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...First Do No Harm (1997)
- "I do solemnly swear... "
- "I do solemnly swear... " "... that I will be loyal to the profession of medicine... " "... that I will be loyal to the profession of medicine... " "... and just and generous to its members," "... and just and generous to its members," "... that I will prescribe regimen for the good of my patients... " "... that I will prescribe regimen for the good of my patients... " "... according to my ability and my judgement," "... according to my ability and my judgement," "and above all else, first do no harm. " "and above all else, first do no harm. " Yep. That emperor marched down the street... ...in front of all the people wearing nothing at all? Yeah. But then a little boy whispered... "But Mother, the emperor has nothing on!" But see, the tailors had told him that they made his clothes... ...out of the most splendid cloth in all the land... ...and that only stupid people couldn't see it. The emperor couldn't see it... ...but he didn't want anybody to think he was stupid. The boy could see the silly emperor didn't have any clothes on. - Mm-hmm. - He believed his own eyes. Did the boy's mother believe her own eyes? Hmm. Well, let's see. No, she didn't, Mommy. Hmm. Why? Well, he was the emperor. Dad's home from his poker game. Oh. Tell him his dinner's in the oven. Mr. Turgen's with him. Okay, buddy. You come on, into the beddy. Into the beddy. Yeah. How much do I love you? - More than life itself? - Don't you forget it. - I want to kiss Daddy. - When he comes up to bed. - I want to kiss Mark. - Mark's doing his homework. - I want to kiss Lynn. - He's all yours. The little bird... - ... is coming to say good night... - No! No! - ... to the little log. - No! - Say good night. - No little bird kisses! The little log is gonna give the little bird good night kisses. - Dave. - Here she comes. Hey, Wally. How are you? I got coffee on. Uhh, no, thanks. I, I gotta get going. What's up? Hey, Mr. Turgen. Sweet truck. Hi, Mark. I lost. You lost. Yeah, well, the good thing is who I lost to. Wally. He's willing to lease it back to us. Lease what back to us? Good one, Dad. He's raggin'on you, Mom. If you're joking me, Dave Reimuller, I'm gonna kill you. And if you're not joking me, I'm gonna kill you. I will! Nah! - Not till you see what I've won. - Oh, man! She's yours. Come on. - Oh, no. Uh-uh. - Mom! Oh, honey, do you have any idea how much a horse like that is worth? - Wow! - Nothing to me. She injured a foot as a two-year-old. She'll never make a field hunter. - You could still ride her. - Mom, please! As deputy sheriff and town councilman... ...I order you to take her. Hey, there, cowpokes! I'm gonna ride him first! - Hey! - Hey, what are you doing outta bed? Well, you can't sleep now. Okay, big fella, mount up. - I'm going to call him "Schwartz". - Schwartz? What kind of name is Schwartz? I'm sure she already has a name, Robbie. Mrs. Schwartz is Robbie's favorite preschool teacher. Right, honey? Schwartz likes me. I guess you can't fight City Hall, you know? No, you can't. - Mr. Turgen gave us this. - Ohh. It was taken at the Vilas County Fair. I just don't feel right about taking her. Well, Wally wanted you to have her. That's how come he put her in the pot. How'd you know you'd win? I always win. That's why they call me "Lucky Dave". How much have we got? Oh, about $600 less than we need. Great. I'll be taking my grandchildren to Hawaii. Why would Wally want to give me his horse? He has a thing for you. Oh, David! She's lonely, Mom. Listen to her. Can I go out and keep her company a while? No, you can go up to bed. Both of you. - Can't I watch TV? - Mm-mm. - Give me a kiss. - Thanks, Dad. - Good night, Dad. - Oh! You know, you've completely ruined your daughter's chances for a happy marriage. Where on earth is she gonna find a guy who'll win her dream horse in a poker game? Well... what have I done for my chances for a happy marriage? Mmm. I take it back. This is why they call me "Lucky Dave". Oh, maybe Lynn's right. Maybe I should go bed down in her stall just for the first night. Or you were hoping I'd bed down in yours? - Yes. - Show a little appreciation? - Somethin' like that. - Oh, sorry, Schwartz. Kansas City's number-one-rated country music... Mom, do you know where my backpack is? No. You think back to where you last saw it. Found it! - Did you make your bed? - I'll do it before we leave. - Hey, Mom, I want to ride Schwartz. - A little later. - You said I could ride him. - Yeah. - It's a her. - How do you know? After school you can. - Promise? - Uh-huh. Scout's honor. Get the oil changed in the car today. Yeah. I'll drop it off on my way. Okay, troops... we have five minutes. Ooh! Strong, darlin'. - Fertilizer should be in in a couple of weeks. - Good. And you can tell Nancy that... Thanks, Lori. See you next week. - Hey, Doc. - Hey, Lori. Looks like the airline's got you busy. Yeah, I'm flying K.C. - Denver - San Francisco this month. - And I'm plantin' my crops whenever I have a few minutes. - Ooh. So, are you still seein' patients too? Not for years. That was another life. I wouldn't know a stethoscope if it jumped up and strangled me. Oh, I hear you have a new mouth to feed over at your place. Wally Turgen's hunter. - Old Mill Hardware. - Where'd you hear that? - Paperboy this morning. - Oh. Grapevine must be slippin'. We had her at least seven hours by then. Lori, that was Robbie's school. He took a tumble. He's okay, but they want you to check it out. Oh, okay. Oh! My car's in the shop. - You need a ride over there? - Is that all right? Thanks. I really appreciate this, Doc. Well, I wouldn't have bothered you except for the way he fell. He was taking a snack plate to the trash... - and it seemed like he just kind of collapsed. - Uh-huh. But he got right up, and he's been fine ever since. Hey, how come you fell down, kiddo? - I didn't fall down. - Well, I'll give his pediatrician a call. - I made a picture of the emperor. See? - The emperor? - Oh, that's goo... - No. Like this. Oh, that... Yeah. Well, I like it better the other way. He's okay, I think. Hey, Dr. Peterson, do you want to see my picture? Hey, Mom! I wanna ride Schwartz! - She's not ready yet. - I'm ready now! When we're done lunging her you can. You promised. Scout's honor! Oh, oh! Wait. No, wait. We gotta get the beans out of Schwartz before we put you on her. Don't want to have