Previously on "Black Box"...
- I think we need to talk. - Yeah.
I took something to help me get through the night.
Thank you so much for understanding.
You're keeping something from me.
Tell me now.
I'm Esme's mother.
- She doesn't know? - No, no.
I'm crushing the books day and night,
but it's not sticking.
- You could try something new. - What's that?
The transcranial direct current stimulation machine.
- I haven't broken up with Will. - So?
So I need to make a decision.
Will, I'm so sorry.
I can't do this anymore.
There's Eggs Benedict under there.
Yeah, I like the fruit-colored O's.
That's brain food.
Is that work?
No.
A woman?
No, it's a buddy of mine in oncology
reminding me the Celtics are on today.
Don't care.
What are you doing?
I only like the cherry flavor.
You're kidding, right?
No.
Close your eyes.
Open your mouth.
What flavor?
It's definitely cherry.
Grape.
Dream stealer.
I thought I could taste color.
I guess you can cross synesthesia off your talent list.
Cyclone.
What?
Four down... It's "cyclone."
- Hello, doc. - Hey. Come on in.
Catherine, this is Joey Giordano,
my indispensable right hand.
Joey, this is Catherine.
Hello.
Per lei, signorina.
Thank you.
And don't let him fool you. He's from the Bronx.
No secrets from the doc here. He knows all.
Good news... I think you won the publishers clearing house sweepstakes.
Again?
Your car is out front, at the curb.
- No rush. - Thanks.
Thank you.
Thanks, Joey.
- Nice meeting you. - And you.
I thought they'd go nice with your hair.
Allow me.
Ohh!
Are you okay?
- Ohh! - Joey!
Joey, talk to me.
Pain, awful... like the worst headache of my life.
Let's get him to the Cube.
All right, get him in the car. I'll drive.
- Help me. - Ohh.
Synced by emmasan www.addic7ed.com
Sorry to give you so much trouble, doc.
Come on, Joey. You're no trouble at all.
Are the pain meds helping? You feeling okay?
Good.
Well, I called your wife. She's on her way.
Now, I'll need to check imaging to confirm,
but I think we'll need to operate.
Long as I'm in your hands, I know I'll be all right.
All right.
Mr. Baker? Excuse me.
I'll be doing your intake today.
You!
You leaving me sitting here, waiting like this, huh?!
You have no right!
Do you know how long I've been waiting?!
I'm sorry you were inconvenienced.
Could you tell me what brings you here today?
Look at me, okay?
Look at me.
Really look at me. I'm a mess.
I'm not normal right now.
I have these emotions, okay? I laugh. I cry.
Right now, I want to throttle you.
I want to... I want to take your head,
and I want to pop it right now.
How about that?!
So you're having mood swings.
Um... that must be awful for you.
It's not how I'm feeling.
It's... it's what I'm feeling, okay?
I feel everything,
and it's agony.
I feel too much.
And I have a cold.
Okay. So, I'm looking at your lab results,
which just came in, and I see here that you have...
No love in my life.
I see here what the problem is.
According to your urine sample,
you're under the influence of methamphetamines.
What? No.
Wait a minute. No, no, no, no, no, no.
Please.
I don't do drugs, okay?
I'll... look, I'm supposed to speak to doctor, uh...
- Dr. Black? - Yeah.
I'll see if we can't get you a psych consult instead,
um, possible rehab.
What?
No, wait, wait, wait, wait.
This is Dr. Phoebe Schwartz, interventional radiologist.
As you suspected...
Joey has a sentinel bleed from a Berry aneurysm.
"The worst headache of my life" kind of gave it away.
The main symptom is...
A thunderclap headache,
because the onset is sudden and severe.
Whatever. Everyone knows that.
I can easily coil it before it rebleeds.
Well, the aneurysm's in a distal arterial segment,
less accessible by coiling.
It's also small with a wide neck,
which makes it the perfect candidate for surgical clipping.
For coiling, as well.
I can thread a catheter, no problem.
It's far less traumatic, with equally good results.
Well, I disagree.
I think there's a higher risk of thromboembolism with coiling,
not to mention recurrence.
You just want to do this one yourself.
Because I believe I can give Joey the best possible outcome.
And I care about this guy.
You ever stay in a hotel and you needed help?
I'm talking about when you're sick with the flu
and you can't get out of bed and you feel like you're gonna die.
