Alright, let me get Liver Transplant on the line for you.
Hello, doctor. Why don't you tell us about the patient?
She comes for fatigue and jaundice.
She turned yellow, and she came into the hospital.
You're thinking autoimmune here?
Yeah, I think it's autoimmune. And now she's doing worse.
Guys, this is an emergency meeting of the transplant listing group
because this young lady is getting much sicker.
She has acute liver failure, autoimmune.
Is everyone in favor of making this patient a status one?
Absolutely.
So the patient is now status one, that's the highest status in the country.
Starting from right now, we're going to be looking for a liver.
And what happens to someone who suddenly gets a hit to the liver,
there's no means of compensating.
They begin to get confused.
She will eventually not know her name.
She's a fourth grade teacher, and she has two young kids.
- What are your kids' names? - Mia and Taylor.
How old are they?
Uh... seven and...
Okay. That's okay.
Soon she won't be able to speak, and then she'll need to get intubated.
This is the natural course of liver failure.
It's a rush, it's a race.
If there's no organ available in the next 48-72 hours,
she will lose and she'll go to God.
- We're going to find you a good liver. - Thank you.
- First one to pop up will be hers. - Let's just find an organ.
Button your jacket. Fix your collar.
Okay.
- Thank you. - Alright, you're fine. Let's go.
Beautiful day.
Subway's packed, restaurants are busy.
Things are looking up.
Finally.
- Oh, there he is. - How are you?
- Thank you so much. - My pleasure, good to see both of you.
And how was the drive up?
It was good, very nice. They wouldn't let me drive.
- I drive too fast.
We're really blessed to be back here. I'm really lucky.
- I want to show you some pictures. - Okay.
So, obviously, when I'm looking at you from the side here.
Dad, you can see that this is the side view.
Mm-hmm.
- And this is the growth. - Wow.
- Can I touch? - Of course.
It's this right here.
You see in the middle here where it's red, worn down, and starting to get infected?
That's the issue.
This became really an emergency.
The mass is growing so quickly, it's starting to erode through his scalp,
so I made him drive up from Kentucky over the weekend.
This is all cancer.
What's fascinating and difficult about his case
is that it's actually metastasized to the lung.
That is a reportable event,
meaning that it happens so infrequently where it leaves the brain.
So, we're going to take all this,
and then we're going to go in and take out the tumor in the brain.
Awesome.
I know you're going to ask, what about the lung?
We're going to deal with that after we get a PET scan.
- Remember we talked about that? - Yeah.
I feel really confident to be here with you guys.
I'm so glad we made this decision.
We appreciate your trust, and we treat 'em like our own.
- Exactly. - We'll keep him out of harm's way.
What a spirit. His whole family, to have that kind of optimism.
I told him to come, he's like, "We're on our way."
I mean, incredible courage, and hopefully he's got a life in front of him.
And you're really nervous.
Thank you so much for being here.
I wouldn't have it any other way.
- What are you doing this weekend? - Sleeping.
I told you.
- I'm taking a mental health day. - Because of the vaccine?
- Yeah, my body needs to recuperate. - I can't with you.
My biggest thing is sleep. I don't sleep enough.
What I try to do is no matter what, no matter what,
I'm going home, take a shower, and get in my pajamas, and get in bed.
Mm-hmm.
If you wanna talk, come talk to me in my bed.
If you want an excuse to be out-- and look...
- Can you respond to emergency-- - Head injury.
A couple of blocks down, right?
Over there.
Where's the kid? Damn.
- Oh, he's crying. - Oh no, there's another kid, Kristina.
He has a big hematoma on his head.
Are you good? Be careful getting out. Put your mask on, okay?
Yeah.
No, you don't move. I want you to sit. Look at me.
I want you to sit and don't move, okay? You're doing a great job.
Okay, what school do you go to?
They're having symptoms? Call another bus then.
We need three busses.
