

I MIGHT AS WELL BE DEAD.

I COME FROM AN ETHNIC BACKGROUND

WHERE SOMETHING LIKE THIS IS NOT FORGIVEN OR FORGOTTEN.

AND I REALIZE THAT SHE'S NOT EXAGGERATING.

[ SCREAMS ]

OW! OH!

Isaac: RUTHIE, ARE YOU OKAY?!

OH, GOD, IT'S MY FATHER.

HER SCREAMING WAS SO LOUD THAT HER FATHER MUST HAVE HEARD...

RUTHIE?

...AND CAME BACK TO CHECK ON HER.

HE CAN'T KNOW. PLEASE, PLEASE, PLEASE, PLEASE.

DON'T TELL HIM, DON'T TELL HIM.

IT'S THE MOST DREAD I'VE EVER FELT.

I WAS REALLY WORRIED.

WHAT WOULD HAPPEN IF THE FAMILY FOUND OUT?

RUTHIE, ARE YOU OKAY?

BUT THEN IS IT ETHICAL FOR ME TO LIE TO HER FATHER

ABOUT SOMETHING SO SERIOUS?

HOW AM I GONNA HANDLE THIS?

WHAT IN THE WORLD?!

HE'S GOT NO PULSE.

Narrator: DR. JAY BAKER'S PATIENT HAS VITAL SIGNS

THAT DON'T ADD UP.

WHAT IS THAT?

AND THERE'S A SOUND IN THE MAN'S CHEST

HE'S NEVER HEARD BEFORE.

YOU KNOW WHAT? I THINK I KNOW WHAT IT IS.

LET'S GET HIS JACKET OFF.

Dr. Baker: SOME PATIENTS WITH HEART FAILURE

CAN HAVE A DEVICE PLACED INTO THEIR HEART

THAT CAN ASSIST WITH MOVING BLOOD AROUND THE BODY.

-WHAT IS THAT? -IT'S WHAT I THOUGHT.

IT'S AN LVAD.

LVAD IS THE ACRONYM FOR LEFT VENTRICULAR ASSIST DEVICE.

THEY'RE PRETTY NEW, THEY'RE STILL RARE,

AND I'D NEVER SEEN ONE BEFORE.

HERE, CATHY, CAN YOU CALL THESE PEOPLE

ON THIS TELEPHONE NUMBER HERE, PLEASE?

EVERYTHING'S DIFFERENT WHEN YOU HAVE ONE OF THESE.

AT THIS POINT, I'M CONCERNED.

IF THIS PATIENT CRASHES,

I DON'T THINK THAT WE CAN FALL BACK

ON OUR NORMAL RESUSCITATION PROTOCOLS.

AND WE MAY NOT KNOW HOW TO SAVE HIM.

LET'S CHECK HIS POCKETS FOR I.D.

DRIVER'S LICENSE. HELLO, RAYMOND.

Dr. Baker: SO, WE BEGIN THE WORK-UP.

I'VE GOT MY STAFF ON THE PHONE,

TRYING TO CONTACT THE LVAD COORDINATOR.

HE'S GOT A WIDE COMPLEX RHYTHM. MAYBE VENTRICULAR.

I THINK HE'S GOT HYPERKALEMIA.

THAT'S A HIGH LEVEL OF POTASSIUM IN THE BLOOD.

AND WHEN IT'S SEVERE, IT CAN CAUSE CARDIAC ARREST AND DEATH.

WE NEED A BEDSIDE POTASSIUM STAT, PLEASE.

WE USE A HANDHELD DEVICE CALLED A RAPID BLOOD ANALYZER,

AND IT CAN GIVE US THE ANSWER IN JUST A MINUTE OR TWO.

WHOA. HIS K IS 7.6.

POTASSIUM OF 7.6 IS REALLY HIGH.

THAT'S A REALLY DANGEROUS LEVEL.

WHAT WE NEED IS 3 GRAMS OF CALCIUM GLUCONATE,

AN AMP OF D50, 10 UNITS OF INSULIN,

AND A CONTINUOUS ALBUTEROL NEBULIZER.

LET'S GET THAT ALL GOING RIGHT NOW.

I'VE GOT HIS LVAD COORDINATOR ON THE PHONE.

THANKS.

SO, WE FINALLY START GETTING SOME SUPPORT.

AND HIS WIFE'S HERE.

OH, THAT WAS FAST.

IT WAS REALLY INTENSE.

YES. YEAH, THE PATIENT'S HERE.

HE'S MINIMALLY RESPONSIVE.

WHAT I NEED ARE THE RESUSCITATION PROTOCOLS.

I'VE NEVER TAKEN CARE OF AN LVAD PATIENT BEFORE.

CAN YOU HANG ON?

CAN THEY COME IN?

OKAY.

HI. I'M DR. BAKER. THANK YOU FOR COMING.

LESLIE. YEAH.

THIS IS TAYLOR.

HOW ARE YOU?

-GOOD. -YOU WANT TO SAY HI TO YOUR DAD?

-YEAH. -OKAY, COME ON IN.

WHY DOES HE HAVE THAT THING ON HIS FACE?

IT'S CALLED A NEBULIZER. IT'S HELPING HIM BREATHE EASIER.

WHY DOES HE NEED THAT?

TAYLOR, HONEY, DADDY'S NOT FEELING WELL.

[ MONITOR BEEPING RAPIDLY ]

HE'S IN V-TACH!

WHAT'S HAPPENING?!

-HE'S IN CARDIAC ARREST. -HOLD ON.

-WHY DON'T WE STEP OUT? -HOLD ON.

STOP! NO C.P.R.

THAT COULD KILL HIM.

Dr. Sessa: I TELL HER WHAT'S GOING ON,

AND I'M REALLY HOPING FOR AN ALLY.

I'M NOT COMFORTABLE WITH THIS.

SHE'S WORRIED ABOUT WHAT WOULD HAPPEN

IF WE DON'T TELL THE FATHER THE TRUTH.

I CAN'T CONTROL WHAT YOU DO, BUT I WON'T LIE MYSELF.

