Can you say when cancer
will be eliminated, when it will be controlled altogether?
I can say this, that it is my belief that cancer can be
controlled, that the amount of knowledge we now have
from basic science and from clinical investigation
permits this feeling of controlled optimism,
Given the scientific brain power,
which we see active today, given resources and equipment,
support for such work, I believe that very
rapid progress can be made,
And I believe firmly that there is
enough knowledge today to warrant an optimistic outlook,
Cancer is not our inherent birthright
simply because we're people,
This comes from many studies which show that up to 95%
of our cancers are extrinsic,
That is, they're not due to our inheritance or to our genetics,
They're due to something that happens,
something that we're exposed to,
And here we are,
There you go,
Good bunny,
Now, Lily, remember what I promised you,
This won't hurt bunny one bit,
Watch,
Now, then, how about your turn on the machine?
It's the type of work in which doctors must
be attuned to being patient and to working for many, many years
to see their results,
But the fact is, the results are emerging,
Dr, Evans,
Dr, Evans, Hi,
Hi,
I'm Brian Foust, your resident,
Oh, pleased to meet you,
I just want to say I really admire your work,
I mean, chapter 16 of ACS is amazing,
You got a rabbit in there?
Yes, indeed,
Well, yeah,
It's just that, you know, we have
a very strict policy about keeping animals
out of the patients' quarters,
Well, then be a dear and return Mikey back to the lab,
will you? -Mikey?
-Oh, OK, -Well done,
Well, his symptoms were being very tired,
He bruised very easily,
And we noticed a difference in his walking pattern,
Well, I think it was seven years when we started coming,
and I'm coming every three months now,
It's something you always think happens to someone
else rather than you,
Good boy,
You're all right,
Neuroblastoma is one of the most common tumors in peds
with dismal treatment results,
One reason for this failure may be due to the natural history
of the tumor, as 70% of children
already have metastases at the time of diagnosis,
So, in general, 2/3 of patients with neuroblastoma are beyond
the bounds of curative surgery and radiation therapy,
which brings me to,
Chemotherapy,
Now, I know opinions vary on the value of chemotherapy
in patients with localized disease,
But some such as myself, believe
it may suppress microscopic distant metastases
in a fashion similar to actinomycin D in Wilms Tumors,
What's that look for?
Yes, I know I'll have a mixed crowd,
but they should be able to keep up,
Hmm?
All right, all right,
I'll be less oncologisty,
Neuroblastoma is one of the most common,,,
Hello,
Your feet are on my desk,
How did you get up there?
So rude,
Are you,,, are you reading my mail?
You do run radiation therapy and research around here,
don't you? -Yes,
Well, I'm Dr, Audrey Evans, chemotherapy specialist
and your new Chief of Pediatric Oncology,
I am aware of that,
What I don't understand is why you're reading my mail,
Well, they're my patients, too, you know,
I'm just doing my homework,
Shall we continue?
You're aware it's a crime to read people's mail?
Are they here?
Who?
Who is that? -The arresting officers,
Have you rung them yet?
OK,
Do you spend a little extra time on Sally here?
I disagree with her previous physician's diagnosis,
I think it's neuroblastoma, not Wilms tumor,
There's even evidence of calcification on the X-rays,
You noticed that the biopsy showed
significant epithelial maturation?
Yes, but that's just one component,
Yeah, but the biopsy didn't reveal any blastomal or stromal
components, though,
Oh,
Yeah,
May I?
But of course,
Thank you,
One more thing,
Has the waiting room always been so dreary?
I really hadn't noticed,
How could you not?
Something like an aviary would do wonders,
Is that your lamp?
Thank you,
Was my mother's,
If you ever need light, come find me,
At the end of the meeting on Friday,
Have you tried hard boiled eggs?
The egg salad, it's actually pretty fresh,
It tastes pretty fresh most days,
Does it feel like,,,
You've had a call with the assistant secretary?
Morning,
Filthy habit,
It is, It is,
It's terrible,
Only time for cardiology and oncology today,
Gastroenterology and infectious diseases will
start next week's meeting,
I trust you've all welcomed Doctor Evans,
-Doctor, -Doctor,
Welcome,
Doctor,
Welcome,
Trained at the Royal College
of Surgeons and Johns Hopkins, headed hematology and oncology
at the University of Chicago,
And worked under the Sidney Farber at Boston Children's,
Oh, and was a Fulbright scholar,
Did I miss anything?
Save the commentary, Dr, Lewis,
The floor is yours, Dr, Evans,
As you know, the three major killers of our children
are congenital heart disease, trauma, and cancer, which has
a survival rate of just 10%,
I have bold ideas on neuroblastoma, the deadliest
solid tumor in peds,
Our standard therapy regimens of single agent chemotherapy,
surgery, and radiation are simply
not aggressive enough to handle such a sinister disease,
I have been tracking a new method called
combination chemotherapy, mixing approved medicines
in low doses,
It has shown to be tremendously successful in leukemia
patients, and I think could be equally
beneficial for neuroblastoma,
The genomic and metabolic patterns of blood cancers
in a peripheral nervous system tumor, apples and oranges,
Of course,
But cyclophosphamide shrinks the cells,
Vincristine slows the spread,
Together, they would attack the cancer from all sides,
It's common sense, really,
Cyclophosphamide can also cause bladder
bleeding and infertility,
Vincristine can cause compromised motor skills,
seizures, neuropathic pain,
It feels as like a lot,,,
And if we do nothing, the child likely dies,
I'll need to create an animal model to know for certain,
but if correct, we could change the way we
treat children in mere months,
Add it to the queue,
The queue?