Requesting two additional busses, BLS to location. Two additional patients.
- They're here, Kris. They're here. - Alright, sit down.
Try to calm down, okay?
Don't worry, we got you.
Can you call the parent?
I got you.
Vicky, I need the blood pressure.
- Okay. - We gotta go.
He has to go to the trauma center now. Now. We gotta get off the scene.
Yeah, can we check out right away?
Squeeze my hand, sweetie, can you squeeze?
You okay? Does this hurt right here? Does this hurt down here?
Every day, I've started my life before 5:30 in the morning for 20 years almost.
And when I was in training, it was 4:00 in the morning.
But I drink my, uh, Cuban coffee,
and I get going.
I can't remember. What name did you give her?
- Did you guys pick a name for her? - Elliana.
Elliana? Okay.
So, I'm going to talk to the team,
and we are going to look over her medical information,
and then we will be heading out to the OR, okay?
So, we're gonna make a final decision,
but I think we're gonna go with the right thoracotomy, and then...
There's a good chance we'll use a patch, depending on the size of the defect.
And we're not gonna use the scope.
We're gonna do it straight open, based on the size of the baby.
Okay.
We're gonna fix a diaphragmatic hernia
in a tiny preemie baby that weighs four pounds,
who is less than a week old.
It was not clear it was going to survive, uh, when this was found.
The baby was found to have a hole in the diaphragm,
before being born, in an ultrasound.
I'm seeing quite a bit of the liver here in the chest,
and all of the intestines here in these gray holes.
And the heart has been pushed completely out of the chest to the other side.
So our job today is going to be to push all of this back into the belly
and give the heart and the lungs the room they need to live and function,
so that we can get to some day seeing her at her wedding.
Say, "Bye, Mommy, Daddy. Be back soon."
See you soon, okay?
Medic 99. Trauma notification TBD, ETA is eight minutes.
I have an 11-year-old male with a head injury, secondary to an MVA.
He has a large frontal lobe hematoma.
He appears lethargic but is alert and oriented.
Let me see your bump.
You gotta keep your eyes open.
He's... He's not, like, alert.
Like...
We think that, you know, he needs immediate care.
It's a kid, and you want to make them feel safe, and it's scary for them.
All this is like chaos in their head,
so we always, you know, try to keep them calm,
but it doesn't matter how much you explain the situation to them,
they're not going to be okay with all the sirens and police and people,
strangers coming up to them.
I'm trying to get there safe,
and hopefully, you know, he's going to be okay.
You gotta try to stay awake because you might have a concussion, okay?
You gotta keep your eyes open.
You're doing good, you're alright.
Jennifer went into coma as a result of fulminant liver failure,
where your liver just shuts off and stops working.
She's on the operating room table right now.
If you cannot transplant her fast enough, then pressure will build up in her head,
and her brain can herniate out of her skull,
and patients don't recover from that.
They either have lifelong brain damage, or more likely they just die.
Luckily, we found a liver.
And the clock has really already started, and it's a race against time.
- Have a good day. - Thank you.
We're going to another state to bring an organ back.
There's never a good donor story.
It's always somebody that unfortunately, in this case,
it's somebody that, unfortunately, that-- that is brain dead.
And the family was courageous
and caring enough to say that they want to donate organs to somebody else.
This lady's sick. She just went down the tubes quickly.
Yeah. Now, the percentage of donors under age 35
who are narcotics is 75%? I mean, it's way more than trauma.
People been home, and drugs, alcohol definitely on the up.
Yeah.
So, you know, we make triumph out of adversity.
When you talk about the brain, it's fixed in a rigid skull.
This is a box. And we have a very simple rule.
There's only really three things in the box.
Spinal fluid, brain, and blood.
And if any one of those increase in any way,
you're still in this fixed box.
Good morning.
Brain tumors, in general, tend to be urgent,
meaning that those patients are under extremis, they're under pressure.
