this procedure's gonna be so cool. sure as hell isn't for the faint of heart. so, first i'll perform a laminectomy to expose the spinal cord. then i'll excise the dura, peel it back, ever so delicately to get my fingers around the neoplasm... if you're trying to get me in bed again... it's not working. are you saying you don't find surgery as exciting as i do? well, i do like the way your mouth moves when you describe it. really? now, are we on or off the record?

i take my recorder everywhere. i don't remember it last night. maybe i dropped it. do you know what's at stake with this procedure? (tape recorder beeps) tell me. 46-year-old male, two-time new york city marathon winner. (inhales deeply) i succeed, he's winning races for the rest of his life. the knife slips... he's in a wheelchair forever. (tape recorder beeps) i do trust those fingers of yours. mm, yeah, smart girl. so that's my lead for my article: "there's nothing michael holt loves more than a challenge." (chuckling): it's what i live for. i gotta go to work. but i assume when that "top ten surgeons list" comes out in your magazine... you'll be right on top.

(michael sighs) whew! nothing like a massive hemangioblastoma to kick off the day. it was like that thing from alien, all octopused around his spine. (chuckles) just had to show it who's boss. you know i heard two surgeons turned this case down because it was such a cluster. (laughing): really? rita: good morning, michael. oh, you're looking happy. you must have forgotten about the dinner tonight. the paralysis research? oh. the fallwyck club at 8:00, business attire. pat ross here? he's not on the schedule. old buddy of mine from med school. i told him to stop by this morning. you don't have time for reunions. he's an er doc. the city shut down his hospital. he's looking for a job. i told him about clinica sanando, how anna was running it when she died and, you know... michael, you already have an interview for your ex-wife's job. i do? mm-hmm. dr. sykora. i don't know him.

he's a she. philip romero called and asked if i could squeeze her in. he said he used to be anna's boyfriend when she died. yeah, and president of the clinic board. i told him i'd find the new medical director. apparently, he wants to micromanage me. maybe he knows how busy you are. here at holt neuro. where you work. dr. sykora, sorry to keep you waiting. i was in surgery. michael holt. kate. hi. thanks for seeing me. yeah. sure. my pleasure. have a seat. please, please, sit, sit. can i get you a cup of coffee or some water? uh, no. i'm good. thank you. all right. you're a friend of philip's? (chuckling): not really. we met last year at a fund-raiser for the west side mission. it's a homeless shelter up near columbia. anyway, we got to talking, and i told philip that i'm looking to get back in the trenches. well, clinica sanando is right at the bottom of one. so let's see what we got here-- wash u. med school,

family medicine residency at uc san diego, family practice for five years, vp, community affairs, glentrix health... it's a nonprofit of some kind? new hmo. i'm guessing you don't see very many hmo patients here. none. so what does a vp of community affairs actually do? uh, well, i was hired to implement a wellness program for the uninsured. it turned out to be a smoke screen. the hmo just wanted the pr buzz, and i spent too much time in meetings and not treating patients. well, you'll get that in spades at the clinic. great. i got to be brutally honest with you though, it's an uphill climb. how steep? almost vertical. too many patients, not enough staff, lousy equipment, no money to replace it. i'm surprised somebody with your experience would want the job. (laughs) what? what's so funny? well, that was the worst sales pitch i've ever heard.

it's not a sales pitch. obviously, you have someone else in mind for the job, and you're trying to scare me away. well, i didn't mean to... offend me? my time is as valuable as yours, dr. holt. and my feet hurt like hell in these heels. so the next time you decide to waste someone's morning, why don't you do everyone a favor and just say no. now wait a minute. hope it works out with your new medical director. we'll call you when... save it, sister. went well, didn't it? no good deed goes unpunished. c-b! ah. thanks for coming. pat ross, this is rita; she runs my life. he can't possibly pay you enough. oh, i like you already. what's the c-b stand for? cadaver buddy. nobody could cut up a corpse like michael here. we were dissection partners in anatomy. hmm. pat: he tutored me a bit. i remember you were the only one who could id the ligament of treitz. mm. i'll let you two to reminisce.

