So no funeral . Well do a memorial next week in st. Catharines. Ill scatter his ashes here. Fun. Yeah, not so much. Wake up, honey, wake up. Is that her . Thats her, right . Definitely. Excuse me, dr. Reid . Yes . exhales my names marvin kapogrecko. This is my son. I have a sarcoma. Nice to meet you. His name is lou. Luke . Lou. Are you the expert . Um. Not an expert, no. June 10th, 2011. Preoperative radiotherapy on Retroperitoneal Liposarcoma results and complications a review by dr. Alex reid. It was my third year paper. Wow. Mine was boils. You found my paper online . I found it. The internet makes my dad say bad words. laughs laughs well, thats thats true, buddy. We are so glad we found you. What can i do for you . Everything, doctor. exhales im not really an expert, mr. Kapogrecko but you can still help us, right . siren wailing in distance so. kissing see you. laus chuckles oh, well, well, well, well, well. clears throat celebrating . You could say that, yeah. Actually, some news the board just extended my term as chief here. Five years. Wow, thhey, congtulations. Mmhmm. Yes, i should be, uh, signing the paperwork later this afternoon. Dont get so excited, joel, okay . cause youre embarrassing me now. Whatwhat, uh. They didnt meet your terms . No, the terms were met. So . What . I dont know. Its the job, i guess. You know, yyou sort of never feel good, you never feel bad, you just kind of feel like youre getting. The b done. Trapped at the top. Poor joel. 26 specialists in this hospital, every single one of them wants something from you. What do you want . Thats the point. Dont matter what i want, dana. Of course it matters. cell phone vibrating guess who this is, by the way. The nurse . Im gonna say someone who wants something. phone clicks and look at that. Im correct. Goodbye. Her names marla. You named your tumor . Its after his favorite nurse. At the grace in winnipeg. She gave an awesome shark figure. chuckles like, awesome shark figure. laughs okay, lou, im gonna check your patellar reflexes. You ready . Hmm. Lets let this dangle. Im gonna hold the back of your knee. Relax. Very good. Now. Push against my hand with your shin. Oh. Wow, youre very strong. Ye, i play sports. Thats what it is. You have a good kick. Yeah. This imaging is it recent . Two weeks. Lets take a look. But the growth has actually slowed, and if you look at it, his, uh. His white cell count is normal. His lir seems to be clear. Youve done your research. Well, we had to. We, uh. Well, tumors are kind of our thing. Yeah, we know a lot about tumors. The doctors back home they dont know what the hell theyre talking about. Why do you say that . When we first went in and this was a year ago he had pain in his abdomen. It hurt when i breathed. You know what the doc gave him . What . Laxatives. He said lou was constipated. They sent him home to eat prunes. Im sorry. This is your oncologist . No, its a g. P. In our small town. We live on a farm. I saw the doctor on the second day of school. They didnt find marla till friend andrews birthday. Eight months. And he shipped us off to winnipeg, then they tell us its too late, theres nothing that can be done. And were supposed to accept that . So youve come here for a Second Opinion . Second, third, sixth. You can cut it out, dr. Reid. Cant you . Ill talk to the chief of surgery. Stay put. Ill be back. Im not changing my mind. Were their last shot, joel. This is a hospital, alex. Its not a refuge for lost souls. I think i can help him. Alex, i understand you just lost your brother. Thats not what this is about. Alex, this tumor has its hooks in bone and tissue, in organs and veins. Its do you want my advice . Yeah, thats why im here. Dont do it. I agree with the surgeon in winnipeg. I mean, we should let this boy live out his last days wi a degree of dignity. No, we cant give up on him. Okay, ill tell you what. You can convince one doctor in this entire hospital that this tumors operable, you go nuts. Joel otherwise, you should just accept what their oncologist has said, and what i am telling you right now. Which is . Which is absolutely not. sighs catch a tiger by. Mr. Kapogrecko. What did he say . exhales deeply huh . chuckles okay, buddy. If you have moderate to severe plaque psoriasis. Isnt it time to let the real you shine through . Introducing otezla, apremilast. Otezla is not an injection, or a cream. Its a pill that treats plaque psoriasis differently. Some people who took otezla saw 75 clearer skin after 4 months. And otezlas prescribing information has no requirement for routine lab monitoring. Dont take otezla if you are allergic to any of its ingredients. Otezla may increase the risk of depression. Tell your doctor if you have a history of depression or suicidal thoughts, or if these feelings develop. 