We have to take that tumor out because they may be having pressure in the brain,
and the urgency is making sure that patient starts treatment right away.
Dr. Dennis.
Boockvar, pleasure, as always.
- My man. - Looking good.
- How was your night? - It was good, yeah, got some rest.
- Slept, meditated a lot, feeling good. - What do you do for meditation?
Um, well, I do Qigong when I have time to kind of do the movements.
Um, I do have breathing exercises, I pray a little bit, and things like that.
Well, we'll be doing some mindfulness in the operating room.
We do it right before every case, so...
- Oh, I appreciate that. - ...we'll give you an extra mindful moment.
I appreciate that so much.
You got the whole world praying for you, Marcos, today.
- I appreciate that. - Okay.
This is for Marcos. He'll appreciate this.
- Really nice guy. - The nicest.
Does all the right things,
and gets perhaps the worst of human cancers that exist.
Just terrible.
I just don't understand why. Guns is very dangerous.
You know.
This is what they can do to you, you know?
He was with friends.
To my knowledge, it was a gathering.
Still have no information, if it's just a drive-by...
It's all I know at this moment.
If you can help take care of Josh, I can introduce you to the mom too.
Yep, yep.
So he's got multiple gunshots,
was initially stabilized, and has an open abdomen.
Maybe he's ready for closure. If not, you can take a look.
If you need me, just let me know and I can pop over.
Okay.
Charlotte, you think we're good?
Yeah. He's already sedated.
Okay. I'll just talk to the mom.
Hi, Mom. The plan is to open up the abdomen that's already open,
but take off the dressing, wash out all the blood, look at the stomach,
the liver, the diaphragm, make sure the repairs are all intact.
If there's any extra bleeding, take care of it,
because we do know there's blood coming out of the drain from the belly,
so we want to make sure we're not missing anything,
and then reapply that dressing.
He's gonna pull through. We're seeing crazy amounts of firearm injury
you know, throughout the city, so he's gonna pull through.
- He's a fighter. - He is, he is.
We'll take good care of him.
Joshua suffered multiple gunshots.
And he's now fighting for his life.
A lot of these bullets don't remain in the body,
they kind of hit all your organs and then exit.
That's typically what we see.
How do you live in a society
where you're at constant risk for this type of violence?
There's a bullet wound here and here, right?
This is where the injury to the diaphragm happened,
the spleen, liver, stomach.
Multiple bullet wounds everywhere else as well.
They're too infected, no? They're too infected.
When we brought the kid to the ER, his mother was waiting there for him.
That immediately made him feel better.
When you go back to the ambulance, you get ready for the next call,
but then you're always thinking about, "I wonder what happened to that patient."
We don't get to see the results, like if they went home.
When it comes to kids, you know, it's always a difficult call.
They're so vulnerable.
It always touches, you know, like, a part of your heart.
Especially now.
- You look really pale, are you okay? - I'm okay.
You better tell me if you're not okay.
I'm okay. Just, I feel like you just want to start an IV on me.
I do. I just wanna hydrate you real quick.
- Yeah? - Yeah.
Dispatch to air transport.
North Shore University Transplant Team is airborne.
Flight time one hour, 11 minutes. Over.
Right now, it's just trying to approximate the timing.
We don't want to do anything with our patient that's getting the liver
until we see the liver to make sure it's suitable.
With a liver, we can go 14 hours.
We prefer it less than 10.
It works better the faster it gets in and it gets reperfused with blood.
We're going to get the liver.
There's going to be someone taking the heart, pancreas, and kidneys.
So, there should be three teams there all working together to get the organs.
But we're each going to do our own thing, so we won't get in each other's way.
We're talking about an hour-and-twenty-minute flight,
plus driving to the hospital, and then getting back to our hospital.
So these are all the time constraints
that we have to try to minimize as much as we can, whatever we can control.
It's happened a few times where we land and there's no transportation.
That's why there always has to be coordination with the coordinator
to make sure that everything's good.