You'll be able to apply for funding in about a year,
My children don't have a year,
Are you saying your patients are more important than theirs?
That's enough,
Seeing if she has a sense of humor,
I hardly see the comedy,
Well, that's because he's not funny,
All right,
Are you going to stand for the entire meeting?
Very good,
Bob, you're up,
I realize that,
But you said that I could continue my research here,
We had an agreement, -We still do,
A year is too long,
It can be frustrating, I know,
Frustrating is when my daisies wilt in the summer,
How long did your study on transfusion of fresh platelet
concentrates for patients with secondary cytopenia took?
Two years,
Mhm,
And how about your clinical trial on the effects of
vincristine in the treatment of leukemia patients?
15 months?
I'm a department head now,
All the more reason to set a good example,
You're tying my hands,
You wanted the job,
You took the job,
Now do the job,
Oh, and I don't want to hear any more about lab
animals in patient facilities,
CHOP is not a zoo,
You need to go this way,
All right,
I want my mommy,
Mia,
Now, I promise this will just take a moment,
We're going to stand on this step,
Look at Mr, Bear,
He's going to watch you get the picture of your tongue,
No,
Please, don't,
Mia, it will be all right,
Just try to stop squirming,
No,
Absolutely not,
We do not use those,
He'll take the straps off if you stop,,,
This is protocol,
Would you let me do my job, please?
So why don't you just tell me how it happened?
I already told you,
We had an argument off the roundabout,
I heard you say that,
You disparage my parenting and then
act like I'm the crazy one,
It is a talent,
I do apologize for the delay,
The X-rays took some time,
Where is she?
Is she OK?
There's no good way to say this,
I'm afraid Mia has neuroblastoma,
an aggressive form of cancer,
That's impossible,
Mia was completely fine just days ago,
Alvin, tell her,
She's fine,
Unfortunately, a patient can go from no symptoms
to a belly mass overnight,
No, you have the X-ray mixed up,
I'm certain of it,
I'm so sorry,
Good girl,
Get that down, you,
We all need our greens,
Bring them to the lab, would you, Bob?
Nice to meet you, Bob,
Good afternoon, ladies and gentlemen,
The quality of this sawdust needs improving,
I will make a note for the technician,
I think you're really on to something with
combination chemotherapy,
If we can figure out how to minimize side effects,
it could be very substantial,
We?
There are people here who want to help, Dr, Evans,
And I suppose you're one of those people?
I am,
Of course,
So tell me, what is it I have to do in order for you
to help me?
Uhm,
Oh,
No,
No, no, no,
I wasn't implying,
Oh, I thought,,,
I was trying to help,
I'm just,,, I'm going to go,
Come on,
Hi, guys,
Who's winning today?
Well, we're all on six,
Oh, gosh,
We we're all on six, so,
Where's seven?
Oh, seven is right there,
Oh, OK,
Who's going first?
Shall I adjudicate?
That was very good flick,
I'll see you later,
Pardon me, coming through,
Oh, excuse me,
Keep on keeping on,
I know,
Thank you,
There, primary tumor extracted,
Thank you,
Lymph nodes ready for biopsy,
Thank you,
Yeah, All right,
And the left area,
Sponge, please,
Thank you,
I need you to move my study up the queue,
-I can't, -Can't or won't,
I can't show favoritism inside my own department,
It's a fast way to lose friends,
I didn't realize it was a popularity contest,
What if I got a pharmaceutical company to sponsor it?
There's not enough room in the lab,
One study in, one study out,
It's common sense, really,
You're shaking them,
-Would you like to hold one? -No,
No, you're doing fine,
Got the lymph nodes,
There must be another way,
Ohm must there be?
You know, I really don't care for your negative attitude,
I'm a realist,
I'm very sorry, Ms, Watson,
Surgery has confirmed that the tumors in Charlie
have spread to his right lymph nodes,
And our treatments will not work fast enough to stop them,
So what?
What are you saying?
Most patients with Charlie's prognosis do not survive,
And if this was my son, I would take him home now,
He was just born,
This can't be it, right?
No,
Dr, Lewis's assessment is valid,
but there is still a chance,
The doses of chemotherapy that have been applied so far
are the lowest available,
Because he's a baby,
There is room to increase the doses should Charlie
be responding, which he is,
You have a choice,
I said no,
Mia, please,
I don't want to be poked,
What if I show you on horsey first?
Here, we got blood going up and down to our hooves,
or your hands,
I'm going to find a nice vein and pop the medicine in,
No,
Hi,
You must be Mia,
I'm Dr, Dan,
Hey, do you like flowers?