two matching shiners, do we? Hey, Mark, I got a world-class assistant truck washer here. Happens to have an opening in his schedule. All right, squirt. - Hey, stop calling me squirt! - Mark. Fine. When I finish washing a spot, you rinse it off. Oh, but, whatever you do, don't do this. Hey, quit it! Mom, Mark squirted me! Mark, be nice to your brother. Sorry. Here you go, squirt. You told me to squirt! Ohhh, I'm drenched. You know I'm just gonna have to get you back double for what you did to me. I'm comin'. Robbie? Robbie, quit screwing around. That's it. Robbie? Mom! Mom! Mom, come quick! Something's wrong with Robbie! Hurry, Mom! Hurry! Mom! Oh, Robbie, Robbie. It's okay. It's okay. It's okay. It's okay. It's okay. He was admitted 45 minutes ago, and he's still post-stictal. Lori, Dave, this is Dr. Neaves... - the ped's neurological consultant here. - Hi. - Hi. - He knows a lot about epilepsy. Epilepsy? Uh, yes. One seizure is just a seizure... ...but two, by definition, is epilepsy. But he's only had one. The fall you called me about this morning was probably another kind of seizure. So we're going to admit him and watch him for a couple of days. But this is a kid who hardly catches a cold. How could he have epilepsy? Well, there's a lot of different triggers for seizure disorders. We're gonna run some tests and see what we can find out. I think the best way to understand what a seizure is... ...is to think of it as a short-circuit in Robbie's brain. Something interferes with the normal electrical flow... ...and everything goes temporarily haywire. Oh, oh, oh. It's okay. It's okay. Look at you so brave. Now, Robbie's going to need a CATscan... ...so we can see if his seizures have a cause that we can treat surgically. We'll inject a dye while his head is being X-rayed... ...and then a computer takes a picture... ...just as if we'd cut a slice of the brain. The EEG is used for comparison if Robbie's seizures change in character. It's helpful in diagnosing some special forms of epilepsy. We do these tests to find out if your son has a tumor or lesion in his brain. - A spinal tap is used to rule out bacterial meningitis. - Hold him just like that. If we catch it early, it can easily be treated with antibiotics. Usually we don't find anything. We don't necessarily need to find a cause. Most of the time we don't. But we do have effective drugs. As a matter of fact, 70 percent of kids with epilepsy... ...have their seizures reasonably controlled with the first medicine. We'll start Robbie with phenobarbital. It's been around the longest, so we know the most about it. Although it can cause behavioral problems... ...and is associated with withdrawal symptoms and lowered I.Q... ...most kids on phenobarbital do just fine. - It's boring! - "And the emperor... " Oh, Robbie, come on. I don't wanna read! It's boring. I hate it. - I know. All right. You just... - I hate it! - I wanna ride my bike! - You can't ride your bike, honey. I told you that. Because we don't want you to fall down and hit your head. I wanna go ride Schwartz! - You can't ride Schwartz. I told you, sweetie. - I wanna go pet him! - Anybody home! - Let's go see who this is. Come on. Maybe it's the emperor. - Hey! - It's just Margeen. Well, nice to see you too, Robbie. You can go play upstairs in your room quietly, but no jumping. You hear me? I ran into Doc Peterson today. He wanted to know if Robbie's okay after the fall he took at school. I told him I wouldn't know since I hadn't seen you in a dog's age. Where have you been? Home, with Robbie. What's the matter with him? Well, they're not sure. Probably just a virus. He's on medication, but it's... he's having a reaction to it. - Coffee? - Sure. What kind of reaction? Well... he won't eat, can't sleep... ...and he thinks that he can leap tall furniture in a single bound. What kind of medicine is he on? What! Our insurance company's computer... ...is unable to handle the fact that Dave has transferred union locals. So I submit a bill; they send it back to me. I resubmit it; they send it back to me. I mean, it's... - Want me to go check on him? - No, it's all right. I'll go up myself in a second. What's new? Robbie! - Check his room. - Okay. Robbie! Hey! How are you... Come back here! - Come here, sweetie. - You'll never catch me! - Ohh! Rob! - I'm too speedy! Come here, honey! - Ohhh! - Oh! Ow! It hurts! It's okay. It's all right. - It's okay. Stay here. - Ow! It hurts! I know, I know, I know, I know. I want my Mom! Hello, this is Lori Reimuller... S ...and I need to talk to Dr. Miller about Robbie's medication. Now! A, B, C, D, E, F, G H, I, J, K, L-M-N-O, P - Hey, when's this new stuff... What's it called? - Dilantin. When's this Dilantin supposed to kick in? Oh, about a week. They're tapering off the phenobarb... ...and they're getting the Dilantin up to a level where it'll work. What did he do? Break every bottle of perfume in the house? This place smells like a brothel. Hmm. Not that you'd know what a brothel smelled like. Q R, S, T, U, V, W, X, Y, Z - Now I know my ABC's Tell me what you think of me - Has it been that long? A, B, C, D, E, F, G H, I, J, K, L-M-N-O, P Q R, S, T, U, V W, X, Y, Z - It'll never be that long. - Now I know my ABC's, Next time won't you sing with me On the other hand... it has been a while. Mmm. Listen. He's okay. Don't let your imagination run away with you. You'll drive yourself crazy. Yeah. Come on. Peanut. Be careful. You'll wake him. I'm just gonna... I'm just gonna cover him up... ...make him cozy. This is embarrassing. What do you mean bringing home a report card like this? No kid of mine is gonna do better than I did in school. - Don't have to make A's to do that. - Well... You have me to make you look good. I hate grammar! It's boring! Well, no argument there. Um, what would make it less boring? If Miss Kirchwall taught naked. Gross! For a year I've been putting money away to buy your mom a good horse. Now we've got Schwartz. - I want to ride him. - Mm-hmm. How boring would it be if I added that money to the trip jar... ...and booked us to Hawaii next month? And there was even enough money left over for, um... ...scuba diving lessons when we got there? Bring your grades up to a mere... "B", and it's a deal. - I'll help you. - Whoa. Grammar rules! Incentive. Bribery. Oh. We're closed! Sorry, we're cl... - Sorry, we're closed. - Lori? - Yeah. - Bob Purdue. High school. I was a couple years ahead of