♪♪

[ SCREAMS ]

Isaac: RUTHIE, ARE YOU OKAY?!

IT'S MY FATHER. HE CAN'T KNOW.

PLEASE, PLEASE, PLEASE, PLEASE.

DON'T TELL HIM, DON'T TELL HIM.

Narrator: DR. BERNICE SESSA HAS DECIDED

TO HONOR HER 18-YEAR-OLD PATIENT'S WISHES

TO KEEP HER PREGNANCY A SECRET FROM HER FATHER,

WHO SHE FEARS WILL REJECT HER IF HE FINDS OUT.

Isaac: RUTHIE?

BUT SHE MUST HANDLE IT DELICATELY

OR RISK TRIGGERING HIS WRATH,

AND WORSE, REVEALING THE SECRET.

RUTHIE?

WELL, I HAVE TO TELL THE FATHER SOMETHING,

BUT I'M NOT SURE WHAT WOULD BE THE BEST WAY TO HANDLE IT.

MAY I COME IN?

SO MUCH IS GOING THROUGH MY MIND.

IS SHE GONNA BE SAFE? IS THE BABY GONNA BE SAFE?

I'M NOT SURE WHAT TO DO.

UH, NO.

SHE'S STILL UNDRESSED, AND I'M EXAMINING HER.

I KNOW I HAVE TO BUY MYSELF SOME TIME,

AND I HAVE TO DO IT QUICKLY.

THERE'S A SIGN ON THE WALL

THAT EXPLAINS THE LENGTH OF TIME OF CAT SCANS AND MRIs,

AND WE ASK PEOPLE TO BE PATIENT.

SO IT OCCURS TO ME -- SHE HAS ABDOMINAL PAIN.

IF SHE WASN'T PREGNANT,

I WOULD HAVE ORDERED ABDOMINAL C.T.

SO I EXPLAIN TO HIM THAT I'M GOING TO ORDER

A CAT SCAN AND THAT I NEED SOME TIME.

ONCE WE GET THE RESULTS, I'LL BE ABLE TO TELL YOU.

YOU'LL LET ME KNOW WHAT YOU DISCOVER?

I WILL -- AS SOON AS I KNOW.

SO I'M PRETENDING THAT I'M SENDING HER OFF TO CAT SCAN,

BUT WHAT I REALLY NEED TO DO IS TALK TO THE OBSTETRICIAN.

SO THE OB COMES DOWN, AND I TALK TO HER PRIVATELY.

I TELL HER WHAT'S GOING ON,

AND I'M REALLY HOPING FOR AN ALLY.

I'M NOT SURE IT'S EVEN WITHIN OUR PURVIEW TO DO THAT.

I'M NOT COMFORTABLE WITH THIS.

SHE'S RELUCTANT.

SHE'S WORRIED ABOUT THE LEGAL IMPLICATIONS

OF WHAT WOULD HAPPEN IF WE DON'T TELL THE FATHER THE TRUTH

AND THE FATHER FINDS OUT.

SO, BASICALLY, SHE'S NOT ON MY SIDE.

I CAN'T CONTROL WHAT YOU DO, BUT I WON'T LIE MYSELF.

I'LL BE EXAMINING THE PATIENT.

I START TO THINK, "AM I REALLY MAKING A MISTAKE?

IS MY JOB ON THE LINE, OR AM I PUTTING THE HOSPITAL AT RISK?"

I DECIDE THAT I NEED TO TALK TO ADMINISTRATION

AND LEGAL AFFAIRS.

BUT THEN I REALIZE IT'S THE MIDDLE OF THE NIGHT.

IF YOU CAN PLEASE CALL ME AT YOUR EARLIEST CONVENIENCE.

THANK YOU.

I LEAVE A MESSAGE.

BUT AT THIS HOUR, I'M NOT GONNA GET AHOLD OF ANYBODY.

IF I'M GONNA KEEP LYING TO THE FATHER,

IT'S GONNA BE ALL ON ME.

Narrator: DR. BAKER IS TREATING A PATIENT

WITH AN UNFAMILIAR DEVICE IMPLANTED IN HIS CHEST.

HE'S IN CARDIAC ARREST.

AND NOW THE MAN IS IN CRISIS.

HOLD ON.

C.P.R. COULD KILL HIM.

YOU CAN'T DO THAT WITH THESE PATIENTS.

WITH THE EQUIPMENT PLACED INTO THE HEART,

C.P.R. CAN DISLODGE THAT.

YOU'LL RIP A HUGE HOLE IN THE HEART.

THERE'S NO RECOVERY FROM THAT.

CAN WE DEFIB?

I THINK SO. I'LL FIND OUT.

GO AHEAD AND PUT THE PADS ON HIM.

HELLO. THIS IS DR. BAKER AGAIN.

HELLO?!

HELLO?!

DANG IT. I THINK WE'VE LOST HIM.

CAN YOU GET HIM BACK ON THE PHONE?

Neal: CHARGED. MAX DOSE.

READY TO SHOCK?

WELL, THEY HADN'T CONFIRMED IF WE COULD SHOCK OR NOT.

BUT IT WAS THE ONLY THING WE COULD DO,

SO WE HAD TO GET READY.

I HAVE NO IDEA WHAT WILL HAPPEN TO THE LVAD

IF WE SHOCK IT, BUT THE LONGER WE WAIT,

THE LESS LIKELY WE'LL BE ABLE TO GET OUR PATIENT BACK.

DO WE HAVE HIM BACK ON THE PHONE?

IT'S RINGING.

I HAD TO TAKE THE RISK.

ALL RIGHT, LET'S CLEAR.

[ PADDLES WHINING ]

GO AHEAD AND SHOCK.

SHOCKING.

I HAVE DR. BAKER. HOLD ON, PLEASE.

HI. THIS IS DR. BAKER.

YES, THE PATIENT'S IN V-TACH. WE'VE SHOCKED HIM ONCE.

THE LVAD COORDINATOR CONFIRMED THAT IT WAS OKAY TO SHOCK.

THEY ALSO CONFIRMED THAT C.P.R. WOULD BE DISASTROUS.