Call a doctor.
A doctor's not gonna bring you his wife's homemade soup.
So what you're saying is, Joey is like family.
All the more reason to let me handle this one.
And deprive my patient of the best care available?
Not a chance.
Going on record here.
Coiling is the better option.
Okay, relax your arms. Good.
Skylar's school insisted I have him evaluated.
He's just a little quiet.
That's all it is. He's fine.
Skylar?
Hey. Answer the doctor, honey.
How long has he been unresponsive?
Unresponsive? He's just shy.
He's in his head all the time.
He can go days barely speaking.
Uncross your legs and relax.
Good boy.
And how's his general health?
He's a delicate kid.
He's had fevers that come and go for a while.
I treat him with herbs and a natural-food diet...
No dairy, no sugar, restricted carbs, of course.
He's hyporeflexic.
A natural-food diet is always good.
Is he up to date with his vaccinations?
Oh, no. He's never been vaccinated.
Why not?
I won't have my child get autism.
There is no connection between autism and vaccinations.
According to Big Pharma.
So he's not been tested for measles, mumps, or rubella?
No need. He's already had the measles...
Five years ago, when he was 3 years old. It was no big deal.
Okay. And did he see a doctor?
No.
Okay.
So, I'd like to do some diagnostic testing,
and, um, and I'd like to do a spinal tap.
- A spinal tap? - Yeah.
Whoa.
Uh, you're scaring me.
Do you think something serious could be wrong?
We'll do the testing, wait till we get the results,
and we'll take it from there, okay?
Get Dr. Farnery to do a spinal tap ASAP, okay?
Okay.
You wanted to see me, Dr. Black?
Yes, um, Tinker...
She said that you did an intake of a patient
about an hour ago... Uh, Fred Baker.
Why didn't you call me?
No need to waste your time.
Urine tested positive for meth.
I turfed him over to psych.
You turfed him before I could see him?
Could I see his lab results?
Mm-hmm.
I'm gonna need that back.
It's basically got my whole life on it.
Yeah, in a minute.
- Hey. - Hey.
Just double-checking Joey's films.
Doing him in an hour.
Are you sure that you don't want Phoebe to coil him?
It might be the safer option.
Do you like Japanese?
You're on for dinner?
I love your hands.
A surgeon's hands.
I got to lock the door.
I already did.
Mr. Baker?
Mr. Baker, wait. Are you okay?
Can you take a look at this?
Yeah.
I thought he was with Dr. Mahmoud.
Yeah...
Page him again.
He's scrubbing in.
Finally.
Here you are, doctor.
The patient wanted to talk to you before the operation.
I waited as long as I could.
The O.R. is booked all day.
We had to put him under.
That's your job, isn't it?
What are you doing?
Nothing.
Transcranial direct current stimulation...
You're supercharging your brain for Step 2.
It's just an experiment.
I took the test already...
Aced it without having electrical currents zap my brain.
What did you score?
277.
Congratulations.
That's a very good score.
99th percentile.
You know that thing is bogus, right?
It's quack medicine.
It's working for me.
Prove it.
I'll test you.
Don't be intimidated.
I'm not intimidated.
You can test me once I'm done studying.
Now cut it.
I brought you in to see this operation
because, in the age of coiling,
open aneurysm repair is increasingly rare.
Coiling is less invasive, safer,
but Dr. Bickman judged it more appropriate for this patient.
Freeing up the aneurysm now.
How's he doing?
Stable.
Forceps.
Oh, my God.
Bipolar penetrated the aneurysm.
I'm gonna need suction!
- Stat, do you hear me?! - You got it.
I can see the artery that's feeding the aneurysm.
I'm gonna need a temporary clip now!
Another aneurysm clip kit from surgical supply.
Suction ready.
Artery's clipped. Bleeding's stopped.
We got four minutes. Start the clock.
Four minutes.
Counting down.
Now he has four minutes to clamp the aneurysm and remove that clip,
which is depriving the brain of blood.
After four minutes,
part of Mr. Giordano's brain will die.
I'm sorry to bug you, Dr. Black.
I really need that iPad.
IPad.
Um, where did I leave that? I...
- Catherine. - Yes?
I've been trying to find you.
I saw your patient, Fred Baker.
You thought he was on meth?
He is on meth.