you. - Oh, yeah. - Can I talk to you for a minute? Sure. - So how you been? - Good. How's your boy, Robbie? Uh, h-how do you know Robbie? I was in here a couple of months ago. He was being your little helper. He took me right over to the garden tools. I'm sorry I didn't recognize you then. Oh, that's all right. You were busy. Such an ugly disease for such a sweet little guy to have, isn't it? Epilepsy. Who told you Robbie had epilepsy? I saw his prescription at the pharmacy. I've taken the same drugs. I've had epilepsy since I was four. So you hide it? No. Actually, they're not even sure Robbie has epilepsy. He's only had a few episodes. Doctors are talking about taking him off medication. You sound a little like my parents. They still won't say the word "epilepsy. " They call it "Bob's spells" or "Bob's condition". I don't remember 'em using the word "episodes", but I'm sure they threw that one in there too. What did you want to talk to me about? Lori, I know this seems like none of my business... ...but Robbie's gonna need a strong ally. Robbie's got plenty of allies. He's got his family, and he's got some really good doctors. But no doctor knows what makes a seizure start or stop. No doctor knows why the drugs work on some people and not on others. So your child becomes something of a laboratory. They type-treat the drugs. That means they start with a low dosage. Then they crank it up until either the seizures go away or your boy becomes toxic. - I think you better go now. - If you place Robbie's health entirely in their hands... Robbie is gonna be just fine. Mom, if you're there, pick up, please! Mom! - Lynn? - Mom, Robbie's had a horrible seizure! - What? - He stopped breathing. They took him to the hospital. Dad went with them. Well, take Mark and go to Margeen. Mom, is he gonna die? No, he's not going to die. The keys? Get out! Do you want to double-check? You're positive that your company's kept up... ...on the contributions to your health plan? It's a major contractor. It's not some fly-by-night operation. - Hi. I'm Dr. Brown. - Hi. How do you do? How are you doing? Oooh, doesn't look like we're havin' fun yet. Let's see if we can't do somethin' about that. All right, I want you to follow my finger, okay? With your eyes. So, Robbie was admitted with idiopathic epilepsy? "Idiopathic"? Of uncertain origin. Oh. He had a grand mal seizure with a respiratory arrest. And since then he's had three more grand mals... ...plus some other kinds too. Hmm, hey, the good news: You'll never have to worry about Robbie being in the military. They won't take him. He was transferred here to see a specialist. Dr. Stanfield. He's the best. Okay. Did we talk to you about compassionate use programs? "Compassionate use"? During the testing period for a new drug... if it shows promise, the government will approve its use for select people... ...who aren't part of the official study. That's something Dr. Stanfield may recommend you look into. Mm-hmm. See, times have changed in medicine. It's not just up to the doctor. We look to the parents to help chart the course. It's called "joint decision making". Great. So do we have to wait for Dr. Stanfield? Only until tomorrow morning. Okay. Thanks. Transportation Health Plan. It's Gene, KC Trucking. Local 59. I got a driver here who's gettin' the runaround on his kid's hospital bills. Give me somebody who can straighten it out, will ya? - I'll transfer you. - Yeah, thanks. Let's see your bear. - Hi, Margeen! - Hey, look at you! - Hi. - Out of I.C.U. already? - Yeah. - They work fast in this place. Yeah, well, all except Dr. Stanfield. - He's a no-show. - Mmm. - Have you seen Dave? - Not today. Isn't he working? I thought he was gonna take off to come here. How are the kids? Oh. Mark's team won three-zip this morning. He scored the second goal. And Lynn's at your place working with Schwartz. They sent Robbie a little something! - Ooh, what do you say? - Wanna see what my bed can do? What do you think I'm here for? Hey! You okay? - I had another one, Mom. - Yeah, he's okay. I know you did, sweetheart. Come on. Come on. We'll take you in. Hmm? Mmmm! Oh, boy! Let's get this off you now, huh? Yeah. There you go. How are you gettin' through this? I'm... gettin' through it. Ohh! Oooh! Cool! Oh, here's stuff. A change of clothes, some potato salad from lunch. - Ohh. - I'm 20 minutes late. - How am I gonna repay you? - You're not. Mmmm. You're in my debt for life. I think so. - Bye, Margeen. - Bye-bye. Bye. Let's see what she's got here. Ooh, gummi bears! Can I have this one? Oh, you're gonna make me dig down to the bottom? Do you want to check the Reimuller boy? So, you're leaving us tomorrow, huh? No. Well, that's what it says here. No, he was transferred here to be evaluated by Dr. Stanfield. He hasn't even seen him yet. I'll make a note of it. - Hi, Dad. - Hi, guy. Hey, where've you been? We have no insurance. What? Yeah, when I changed locals, there was a six-month "no benefits" period. It's not up for a month. And after that they won't cover him because he'll have a pre-existing condition. No. Nobody, nobody ever said anything about a "no benefits" period! Supposedly, we were notified. I read the fine print, Dave, and I do keep records. We were not notified. That's their policy. That's why. That's why Robbie's transferred out of I.C.U.! I'll bet you that's why Stanfield never showed up too! And I'll bet you that's why they're gonna kick us outta here! Oh. So what are we supposed to do now? Well, what people that don't have insurance do. We take him to County Hospital. And you're just gonna accept that? - Do you have a better idea? - Yeah, I do! Hey, wanna see my truck? - Kansas City. - That's not your truck, Dad. Transportation Health Plan. Hey! That's a flammables carrier, Dave! Yeah. I put in to drive nights. No way. No way! You promised! We agreed you would never... You know how many thousands of dollars we are in the hole? Well, I'll take a telephone sales job where I could work at home. We could go on welfare! But you are not gonna drive a flammables carrier! My family is not going on welfare! There's no way you could make a dent in our debt with hazard pay! Do you know why they call it hazard pay in the first place? Why don't you just take a rider on your life insurance and live off of that? - Stop yelling! - What am I supposed to do, Lori, huh? Huh? What in the hell do you want me to do? Oh, no. Oh, damn it. Okay. Dilantin. A