OKAY, WE'LL GO AHEAD AND GIVE ANOTHER SHOCK.

MAX DOSE CHARGED.

OKAY, GO AHEAD AND CLEAR.

AND SHOCK.

SHOCKING.

[ SOBS ]

THAT'S RIGHT. WE'RE GIVING HIM STACKED SHOCKS.

NO, WE DON'T HAVE ANY RHYTHM CHANGE YET.

Dr. Baker: WITH A NORMAL PATIENT IN CARDIAC ARREST,

YOU BEGIN C.P.R. RIGHT AFTER YOU SHOCK,

BUT WE COULDN'T DO THAT WITH THIS PATIENT.

GO AHEAD AND CHARGE TO MAX DOSE. ONE MORE TIME.

-CHARGED. -AND SHOCK.

BUT IN THIS CASE, IT'S THE ONLY THING WE COULD DO.

OH, I FEEL DIZZY.

Narrator: DR. GARVIN IS TRYING TO DIAGNOSE TWINS

WHO HAVE SOME OF THE SAME SYMPTOMS.

OH, MY GOD!

MEL!

BUT ONE OF THEM HAS A SEVERELY LOW HEMOGLOBIN LEVEL...

B.P. IS DOWN TO 90 SYSTOLIC.

...AND IS GOING FROM BAD TO WORSE.

Dr. Garvin: HER HEMOGLOBIN LEVEL IS 3.5.

IT COULD BE CAUSED BY A LOT OF DIFFERENT THINGS --

BLEEDING INTERNALLY, SOME OTHER PROCESS

THAT'S MAYBE CAUSING HER BODY TO DESTROY RED BLOOD CELLS.

EITHER WAY, SHE'S GONNA NEED BLOOD.

LET'S GO AHEAD AND LOWER HER HEAD ABED.

LET'S GIVE HER A LITER OF NORMAL SALINE.

AND LET'S TYPE AND CROSS HER FOR FOUR UNITS OF PACKED CELLS.

LET'S ALSO GET AN E.K.G.

ON IT.

WHAT'S HAPPENING?

SO, WE NEED TO GIVE HER A BLOOD TRANSFUSION.

DO YOU KNOW HER BLOOD TYPE?

O NEGATIVE.

HER HEMOGLOBIN LEVEL IS DANGEROUSLY LOW.

FOR SOMEONE WHO'S YOUNG AND HEALTHY -- A FEMALE --

THEY SHOULD NORMALLY HAVE A HEMOGLOBIN LEVEL

AT LEAST 12 AT THE LOW END.

THANK YOU.

HEART RATE IS 160. B.P. IS DOWN TO 80 SYSTOLIC.

SHE'S IN A-FIB WITH R.V.R.

IT'S AN ABNORMAL RHYTHM WHERE THE TOP PART OF THE HEART

IS BEATING REALLY FAST AND THE BOTTOM

DOESN'T HAVE A CHANCE TO RESPOND APPROPRIATELY.

IT CAN BE REALLY DANGEROUS,

ESPECIALLY IF THE RATES GET REALLY HIGH.

IT'S ALSO REALLY UNCOMMON IN YOUNG PEOPLE.

MAXINE, YOUR HEART IS BEATING IRREGULARLY.

I NEED TO GIVE YOU SOME MEDICINE

TO HELP GET IT UNDER CONTROL.

OKAY.

CAN YOU GET 150 OF AMIO

AND START A DRIP

AT ONE MILLIGRAM PER MINUTE, PLEASE?

SHOULD I GET ONE OF THOSE?

SO, RIGHT NOW, YOUR SISTER REALLY HAS MOST OF THE SYMPTOMS,

SO LET ME FOCUS ON HER.

AND THEN IF I THINK I NEED TO COME BACK

AND TAKE A LOOK AT YOU, I WILL.

SO, I THINK I NEED TO LOOK FURTHER

FOR SIGNS OF INTERNAL BLEEDING.

FOR THAT, I TURN TO ULTRASOUND.

I THOUGHT THE FIRST TIME I'D BE HAVING AN ULTRASOUND

WOULD BE FOR A HAPPIER REASON.

ME TOO, BUT FOR NOW, YOU JUST GET BETTER.

Dr. Garvin: THE ULTRASOUND CAN BE USED TO HELP US

FIND SIGNS OF FLUID OR BLOOD IN THE ABDOMEN.

ULTRASOUND DOESN'T SHOW ANY SIGNS OF INTERNAL BLEEDING.

THAT'S GOOD.

THAT'S GOOD.

NOTHING. IT IS TOTALLY CLEAN.

SO, WHAT'S WRONG WITH ME, THEN?

HEART RATE HASN'T DROPPED BELOW 140.

I THOUGHT THE MEDICATIONS WERE SUPPOSED TO HELP.

-[ GASPS ] -WHAT'S WRONG, MAXINE?

Maxine: MY HEART FEELS LIKE IT'S GONNA JUMP OUT OF MY CHEST.

OH, I'M SCARED!

THIS PATIENT, NO MATTER WHAT WE'RE DOING,

SHE JUST KEEPS GETTING WORSE.

PLEASE. YOU HAVE TO HELP HER.

CAN HE HEAR US?

IT'S ALWAYS A POSSIBILITY.

I'D LIKE TO BRING MY SON BACK IN.

BUT LET'S BE BRIEF.

I'D HATE FOR ANYTHING SCARY TO HAPPEN AGAIN.

SAY GOOD NIGHT TO DADDY, TAYLOR.

♪♪

AND SHOCK.

Narrator: DR. BAKER'S LVAD PATIENT'S HEART HAS STOPPED.

DAMN IT. WE JUST LOST HIM.

CATHY, PLEASE GET HIM BACK ON THE PHONE.

AND NOW HE'S TRYING TO GET ADVICE ON WHAT TO DO NEXT.

HOW MANY TIMES ARE WE GONNA DO THIS?

Dr. Baker: HOLD ON.

LOOKS LIKE HE MIGHT BE GOING BACK INTO SINUS RHYTHM.