- They took us to the wrong airport. - What's up?
Anyone knows how long to go from here to the hospital?
- I wouldn't know. - We'll ask the ambulance.
Hey. Our OR is a little delayed, till 12:30 now.
Guess one of the other teams had a delay in getting here,
-so I'll keep you updated. - Okay.
One of the problems when working with so many teams,
times get affected.
Unlike kidney failure where there's dialysis,
there's no such thing as liver dialysis,
and there's no replacement for a liver other than a liver transplant.
So, Miss Perez is in hepatic coma,
and you can't be in hepatic coma for that long.
Guys, we have incised.
Suction over here to me.
- She's a bleeder. - Mm-hmm.
She dumped a lot.
She can herniate her brain.
Do we have smaller patches than this?
So we want the one millimeter thickness, we think?
- I think for a 1.8 kilo preemie. - Yeah.
The hole we're going to try to fix relative to the baby is big,
but in the real world it's a tiny little opening.
There's going to be teamwork between the anesthesiologist and surgical team,
'cause we're pushing on the heart, the lung, pushing on the liver.
All of that can affect the circulatory system
and really put the baby's life at risk.
So I need to do something with his little arm still.
We're going to open up here, the chest, to be able to torque the liver,
which we think is up here, down towards the belly.
There's no liver in here right now.
This is one of the things about a surgery like this.
You can't really get MRIs and fancy CT scans like we do in big grown-ups.
So I don't 100% know what I'm about to find.
We're about to just pop into the chest, so we just did there.
Now we're going to open up space, and this is an unusual thing.
We open up the chest and we see intestines.
I don't really wanna see them now because I don't wanna hurt them,
so I'm going to try to see if I can tuck them away from us a little bit
without putting too much pressure on the heart inside.
I'm going to try to reduce the contents into the belly now.
Okay, there's the heart.
Can I have a second kittner like this?
Putting pressure on the lungs and heart. Let us know if we need to take it off.
So let's start unfurling what we can unfurl.
A little bit back here.
Gonna try to use the liver as a blocker for the bowel...
Uh-huh.
...as long as the baby will tolerate the torque.
Do you have something longer if we need it?
We have such a privilege to serve the people who need it in those moments.
I need something finer than this.
I found that when I took care of children, it took it to such another higher level.
Because when someone hands you their child,
the weight of the responsibility,
but also the tremendous privilege of making an impact,
that really called to me.
The idea that you're not just saving someone's life,
but when you think about a child, you just saved a lifetime.
I thought these were all in the right upper quadrant.
Main concern is the fact that there's still blood draining
from the temporary covering that's over his abdomen.
You know, he still is very, very sick.
- Okay. Alright. Careful there. - Slowly.
Okay, here you go.
- Oh God, these rings are terrible. - Really bad.
Oh man, it's like plastered. You can see quite extensive liver injury.
I don't see any active bleeding.
Don't speak too soon. Lift up.
- One here too.
We have to get all these packs out. They were stopping the bleeding.
Yeah, let's not rock the boat here.
It's bleeding right there, see that? That's fresh.
Okay.
- So let's not touch that. - Mm-hmm.
- Down there, suction. There.
- Is that a hole? - Yeah, different.
We've got a lot of blood in his gut.
We're going to leave the packing in here because it's controlling liver bleeding.
We've washed things out, stabilized stuff, and we're coming back in a couple of days.
Hopefully by then, enough fluid's off the body and we can close the abdomen.
As you can see, it's tight right now,
and we need abdominal closure to see if any blood wells up.
And hopefully his body will recover, then we'll be able to close the abdomen.
That's the news we're hoping for.
Alright, so bone is off.
- Oh, baby. - It almost looks like it receded.
- This looks like a cranioplasty. - Yeah, like a--
Oh, Marcos.
- This is also... - Yeah. Send this for culture, dura.
This little tumor...