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I predict you will sink step by step into a bottomless quagmire. Mmhmm. And you can quote me on that. Thank you. Press against my hand, please, ida. Yeah, you seem to have lost a little power since you fractured your leg. Lets lift this up. Ill check your extension there ohh what is it . You do know that riskseeking behavior can be a side effect of the dopamine you take to control your tremors, right . Its just a scratch ticket. Im not running away with a gigolo. chuckles door opens ida . Dr. Hamzas ready to start the study. What study is this . Were going biking. pounding on door dr. Murphy i need your help right now pounding continues i need your help. Right now. stammers walter. Our appointments not till 4 00. I brought her in like you asked me to, dr. Murphy, so you could help me say goodbye to vallenween. Yes, and we discussed that wed meet later. Dr. Murphy, shes gone. Shes gone, and i lost her. Ohwalter. Vallenween vallenween walter. Vallenween walter panting i thought we were making good progress. My heart my chest is, uh. Walter, you need to calm down. Youre feeling anxious because okay. I cant think. I. Walter i. panting where did you last see her . She was with me in the lobby. Somebody kidnapped her. chuckles or somebody found her, and shes safe. She cant take this sweater off. She doest have thumbs like us. Someone took it off her. Walter. Mm. I need you to calm down, okay . Oh, boy. Oh, boy, dr. Murphy, im not feeling very well at all. Walter. Walterwalter oh. Okay. Walter panting and muttering take some breaths, okay . Can i get a stretcher, please . Dr. Murphy, you need a hand here . Yeah. This is. Walter. Hes complaining of chest pains. Okay, take a nice, deep breath, walter. exhales what happened . He lost his guinea pig. breathing heavily mmhmm. walter sighs bicycle therapy. I know. Its exciting, right . Improving gait and postural therapy in parkinsons patients using bicycles. So how much . Im sorry . How much am i spending . Uh, 223,000. Youve got to be kidding me. I dont kid. But watch this. Okay. Can you get up . Okay. Ida, step. Shahir, she doesnt have this kind of mobility. Step, ida. Step. Do you see how well shes walking . Hmm . Step. We call it kinesia paradoxica. Nurse. Guided movements can help these patients become more mobile. So does it last . Well, the tremors and rigidity, um, start up almost immediately once the exercise is stopped. Okay. Thats great. Easy. lowered voice so. What is the point . lowered voice we dont know the point, which is what is so exciting. 200,000 . No, 223,000. Bicycles . Mmhmm. Bicycles. indistinct conversations hey. Wow. Thats the most advanced liposarcoma ive ever seen. Do you think its operable . I mean, that would be a long shot, but, uh, its better than. breathes deeply well, youre gonna need a lot of skill, a lot of hands, and a lot of luck. Will you help . Tumors too big. I know. When the digging is done, youll have a big hole to fill. No way. Would you do a pedicle flap . Pe. Rotation. And stop trying to close your girlfriends deals. Ah, come on, dana, all you got to do is come in for a patch job. Its a st. Jude special. The patron saint of. Lost causes. And kids. This kid, dana hes amazing. He would remind you dont say it. Molly. sighs you know, that really is below the belt, playing the dauger card. Okay, ill tell you what. You drain this, and im in. I dont golf. Oh, thats too bad. Fine. New england vs. Miami. Miami. Reycraft, can i talk to you . Yeah, yeah, one second. Denver oakland. Denver. I want you to scrub in on my liposarcoma. Which part of sinking into a bottomless quagmire didnt you understand . Atlanta vs. New orleans. Charlies in. Dude is your boyfriend. Doesnt count. Atlanta vs. New orleans. New orleans. What are you doing . Girl has picked every winner two weeks in a row. I didnt know you were a football fan. Im not. He names two cities, i say where id rather vacation. Look. I need fast hands in there. Name your price. Its like indecent oposal. No. Six weeks. Two months. Youre on. And you take my niece jada to see the wizard of oz. We didnt shake on it. Dont care. I hate musicals. Okay. Sure. Speaking of which, wheres my cut from lasweek . How much did you win . Lets just say business is good. Im telling you, she has got a horseshoe up her butt. Ive never met anyone that lucky. Huh. Maggie, wait. So we need to deliver this bad boy en bloc, in one piece. Reycraft and i will free it from the intestines. Then i can extend the incision d use the perispinal muscles as my posterior medial margin. Well go in the front door and start cleari house. Then ill come in and clean up after you. And what is my job . You are our goodluck charm and our muscle. Muscle . Yeah. Once we lift up the tumor to start cutting, you cant put it down. Okay . Okay. Lets do this. Anything the tumor touches has to go. His chest c. T. Showed metastases, but first id like you to meet the patient. sighs