IT WAS AMAZING, BUT THE NIGHTMARE WASN'T OVER YET.

[ RAPID BEEPING ]

WHAT'S THAT BEEPING, THOUGH?

WHEN THE ROOM QUIETS DOWN, WE HEAR A BEEPING SOUND.

IT'S LIKE IT'S COMING FROM HIS LVAD.

SO AT THIS POINT, I WONDER IF WE FRIED THE LVAD.

HELLO. THIS IS DR. BAKER.

YES, WE'VE JUST SHOCKED HIM FOR THE THIRD TIME.

HE'S BACK INTO SINUS RHYTHM,

BUT I'M HEARING SOME BEEPING FROM HIS LVAD.

UH, IT MIGHT BE THE BATTERIES.

YES, IT IS. IT'S THE BATTERIES.

THE GOOD NEWS IS, I STILL HEAR THE WHIRRING OF THE LVAD.

[ WHIRRING ]

ALL RIGHT. DO YOU HAVE ANY SPARE BATTERIES?

I DON'T, BUT HE MIGHT IN THE CAR.

COME ON. I'LL GO WITH YOU.

IF WE DON'T FIND MORE BATTERIES,

WE'RE GONNA HAVE TO FLY THIS GUY TO ANOTHER HOSPITAL

THAT CAN HELP HIM

AND CROSS OUR FINGERS THAT HE MAKES IT.

THANK YOU.

DID THEY SAY HOW LONG WE HAVE?

USUALLY 15 MINUTES AFTER IT STARTS FLASHING.

STAY WITH US, MAN.

BATTERY CHARGER.

GREAT.

WELL, WE DODGED THAT BULLET.

SO, HOW LONG HAS HE HAD THE LVAD?

JUST OVER A MONTH.

HE'S IN LINE FOR A HEART TRANSPLANT.

THAT'S NOT A SURPRISE.

HEART-TRANSPLANT PATIENTS ARE THE BIGGEST GROUP

OF PATIENTS TO HAVE LVADs.

THE LVAD KEEPS HIM ALIVE UNTIL THEY FIND A DONOR HEART.

WHAT'S THE MATTER WITH HIM?

WHAT WOULD CAUSE HIS HEART TO STOP?

WE'RE NOT EXACTLY SURE YET.

WE STILL HAVE SOME TESTS PENDING.

BUT I THINK WE SHOULD HAVE SOME ANSWERS HERE PRETTY SOON.

CAN HE HEAR US?

IT'S ALWAYS A POSSIBILITY.

RAY, I'M HERE.

I'M RIGHT HERE WITH YOU.

Man on P.A.: BLUE TEAM TO I.C.U., PLEASE.

BLUE TEAM, I.C.U.

HOW DID HE END UP COMING HERE ON HIS OWN LAST NIGHT?

I HAVE NO IDEA.

I WAS ASLEEP UNTIL THE NURSE CALLED.

THIS IS SO UNLIKE HIM.

HE JUST SLIPPED OUT IN THE MIDDLE OF THE NIGHT.

I'D LIKE TO BRING MY SON BACK IN

SO HE CAN SEE HIS DAD'S OKAY.

OKAY, I THINK THAT'S OKAY. BUT LET'S BE BRIEF.

I'D HATE FOR ANYTHING SCARY TO HAPPEN AGAIN

WHILE HE WAS BACK HERE.

I'LL TAKE HIM RIGHT BACK OUT.

OKAY.

IT'S A MYSTERY ON WHAT WAS MAKING HIM SO SICK.

HE'S JUST IN HERE. IT'S OKAY.

ALL RIGHT.

SAY GOOD NIGHT TO DADDY, TAYLOR.

SHOULD I WAKE HIM UP?

NO, HONEY. HE'S SLEEPING.

JUST SAY GOOD NIGHT.

GOOD NIGHT, DADDY. SLEEP TIGHT.

SEE YOU IN THE MORNING LIGHT.

AND ALL I CAN THINK OF AT THAT MOMENT IS,

"I SURE HOPE SO."

SHE'S IN A-FIB WITH R.V.R.

Narrator: DR. GARVIN'S PATIENT IS EXPERIENCING

AN IRREGULAR HEARTBEAT AND CHEST PAINS

IN ADDITION TO OTHER PUZZLING SYMPTOMS

THAT ARE UNUSUAL IN A TEENAGER.

MY HEART FEELS LIKE IT'S GONNA JUMP OUT OF MY CHEST.

Narrator: NOW SHE HAS TO FIGURE OUT WHY BEFORE IT'S TOO LATE.

OH, I'M SCARED!

PLEASE. YOU HAVE TO HELP HER.

Dr. Garvin: MORE AND MORE SYMPTOMS ARE DEVELOPING

THAT I CAN'T WRAP MY HEAD AROUND.

LET'S GIVE HER ANOTHER 150 OF AMIO,

AND LET'S MAKE SURE THAT ANEMIA PANEL WAS SENT.

OKAY.

-BLOOD IS HERE. -GREAT.

CAN YOU HANG IT AND RUN IT OVER TWO HOURS, PLEASE?

WE HANG THE BLOOD, AND THEN WE WAIT

TO SEE THE EFFECT IT HAS ON OUR PATIENT.

HOW ARE YOU FEELING?

MY HEART'S NOT RACING AS MUCH.

HEART RATE IS DOWN TO 110.

B.P. IS UP TO 100 SYSTOLIC.

Dr. Garvin: THANKFULLY, THE BLOOD THAT WE HANG

AND THE INCREASED MEDICATION WE GAVE

IS MAKING OUR PATIENT FEEL BETTER.

BUT I KNOW THIS IS JUST TEMPORARY.

I STILL HAVE TO FIGURE OUT WHAT IS CAUSING

ALL OF THESE PROBLEMS.

SO, MY PATIENT HAS STABILIZED FOR NOW,

SO I THINK IT'S OKAY TO WALK OUT AND SEE ANOTHER PATIENT.

[ COUGHING ]

I NEED HELP IN HERE.

[ COUGHING CONTINUES ]

O2 SAT IS AT 77%.