hundred milligrams. That a boy. And Tegretol. A hundred milligrams. That's it. Good boy. - And the depakene. - I don't want that. - I know, honey. - It tastes yucky. It makes my tummy hurt. I know, darling, but I got a new medicine for that. Come on. That's a boy. - Foreclosure? - They take our house. What do you mean, they take our house back? It's our house. Yeah, as long as we make the payments. Well, don't we? When we can, as much as we can. We have to pay the hospitals first, or, uh, they'll take my pay. How can they take your pay? You earned that! Well, they earned it too, taking care of Robbie. Come on, kids. The bus'll be here in a second. We can talk about this later. Okay, okay, Rob. I'm here, honey. I'm here. That's okay. So, what happens when the bank takes back the title of our house, or whatever you said? - They'll sell it. - They'll sell it? Where are we supposed to live? What about the animals? What about Schwartz? - I don't wanna sell our house. - I know, honey. - And what, you're just gonna let them? - Mark! I'll do everything I can to keep our house. I could use some support. Fine. I'm sorry. Lynn? Lynn? [Let's see. Um, do you have any untapped financial resources? Savings, investments, family? Well, uh, we've already gone through our savings. All we have left is the farm. We're not in the business of taking people's homes. We'd much rather work something out. What kind of payments do you think you can handle, say, half-monthly? Well... ...that's how much I have today. I don't know about next month. Come on, Lori. Come on, sweetie. I want to pet him. Can I ride him? Someday. I promise. Scout's honor? Scout's honor. Mom is gonna be so excited! - I get to tell her first. - Okay. Hey, where were you guys, huh? Huh? I called and I called from the doctor's office... ...to get Daddy to pick up Robbie's prescription. And the phone rang and rang, and nobody answered it. We were here. Maybe you dialed wrong. What did the doctor say? Well, it's not measles. You want that? It's Stevens-Johnson's Syndrome... ...one of the rare side effects of Tegretol. I don't know why they call 'em side effects. As if a 102 temperature and a rash over his whole entire body... ...is somethin' off to the side somewhere. Did I forget somebody's birthday? No, it's something else. We're gonna wait for Dad. What is wrong with this... Oh, my God! What time is it? I still have time. - Lynn, do you have any money? - Uh, a couple of dollars. - Never mind. I think... - What are you doing? The phone's turned off. We didn't pay the bill. Well, good. We won't be waked up by stupid people yelling we owe them money! - I have ten minutes. Will you watch him for me? - Uh-huh. You can't take money out of there. No one touches that money! We have to have a phone, Mark. What if Robbie needs 911? No, this is for our trip! What trip? Mark, look at your brother! You really think we're gonna take him on a trip? When they kick us out of our house, you think we're gonna go on vacation? Oh, well, I thought since I got an "A" in English... ...we'd be going to Hawaii and taking diving lessons like Dad said. - Dumb me! - Oh, honey, I'm sorry. Me too! I'm sorry Robbie was ever born! - Don't say that! - If he's gonna die, why doesn't he do it? Mark! Mark! Mark! Mom, Robbie's having a seizure! Mark! Mom, it's a bad one! Okay. Okay, darling. It's okay. It's over. He's doing it again. It's okay. It's okay, honey. It's okay. We're here. It's okay. It's okay, sweetie. County Hospital cafeteria will be closed in ten minutes. - I'm Dr. Abbasac. - Hi. Robbie's failed to respond to most of the usual anticonvulsive medications. The problem's compounded by the fact that he has multiple seizure types. We're gonna try some less commonly used drugs. What about a compassionate use program? I see no reason to use an unproven drug when there are proven ones left to try. I'm ordering a series of tests for tomorrow morning. We'll repeat them on a regular basis... ...to monitor changes as we begin the new med regimens. - Is that necessary? - Is what necessary? Well, he's had the same tests over and over, and they're pretty hard on him. - Yeah. - They always turn out the same. There's something I should make very clear to both of you. After a first antiepileptic drug fails... ...there's only a 15 percent chance the drugs will ever work. After that, there's only surgery. You shouldn't expect this to be easy. Why not? So far it's been a piece of cake. Robbie's what I consider a high-stakes case. If I can stop his seizures, he still has a very good chance for a normal, healthy life. But a young brain can't tolerate seizures of his intensity and frequency indefinitely. Well, what if you can't stop them? There are no hard and fast rules... ...but it's not unusual to find neurological compromises: diminished capacity, developmental delays... progressive retardation. Excuse me. Not much of a view, huh? No. - Your boy has seizures? - Yeah. That's what Lili had. They did brain surgery. Oh. How is she doing? Okay, I guess. She's a beautiful little girl. And I checked with several colleagues from across the country, all of them very accomplished neurologists. A few of them run pediatric neurology departments at major meds schools and hospitals. It sounds like you're in very good hands right where you are. Uh-huh. Okay. They differ slightly in the order that they try the drugs. After that, there's surgery, but you're not ready for that yet. - Oh, no, we are not. - Oh, Lori, one other thing they did agree on: Treating seizures in kids is much more art than science. Okay, Doc, thanks. Bye. I'll put a request in to Dr. Abbasac for a stool softener. That should help. Why does he have hemorrhoids? The medication causes the constipation... ...and the pushing causes the hemorrhoids. Hey, little pretty girl Hey, KC Tanker. Will you be needing any 24-hour roadside assistance there, good buddy? Come back. Negatory there, heavy hauler. Just pullin' over to check my rig. Thanks a lot. Stay away! Come here, Robbie. Robbie. - Oh, God! - Get away from me! - Come back here, you! Robbie! - You're gonna kill me! - I got you now. - Let me go! - I got you. There's your Dad. - Hey, what's goin' on? - Get out of here! - It's a reaction to the mysolene. - Get out of here! - Will you be still? Look at Daddy's truck. - Let me go, you pig! I hate you! - Ohhh! Hey, don't you ever talk to your mother like that! Do you hear me? Ohh! Oh, no! Oh, honey. Come