Dr, Audrey's medicine is actually made out of flowers,
It's called the Madagascar periwinkle,
And it's a beautiful pink flower,
And it's very hard to find,
That's true,
And it's only for the very special children,
this magic medicine,
You talk funny,
Whatever do you mean?
Mia or Philadelphia?
Shall I give thee the magic medicine,
or shall I give it to somebody else?
Hmm? Yoo hoo,
Is there anybody who would like Mia's medicine?
No, I want my magic medicine,
Ah,
Well, seeing as you asked so nicely,
I think we can arrange that,
Shall we count to three?
One, two, say magic medicine,
There we go,
That was rather good, that flower bit,
-Oh, it works half the time, -And the other half?
Bribery,
What else have you got up your sleeve?
The cure to cancer?
Slow and steady wins the race, right?
We can do better than that,
The Cobalt-60 source has a Dmax of 0,5 centimeters,
just under the skin,
Now, since Mia's abdominal neuroblastoma is mid plane,
we'll treat her with anterior as
well as posterior post fields, 150 rads a day, five days
a week,
Clear?
As you learned, the lead kilometers prevent radiation
leakage to unintended parts of Mia's body,
as well as anyone else in the room, such as me, you,
there's Roberts over there,
So let's head out,
Good,
There we go,
I got you right here,
All right,
I know,
The Carroll family wants to talk to Dr, James,
They've run into some financial hardship,
and they're thinking about taking Courtney home,
Tried to find him somewhere to stay,
I've looked over on Bainbridge,
No luck,
If you can think of anything, will you let me know?
OK, Thank you,
I wonder what the food up there is like,
Oh, yeah,
Everybody can eat everything,
Will there be cotton candy?
I think so,
Are you scared?
Not really,
I'll probably miss my brother and my friend Billy,
Because Billy has the best treehouse,
I wonder if we'll be able to play with the clouds,
We should be able to,
I mean, it's our own place,
How are you finding Philadelphia?
A bit rough around the edges,
Hmm?
Well, I'm a New Yorker, so,
Well, I'm a Yorker, so,
You know, York, England, historic walled city,
No, I understood,
You didn't laugh,
I didn't realize it was a joke,
Where's the farthest place you've ever been?
Japan,
-Oh, marvelous, -Mhm,
Work or pleasure?
Before I was married, I was a military physician,
I still wonder what we might have given those pilots
to keep him awake,
It's rather funny, isn't it, that you went around the world
to become a doctor, and I had to come all the way here,
Do I tip my hat to you?
What for? Passing the same tests as you?
Moving to a new country alone,
I wanted to be a doctor,
There's a lot to do,
OK,
Thanks, Ray,
Good afternoon,
Jarva Pharmaceuticals,
How may I,,, miss, you can't go back there,
Miss,
Miss, you're not allowed back there,
Miss,
Miss, they are in a meeting,
Jarva Pharmaceuticals,
We allocate resources to develop these,,, whoa,
Who,,, who are you?
Dr, Audrey Evans, head of pediatric oncology at CHOP,
I'm sorry, sir, She didn't,,,
It's all right,
I'd like to speak with you about sponsoring
a groundbreaking new research study with two
of your chemotherapy drugs,
We're in the middle of,,,
Hold on a moment,
Continue,
The proposal suggests applying
cyclophosphamide and vincristine in low doses
in combination to combat neuroblastoma,
I've laid out the projected expenses there on page three,
The mice, the resources, and the drugs
will cost you $350,000,
How much?
That's a lot of money,
I know,
But if this works, not only will we save
lives, but it will positively impact your bottom line,
Imagine how many chemotherapy drugs
you'll sell if it becomes commonplace to use
two instead of one,
We're ready, Dr, Chicken Koop,
Oh, you think so, huh?
All right,
Let's get out here in the hallway,
I'm going to win this race,
Right out the door, both of you,
There you are,
All right,
Come on, Right down the hall,
All right,
Runners, stand,
Ready, set, go,
She got Jarva Pharmaceuticals to sponsor her study,
She did?
Do you know what that means?
I don't have all the facts,
Why does that matter?
It's as if the rules don't apply,
She's making a complete mockery out of all of us,
Have you finished your citations for your paper
on bone marrow transplants?
Have I finished my,,, no, I haven't, but I've been on,,,
Well, do your work, Jeremy,
Under no circumstances are you to hurt the mice more
than absolutely necessary,
Animals are living beings, and thus we treat them
politely and with respect,
Thank you very much,
You may leave,
I didn't mean to,,,
Anyone else find this funny?
Absolutely not,
These are the standards that Jarva
demands, and so do I, We do not do tail injections in my lab,
If that was part of your training, unlearn it,
It causes unnecessary discomfort to the mice
and has a higher risk of extravasation,
We exclusively do retrobulbar sinus injections,
Be extremely careful,
Excessive pressure to the neck and the surrounding vessels
can impede blood flow or worse, collapse the trachea,
Now then, like so,
And finally, we give thanks to our little friends
for their service to the greater good,
Who's first?