No doubt... urine tests don't lie.
They do if you get a false positive.
What about his blood test?
He has indirect bilirubin of 2.4, hemoglobin of 10.6.
What?
He's hemolyzing, and he looked jaundiced.
Didn't you check his labs?
Where is he?
He walked out.
Actually, he kind of shuffled out.
We need to get him back here immediately.
Get his telephone number and his address.
30 seconds to a major stroke.
Wipe!
B.P. Is falling.
Beta clip.
Come on.
Come on!
Let's get another one.
It's coming.
10...9...8...7...6...
5...4...3...2...1.
Aneurysm's been clipped, blood flow restored. Time?
It just ran out...
Just now.
Close him up.
You've reached Fred Baker.
I can't come to the phone right now.
Please leave a message.
Mr. Baker, it's Dr. Black here from the Cube.
I need you to call me back.
It's very important.
I need to talk to you about your blood-test results.
Thank you.
20.
55.
Negative.
16.3.
Ohh.
What's happening?
Are you married, Mrs. Redmond?
Divorced.
His father's no longer in the picture.
I was hoping that there would be someone
who could be with you right now.
Why? What is it?
The spinal tap shows that Skylar has a rare encephalitis caused by measles.
But I told you he had measles when he was 3.
It was fine.
Some children can keep the virus inside their body
long after the symptoms have passed.
With time, slowly, it attacks the brain.
And...
Skylar has progressive, irreversible brain damage, Mrs. Redmond.
It can't be undone.
It can't be fixed.
It can't be changed.
Uh... I-I don't understand.
Brain damage?
I would do anything not to say this to you,
but by stage 2, measles encephalitis is fatal.
I hate to give up, but this time, we're powerless.
I can't imagine how hard this is for you to hear.
I'm sorry.
But it's just... It's too late.
The damage is done.
My son will die from measles?
What have I done?
You were...
trying to do what you thought was right for your son.
I'm sorry.
No.
Why hasn't he been extubated?
We've been trying.
He isn't initiating any breaths on his own.
Well, then, hold all sedation.
Dr. Bickman, he's been off everything
for over six hours now.
Maybe he just needs more time.
No, I'm the one who needed more time.
Glucose in fungal meningitis... High or low?
Low.
Gram-positive cocci in chains belong to what genu...
Streptococcus.
What cranial nerve is affected in lateral strabismus?
Third.
You're doing well.
You're pissed off.
Why?
This isn't fair
because you're wearing the transcranial stimulator.
You won't be allowed to use it during the test.
Take it off.
Okay. This is a tough one.
I won't be surprised if you don't get it.
What antibody is found in the CSF of patients with NMO?
Just give me a second. It's on the tip of my tongue.
Nope. This is the lightning round.
Prove you can do it without your crutch.
- Come on, Leo. - Aquaporin 4...
The channel receptor to ADH.
Enh! Wrong. It's NMDA.
Flip the card.
"NMDA," just like I said.
Okay.
I need a break.
How's Joey?
They can't get him off the vent.
Four minutes without blood to the brain...
He's never gonna take a breath on his own
for the rest of his life.
You don't know that yet, okay?
It's only been six hours, Bick.
I never should have operated.
Coiling would have done the trick.
It's all my fault.
Bick, please don't.
An infarction of the ventrolateral medulla...
Knocked out his breathing center.
Joey has Ondine's curse.
Ondine was a beautiful water nymph,
who caught her husband in bed with another woman.
In revenge, she took away his ability to breathe involuntarily.
So like Ondine's ill-fated husband,
if Joey falls asleep... he'll die.
And since no one can stay awake forever,
Joey is married to his ventilator.
Bick, don't cut me off.
Don't blame yourself.
And who should I blame?
My mind wasn't on the job that I was meant to be doing.
I wasn't thinking straight.
I dropped the ball with a patient, too.
I didn't check his lab results in time,
and he's sick. He left. He walked out.
Now we can't find him.
What are we doing?
I feel sick.
I feel nauseous.
I feel disgusted in myself.
I forgot that I'm married...
Married to my work,
married to this place
and my patients.
And I let you fill my mind.
Is that so wrong?
If it gets in the way and takes the place of what matters most,
then, yeah.
I should have known better.
I should have known my own limitations.
I should have known my own heart.
No, screw that. I should have known my own mind.