on. Somebody help me, please! Somebody help us! Oh, it's okay. It's okay. Ohhh, okay. I've called Dr. Abbasac to authorize a sedative. Why don't you go home and get some rest? I'll look out for him. Go on, Lori. It can't do him no good to stay and sit. I will, I will. Mommy, Mommy, let me out! No! Mommy! Mommy, don't leave me! I'm not going anyplace, honey. We're gonna stay here. Let me handle this. - Here. You know what? - Mommy! You know what we're gonna do when you get better? We're gonna go to the playroom. - Mommy, don't leave me! - They have some neat toys in there. And when you get really, really better... - we're gonna go down to the cafeteria... - Mommy! - and we're gonna get some lemon merengue pie. - Mommy! It's the best. Oh, I can't. I just can't. - It's okay. - Mommy, Mommy, let me out, please! - It's gonna be okay. - Help me! Please let me out! Dr. Abbasac, code blue. Dr. Abbasac, code blue. Dr. Abbasac, code blue. - Good morning. - Good morning, Steve. Ohhh! Oh! - He has a fever. - How high? - We've stabilized it. - Oh. Why does he have a fever? It could be an infection. It could be part of the seizure disorder. It could be the medication. That's something you're gonna have to talk to Dr. Abbasac about. That a boy. You're okay. Where is Lili? The little girl in the other bed. What happened to her? - She's dead, isn't she? - It's extremely rare. She died of the epilepsy, not the surgery. There's something wrong here. There's something really, really, really wrong! I bring my kid to you people for help, and all you do is make him sicker. You give him one drug, and then he needs another drug to cure him of the first one. And then he needs another drug to take away the side effects of that one! And another one and another one and another one... I mean, he... He has had a rash, swollen glands, a fever... ...constipation, hemorrhoids, bleeding gums... And he acts like a drunk, a zombie, a psycho. And it's not because of his sickness. It's because of your cure. If Robbie doesn't get better... ...if he ends up in a home, strapped to a wheelchair somewhere, huh... ...what are you gonna tell me then? That it's all some big idiopathic tragedy? - Lori. - I'm sorry. But, you know, there must be something else that you can do. There must be something. Lori, wait. I've been meaning to give this to you for your signature. It's the paperwork on the compassionate use program. We want to try an experimental drug. Dr. Abbasac, code blue. Dr. Abbasac, code blue. Dr. Abbasac, code blue. He's in status. Two milligrams, Valium IV. One more. Help me! Help! Another milligram Valium IV. Repeat until we have cessation. Get me four milligrams paraldehyde. Hurry. He's in status epilepticus. If we can't stop it, we risk permanent brain damage. Paraldehyde is a drug that temporarily freezes the central nervous system and prevents that. But like any drug, - it carries its own risks. - What risks? Depressing the nervous system can result in pulmonary edema, even death. That's the choice? Probable brain damage or possible death? Paraldehyde. Not oral. Miss Warren, get me a rectal syringe for the paraldehyde. But not plastic. Miss Warren. Get me four more milligrams paraldehyde. Paraldehyde. Turn him on his side. Hi. Oh, I... probably average three or four seizures a month. Be better if they restricted themselves to weekends and holidays. Yeah. Um, when I was in elementary school... I was on so much medicine, the other kids assumed I was retarded. I had a seizure during our fourth grade talent show. They must have thought I was doing my impression of a fried egg. Not too many kids wanted to play with me after that. Took my parents weeks to go back into public. Later on, I got to where I could... ...tell a couple minutes in advance when one was coming. I get auras. Things start to change colors. My head aches. I try to hide it at work. I don't wanna lose my medical insurance... ...or worse, my job. Can't drive. My marriage broke up because the drugs keep me from being a normal lover. And I seize in my sleep, I cuss, I make animal noises. There is anger and loneliness. But when the self-pity comes, I try to say to myself... ...instead of, "What life do I have?"... ..."What life can I build?" Then who did take it down? I don't know. What are you blaming me for? Because it's a criminal offense to remove a foreclosure notice. You can go to jail. So you better tell me you didn't trash it and you're gonna put it back. Fine. You want me to say I took it down? I took it down. Then put it back. - How come you're always pickin' on me lately? - I'm not pickin' on you. Yeah, you are. You and Mom think everything's my fault. I suppose if Robbie dies it'll be my fault too. What? It's not like I meant what I said. I was just mad. What are you talkin' about? Oh, right. Like Mom didn't tell you. Tell me what? I'm sorry! I didn't mean it. I don't want Robbie to die. He's my brother. I love him. Please don't let him die, Dad. Please don't. A, B C, D E, F, G - A, B, C - H, I, J, K - L-M-N-O - D E, F, G A, B, C - D, E - What's gonna happen to him? - F - Do you think he's gonna be a vegetable? Because if he is, I don't know... I don't know if I could take care of him. - I don't know if I could stand to see him like that every day. - E, F, G Could you? - Nobody seems to know anything... ever. - A, B, C - Nobody can give us a prognosis. - D So maybe... maybe he's gonna die. - Do you think he is? - How would I know? Well, I... Do you care? Shut up, Lori! Don't you even care if your son is gonna ever be happy again? - Just think before you talk! - Don't you... wanna know what's gonna happen to him? God, what kind of a father are you? - You deal with this your way, and I'll deal with it mine. - Oh! I'm havin' enough of a problem the way it is right now. Do I wanna know how much worse it's gonna be a week from now? Or, or a month? Or a year? Well, I'm not sure I do. To tell you the truth, there are times when I look at Robbie and... and at my family, and I think if this is the life he's destined to lead... ...if all he has to look forward to is more drugs, more seizures... ...brain surgery, retardation... ...and if we really start runnin' out of hope... ...he may well be better off dead. Can I help you? Point me to the section on epilepsy. That's a vast area of research. What kind of epilepsy do you want to know about? The kind that's taking away my son. Somewhere Over the rainbow Way up high There is