SHE CAN'T BREATHE.

THIS PATIENT'S NOW IN RESPIRATORY DISTRESS.

WHAT IS GOING ON WITH HER?

[ COUGHING ]

WHAT DO YOU THINK SHE HAS?

WELL, I'M NOT SURE.

WE WILL HAVE MORE INFORMATION ONCE WE GET THOSE RESULTS.

IF YOU COULD JUST WAIT IN THE WAITING ROOM.

Narrator: DR. SESSA'S PATIENT FEARS SHUNNING

BY HER FATHER AND HER COMMUNITY

IF THEY FIND OUT SHE'S PREGNANT OUT OF WEDLOCK.

SO THE DOCTOR HAS GONE OUT ON A LIMB

TO PROTECT HER PATIENT'S PRIVACY.

WHAT HAPPENED? DID YOU TELL HIM?

NO, I DIDN'T TELL HIM ANYTHING ABOUT THE BABY.

Dr. Sessa: I'VE NEVER BEEN IN THIS POSITION BEFORE,

AND IT'S A VERY UNCOMFORTABLE POSITION TO BE.

HER CONTRACTIONS ARE TWO MINUTES APART.

IT'S DEFINITELY TIME TO GET HER UPSTAIRS.

NOW GETTING HER UPSTAIRS POSES A PROBLEM.

THERE'S NO OTHER WAY TO GET HER UP TO LABOR AND DELIVERY

WITHOUT PASSING THE WAITING ROOM.

HER FATHER'S THERE.

RUTHIE!

I THOUGHT SHE WAS GETTING SOME SORT OF SCAN.

YES, WELL, SHE WAS. SHE IS.

HE'S NOT HAPPY WITH ME

BECAUSE I'M NOT GIVING HIM DEFINITE ANSWERS.

WHO'S THIS?

AND I'M WORRIED ABOUT WHAT THE OB MIGHT SAY

BECAUSE SHE HAS ALREADY MADE IT CLEAR

THAT SHE DOESN'T SUPPORT ME ON THIS.

I'M DR. LIN. I AM A SURGEON.

SHE NEEDS AN OPERATION?

WE'RE CONCERNED ABOUT SOMETHING CALLED OVARIAN TORSION.

SO, YES, WE MAY NEED TO OPERATE.

AS SOON AS THE OB SPEAKS TO THE FATHER, IT'S A BIG RELIEF.

I DON'T KNOW WHAT THAT MEANS.

IS SHE IN DANGER?

POSSIBLY.

NOW, I'M AFRAID TIME IS OF THE ESSENCE.

I'M SURE DR. SESSA WILL KEEP YOU INFORMED.

I KNOW SHE'S ON MY SIDE,

BUT MORE IMPORTANTLY, ON THE PATIENT'S SIDE.

WHY DON'T YOU WAIT RIGHT HERE?

SHE'LL BE OKAY.

WE FINALLY GET THE PATIENT UP TO LABOR AND DELIVERY.

NORMALLY, SHE WOULD BE OFF MY SERVICE,

AND HER CARE WOULD BE EXCLUSIVELY

IN OTHER PEOPLE'S HANDS.

RUTH, I NEED TO ASK YOU ONE MORE TIME --

ARE YOU SURE YOU WANT TO PUT THIS BABY UP FOR ADOPTION?

BUT GIVEN THE CIRCUMSTANCES, I NEED TO STICK AROUND

AND MAKE SOME ARRANGEMENTS.

AND YOU CAN DO THAT, AND NOBODY WILL FIND OUT?

YES.

YES, I'M SURE.

OF COURSE, SHE'S ABLE TO GIVE THE BABY UP FOR ADOPTION,

BUT IN ORDER TO DO IT SECRETIVELY,

WE NEED TO CHANGE THE BABY'S SURNAME

AND TRANSFER IT TO A DIFFERENT HOSPITAL.

THIS CAN BE VERY DIFFICULT.

I'M GONNA GO START WORKING ON IT.

OKAY?

[ GROANS ]

[ BREATHES DEEPLY ]

YOU OKAY?

Dr. Sessa: AND THEN A SOLUTION JUST HITS ME.

HI, SWEETIE. I'M SORRY TO WAKE YOU.

LISTEN, I KNOW THIS IS SUDDEN,

BUT I WOULD LIKE FOR US TO ADOPT A BABY,

AND THE BABY'S BEING BORN TONIGHT.

TALK ABOUT TESTING YOUR MARRIAGE.

GO GET ME THE AIRWAY CARD.

GET ME 20 OF ETOMIDATE AND 100 OF SUCCS.

WHAT'S HAPPENING?

Dr. Garvin: WE NEED TO GET HER INTUBATED SOON,

'CAUSE WITH HOW FAST HER OXYGEN LEVELS ARE DROPPING,

SHE COULD DIE.

PLEASE HANG ON, MAXINE.

I WOULDN'T KNOW WHO I AM WITHOUT YOU.

♪♪

[ PADDLES WHINING ]

RUTH, I NEED TO ASK YOU ONE MORE TIME --

ARE YOU SURE YOU WANT TO PUT THIS BABY UP FOR ADOPTION?

YOU CAN DO THAT, AND NOBODY WILL FIND OUT?

YES.

YES, I'M SURE.

Narrator: DR. SESSA HAS AGREED

TO KEEP HER PATIENT'S PREGNANCY A SECRET FROM HER FATHER.

IT'S A NEARLY IMPOSSIBLE TASK IN THE MIDDLE OF THE NIGHT

WHEN HOSPITAL ADMINISTRATION

ISN'T AVAILABLE TO HELP WITH PROTOCOLS.

WITH NO NURSERY TO HIDE THE BABY

AND A NAME CHANGE NEEDED...

I'M SORRY TO WAKE YOU.

Narrator: ...DR. SESSA GETS AN IDEA.

I KNOW THIS IS SUDDEN,

BUT I WOULD LIKE FOR US TO ADOPT A BABY.

MY HUSBAND WAS LIKE, "EXCUSE ME?"

NO, REALLY. DON'T BE SURPRISED

IF I COME HOME WITH A BABY -- FOR REAL.