What are you thinking?
At the moment?
Whether I really want that sandwich or I
want to skip to dessert,
You went to Jarva,
Ah, that,
Yes, that,
If I use smaller batches of mice,
we can get another study in there,
Jarva committed up to $1 million for a new study here,
A million?
That could have gone to Bob's congenital heart
disease proposal or Stanley's whooping cough study,
But instead, we are stuck with a chemotherapy study
at a third of the price with drugs we already use,
But not in combination,
It's about,,,
I really have to get on with this,
You took their bait,
Shuttle time, 6:00,
School pickup's at 4:00,
Host families are full,
For those of you looking for long-term housing options,
here's a list of rentals,
Very good,
And a few more,
Ready for backstroke?
And splash,
2, 3,
Very good,
We're nearly at the end,
Arms out like a zombie,
And bend the knees,
2, 3, 4,
Bravo,
Well done,
Thank you so much,
Thank you so much for your donations,
And you braved the rain,
Thank you so much,
See you soon,
I'm exhausted just watching you,
Next time, I'll make you join in,
Maybe,
We left off on the lack of funding for cancer research,
Could you turn that off?
Right,
So the federal government allocates
$0,89 for cancer research for every $19
that it spends on defense,
If we were to mount a,,, thank you, ladies,
Thank you,
If we were to mount a thrust like the space program,
we could have cancer licked in the '70s,
Well, how do we get the government's attention?
Well, we make noise by excelling at our craft,
In fact, I'm actually waiting on results
for what could be a huge breakthrough in cancer research
as we speak,
I'm so impressed by your enthusiasm, Dr, Evans, really,
Well, most think I'm an acquired taste,
I'm just pleased you returned my call,
Lisa, I'm just going to leave my bag here,
All right,
Hey,
Hi,
You missed this,
Wow,
Ta-da,
You know how to make an entrance,
You were not at supper with everyone,
Did you find somewhere to stay tonight?
Charlie's not getting any better,
And the bills are piling up,
I just,,,
The treatment makes him appear worse than he is,
So how do you know it's working?
Time,
I don't know what else to do,
I've been meaning to tidy up,
It's beautiful,
Hardly jams,
Yeah,
I love mine,
Hot date?
Oh, yes, with a big, handsome hospital function,
Wow,
I sure hope you're going with someone
special dressed in this,
Well, Sean Connery hasn't returned my calls yet,
but there's still time,
The shower's just down the hall to the left,
Everything all right?
I feel like I should be there,
You're no good to him exhausted,
We'll get you fed, and watered, and rested,
And you'll be back at it tomorrow,
OK?
I could eat,
Marvelous,
I can cook you scrambled eggs, poached eggs, or hard boiled,
What would it be?
I mean, they're charging $80 a week for one
room in this piece of junk,
That's just silly,
Remind me where home is,
Tennessee,
And how did you end up at CHOP?
Two buses and a train,
I would have walked if I had to,
Wow,
Wait,
You went scuba diving?
Yes,
It was a lovely trip,
But the littles did keep trying to catch the fish,
How old are your kids now?
Oh, no, no,
Not my children, my friend's children,
Sounds like a lot of work,
They're dears,
Plus, it's nice to have the company,
Can you imagine littles running around here?
It would be chaos, I'm sure,
Bon appetit,
Is it all it's cracked up to be?
Australia?
Oh, yes, worth the ages that we spent on the plane,
I mean, like, all of it,
It's a big world out there,
Who gets to see it?
Anyone who wants to,
I don't think it's as easy as that,
I didn't say it was easy,
We made it here, didn't we?
Yeah,
I guess, we did,
Thank you,
Do you have a second to join me downstairs?
Yeah, do you want to take a little weight
off that ankle for a while before we go out in public?
I'm never going to hear the end of this, am I?
I am feeling relatively chuffed about that win,
Oh, are you?
And I did tell you not to dive for that,
I had it,
Just trying to help,
Well, that is your problem, isn't it?
You're always just trying to help,
First time I've heard that complaint,
How long are you going to keep up this act with Audrey?
$650,000 she cost us, Dan,
What else?
Who else will she reach out to, Vero Labs?
Zaltran Pharmaceuticals?
The more you help her, the more she thinks that her actions
are acceptable,
Can't make this up,
Case in point,
The result's inconclusive,
The mice that received equal parts
cyclophosphamide and vincristine
should already show significant tumor
regression based on dosing,
And yet some tumors are shrinking and some aren't,
What am I missing here?
He really is so cute,
He really loves you,
I think I'll call him Frankie,
Oh, brilliant choice,
Frankie here gets magic medicine like you
for his neck boo boos,
Here?
That's right,
Do you want to stroke his back?
My boo boo is bigger,
Well, that's because you're bigger than Frankie, isn't it?
Does he have a tummy?
He does have a tummy,
Look,
It's here, See?
It's not blue,
True, but that's because his boo boos are in his
neck, remember?