Who has the key to the pharmaceutical cabinet...
You or Tinker?
I have it. All right.
I need you to fill this prescription for me.
Thanks.
Whoa. Oxy?
Yeah, it's for Skylar Redmond.
He has a post lumbar puncture headache.
I can't believe the mom's okay with giving him opiates.
She won't even let him drink orange juice
because of the sugar content.
He's in pain.
He's terminal, and I won't have him suffering. Thanks.
Dr. Black, I have the oxy for Skylar.
Okay, good. I got him. Thanks.
- Oh. N-nurses usually administer the meds. - Yeah, I know.
- I'd be happy... - I'll give it to him. Thank you.
Okay.
You can go.
Hello.
Josh, I need your help.
I have this voice in my head.
He's telling me to hurt myself,
but I can't... I don't know what to do.
Where are you?
I'm in my apartment.
I'll call an ambulance. Hold on.
No, no, please.
I just... Can you come here?
I just need you right now.
Okay.
Okay. I'm coming.
Just sit tight, okay?
What if you don't go?
And she kills herself?
How do I live with that?
Kate?
I'm here.
Hey, hey, hey, hey. Hey.
Okay.
All right.
Okay,
let me see.
Okay.
You're all right.
Thank you.
Okay.
Thank you.
Kate.
We're gonna go to the hospital now, okay?
- No. - Yes.
I don't need to go to the hospital, Josh.
I just need to stay here with you.
I'm okay.
Have you been drinking?
- No, it's just... - Are you drunk?
I had some Tequila, but I just... I'm fine.
I took some pills.
Pills? What kind of pills? What'd you take?
I just took some oxy, just to calm me down.
I'm fine.
Oh, Josh.
- Oxycodone? - No, please, don't.
- Josh, please. - No, no, no.
Please. Just...
Oh, my God. Oxy?
Oxy? Really?
You know, I'm done. You did this to yourself.
No, Josh, don't go! Come back.
Don't go, please!
Please.
I'm sorry.
Go to sleep, Kate.
__
I'm taking Esme to school.
Thanks.
Can you get some rest?
No. I'm too angry.
It's about time.
Ohh!
Come on!
What are you doing?!
Can I help you?
Thank you.
Are you Fred Baker?
Yeah.
I'm Dr. Black, from the Cube.
Dr. Finney's office.
Hi. This is Dr. Ian Bickman from the Cube.
I'm trying to reach Dr. David Finney.
Oh, hey, Dr. Bickman.
We're so glad to see you.
Aren't we, Joey?
Hello, my friend. How are you?
Oh, he... he wants to know when that thing is coming out.
Well, that's exactly what I'm here to talk to you about.
There was a complication during surgery.
I feel personally responsible.
No, no.
Joey and I are so grateful you're taking care of him.
We trust you.
Well, the result was damage to part of Joey's brain.
No, his... his brain is okay.
He's still Joey.
No, he understands everything.
Don't you, Joey?
Most of your brain is fine... It's working perfectly.
It's just a small part that talks to your diaphragm,
that initiates breath.
That part is damaged, so...
You will no longer be able to breathe on your own.
He will get better, right?
The damage is permanent.
But I haven't given up.
I've found another doctor who may be able to help.
No, no, no. He wants you to be his doctor.
No, no. Listen to me, Joey.
This... this man has a new surgery.
He may be able to correct your condition.
Now, it's his idea. He's done all the research.
He is the best man for the job.
Now, he would need to implant a pacemaker into your diaphragm
to make up for what your brain is no longer able to do.
I'm not sure if this is gonna work, but...
I think it's worth a shot if you're willing.
Mm. Yeah.
He says no...
He wants you to do the surgery.
Thank you, Mrs. Giordano,
but in this case, I trust Dr. Finney more.
Oh.
You're bringing Finney in to try that new procedure on Joey?
That's right.
It's never been tried,
and there is no reason he'd be better at it than you
just because he thought of the idea.
You're the better surgeon.
What is going on with him?
I didn't think it was possible.
He's scared.
- These are for Mrs. Redmond. - Okay.
Vitals look good, Dr. Finney.
All right, Dr. Bickman.
I'm implanting the phrenic nerve stimulator into Joey's diaphragm.
The device will charge percutaneously.
100cc flush.
Maintain suction.
Suction now take at 100cc.