I'M ALREADY A MOTHER, AND I WOULD LOVE ANOTHER CHILD.

WHAT BETTER CHILD TO HAVE THAN ONE

THAT I ALREADY HAD SUCH A STRONG CONNECTION TO?

YES.

OKAY. WHAT'S THAT FOR?

BLOOD TRANSFUSION FOR THE AMISH GIRL.

I'VE GOT TO GO. I'LL CALL YOU BACK.

I'D BEEN SO BUSY WITH THE ADOPTION

AND THE FATHER THAT IT DIDN'T OCCUR TO ME

THAT THERE WOULD BE A PROBLEM WITH THE LABOR.

WHAT'S GOING ON?

GOT HER CBC BACK, AND HER HEMOGLOBIN IS LOW.

HOW LOW IS IT?

5.

IF HER HEMOGLOBIN IS LESS THAN 5,

IT GREATLY INCREASES THE RISK OF MORTALITY,

BOTH TO THE BABY AND THE PATIENT.

AND HER FETAL HEART TONES ARE DROPPING --

BELOW 100.

SHE'S ONLY 3 CENTIMETERS DILATED.

BABY'S ONLY DROPPED ONE STATION.

DR. SESSA, IS EVERYTHING OKAY?

EVERYTHING'S GONNA BE OKAY.

THE BABY HAS FAILED TO PROGRESS,

WHICH MEANS THAT SHE'S NOT FULLY DILATED

AND THEREFORE NOT READY TO PUSH.

THE BABY MIGHT BE AT RISK OF NOT GETTING ENOUGH OXYGEN.

CALL THE O.R. AND TELL THEM WE HAVE AN EMERGENCY C-SECTION.

RUTH, THEY'RE GONNA HAVE TO TAKE YOU

TO THE OPERATING ROOM TO HAVE THIS BABY.

BUT YOU'RE GONNA BE OKAY.

I'M GONNA GET YOU TO TURN ONTO YOUR LEFT SIDE.

THAT WILL HELP THE BLOOD FLOW TO THE BABY.

[ BREATHES DEEPLY ]

GOOD.

HERE, I THOUGHT I HAD PLENTY OF TIME

TO MAKE ARRANGEMENTS.

BUT NOW THE BABY'S GONNA BE HERE IN LESS THAN 20 MINUTES.

I STILL HAVEN'T MADE ANY OFFICIAL ARRANGEMENTS.

WHEN THE BABY IS BORN,

IT WILL BE REGISTERED UNDER HER NAME,

AND BECAUSE WE HAVE NO NURSERY,

THE BABY WILL BE PUT IN HER ROOM.

RUTH.

I'M SCARED, DR. SESSA.

I KNOW. I'M HERE WITH YOU.

AND HE WON'T KNOW, RIGHT? MY FATHER?

NO, HE WON'T KNOW.

THERE'S NO WAY I CAN KEEP HER FATHER OUT OF THE ROOM ALL NIGHT

UNTIL I REACH SOMEBODY IN THE MORNING.

ALL RIGHT, PEOPLE, LET'S DELIVER A BABY.

I'M DEVASTATED.

I WON'T BE ABLE TO KEEP HER SECRET,

AND IT WILL RUIN HER LIFE.

SLEEP TIGHT.

SEE YOU IN THE MORNING LIGHT.

Narrator: DR. BAKER HAS MANAGED TO KEEP HIS PATIENT ALIVE,

BUT HE STILL NEEDS TO FIGURE OUT

WHY THE MAN'S HEART STOPPED IN ORDER TO TREAT HIM.

NOW WE'RE STARTING TO PUT THE CLUES TOGETHER.

HE'S GOT A HIGH BLOOD POTASSIUM

WITH A LOW SODIUM AND A LOW GLUCOSE.

YOU KNOW, MA'AM, I'M CURIOUS

JUST WHAT MEDICATIONS YOUR HUSBAND WAS TAKING.

OH, GOSH. HE TAKES A LOT OF THEM.

WAS HE TAKING ANY STEROIDS?

I DON'T KNOW.

MAYBE PREDNISONE?

YES.

YES, HE DOES TAKE THAT.

ALL RIGHT.

LISA, WILL YOU GIVE 100 MILLIGRAMS OF HYDROCORTISONE

I.V., PLEASE?

ADRENAL INSUFFICIENCY, YOU'RE THINKING?

EXACTLY.

MAYBE HE STOPPED TAKING THE STEROID.

WE DIDN'T REALLY KNOW.

BUT THAT WOULD CAUSE HIS ADRENAL GLANDS

TO STOP WORKING.

ADRENAL INSUFFICIENCY -- WHAT IS THAT?

THE ADRENAL GLANDS NORMALLY PRODUCE CORTISOL,

WHICH REGULATES BLOOD CHEMISTRY.

PREDNISONE MIMICS THE CORTISOL, AND SO THE ADRENAL GLANDS

DON'T HAVE TO PRODUCE IT ANYMORE.

HYDROCORTISONE'S IN.

AND THAT WOULD CAUSE HIS HEART TO STOP?

IT WOULD CAUSE A HYPERKALEMIA,

WHICH, YES, WOULD CAUSE A CARDIAC ARREST.

SURE ENOUGH, IN ABOUT 15 MINUTES,

HE BEGAN TO WAKE UP.

ALL RIGHT.

FINALLY, IT'S ALL ADDING UP.

HIS HIGH POTASSIUM, HIS LOW SODIUM,

HIS LOW SUGAR,

HIS LOW BLOOD PRESSURE --

IT'S ALL CAUSED BY THE ABSENCE OF STEROIDS IN HIS BODY.

SWEETIE.

HI, RAYMOND. I'M DR. BAKER.

WELCOME TO THE E.R.

WHAT HAPPENED?

YOUR HEART STOPPED.

WHERE WERE YOU? WHERE DID YOU GO?

[ SIGHS ]

UH...

PHARMACY.

OPEN ALL NIGHT.

WHY DIDN'T YOU WAKE ME?