You said he gets magic medicine,
That's right,
But his boo boo isn't here,
Yes, dear, but that's because,,,
you're absolutely right,
You're absolutely right,
Frankie should get different magic medicine
from you because his boo boo is in a different place
on his body,
Of course,
I need to put Frankie to bed and talk to my friend,
And then I'll be right back,
OK?
Have you seen Koop?
No,
He's conducting rounds in the NICU,
I was looking in the wrong place,
I'm running late, Audrey,
I was analyzing the effects of combination chemotherapy
on all tumors together,
Once I separated them by location,
abdominal tumors had a 70% response rate, 70%,
And the neck tumors, they barely respond at all,
You're suggesting location is a major factor
in how patients respond,
And that we should tailor treatment accordingly,
This is bigger than combination chemotherapy,
That would be significant,
I need access to CHOP's records,
I need the additional data points,
You have to help me to ask Koop,
I can't,
What about later?
In about an hour, what are you doing?
I'm sorry,
Hi, baby,
Hello, my friend,
Hello Hello, young man,
Koop, I'd like to ask you for permission to access
our neuroblastoma records,
Operating on a baby's esophagus
is like sewing together two pieces of wet spaghetti
at the bottom of an ice cream cone,
Koop, the records,
The results were inconclusive,
No, no, no, no,
I'm so close,
I have data that I want to show you,
but it's just not enough yet,
I just need a little bit more time,
Time that you weren't afforded to begin with,
Return the funds,
No,
I'm,,, I'm just a little,,,
I could have fired you, Audrey,
Call Jarva,
Return the funds,
Yes, I'm coming,
I'm coming,
Don't be so impatient,
That chicken was delicious,
You must give me the recipe,
There's a little creek by our apartment that Charlie loves,
He giggles every time the stream tickles his toes,
I want to give him that one more time,
There's still more we can try,
No,
You have done more than I could ever thank you for,
Now I have to do what's best for my son,
There's nothing I can say to change your mind?
For what it's worth, I think you would make a great mom,
Dr, Koop,
Dr, Evans?
I need you to reconsider,
Oh, good grief,
You're one of the most decorated
surgeons in the country,
You successfully separated the conjoined twins,
And then you set up the first surgical NICU
of the United States,
That's because you don't wait for science to catch up,
We have the opportunity to do something extraordinary,
to change, change the,,, the course of a deadly disease,
I know you're not going to give up now, Dr, Koop,
Please,
Just please talk to me,
Please,
I need,,, I need to,,,
Dr, Koop,
Dr, Koop, please,
I'm having a swim,
Dr, Koop,
Have you lost your mind?
I need to continue the trial,
I need those records,
I said no,
What alternative do we have to innovate at all costs?
Dr, Evans,,,
Please,
Please, we cannot,,, we cannot let perfection
get in the way of progress,
If we stop moving, then we'll lose all hope,
And hope is what we have,
Thank you,
My first year on the job, a newborn was
delivered with her abdominal organs in her chest cavity,
She had maybe 15 minutes to live,
There was no time for permissions or protocols,
and I decided to operate,
Did she live?
She did,
What some saw as brilliant, others saw as reckless,
Or both,
I've learned the difference between impulse
and action, Doctor,
There's a fine line,
And when that line is crossed, it can be near
impossible to reverse course,
Why did you bring me here?
I'm a masochist,
Ha ha,
Why do you think?
Children think I'm funny,
I know what you're capable of,
Do you?
I'll give you access,
Thank you,
You have until the gala,
That's two weeks,
OK then,
Find the line, Audrey,
That's not my car,
Well, thank goodness,
It's needlessly flashy,
I'm getting the data,
I've got two weeks,
Good,
I know you're intrigued,
I've read your work,
You don't write over 100 publications on radiation
therapy being a hat rack,
We need each other,
What are you afraid of?
This is how it would have to be done,
no barging into pharmaceutical companies, no reporters,
everything by the book,
You have my word,
You do,
There's a lot to do,
We're sorting the files in here?
It's perfect,
Name, age,
Julian Freeman, 12 years old,
Tumor's in the bone marrow and liver,
Deceased,
12 years old? DAN D'ANGIO: 12,
Yeah,
David Galloway, 13, abdominal mass biopsy,
Deceased,
What is it?
Well, tumors that start in one place and then move
to another have a different response
rate than those that don't,
So we shouldn't be sorting only by initial tumor location,
But also if it metastasized and to where,
You're right,
Wait,
Children 18 months and younger have a higher survival rate,
Yes,
And the older children, their survival rate
is significantly less,
Because the tumors have already metastasized
by the time of diagnosis,
Age is definitely another prognostic factor,
Definitely,
We need to start again,
Where do we get more data from?
That is the question,
Dr, Evans?
Come quick,
It's OK, baby, It's OK,
OK, It's OK,
It's OK, It's OK,
Where is your special cup? -I forgot it,
What do you mean you forgot it?