howd she get you to say yes . Oh. Challenged her to sink a putt. And she drained . Nah. Missed it by a mile. How about you . I hate musicals. Fair enough. door opens lou, can i introduce you to some folks . Yeah, sure. This is dr. Harris. Hi. Hi. Dr. Reycraft. Hi. How you doing, champ im maggie, and this is dr. Kinney. Call me dana. This is youream of surgeons. Were gonna hunt down the tumor, and when you wake up. No more marla . No more marla. Okay, well, text me when youre done. All right. Well see you soon. Okay. What happens when lobster gets grilled, baked, and paired with even more lobster . You get hungry. And you count the seconds until red lobsters lobsterfest is back with the largest variety of lobster dishes of the year. 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Thats great it is great both simultaneously thank you. At discover, we treat you like youd treat you. She wont let go. Shell sign those papers eventually thats not soon enough. I cant be talking to her about you right now. You saw what hpened you dont understand what this is like, charlie. I am in hell. I see her. I see life all around me, and i cannot be a part of it. elevator bell dings monitor beeping steadily oh, this tumor is heavy. Hang in there, maggie. The intestines are more involved than i thought. By the way, my niece that youre taking to the show she isnt entirely toilet trained. alex could you hold it up a bit higher . Yeah. Hows that . Good. Reycraft, how do you feel about this kidney . monitor beeps not good. Being invaded by the tumor on its lower pole. Then its gotta go. Clamps. monitor beeps clicking clamp. sighs snips okay. The kidney is free posteriorly. Maggie, youre gonna have to hold that up, too. Awesome. Im feelinsome resistance here. Uh, could be the presacral plexus. sighs i dont know. I just. I cant there. There is a monster vein heading right into the tumor. I ci cant visualize it without risking tearing it out. squishing youre gonna have to cut it. Blind . I dont even know what it is. You have any other ideas . sighs satinsky clamps. Okay. The vein. clicking metz. snips twice got it. Oh, hell, its the cava. You cut off blood supply to the legs. You need to call cardiac. Get someone down here to do a dacron graft to replace the cava. No, we dont have time. His sats could drop. You cut the damn vein that brings all the blood from his legs to his heart. We have to deal with it. Can i just put the tumor down while you guys no no okay. Hes young. Hell grow collateral veins. Little roads that take over after the highways gone. Are you confident with this . Yes. Sats and pressure are holding. heartbeat whooshing thank god they found her. Where was she . In an elevator. sighs okay, walter, im just looking at your heart right now. Are they feeding her . They shouldnt give her oranges. They give her mouth sores. They will not feed her unless you tell them to. But lets worry about working on you first, and then well worry about vallenween. Your left ventricle is barely moving. Put a stent in it, problem solved. Her mother abandoned her, and thats why she wound up in a pet store. So thats why i cant give her to another pet store. And the creeps that had her before, they never would change her hay. So when i adopted her, all her hair was falling out, and she was, like, scared of everybody, but now she has got, like, this silky coat, and she is, like, so friendly. Isnt she friendly, dr. Murphy . Youve definitely given vallenween a new lease on life. Its true. Dr. Murphy is helping me see how dependent i am on her. Walters overly attached to vallenween, so were working on strengthening the attachments to the people in his life i just want to give her a good home. I cant bear the thought of her going to some strangers. Ill take her. At . You will . You will . Yeah. They want lettuce, right . Arugula has the most calcium, but yes. I will take her. I will give her a good home. Dr. Bell, that is so nice. Dr. Murphy, isnt that amazing . Uh. Ill see you in a bit, walter. exhales door closes everyone, in order for us to get the most out of this little spin class were doing, were gonna have to really push ourselves and light up the thalamus. Whos ready to light that up . Heering great. Okay. Lets. disco music playing feel the pain,nd. with patients oxygenate the brain. Great. Joel, youre more than welcome to join the spin class here. Ill be doing a little guided imagery. No, thank you. m just here to watch hope zions money disappear into the toilet. Sorry . Ida wheels spinning okay. Careful now. I can do this. Ida, just. Careful. clicks loudly ohh ida ida clamoring joel hey, hey, hey. Ida, are you okay . stammers sats and pressure again. Still holding. exhales okay, so far, so good. Kidney is free anteriorly. Hes tolerating the rection. I dont feel any cancer on the liver. Feeling the vertebral bodies. sighs there is definitely more