thanks, rita. yeah. so, this is it. looks like a fixer-upper. tavo: oh, dr. mike! glad you're here. only to give a tour. this is pat ross; he's going to replace dr. anna. oh, today? right on! yeah. right. so we got a great staff, they got three exam rooms, you got a private office in the back... hmm, uh, who's in charge of securing funding? you. purchasing? yeah, you. accounting? you, you, you. all you. you're in the driver's seat. while i'm treating patients all day? yeah, well, you know, i know it needs a lot of work, but you can make it your own. hmm... michael. thought i heard your voice. admit it, you can't get enough of us. yeah. zeke barnes. pat ross. zeke's a family doctor. i helped him out last week. you could do it again. i got a compression fracture in room two with your name on it. you look like a doc, too. i do? johns hopkins tie tack gives it away. pat is going to be your new boss. oh, great. awesome. hey, you can take the lady in the waiting room with the mask on. rule out yellow fever. you can use your new office. yellow fever? oh, yeah.

immigrants come in from all over. you get to see everything here. i've seen enough. come on, it's not that bad. (laughs) it's not that bad? it's a dump. look, mike, mike, i'm used to having everything i need. what, you don't need a job? not this one. thanks anyway. if i change my mind, i'll call you. you kidding me? i'm sorry, mike. tavo: dr. mike, i need your help! tavo, actually i'm just leaving. rafe, this is dr. holt. oh. what happened to you? he shattered the backboard. i was showing off for the kids, trying to slam-dunk, and think i broke my arm. did you make the shot at least? (suppressed groan) ah! yeah, you dislocated your shoulder. tavo: come on, let dr. holt take care of your dad. tavo, honestly, i gotta... it's cool. i got donuts for him. (hiccups) i got these hiccups, too. oh, it's not uncommon after a shock to your system. now, what's going on here? let's take a look. right here. hold still. (hiccups) kind of old to being doing slam dunks. i run a youth league for troubled kids.

i'm the only dad most of them got. (hiccups) boys like that will eat you alive if you don't walk the walk, right? how are you doing over there? it's done. clean up those cuts. (rafe hiccups) sorry, i was lancing a mother of a boil. about time. (rafe hiccups) michael: all right, finished. you're in good hands with dr. mike here. he's a top-notch surgeon. sedate him with some midazolam. we'll pop that shoulder back into place. uh, we don't keep midazolam here. you're kidding. no, we dispense benzos or narcotics, we're sitting ducks for a robbery. so, good ol' fashioned lidocaine will have to do. i gotta get to work. how long is this gonna take? zeke: what do you do? rafe: i used to teach phys-ed in the bronx, but i got laid off. now i'm flipping burgers to keep it together. this is gonna sting and burn a little. okay. all right, switch with me. sit up for a second. well, what's that for? countertraction.

(hiccups, groans) tell me when you're ready. (grunting): almost there. ow! there we go. ow. (hiccups) hold still. man, feels better already. hey, uh, what do i do about these hiccups? try breathing into a paper bag. hey! michael, hold up. professor philip. i just called your office. your assistant said you were here, giving our new clinic director a tour. i'd like to meet him. well, unfortunately, he didn't take it uh-huh. over money? it wasn't a good fit. what about kate sykora? you met her, right? yeah. she wasn't really right for the job. this place is a hard sell. i know. anna was here 24/7. hard to date someone you barely get to see. don't worry. i'll find someone to run it. boy: dad! somebody help! please, help him! everyone stay back. nathan, come with me. he suddenly got dizzy and then collapsed. he's not breathing. we need a defibrillator! michael: hurry!

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syncopal episode. his pulse is thready. where's the defibrillator? right here. i'll check his rhythm. (rhythmic beeping) he's in v tach. from a dislocated shoulder? yeah. we gotta zap him. everybody stand clear. (rhythmic beeping) (respirator hissing) zeke: he's back in sinus rhythm. he's breathing on his own. michael: his pulse is getting strong. wh-what happened? you passed out. we had to shock your heart back into normal rhythm. all right, tavo, let's get him into a room. yo, philip, give me a hand. gently, slowly. watch his shoulder. (grunting) easy, easy, easy. i don't get it. a few lacerations shouldn't have sent him into v tach. yeah, neither should a shoulder reduction. lidocaine toxicity could have caused the arrhythmia. no, i didn't hit a vein when i gave him the anesthetic. maybe it was cardio myopathy from a recent virus.