a land That I heard of - Once in a lullaby - Why is he wearing a helmet? Epilepsy. The helmet protects his head when he falls down. Somewhere over - The rainbow - Charlie, it's time to go. Come on. Get up. - Skies are blue - I wanna bring it! And those dreams That you dare to dream They really do come true Someday I'll wish Upon a star And I'll wake up Where the clouds are far behind me Oh, yes Where troubles melt like lemon drops Way above the chimney tops That's where you'll Find me Hi. - Somewhere - Hi. - I didn't know this was your place. - Over the rainbow So you... you do the algebra homework? - And those dreams - We're supposed to pick up the washer and the T.V. - That you dare to dream - Oh, okay. - You know, but we could come back in an hour or so, - They really do come true if you got a wash goin'or somethin'. Someday I'll wish Upon a star And I'll wake up Where the clouds are far behind me Oh, yes Where troubles melt Like lemon drops Way above the chimney tops That's where you'll Find me Gonna be somewhere Over the rainbow Oh Where pretty little bluebirds fly Birds fly All over the rainbow Why Then, oh, why Can't I? What's goin'on? - It's Mom. - Is Robbie worse? No, he's the same. She said she found something, um... Different kind of treatment that could help Robbie. A diet. You mean it can make his seizures go away? Good, Mom. A diet. Why don't we try a rain dance? Then I'll get a doll that we can all stick pins in. Dr. Forman's office. How may I help you? Hi, this is Lori Reimuller, and I've just read, uh, Dr. Livingston's book about the diet, that treats childhood epilepsy, and I would like to make an appointment for my son. Well, we have a cancellation tomorrow at 1:30. But you're, uh, in Maryland, and I'm calling from Kansas City. I'm sorry. Well, that's our only opening for three months. Three months? Oh, no, no, no, no, no. Robbie can't wait three months. He's too sick. Well, then he'll require hospitalization, and there are no available beds... ...in our inpatient program for the foreseeable future. Uh, why don't I put you on our waiting list. We do have cancellations. - I need to talk to the doctor. - He's with patients, Mrs. Reimuller. Why don't you send us your son's records. I'm sure something will come up before too long. Okay, I'll take that appointment tomorrow. - What is the patient's name? - Uh, Robbie... ...Reimuller. R-e-i... - Excuse me. - ... m - u - l - l - e - r. - Thank you. - Who is it? I've, I've been doing some reading, and I've... ...come across a treatment for epilepsy... ...called the keto... ketogenic diet. It's by a doctor from Johns Hopkins. And the diet, the best I understand it... ...makes the body go into a fasting state, and something about that fasting state... ...stops the seizures. The Comprehensive Management of Epilepsy in Infancy, Childhood and Adolescence... ...by Samuel Livingston. The bible on pediatric epilepsy. Every neurologist in the country owns a copy. With the exception of the material on the ketogenic diet... ...it's an invaluable piece of medical literature. The diet is not an approved treatment. - But there have been a lot of studies. - Those studies are anecdotal... ...not the kind of studies we base sound medical judgement on, not double-blind studies. The ketogenic diet is highly suspect. You have to starve the child to begin with, and what you feed him consists mainly of fat, which is not only unpalatable but nutritionally inadequate and extremely difficult to maintain. I've seen it tried a few times, and my experience is that it simply doesn't work. I've been meaning to give this to you. It's the number of an outstanding pediatric neurosurgeon on our staff. It's time to see if we can find a focus... ...a starting point in the brain for Robbie's seizures. If we can, there's a good possibility we can remove it. Not brain surgery. We don't want brain surgery. I'm not proposing surgery. Not yet. I'm talking about a diagnostic procedure. We remove the top of the skull and place electrodes on the brain for a few days... ...to see if we can map it and try and locate the problem. It's the next logical step, and I'd like to schedule it immediately. We can't because we're goin' to Baltimore. Robbie has an appointment with Dr. Forman at Johns Hopkins tomorrow. And how are you planning to get Robbie to this appointment? I booked us on a flight. There is a danger of a life-threatening seizure if you stop the drugs abruptly. Well, who's talking about stopping drugs? I, uh, have administered enough drugs to Robbie in nine months to get a pharmacy degree. You'll need an ambulance to transfer him from the hospital... ...a plane that will accommodate a medical transfer, his meds... ...a drip, emergency oxygen and a doctor to accompany him. There is no way that we can afford all that. When you have met these conditions for his safe transport... ...I'll be glad to sign for his release. Shh, shh, shh. - Have you taken his B.P.? - Yeah, I did. Oh! - Can I help you? - Radiology, um... My son needs an X ray. - Let me see your lab slip. I'll tell you where to go. - Oh, huh... I must've left that down in emergency. Take the elevator to the first floor, follow the signs. Okay, thanks. Major babe. Ma'am? Ma'am. Security. Ma'am? Ma'am, excuse me. You'll have to come with me. Do you know what would have happened if he hadn't stopped you? Yeah, I'd be on a plane to Baltimore. When he was discovered missing, an all points bulletin would have gone out. - What? My arrest? - Yes. - I was the mother. - It doesn't matter. You could have been charged with kidnapping and child endangerment. - You could've lost custody. - What? The institution can petition for legal guardianship of any child... ...whose interest and well-being they feel aren't being served by his parents. And the courts usually grant it. Well, what if I feel that his interests are not being served by the institution? What if I feel that he's, he's actually being harmed by the whole, you know, system? What if, what if I just can't sit here and watch him... fade away? Don't I have a right? Don't I? - To try to protect my own child? - Lis... I... I shouldn't be telling you this. I could get in a lot of trouble. We had a staff meeting this afternoon. Dr. Abbasac discussed your plans to take Robbie to Baltimore. She believes you're losing it, that your judgement's impaired. - And after tonight they have all the evidence they need... - Oh, they're not... they're