this x-ray is that of a normal, nine year old heart. this one is your son's.
there are septal defects here, here, and here, which have induced a myopathy resulting pulmonary edema, and malignant ventricular ectopy. as you can see, mike's heart is approximately three times normal size.
of course. basically, there's not enough blood being pumped by the heart, so it backs up in the lungs. sort of like a sponge getting wet. mike's heart is trying, but i'm afraid it's working too hard.
i'm afraid we're considerably beyond the point of corrective surgery, mr. and mrs. archibald. your son's heart is useless. he is going to need a transplant.
he's going to seem fine. but as his heart gets worse, he will become increasingly fatigued, need more and more sleep, until one day, he'll go to sleep and he won't wake up.
this isn't my decision.
not long. months. weeks. days.
i'd do the transplant. absolutely.
the first step is to get mike's name on an organ recipient list. once he does, his chances are very good. your son's an extremely rare type so there's less demand. with b-positive blood, mike could go to the top of the list right away.
you're doing great, carroll. you've already gained back five pounds. i think you're the only patient i have who actually eats the food here.
hello, john. this is mr. archibald. his son's a patient of mine.
mr. archibald, i'm a physician. i don't make policy decisions. that's handled by the board of trustees.
i make recommendations all the time. the final decision rests with the board. not me.
please take your hands off me.
i'm sorry. i tried to help. but it's out of my hands.
mr. archibald, i understand how upset you are, but this is not the right way to handle it.
mr. archibald, these people have nothing to do with this. you have got to let them go. they need treatment.
no, no. this is out of my department. i'm a heart surgeon. i'm not an emergency room physician.
seventy-five milligrams demerol iv lidocaine, local. two percent.
he's going to make it.
was he ever diagnosed with a murmur?
he might not have been tested thoroughly enough.
possible. not likely, but possible.
who knows?
that's not how it works.
shut up. enough already. i've heard all the bitching and moaning i can stand. sure, the system sucks. there's red tape and there's worse. there's tough luck. and if you're looking for kindness and compassion, they're in short supply these days. but some of us got into medicine to do something about it. i break my ass every day trying to make a difference, trying to plug the dam. i'm in it up to my elbows. i've seen people live who shouldn't, and the other way around. and when i say i do my best, i mean it. so don't tell me about doctors, because they're the last stop between you and six feet under. and if you all want to regard me as some blood sucking vampire, fine. i'm the bad guy. but who's holding the fucking gun?
no.
it's not a solution. it's only a band aid. mike's immune system may be too weak.
not long. it's only a temporary measure.
out.
i need some time to examine mike and i don't need you getting in the way. it's crowded enough in here.
i'm serious, john. let me do my job.
yeah, kid. yeah, i am.
john?
mike's blood pressure has dropped into the mid-forties. his atrial blood pressure should be in the low teens. it's thirty-five. if i put that lvad into him, his heart will never be able to handle the extra strain.
not buts, john. without a new heart, he's not going to make it.
what?
you can't be serious.
there's too many unknowns. matching a donor and receiver is extremely complicated. there's several critical tests that have to be taken.
cross matches for blood type, chest cavity measurements. if both blood tissues aren't compatible, there's a very high likelihood of rejection.
no, we don't. you're an adult. mike is strong, but the amount of blood your heart pumps may be too much for mike.
out of the question. too risky.
can't do it, john.
that mike's going to die.
i do like him.
i'd like to. i really would. but what you're asking crosses the line. it's completely unethical.
so, what, you're going to kill me if i don't operate.
alright.
i'll do it. if that's what you want.
once he's dead. why not?
so, what are they going to do? sue me? disbar me? evict me from the country club?
yeah, well, what is myself? because right now, i really don't know. let's see --
i run six miles a day, drive around in my little black porsche and date girls thirty years younger than me. is the picture clear now? i like twelve hundred dollar shoes and i've always got a great tan. and here's the best part. everybody kisses my ass and acts as if that's the way doctors are supposed to be, that's the reward. reward for what? what i am is a plumber. i connect valves to tubes and tubes to valves. that's what i do. but back in that room with your son, i got a very short glimpse of my soul. and let me tell you, it's been long lost.
this is still a hospital. there's a sick kid in there and i'm his doctor. and if there's a heart available, i'll be damned if i'm going to let it go to waste.
john. stop. i changed my mind. i won't do this.
no! come on, goddammit! i'm not losing this boy!