Gets weirder and weirder, this case.
Nothing looks normal here. This is tumor.
Drop the table down all the way, we're gonna go under the microscope.
This is actually much more... ...upsetting than before.
I think with what I'm looking at,
and what we have in the lungs,
and what we saw in the scalp, and the rapidity of what grew,
I don't see how he can live more than six, twelve months.
I didn't realize this disease was so extensive intracranially.
Brian, we just filed our flight plan. We're going to start our initial descent.
Okay.
- Dr. Teperman? - Yes?
They clamped at 15:09.
- Okay, thank you. - Suction over here.
They're calling me again.
Okay, great.
All right.
- Dr. Grodstein? - Yeah, that's me.
I just spoke to Dr. Winnick.
He'll be leaving the hospital in about five minutes.
It's stressful. It's very stressful while waiting for the liver to come.
We have to synch operating rooms very closely
because the liver can only be outside the body for a certain amount of time.
We are praying that her brain is staying where it is,
and that we can get this new liver in quickly so that it can
lower a lot of the pressure in her head, and that she can wake up at the end.
Why is Dr. Winnick taking so long? Doesn't he know that we're operating?
Now we have to get this back soon as we can so they can sew it in.
They already started there, and once we get there,
we clean it up, and it's ready to go without any more delays.
- They start flying yet? - Not yet.
There's no reason for us to try to take the liver out until the liver's here.
Where is Winnick?
Look at this.
He's gonna show us where the plane is. This is the app.
Scheduled. They haven't taken off yet.
Sixty-mile-an-hour winds, they said, in New York.
No, I understand. They got delayed and we went faster.
You know, normally, as soon as I leave, they'd sew it in, except there's no liver.
I'm going.
There's been cases where people haven't woken up.
You do this whole thing, send a team out, do the operation,
then they don't wake up after. That's it.
Hey.
Nothing. Yeah, but they still haven't landed.
Yeah, so we're ready to cut out the liver, but do you wanna order some Italian?
I think it looks great, and the closure looks good too.
And this position?
Back to the NICU. Intubated to the NICU.
Thanks, everybody. It was a lot of set up. Thanks for running around.
Takes about 10 years to be trained as a pediatric surgeon.
Nine to ten years, between the research and the clinical training.
There's more NFL football players than there are pediatric surgeons.
Any more questions? Sorry, I don't know if you understand me.
It's just that to me...
Not sure if you understand my Cuban accent.
I don't know if my accent makes it difficult.
Now we won half the battle, but now we have to keep going.
Yes, it's like a marathon.
It's not a short run. It's a marathon overall.
It's really common that everything won't go in a straight line.
It's more likely that we're going to have good moments and bad moments.
- Okay? - Thank you.
- Dr. Boockvar. - How are you? Everything went fine.
- Can I use that room? - Please.
We removed that. It looked very, like, broken down.
And basically enlarged the bone opening, and that's all being fixed,
so you're not gonna be able to see any of it.
Mm-hmm.
I'm pleased that we made it bigger
because there was tumor in there, underneath.
And the tumor was growing in sort of both directions,
up out through the scalp and down into the brain.
- So, I took it all out of the brain. - Mm-hmm.
If there is a lot of disease elsewhere,
I'm going to tell you that that's going to impact his survival.
However, we sort of reset the clock a little bit with this operation...
Mm-hmm.
...and hopefully with the information
we gleaned from the pathology and the genetics,
we can come up with something that is effective.
- He wants to live so bad. - I know.
And this was a good step toward that.
- It's a terrible case. - Thank you so much, Dr. Boockvar.
Appreciate it.
But you know, miracles do happen in some way.
You know, we've seen
turnarounds in cases, and I just pray he's one of them.
- Be happy with what he has done.
I have a transplant pickup at Republic Airport,
going to North Shore University Hospital.
10-4.
Thank you, guys.
Suction to me, please.
Is Aaron here?
Getting out of the elevator.