[ SIGHS ]

I DIDN'T WANT TO INTERRUPT YOUR SLEEP.

MY PRESCRIPTION RAN OUT.

LAST NIGHT, I STARTED FEELING SICK.

SO I THOUGHT I WOULD GO GET THE PILLS.

AND ON MY WAY, I STARTED HAVING CHEST PAINS,

SO I CAME HERE.

SO, WE FINALLY GET AN EXPLANATION.

COME ON. HE'S RIGHT OVER HERE.

LOOK WHO'S AWAKE.

HEY, BUDDY.

YOU WOKE UP.

YEAH, I DID.

WHY DON'T YOU COME HERE AND GIVE US A KISS, HUH?

ALL RIGHT, THANKS.

I THINK WE'VE GOT IT ALL WRAPPED UP.

THANKS AGAIN FOR BEING THERE. BYE, NOW.

HEY.

ALL RIGHT, RAYMOND.

WE'RE GONNA ADMIT YOU TO THE HOSPITAL.

YOU'LL STAY OVERNIGHT, AND YOU'LL SEE A CARDIOLOGIST

IN THE MORNING.

THANK YOU.

YOU'RE WELCOME.

RAY, DON'T EVER DO THAT AGAIN.

YOU'VE GOT TO TALK TO ME, OKAY?

YEAH, I PROMISE.

Dr. Baker: MY PATIENT DID WELL

AND EVENTUALLY GOT A HEART TRANSPLANT.

IT WAS A GREAT ENDING TO MY FIRST AND ONLY LVAD CASE.

I NEED HELP IN HERE.

Narrator: DR. GARVIN'S PATIENT HAS A PUZZLING LIST OF SYMPTOMS,

AND NOW SHE CAN'T BREATHE.

O2 SAT IS AT 77%.

MY PATIENT WITH THIS MYSTERIOUS CONDITION --

NOW THIS HAS REALLY BECOME LIFE-THREATENING.

GO GET ME THE AIRWAY CARD.

GET ME 20 OF ETOMIDATE AND 100 OF SUCCS.

WHAT'S HAPPENING?

SOMETHING'S CAUSING HER NOT TO BE ABLE TO BREATHE.

I NEED TO PUT A BREATHING TUBE IN,

AND I NEED TO DO IT NOW.

WE NEED TO GET HER INTUBATED SOON,

'CAUSE WITH HOW FAST HER OXYGEN LEVELS ARE DROPPING,

SHE COULD DIE.

[ COUGHING ]

OH, MY GOD!

FROTHY SECRETIONS COMING OUT OF HER MOUTH.

THAT CAN ONLY MEAN ONE THING, WHICH IS PULMONARY EDEMA.

PULMONARY EDEMA IS WHEN THERE'S TOO MUCH FLUID

ON A PATIENT'S LUNGS.

THAT CAN BE FROM A LOT OF DIFFERENT REASONS.

BUT WHY IN THIS PATIENT, IT DOESN'T MAKE ANY SENSE.

[ COUGHING ]

20 OF ETOMIDATE, 100 OF SUCCS GIVEN.

ALL RIGHT. LET'S GET READY TO ROLL.

LET'S GET THIS PILLOW OUT.

SO, THE ONLY THING I COULD THINK OF IS FROM THE BLOOD,

BUT WE HAVEN'T GIVEN HER THAT MUCH THAT WOULD CAUSE HER

TO BE FLUID OVERLOADED ALREADY.

[ MONITOR BEEPING ]

WHEN I'M FACED WITH A SITUATION

WHERE PEOPLE ARE TRYING TO DIE RIGHT IN FRONT OF ME

AND WHEN THEIR FAMILY IS THERE,

IT'S OFTEN A VERY TRAUMATIC AND TERRIFYING EXPERIENCE.

PLEASE HANG ON, MAXINE.

I WOULDN'T KNOW WHO I AM WITHOUT YOU.

REMEMBER WHEN YOU PUSHED ME OFF THE HIGH DIVING BOARD

FOR THE FIRST TIME?

I'M SORRY YOU HAD TO KEEP ME FROM DROWNING.

I'M SORRY I STOLE YOUR BOYFRIEND LAST YEAR.

AND I'M REALLY SORRY I STOPPED EATING VEGAN

AND DIDN'T TELL YOU.

I KNOW HOW IMPORTANT IT IS TO YOU.

SOMETIMES ALL YOU NEED TO CRACK A CASE IS A CONFESSION.

IS MAXINE VEGAN?

YEAH.

WE PLEDGED TO EACH OTHER TO GO VEGAN.

BUT I WAS CRAVING OTHER FOODS TOO MUCH.

I STOPPED AND DIDN'T TELL HER.

SHE WAS DOING SO WELL ON THE DIET.

AND SHE WAS SO PROUD ABOUT IT.

A STRICT VEGAN DIET CAN MAKE PEOPLE DEFICIENT IN VITAMIN B12.

AND B12 IS ESSENTIAL FOR NORMAL HEMOGLOBIN FORMATION.

DID SHE TAKE B12 SUPPLEMENTS?

I DON'T KNOW. I DON'T THINK SO.

I THINK I MAY KNOW WHAT'S GOING ON WITH HER.

SO, WHEN WE GOT THE RESULTS OF THE ANEMIA PANEL BACK,

IT CONFIRMED OUR SUSPICION --

A RIDICULOUSLY LOW B12 LEVEL.

THIS WAS THE MOST EXTREME CASE

OF B12 DEFICIENCY I'VE EVER SEEN.

AND IF LEFT UNTREATED, IT COULD HAVE BECOME DEADLY.

-OH. -OH, MY GOSH.

IT'S VERY EASY TO FIX.

WE STARTED HER ON B12 SUPPLEMENTS

AND ADMITTED HER FOR OBSERVATION.

THE NEXT DAY, I WENT TO CHECK ON MY PATIENT.

ACTUALLY, YOU LOOKED WORSE THAT TIME WE PERMED YOUR HAIR.

HEY, MAXINE. I JUST WANTED TO CHECK IN

AND SEE HOW YOU WERE DOING.