I asked you for one thing,
Just give her a cup of water,
She won't drink from these cups,
If you were here, you would know that,
It's OK, It's OK,
It's OK, baby, It's OK,
It's OK,
It's OK, baby, It's OK,
It's OK,
All right,
All right, All right,
Two milligrams of morphine,
It's all right,
We're going to take the pain away,
It's all right,
The nurse is getting you some medicine to make it
better really, really quickly,
Thank you, We need new sheets,
Oh, baby,
It's OK,
All right,
The newspaper doesn't sell itself, you know,
And John quit,
I got his clients,
About to receive top sales bonus
if I keep the pace of them going,
How nice,
How can she think that I don't want to be here?
Emotions are high,
Yeah,
I need to be in five cities this week,
I won't make it to all five,
I wish I could give you the answer you want,
I'm so sorry,
I don't want you to be sorry,
I want you to save my daughter,
I'm trying,
Trying?
God,
There is something else, but it's new,
It's experimental,
I believe in it,
Today, you're going to get two magic medicines
instead of just one,
I am?
Yes,
You're going to be the first person in the world
to get two in combination,
And then hopefully, if it makes the boo boo in your belly
get smaller, we'll be able to give it to your friends too,
OK,
Now, this is your pink flower,
Well done,
And I'm going to wash that down,
Now we're going to get number two,
We're going to put your arm here,
Let's keep that nice and stable,
You keep that still for me,
All right?
So impressive,
You got his access to Keystone General,
And who did you say your friend was again?
Old college buddy,
Excellent physician, Dr, Laurie Naiman,
all the data we can gather,
But we must respect his parameters,
No wandering the hospital halls,
stay quiet, and put the files back where we find them,
and keep a low profile,
Oh, hello, lovely,
Oh, you're gorgeous,
Look at you,
Low profile,
And maybe no more coffee because we're
going to be stuck in a closet for about two hours,
Oh,
Oh, you don't need to worry about that,
My detrusor muscle is very relaxed,
I can hold it all day,
That's good to know,
How old do you think she is?
Large trunk,
Horizontal branches,
Pretty old,
Oh,
A fellow horticulturalist,
Not just a hat rack,
My goodness,
He does have a sense of humor,
Don't tell,
Please,
Hey,
Audrey,
Come on in, Watch your step,
Thanks, Laurie,
We're going to go up these back stairs here,
There she is,
Stay here till I come get you, OK?
Thank you so much, Laurie,
And that's true,
OK,
I still don't understand why we're not meant to be here,
If it's their data and we make the breakthrough,
CHOP gets all the credit, so,,,
And so?
And so, so, so politics,
Are you ready?
Start at the top,
Yes, ma'am,
Thank you,
Tommy Gallagher, five years old,
Neuroblastoma in the abdomen,
Next one, Herbert Jacobs, 18 months old,
It's a neuroblastoma in his abdomen, left anterior,
His ferritin was 18,
Encapsulated clotted blood,
Tumor in the biopsy,
I actually wanted to take a look at this file,
just kind of poking around,
Make sure I didn't miss anything,
Hey,
Come here, What are you doing?
I think, Mr, 86,,,
Shh,
I think Mr, 86 in the tight joggers
was here raising money for cancer research,
He did,
That is Fred Hill from the Eagles,
The Eagles?
Yeah,
The Eagles is a football team, not,,,
not soccer, though,
It's more like rugby,
But it's better than rugby,
Well, let's talk about it,,,
Whoever they are, we should go and talk to them,
No, let's not, Let's not,
Yeah, just a minute, Just a minute,
Audrey, We're going to,,,
Just come, Just follow me,
Are you going to speak to me?
OK,
Act like a child,
Me act like a child?
What are you implying?
It was a mistake to take you,
That's rude,
Why did you drag me into this?
I'm sorry for dragging you into finding a better
way to treat my children,
They are not just your children,
Audrey, I carry them with me everywhere I go, when I sleep,
when I eat,
Wherever I am, their faces are there,
This new system could mean that they didn't die in vain,
And you're just going to throw it all away,
How could you be so careless?
How dare you?
Is there a point where you take
accountability for anything?
Would you please get back in the car?
Why would I?
I'm careless,
Audrey,
Hello,
I told these damn kids to get off my property,
or I'm going to call the cops if I have to come
down here one more time,
Who are you?
I'd like to buy your house,
No thanks,
Why on earth not?
Bring your husband,
I'll consider it,
It's not for me,
If you must know, it's going to be a home away from home
for families to stay free of charge
whilst their children are treated at CHOP,
I don't care if you're buying it for the queen
of England, lady,
Doctor,
Right,
I was going to get the red roses,
but the florist convinced me that she
liked the white ones better,
Now, I don't know,
Do you think I should go back and get the red roses too?
Sure, Why not?
Right, That's what I was thinking too,
Wait,
Wait, Wait,
Are you sure we should be walking around here?
Yeah,
I,,, I really,,,
I really don't think we should be here,
All right,
Stand up straight, and be my husband,
Sorry, your what?
No, No,
Audrey, this is a bad idea,
My husband,
How much for the house?