not talkin' about takin' Robbie away from me. She's on her way down here now. It might be best if you were gone when she gets here. All right. I don't agree with the doctor. I think you know your child better than any of us... ...and you're just trying to do what's right for him. A lot of kids get well here... ...but Robbie's not. Oh. Come on! So even though we missed the appointment, I went back and looked it up again. And all these doctors had the same results. About a third of the kids that stick with the diet have their seizures go away. And another third are significantly improved. Look. 1927. Dr. Hemholtz from the Mayo Clinic. Uh, 1937. That's Dr. Wilkins from Johns Hopkins. And, and... And 1954, 1973. Dr. Livingston from Hopkins. And 1963, Dr. Keith from the Mayo Clinic. And 1989, and... We're talking a couple thousand kids, here. And-And look, look. Just last year. Published 1992. Johns Hopkins. They took 58 of the sickest kids, put them on the ketogenic diet... ...and almost a third of'em had their seizures go away. The 1920s? How many kids like Robbie have there been since then? I mean, how many children have been given drugs and operated on... ...and not one of them was told of this diet? Something doesn't make sense. I mean, if all the doctors we've talked to know about this "kenogenic" diet... - Ketogenic. - Ketogenic diet. Even if they don't like it for some reason, don't they have to tell us about it? Can they really censor information like this? How can there be joint decision making if they don't give us information, - tell us options? - Didn't you say Doc Peterson, talked with his neurologist friends about Robbie... - ... and not one of them mentioned a diet? - That's right. Just drugs... and surgery. If this stands any chance of working, let alone... ...a one in three chance of stopping his seizures altogether... ...why would they rob us of that hope? Dave Reimuller. We'll be there. Meeting with Abbasac in an hour. She wants to talk about Robbie's surgery. - Oh. - Uh. I'll, uh, I'll meet you. Don't see anyone until I get there. I'll meet you in an hour. Doc? Hi. Dave tells me I might be of some help to you. Come in. - There's no need to have an attorney present. - I'm not a lawyer. - I'm a friend of the family. - This is Jim Peterson. Dr. Abbasac. This is Dr. Alison, the pediatric neurosurgeon I mentioned to Lori. - How do you do? - Hi. Please sit down. I examined Robbie this morning and, uh, reviewed his record. We have his procedure scheduled for tomorrow morning. I'll just need the signed consent form I gave you so we can process the paperwork. The Reimullers have decided to go in another direction. They're gonna enroll their child in the ketogenic diet program at Johns Hopkins. I told Lori what conditions for safe transfer must be met... ...including a medical doctor to accompany Robbie. Now, I don't know of a single M.D. who would endorse... ...the kind of foolishness she's proposing to subject her son to. Of course you don't. Since so many in our profession... ...choose not to look beyond the limits of drugs and surgery. It's what made me change careers, but I've kept my medical license current. - You're a physician? - We'll meet your conditions for Robbie's safe transfer. I'll accompany him to Baltimore. I assume you've spoken to Johns Hopkins about these arrangements? I have, and the arrangements have been made. They're expecting us. Dr. Peterson? I assume you know all the evidence in favor of the ketogenic diet is anecdotal. There is absolutely no scientific evidence this diet works. When you say scientific evidence, if you mean double-blind studies... ...then I have to ask you, where are the double-blind studies on the effects... ...of the interactions between all the drugs you've had Robbie on? Where are the studies on the surgery you'll propose... ...as a result of the electrocorticogram? Dr. Abbasac, to arbitrarily pretend that your treatments for epilepsy are science... ...and then argue against a ketogenic diet... ...seems to me to be the cruelest of double standards. When you and I became doctors, we swore an oath that said, "First do no harm. " Now, if these folks wanna try to control their son's seizures... ...by changing what he eats instead of drugs and surgery... ...well, I think they deserve that chance. Dr. Abbasac gave the order to pull him off the paraldehyde... ...to prevent respiratory problems while he's traveling. Hopefully there'll still be enough left in his blood to keep him from seizing. I put in for a couple of vacation days, and my supervisor's... ...pulling together the meds he'll need for the trip. You're goin' with us, then? Things don't fall into place the way this has... Dr. Peterson offering to go with you... ...another space opening up for Robbie at Hopkins... unless they're meant to be. Besides, I think Dr. Peterson is volunteering his degree, not his expertise. If something should go wrong, he'd need me. I haven't seen a doctor insert an IV in 15 years. - Heads up. - Hey. Found a place for you to stay... free! Wh... Holy Sisters of Saint Francis? Mmm! My sister was a novice there. She says the nuns are very nice, even though they don't talk. Uh! Mom in a silent convent? Well, it could happen. Come on, buddy. Whoa! We're goin' on an airplane, you know that? Big, big, big one. I'm excited, Mommy. You know that I believe in my bones what you're doing is wrong. I know you do. I've been told over the years that I'm not the easiest person to deal with. I hope you're not sacrificing this beautiful child to a personality conflict with me. He's my boy, and I'm his mom. I'm just doing what I think is right. If it were your child, can you honestly say you'd do anything different? I'll be sending you little bird kisses. Hope you get to ride in a jumbo jet. Bye, buddy. - Bye, Mom. - Bye, Mom. - I'll take care of him. - Okay. - Thanks. - Be nice to the nuns. Be careful. - Bye, Robbie. - Have a good flight! Good luck, squirt. - Put this underneath. - We've arranged for an ambulance. - It's okay. - It's already been 15 minutes. - Should we give him some Valium intramuscularly? - That's it. - He's okay. - Good. I'll tell the pilot. That's it, sweetie. - Hi. - May I help you? I'm... I'm Lori Reimuller. Oh, yes, Mrs. Reimuller. Your son's appointment was two days ago. I know, I know, I know. But, uh, this was the soonest that we could get here. I'm sorry. Don't you remember I told you very clearly on the