Place your chin in here for me, please,
your head up against the bar. Perfect.
I'm just gonna look into your eyes.
I see Kayser-Fleischer rings.
MacKenzie, what does that mean?
Rings encircle the iris due to copper deposits.
It's diagnostic of Wilson's Disease.
It means Mr. Baker has a rare
inherited disorder of copper metabolism.
Copper accumulates in the liver
and then in the red blood cells and brain.
These copper deposits in your brain
is what causes the tremors and your mood swings,
but we're gonna do a urine test
and a blood test to confirm, okay?
Uh, his urine test would be high for copper.
Yes, thank you.
So the copper building up in your body
could cause liver damage.
That's why your eyes are yellow.
It's why you're confused.
That's what's causing your emotions to go haywire.
But there are treatments
to remove the copper from your body,
and we're gonna get on that right away.
Thank you. Thank you.
MacKenzie, I'd like to see you in my office...
Right away, please.
I know what you're going to say, and I'm sorry.
If we didn't get his diagnosis in time, he could have died.
I mean, as it is,
he's gonna need a liver transplant, possibly.
He tested positive for meth. How was I supposed to know?
Because he was using a nasal spray!
That can create a false positive.
Why didn't you know that?
When you do a physical exam of a patient,
you look at them,
you talk to them, you check,
and you recheck the lab results, MacKenzie.
My God.
Dr. Black, I'm so sorry.
I... I don't know how this happened.
- Now I'm never gonna get... - Don't cry.
That letter of recommendation from you,
and I'm gonna fail this rotation.
- And all I've ever wanted in life... - MacKenzie.
Was a residency at the Cube
so that someday I could be just like you.
Sit down.
I try so hard.
I try and try to be perfect,
and still I make mistakes.
What can I do to fix this?
I'll do anything.
You have to stop thinking of this as a race.
You have to stop thinking about the outcome for you personally.
Stop trying to be better than all the other fourth years
and just care about your patient.
Okay. I can do that. Let me write that down.
No. Don't write anything down. Just look at me.
Listen to me.
You have to care more about your patients than your residency.
Do you understand me?
Yeah.
You were right.
What do you mean?
The last flashcard... You were right.
It's Aquaporin 4.
I got the question right?
Yes...
Without the device on.
Leo, I don't think you need transcranial stimulation.
It's a placebo.
It works because you lack confidence,
but you're smart even without the stimulator.
You might be as intelligent as me.
Why did you lie to me?
I didn't want to be wrong.
I didn't want to lose.
That was terrible.
It was mean, and I'm sorry.
Thank you.
I can't wait to get Joey home and make him some nice pasta.
And I can't wait to get there, too.
All right, I got you.
H-hang on, doc.
Give me a sec.
Please...
Allow me.
Thank you.
Going home.
I heard the surgery went well.
Yeah, and Joey will breathe again on his own.
That's good.
First time the procedure's been done anywhere in the world.
It should have been you.
You had a bad day... That's all.
I don't want bad days.
- I want to be the best. - You are.
When I walked into that O.R. to operate on Joey,
I was still thinking about you.
I had... feelings for you I've never had for anyone.
I don't want them.
You think emotions get in the way.
I think they make life worth living.
That's a huge divide.
I think we need to take a break.
So, it's over with Will...
And now with Bickman.
Yeah.
Even Josh is angry at me.
Why?
I slipped up.
I, um...
I took oxycodone.
Ohh, Catherine.
I know.
He has every right to be angry at me.
I'm a lot angrier at myself, okay?
So, what do you think you should do?
We have to rebalance my meds.
That is a good decision.
It's not what I want.
I want to feel more, not less.
I-I-I want less medication, but it just leads to mistakes.
What about Bickman?
Do you agree with him?
No, I should never have gotten involved with him.
The Cube... it's like my...
magical silver cloak.
Before him, nobody could penetrate it.
So Bickman is your Achilles' Heel?
No, my feelings are.
My feelings threatened the thing that I count on.
The work has got to be separate, untouchable,
the most important thing.
I want to go there now.
The Cube is what holds me together.
Do you still hope for a more balanced life?
Right now, I just want to survive.
And your survival is at risk?
Always.
We can try the woods, trophy bar, bembe.
I mean, they're all bumping.
Just a sec.
You've reached Joshua Black. Please leave a message.
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