We should go,
Dr, Evans,
Lady, get the hell off my property,
Don't speak to my wife like that,
I mean, besides, your house is falling apart,
I mean, like, this porch, for instance,
It's sloping,
And the caulking is,,, is peeling,
And I am certain that it is rotten underneath these stairs,
No one is going to buy this place, including us,
So let's go,
Doc,
Audrey,
Wait,
60,000,
-30, -50,
31,
37,
34, and I'll get a mortgage today,
For a five-year mortgage, it'll be 10% interest,
First payment is due next quarter,
When your husband gets here, we can finalize the paperwork,
Sadly, he's drowning at work,
He's got a really important job in finance,
I call him my money man,
Everyone needs a money man, right?
Then I'll need a form of government identification
and your marriage license,
Can't I just sign for him?
Afraid not,
I need your paperwork or your husband,
Like I said, he's terribly busy,
And I actually lost my marriage license,
Can you believe it?
I'm so careless,
He's always telling me I ought to do better,
Do you have a male family member
nearby that could co-sign?
I don't know if the accent gave
it away, but not nearby, no,
Right,
I'm,,, I'm sorry, ma'am,
I don't make the rules,
Standard procedure,
I have an idea of how to get more data,
I'd like your permission to pursue it,
May I?
You may,
OK,
See you next week, sir,
Hey,
I'm on probation, Dan,
I've never even missed a day of work,
I'm so sorry, And you know me,
You messed up,
I sure did, so you know if I'm here,
it'd for a very important reason,
What if CHOP and Keystone General work together?
What if we started the world's first neuroblastoma
research crew?
-Dan, -Come on,
We're going to share data,
We're going to share test results,
And then we're going to finish the staging system together,
As in we share the success, not just CHOP?
No, And it doesn't stop there, OK?
We're going to recruit hospitals
from all over the country, someday the world,
Hello,
Hi,
What are you doing?
Is Mia asleep?
Looks like it,
I'm going to a party,
I wish you could all come with me,
It'd be much more interesting, -Yeah,
What color would your dress be if you were going to go?
Rainbow,
Rainbow color,
I'm going to give Mia a little surprise because she's been
so sad recently, hasn't she?
Do you think a surprise is a nice idea for her?
Yeah,
And then Bunny can cheer her up,
Can I give Bunny a kiss good night?
-Yeah, -OK,
Good night, Amora,
Sleep tight,
Good night, Charles,
Mia,
Mia, dearest,
Hello,
Why are you in that dress?
I know,
I've got a surprise for you,
Do you feel strong enough to sit up?
Mm-hmm,
All right,
Slowly,
All right,
Wave to Charles,
Try and get some rest, Ashley,
Off we go,
Hang on one more moment,
And open,
Why is the sky pink?
God took a paintbrush and made
it extra pretty because He knew you were coming to see it,
Oh,
Now, Mia, tomorrow, we're going to take a few more
pictures of your tummy, see if the magic medicine
is working, all right?
I'll be right there beside you,
Do you trust me?
You know, when I was your age,
I didn't feel good either,
You cut your hair too?
No, dear,
But I stayed in the hospital for a really long time,
Some of my friends floated up together too,
But I don't want to float up,
We all float up to heaven sometime,
But what if I get lost and my mommy can't find me?
Oh, sweetie,
You don't need to worry about that,
Your mommy will always, always be able to find you,
How can she see me if I'm clear?
My pop pop's in the sky, and I can't see him even though I
squeeze my eyes really hard,
Oh,
Did he forget to tell you how to see
him before he floated up?
Oh,
Well, let me show you,
When you go to heaven, you get to pick a cloud to live in,
But only your family knows which cloud is yours,
So you tell me, which one does grandpa live in?
The heart-shaped one,
Brilliant,
Now, every time you see a heart-shaped cloud,
that's grandpa saying hello,
Hi, pop pop,
We expect our boys to bring home a Super Bowl,
You gentlemen can make that happen, right?
Easy,
Excuse me a moment,
Well, you clean up nice,
Not so bad yourself,
I want you to present your staging system tonight,
Here? It's not ready,
You'll do fine,
Walk with me?
We will be going through the grand legislature
entrance of City Hall,
Now, there are four completely different unique entrances,
And each one has its own themes, its own allegory,
Apparently, when the architect John McArthur Jr, began
construction in 1871, I believe,
he had some pretty high hopes to give
Philadelphia the tallest building in the world,
Well, about 30 years later, when they finally finished
construction, it was too late,
The Eiffel Tower and the Washington Monument
had already been completed,
And Mr, Tour Guide, what's this?
Well, some people believe it stands for unity,
It's all working together to uphold democracy,
Yes, but at what point do the big cheeses
lift up the people instead of the other way around?
Yeah,
So, where next?
We could just run away,
I don't have a driving license,
I will do the driving,
Where should we go?