yeah, or he's on something-- speed, energy drinks. well, whatever it is, i'd better keep him monitored. yeah. i gotta go. thank you. nice work. not now. believe me, if i could, i would call your oh-so-adorable assistant and make an appointment, but i can't control when i appear. yeah, i can't stop and chat every time the ghost of my ex-wife shows up. were you talking to me? no, i was... not... i was just... going in here. wow. this is more of a mess than i remember. (laughing) is that-- that's, that's what this is about, just, uh, cleaning up your, uh, your messes? because i'm not gonna do that. why not? what?! why can't you clean up my messes? what would be so wrong with that? i have a job. curing people with brain tumors, people with paralysis... people with checkbooks. yeah, so? they get sick, too.

can you just haunt somebody else for a while? oh, believe me, there is nothing i would like more than to be resting in peace instead of fighting with you. but something even bigger than you, michael holt, put me here, now, with you, and if you can't respect that and help to do the things that i can't do any longer, because i got hit by a damn car, then you might as well be dead, too. zeke: wait a minute... rafe: i gotta go. zeke: hey, come on, man. i don't have time! dad, you're okay! yeah, i'm all right. hey, dr. mike, rafe here is refusing to stay and be monitored. mr. douglas, listen to your doctor. let's roll.

hey, dumb-ass! you could've died in there. you need to be monitored and then go see a cardiologist. yeah? how much is that gonna cost? echocardiogram, stress test, ebct-- i don't know-- maybe three grand? are you out of your mind? that's three months rent. all right, come on, i can get you in to see a guy at county by the end of the week, for a couple hundred bucks. what world are you living in, man? i make eight bucks an hour, and i don't have insurance. i don't show up for work, i lose my job. so what if you drop dead, face-first, into a deep-fat fryer? look at you in your fancy suit with a smirk on your face, telling me what to do. tell your patient... i'm sending him for a full workup. hey, i'm standing right here, and i'm telling you i can't afford any workup. tell him i'm referring him to howard eastman, best cardiologist in new york. arrogant son of a bitch. do what the doc says-- call the guy.

yeah, all right. i'll call him. (sighs heavily) wow, you really are good with people, aren't you? got him to see a doctor, didn't i? do me a favor-- you need any more help, don't call me. (horn blaring) man: first, it's hay fever, then it's a sinus infection. woman: ed's sniffling and hacking all day long. it scares the dogs. (laughs politely): yeah, i bet. well, i wish i could help, but you need an allergist, and i'm a... neurosurgeon. excuse us. excuse me. michael holt, right? have we met? not face-to-face, but... i flew an emergency nerve donation from seattle to laguardia last year. ambulance brought it to holt neuro. i think the patient's name was santiago. yeah-- left arm was mangled in a motorcycle accident.

transplanted the radial nerve, got it working again. you're the pilot who made that happen? (laughs) carol gordon. nice to meet you. (gasps) ow. you okay? please, i don't want to be one of those people at parties that pesters you with all of their little aches and pains. oh, no, you just rescued me from that. may i? any, uh... swelling? does it ever feel hot? both. mm. couple of times. you know, it could be carpal tunnel. guessing you do a lot of repetitive motions in the cockpit. uh, flicking switches, pressing buttons up and down panels. it's a pretty simple procedure, actually, for the pain. i'd be happy to do it. personally? quick snip of the carpal ligament, you're good as new. send you home the same day. maybe after i'm healed, i'll fly you down to the caribbean. personally? in my very own challenger 604.

wow! i'll drink to that. (gasps) ooh! i'm so sorry. let me help you. got myself good, didn't i? yeah, you could use a couple stitches. uh, let's get out of here. oh, you don't have to take me to the er. i'm not. come on. seems like overkill-- a neurosurgeon wasting time on a dumb cut. i suture skin all the time. your place is impressive. it's like a spa... that happens to have an operating room. we also have a top staff of neurologists, psychiatrists, sports medicine specialists, sauna and steam, 24/7 concierge... so only the best for your patients. i assume you do the same for your passengers. all-leather seating, sleeping cabin, shower, a fully stocked galley, and all the latest state-of-the-art avionics. we have a building-wide, positive-pressure hepa filtration system. not a single post-op infection since we opened for business six years ago.