phone... ...we have no appointment openings with Dr. Forman - or available beds in our hospital program. - He has to be in the hospital. He transferred out of pediatric intensive care to come here. Wait here. What do we got here? Oh! This is Robbie Reimuller. I'm his mom. - Uh, I have his medical records. - I've seen them. As my receptionist told you, there are no more beds in the clinic. Please, you're not gonna tell me after we've come all this way... ...that we have to turn around and go... back. It's of the utmost importance that the ketogenic diet be started... ...under strict medical supervision. There are risks. Do you have a place nearby to stay? Yes, yes. Five minutes away. No needles. Follow. When was his last meal? Uh, breakfast, this morning. Push. All right. No more food for two days. And then we'll start the diet. You know, they took him off paraldehyde to make the trip out here. And the place where we're staying isn't really set up for a sick child. He wants to be treated like a normal healthy boy. Do that, starting now. I've been on an airplane. And how'd you like that? Fun. I'm sorry. I thought he would be staying in the hospital. I wouldn't ask you except that we don't have anyplace else to go. No male has ever slept on these premises. If you can manage with the simple essentials... ...you're both welcome to stay with us as long as you need to. - Thank you. - Sister Josephine will show you to your room. Can I have a minute? If, uh, he gets bad, you be sure and call 911. The hospital can always find a bed on an emergency basis. I know "sorry" doesn't begin to cover it, but... You understand if anything had happened... ...Marissa could've lost her license and her livelihood. - Thank you. - Oh. I wonder if you'll ever know how lucky you are to have this lady for a mother. - There you go, buddy. - Hey. Thanks. Okay. - Hi. - Good morning. How's everything going so far? Good! I, um, I dreaded the fast. I thought he'd be beggin'me for food, but so far he's not. He has had... seizures the last two days... ...but only small ones. I don't know if it's my imagination or not, but his whole body seems more relaxed. Many parents notice positive changes during the fasting period. Fasting rests the body. Now, you'll know within a month whether the diet is gonna work for Robbie. And if it does, you'll keep him on it for two to three years... ...before returning him to a normal diet. - Okay. - To be effective, the ketogenic diet... ...must be rigidly controlled. Each meal is precalculated, and all foods are weighed on a gram scale. - Right. - It's difficult. Well, is it more difficult than watchin' your kid have a hundred seizures a day? I've been teaching and administering the ketogenic diet... ...here at Hopkins since 1949... ...to well over 500 patients. I've never seen a parent, win, lose or draw, that regrets having given it a try. Dear Dave, Lynn and Mark: This is day five. I'm holding my breath. No seizures for three whole days. Not one. I guess it could be the drugs, but we already started to take them away. The plate is already weighed and now I'm gonna weigh out 17 grams... Mrs. Kelly, the dietician here, she's been so enthusiastic and helpful. She treats us like we were her first patients. It's hard to believe... ...she's been doin'this for over 40 years. See how close to 17 that is? Yeah. - I wanna know how good it tastes. - He loves bacon. Robbie's meals are actually much better looking than I thought they'd be. And he wolfs 'em down. Our scripture today is from Matthew 17. "A man came to Him saying, 'Lord... " "... have mercy on my son, for he has epilepsy and suffers severely". "And Jesus rebuked the demon, and he came out of him... " "... and the child was cured from that very hour. "Then the disciples came to Jesus privately and said... " "... Why could not we cast him out?" "And Jesus said, 'This kind does not go out except by prayer and fasting'. " Let us pray. Father... ...we ask Your blessing on this child, Robbie... ...that he may come forth from sickness into health, to live as Your servant in wholeness... The nuns are so good to us. They really made us feel welcome. And we're trying not to disrupt their lives too much. - Roast beef. - I'm almost afraid to say this, but I think this is working. - Tonight we have a choice of... - I know it is. Dave, I keep remembering the questions you asked... ...about the doctors censoring information... ...and robbing us even of hope. And I keep wondering, what could have gone so horribly wrong... ...with this whole medical system? Hey, I'll race ya! We gave them our son. We gave them our trust. We damn near had to give 'em our home. But instead of giving us the simplest information... ...they abused Robbie, and they almost destroyed us all. - Yea, I won! I won! - Not that any of'em will ever ask... ...but I wonder if they have any idea of the pain they caused. And I wonder if someday I'm gonna be able to find... ...in my heart a way to get past the anger... ...and feel forgiveness. I don't know, Dave. I don't know. - Hello? - Hi, it's me. - Is everything okay? - Yeah, we're fine. - How's Robbie doing? - Well... ...he's almost our old kid again. I think he's comin' back to us, Dave. Ohh. Thank God. I miss you so much. I miss you too. I miss us. Do you miss us? Oh, boy, do I miss us. Tell me. Dave, we're in a convent here. Give the nuns something to remember you by. Come on! Hurry up! - Do you see him anywhere? - I don't see him. See him? Hey, squirt! Good goin', but you need to hang on. I don't need to. I'm big! Gotcha! Hey, Margeen, look at me! Ride 'em, cowboy! Hi, Marissa! - Hi, Mom and Dad! - Hi, sweetie! Somewhere Over the rainbow Way up high There's a land That I heard of Once in a lullaby. Not much of a view, huh? Somewhere Over the rainbow Skies are blue Security. And those dreams That you dare to dream - Hold him just like that. - They really do come true. Someday I'll wish Upon a star And I'll wake up Where the clouds are far behind me Oh, yes Where troubles melt Like lemon drops - Way above the chimney tops - I've never seen a parent... - win, lose or draw, that regrets having given it a try. - That's where you'll Find me Gonna be somewhere Over the rainbow Oh, where pretty little bluebirds fly For more information on the ketogenic diet, please call the Charlie Foundation at: All over the rainbow Why Then, oh, why Can't I? Can't I? |
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