- Let me see a pickup, hold this? - I can't, it won't move.
- Thanks, see you in there. - Coming in the back?
Yes, I'm gonna go change.
Oh, look at that.
- Do you have anything finer? - The key is not to drop it.
- There you go. - Thank you.
Wow, that's a big liver, Aaron.
It's a beautiful liver. Big for her, but she'll be fine.
It's life-saving.
Why don't we check to make sure there's no holes that we missed?
Yup.
- Lew, you ready? - Ready.
Alright, let's cut this thing slowly out.
Okay, push, push.
- Uh-huh.
Okay. Take the liver out. Firm like a rock.
She had autoimmune hepatitis,
and possibly made a little worse by medication.
This is basically a dead liver.
Here. Excuse me. Excuse me.
On my way. I need a blue towel up there.
Right here.
You guys, connect this thing.
I'm going to pass this one behind the corner.
It's a big liver.
Okay, that's enough knots, guys.
- We're going 40 knots on this ship. - We're being knotty?
Irrigation, please.
Okay, stop, pull it out.
That's just... Okay, we're going to come out of bypass.
Okay, everything's good.
Liver full, it's in the hole, her old one is out.
And now it just has to do its job, it has to give her life.
We'll know right away. The question is, does she wake up?
Okay, let's see if we can find her family.
- Hey, things went very well. - Okay.
Um, there was clearly extensive damage to the liver, the stomach.
We have to wait, let his body recover, um, and take it day by day.
In a couple of days, re-evaluate to take back, wash out, maybe even close.
- That's good. That's really good news. - Yes.
And we know there's some bullet fragments in the arm, some by the heart.
It'll take time to tell the full extent
of what type of long-term issues there might be.
You know, he's doing a great job of fighting, and we'll be with you.
We basically did a wash out.
It's rewarding to be able to assist in the care of a child like this,
but it gets tiring seeing a lot of these innocent kids being injured by bullets.
We don't always, often have the chance to kind of save a life,
or to see somebody come through after being shot this many times,
so it's really very kind of encouraging to see what we saw today.
You get to take not only a kid through a journey, but also parents.
Because of the anxiety that parents go through
when their kid goes through a health crisis,
it's an insurmountable level of stress.
I love you.
I'm right here with you.
I'm going nowhere, I'm not going to leave your beside.
Be right here with you the whole time.
Hi, beautiful. How are you? Let's see if I can do this without...
totally detaching everything.
That looks great.
Okay, princess.
After raising three kids, I still kind of remember how to do that, right?
We went from her being born and not even sure if she's going to live.
Now, she's breathing on her own, her x-rays look great,
and the heart has kind of come back to where it belongs.
To see that transformation, that sense of peace in a mother,
it's the kind of thing that keeps us going and brings us back to do more of this.
And you need those highs because the valleys are really deep.
I'm so tired.
This is just unbelievable.
Look how amazing I look.
Dr. Teperman, you really saved my life.
I just am so thankful to the family
because this person gave me a second chance at life.
And I know that must have been really difficult to make that decision.
You were sick, we weren't gonna let you go.
- How are you? - Good, and you?
Good, we just finished.
Yeah, thank God.
That's good. How did it go?
It went well, thank God.
I'll see you in a few.
- And our little guy? - He's moving a lot. He's really hungry.
He's hungry.
- Okay, be careful, okay? - Okay, love you.
At the end of the day, I always think about all the patients that I had.
Sometimes you assess the situation in your head and you think about it,
think about, well, what can I make different the next time?
It just helps you to decompress,
so by the time I get home, I don't bring that to my house.
Because that's the time for my family.
- Hi, papi, how are you?
How's my son?
- Mm?
Medic 88. We have a call for a pregnant female.
Complaining of vaginal bleeding.
Does not speak English.
Family member reported she was still conscious at the time of the call.
Heading to Lenox Hill ER.
This is a code 3.