are you trying to seduce me, dr. holt? i'm trying to get you to let me run tests to confirm your carpal tunnel. when i have time. carol, you let this go, your hand gets weaker, the pain and numbness gets worse. you don't want to drop any more martinis. i'm flying a charter to bermuda late tomorrow afternoon. think you can test me first thing in the morning? yes. come by. i'll make sure you get in. thanks, rich. (elevator bell dings) morning, rita. oh, i'm sure it is. after the night you had in the or with the young lady who was waiting here this morning. her name is carol and i was suturing her hand. is that what the kids are calling it these days? she's here for a carpal tunnel test. just grab her a gown while i track down bax. oh. okay.

you didn't prepare me for electroshock therapy. bax has to do the tests to indicate whether or not i need to operate. so he's like your ground crew. (laughs) yes, the navigator in the or. how we looking? uh, latency and amplitude are normal. it means your nerve functions are fine. then what's causing my pain? could be tendonitis, arthritis-- i'll know more after i test your fast-twitch muscle functions. that's going into me? only into your abductor pollicis brevis muscle. your hand. bax: i'll be gentle, but... it's gonna feel weird. you ready? i guess. all right. (groans quietly) so... where exactly do you fly? where do you want to go? i can get you to europe and south america non-stop; australia and asia with one layover to refuel. bax: very good. now, flex your thumb slowly,

until i tell you to stop. your family must miss you, you being gone so much. no family. just me and the big blue sky. my father was a pilot. i wanted to fly since the moment he let me take the yoke. bax: okay, you can stop flexing your thumb. emg is normal, too. so i don't have carpal tunnel. not necessarily. some people have it and their test results are still negative. how much did you have to drink last night? just the one cosmo. i was dying for another, but dropping that glass kind of nipped that in the bud. (laughs): yeah. everything okay? yeah, fine. bax and i need to discuss a few things. maria will take you in the exam room. hang tight. we'll be right in. i'll be waiting. you saw the tremor, right? yeah, yeah. i got this new thing called "vision."

she mention any other history of neuro symptoms, besides carpal tunnel? no. no. that's why i asked how many drinks she had at that benefit last night. could be alcohol related. pilot with a drinking problem-- that's, that's fantastic. it's a high-stress job. that could cause tremors; fatigue, too. so could drug abuse, strokes and a brain tumor. she needs an mri. mri. all right, carol, let's get you to an mri... colette, did you see miss gordon leave? uh, yeah, couple minutes ago. she said she was done and you told her to go home. i've never seen a patient run out on you. yeah. second one in two days.

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(phone ringing) finished with your lady pilot yet? no. 'cause i've got all your other patients in a holding pattern. (ringing continues) let me guess-- zeke? it is indeed. hey, i never heard from rafe douglas, our dislocated shoulder from yesterday. i got enough problems with my patients without having to deal with yours. i just want you to ask your cardiologist pal if rafe ever showed up there. do i have to hand-hold everybody? i gave you the number. call him yourself. don't call me. i've had it with people who don't listen. are we leaving surgery to become a pathologist? dead people never talk back. that's what she thinks. uh... rita...

call the faa. get me someone in air safety. what on earth for? just do it. never easy, is it? thought you weren't speaking to me. eh, we could never stay mad with each other long, could we? yeah? try me. so, besides me, what's bothering you? (wry laugh) my patient, carol gordon, just walked out on me. she's a pilot. her hand tremors. until i know what's causing it, she's got no business being in the cockpit of a plane. like the ice road trucker in alaska. with the crazy mustache. looked like he had a ferret on his lip. (both laugh) his big ol' pupils. hands shaking. you thought he had dts from alcohol withdrawal. you were about to call the cops. until you asked him how much coffee he drank. "18 cups a day. "18 cups a day.

five sugars in each." five sugars in each." that was different. he was right there. she... ran away. i let her fly, something bad happens, it's on me. i got to call the faa. so you can fly off into the wild blue yonder? no, i am just doing my job, anna. rita, you got them on the line yet? but what if you report her to the faa and they yank her license? what if you find out it's just one too many cups of coffee? so she quits drinking caffeine-- no harm, no foul. i'm not the bad guy here, anna. yeah, that's not the same thing as being the good guy. (sighs) do you think the faa will ever let her fly again after you've turned her in? they'll wonder why she didn't go see a doctor and report herself. rita: faa safety officer collum on line two. michael. i got it. michael.