tumor there. Near the spine. Give it a feel. Tell me what you think. Page dr. Harris, please. Theres no plane. Yeah. Damn. I think the tumors invading the l3 vertebra. The c. T. Didnt show it. Tumor has the same consistency as the surrounding tissue and fat, so it wouldnt show on the c. T. Right. Did you reach dr. Harris . Hes not picking up. We, he should be answering. He knows that we need him. man dr. Reid . beeping continues dr. Reid . Give him his lidocaine drip. Stabilize him. Whatwh where are you going . gloves snap reycraft, make sure we didnt miss any tumor. Wassup . Im hannibal im gonna use samsung pay to get a katzs deli pastrami sandwich. katzs employees hey hey whats up . Hey can i pay with my phone . You mean like apple pay . We dont got that. No like samsung pay. Kind of works everywhere. Even on this janky old thing. He wants to pay with his phone. I want to pay with my phone. Dont look at the cameras mike. It doet work. Watch me. Boom oh dont let a cracked windshield ruin your plans. Trust safelite. With safelites exclusive on my way text youll know exactly when well be there. Giving you more time for what matters most. team sing safelite repair, safelite replace. Marie callender knows that a homemade turkey dinner can make anyone slow downand pull up a seat to the table. Thats why she takes the time toseason her turkey to perfection, and roast it until its just right. A healthy helping of delicious gravy. Marie callender spends time on the little things, so that you can spend time on what really matters. Marie callenders. Pick up, pick up, pick up. Dr. Reid . Mr. Kapogrecko. Wh shouldnt you. gasps no. No. Itits okay. There were complications during lous surgery. Hes not out of the woods yet, but we managed to stabilize him. Oh exhales and sniffles i thought you were gonna tell me that he died. Thats, uh, how it happened with his mother. I mean, you never expect a doctor to come out and tell you that. sniffles marvin, hes hanging in there. Hes smarter than me. And he never ges up. Hes a good kid. No, hes a great kid. We are gonna get through this. Okay . sighs just hang on a little bit longer. buttons click sighs, under breath come on, charlie. Answer the damn phone. You lied to my patient. What, about adopting his guinea pig . Yes. Youre not really gonna do that, are you . No, im not. But it worked, right . He feels better. I cant lie to my patients, and that means that you cant lie to him with me. The most important part of my care is trust. Dr. Murphy, we give patients placebossugar pills. They heal. They feel better. That is good medicine, too. Everything that he said about that guinea pig is true about him. He was abandoned by his mother. He was malnourished, incommunicive. His adoptive parents gave him onetenth of the love and encouragement that he needed to be a healthy man with healthy attachments to people. Guilt trip recved. Okay, now im gonna have to give that guinea pig back to him, and everything we worked on is gonna backslide. He may not ever part with it again. You gonna waste time backsliding . That is a choice. Right now your patient is on his way to being healed. That is your choice. telephone ringing in distance horn honks in distance clears throat you canceled the study. Shahir, wont you come in . I am in. Joel, i dont understand your decision. Your patient fell. Shes your patient, too. She may have sprained her wrist. Yes, because shes old. She has parkinsons. But soon shell be frozen. She wont be able to move at all. I mean, i. It feels a little pointless. Its not pointless, joel. sighs i believe if a patient seeks treatment early enough, cycling can be just as effective as deep brain stimulation. You injured your patient. It was minor. Okay, if hope zion is spending money, i wanna see concrete results and no lawsuits. So then the outdoor component thatsthats out of the question. Is it . Im sorry, shahir. I. I feel bad. Nah. You dont feel bad. You dont feel anything. Trust me, im a bit of an expert on that. But, see, ii have aspergers. Whats your excuse . Three months you were stuck like this wandering these halls . Yep. Alex was here fighting for my life, searching for a y to bring me back. sighs well, im dead, charlie. Theres. Theres no coming back from this. I know. She always felt responsible for you. I think in a way she feels like she let you down. Maybe thats it. Maybe thats why im still here. Maybe its my turn to take care of her. And when i know that shes okay, illill move on. That could take a while, luke. Right . In the meantime, lets, um, lets try this funeral home release. Couldnt hurt, right . Baby steps. Get her to sign it when i see her, and well see what happens. Thanks. I really appreciate you helping me figure this out. Hey, man, this is apparently what i do. Charlie. Hey i was, uh. Weve been paging you. We need you in the o. R. Now. Okay. Ill sign the release