Together: BETTER THAN LAST TIME

YOU SAW ME.

YEAH, MOST DEFINITELY.

IT SOUNDS LIKE A COUPLE MORE DAYS OF B12 SUPPLEMENTS

AND YOU'LL BE ABLE TO GO HOME.

IS THERE ANY WAY I CAN STAY ON A VEGAN DIET?

IT'S REALLY IMPORTANT TO ME.

I DON'T THINK THAT SHOULD BE A PROBLEM.

THERE'S NO REASON WHY A VEGAN CAN'T MAINTAIN A HEALTHY DIET.

THEY SOMETIMES JUST NEED A B12 SUPPLEMENT.

STILL, I WAS CURIOUS

ABOUT THE UNEXPLAINED BRUISING ON THE OTHER TWIN.

DID YOU GET YOUR B12 LEVEL CHECKED?

OH, TURNS OUT I DIDN'T NEED TO.

SHE FORGET THAT WHEN SHE WAS HELPING ME TO THE CAR

TO COME TO THE HOSPITAL, SHE TRIPPED...

I TRIPPED AND BANGED MY SHINS ON THE CURB.

WELL, THAT EXPLAINS THINGS, THEN.

ONE MYSTERY SOLVED AND ONE TO GO.

SO, WHAT SHOULD I BE SNIFFING FOR TODAY?

OR DID YOU FIGURE OUT WHO STOLE YOUR LUNCH?

OH, I ACTUALLY REALIZED AFTER MY LAST SHIFT

THAT I LEFT IT IN MY CAR.

FIGURES.

I GUESS I'LL STICK TO MEDICAL MYSTERIES.

[ TELEPHONE RINGS ]

OH, THIS COULD BE THE CALL I'VE BEEN WAITING FOR.

Dr. Sessa: I GET A CALL FROM HOSPITAL ADMINISTRATION.

I'D LIKE TO ADOPT THIS BABY.

THIS CAN GO EITHER WAY.

♪♪

I'M SCARED, DR. SESSA.

I KNOW. I'M HERE WITH YOU.

AND HE WON'T KNOW, RIGHT? MY FATHER?

NO, HE WON'T KNOW.

Narrator: DR. SESSA IS TRYING TO HONOR HER PATIENT'S DECISION

TO KEEP HER PREGNANCY

AND ADOPTION A SECRET FROM HER FATHER.

BUT THE DOCTOR HASN'T HEARD BACK

FROM THE HOSPITAL ADMINISTRATION,

AND SHE'S RUNNING OUT OF TIME.

I AM DREADING WHAT'S GONNA HAPPEN

AFTER THE BABY'S DELIVERED.

I GAVE HER MY WORD,

AND NOW I MIGHT NOT BE ABLE TO PROTECT HER.

[ TELEPHONE RINGS ]

OH, THIS COULD BE THE CALL I'VE BEEN WAITING FOR.

NOW I GET A CALL FROM HOSPITAL ADMINISTRATION.

THIS CAN GO EITHER WAY.

I EXPLAIN WHAT'S GOING ON.

I'D LIKE TO ADOPT THIS BABY.

NOW IT'S REALLY THEIR CALL,

AND I PRAY THEY MAKE THE RIGHT ONE.

REALLY?

OKAY. I UNDERSTAND.

THEY WOULDN'T LET ME ADOPT THE BABY.

THEY SAID THAT WE WOULD HAVE TO GO THROUGH THE ADOPTION AGENCY.

IT WAS THE ONLY LEGAL WAY TO DO IT.

I'M DISAPPOINTED

BECAUSE I REALLY WOULD HAVE DONE IT IN A HEARTBEAT.

NOW I'M REALLY WORRIED ABOUT WHAT ELSE THEY'RE GONNA SAY.

YES?

REALLY? OKAY, GREAT.

THEY TELL ME THAT I'M NOT LEGALLY REQUIRED

TO TELL THE FATHER WHAT'S GOING ON.

SO, I CAN GO AHEAD AND TRANSFER THE BABY?

IT'S A BIG RELIEF.

NOW MY FIRST PRIORITY IS TO MAKE SURE

THESE ARRANGEMENTS GET EXECUTED

BEFORE THE FATHER GETS WIND OF WHAT'S HAPPENING.

[ CRYING ]

HOW IS SHE?

SHE'S DOING GOOD.

BREATHING WELL. APGAR IS 9.

WELL, HEY, LITTLE ONE. WELCOME TO THE WORLD.

IT WAS ONE OF THE MOST EMOTIONAL NIGHTS OF MY CAREER.

AND AS A DOCTOR,

WE ARE TAUGHT TO DISTANCE OURSELVES EMOTIONALLY.

BUT THIS TIME, I COULDN'T DO IT.

♪♪

HI.

THE BABY?

THE BABY'S FINE.

WE DON'T HAVE A NURSERY HERE,

SO THE BABY'S BEEN TRANSFERRED TO CENTRAL HOSPITAL.

AND A SOCIAL WORKER WILL FIND THE BABY A GOOD HOME.

AND MY FATHER?

HE DOESN'T KNOW A THING.

I'VE MADE ARRANGEMENTS SO THAT HE DOESN'T GET A BILL

AND NO ONE WILL EVER KNOW.

THANK YOU.

YOU'RE THE NICEST PERSON I'VE EVER MET.

YOU'RE WELCOME.

I FEEL AS THOUGH WE WERE ABLE TO GIVE THIS GIRL HER LIFE BACK.

FATHER, I'M OKAY.

THEY SAID YOU HAD A PROBLEM WITH YOUR...

WOMAN PARTS, BUT THEY FIXED IT.

WE ENDED UP TELLING THE FATHER THAT SHE HAD AN OVARIAN TORSION

AND WE SURGICALLY REPAIRED IT.

THE INCISION WOULD BE IN THE SAME PLACE

AS HER C-SECTION SCAR,

AND, THEREFORE, IT WAS A GOOD, PLAUSIBLE EXPLANATION.

YEAH, THEY DID.

THEY FIXED EVERYTHING.

The Description of Doctor's Dilemma