Well, I hear Timbuktu is lovely at this time of year,
Me too,
Dan, I,,,
Rally this crowd,
Get them to see the importance of the staging system,
It could change everything,
You really know how to calm the nerves,
My wife says I'm too blunt at times,
I will share the implications of identifying
the proper prognosis early in the staging system,
And then I will,,,
Audrey,
It's a good plan,
We have access to laboratories and research,
unparalleled engineering, physiological,
and pharmacological expertise,
And our new building will be second to none,
But there are hurdles ahead,
We need your help now more than ever before,
Your gifts, great and small, for the construction
of our new children's hospital will never pay dividends
in cash, but it will do so in the benefits
to children, this nation's only priceless possession,
We have gathered the world's brightest minds,
This year, we have recruited the leading force
in oncology, Dr, Audrey Evans, to lead our cancer department,
And I ask her now to say a few words,
Dr, Evans,
Hello,
Um,
Nothing more uplifting than pediatric cancer
on a Thursday evening, hmm?
I have a friend called Mia,
She's seven years old, beautiful little girl,
Has her whole life ahead of her,
except she has neuroblastoma, the deadliest solid tumor
in pediatric cancer, which kills 90%
of the children who have it,
Earlier today, Mia asked me if she could take her toy
pony with her to heaven,
I don't know about you, but I'd much
rather she play with her pony here
with the people who love her,
Our current methods simply aren't working,
And the ones that do work leave lasting long-term damage
to our children,
So we are creating a revolutionary staging system
that will allow us to tailor treatment to each child's
unique diagnosis and pave a brighter future for the Mias
that we treat every day,
But a sick child is also a sick family,
Not only must we treat the medical needs of a child,
but also the emotional and financial needs of the family,
People travel from all over the world to be treated at CHOP,
And they often have nowhere to stay,
The lucky ones, they sleep on floors, hallways,
But often, they cut their child's treatment short because
they can't afford the hotels,
So I humbly, humbly ask you this evening for donations
so that we can buy a home for them to stay, free of charge,
There's our dreamer,
Thank you, Dr, Evans,
Next, we will hear from our cardiology department, whose
surgical innovations have led to significant strides
in the treatment of congenital heart disease,
You administered trial combination
chemotherapy on Mia?
I had to,
Oh, you had to?
She's going to die anyway, and you
put her through unnecessary pain
for nothing, and her parents,
Her parents were the ones who begged me to do something,
God damn it, Audrey, They're desperate,
They're going to agree to anything,
You have no idea what it's like,
Well, of course, none of us do, really, but,,,
I had a son,
I didn't know,
Until the board reaches its decision, you cannot be here,
What about my patients?
They're no longer your responsibility,
Please don't do this,
I tried, Audrey,
You didn't listen,
I want Dr, Audrey,
I don't want to go with you,
Dr, Audrey, you promised you'd go with me,
Oh, dear, I'll put a Band-Aid on it,
It's OK,
It's all right,
I'm a doctor,
I have a Band-Aid in here,
One moment, dear,
Just in here,
There we go,
I knew I had one somewhere,
I'm sorry,
I'm,,, sorry,
Sorry, I'm sorry,
I'm sorry,
Dr, Audrey Evans, who was recently recruited by this
institution as chief of pediatric oncology,
has violated hospital rules by applying chemotherapy agents
in unapproved combinations to seven-year-old cancer patient
Miss Mia McAlister, correct?
After seeing significant progress in animal research,
yes, I applied targeted combination chemotherapy
to a dire patient,
Yes or no will be fine,
Dr, Evans' actions have violated hospital
codes 301, 373, and 546,
The codes are as follows, not gaining appropriate permissions
on a clinical trial, exposing the hospital
to a potential lawsuit, and the worst infraction,
endangering a patient,
Dr, Evans, you now have a chance to tell
your side of the story,
I have worked at the most prestigious
institutions all over the world and
trained under Sidney Farber,
We have your resume,
We just need to understand why you changed Mia's therapy,
Mia is what I classify as an extreme case,
Her tumor had already spread from the abdomen
into the bone marrow,
Our standard therapies are not targeted nor strong enough
to combat such a scenario,
And what made you think your new method would work?
Applying chemotherapies in combination
has a track record of success in leukemia patients,
But Mia has neuroblastoma,
Often one can infer patterns,
That alone is not reason enough to act,
But coupled with a mice study and a new staging system,,,
A staging system?
- I - and my colleagues
have reason to believe that tumors
respond differently based on a number of prognostic factors,
We can no longer treat all children the same,
Please submit the staging system to the board for review,
I need more data to complete it with certainty,
So after getting short-term lab-based data and using
an incomplete staging system, you changed
a patient's treatment to a therapy
regimen that lacks any prior clinical trial or permissions,
Dr, Evans, no one here is doubting your talent or
your impressive credentials,
I do not envy the work that you do,
In fact, I empathize and even understand why you
acted the way that you did,
Any person might do the same,
But you are not any person,
You are a doctor,
And if we keep you, we would be endorsing
this reckless and potentially life-threatening behavior,
That is not a standard we wish to set at CHOP,
Kate, is everything all right?
Yes,
It's terrific,
Just terrific,
Look,
No more blue,
Oh, my goodness,
I know,
It's incredible,
Did he undergo a different treatment at home?
No, It just went away,
Can you believe it?
Clever boy,
Come in, Come in,
Come in,
Up we go,
Children's Hospital of Philadelphia,
Dr, Brian Faust, please,
Oh,
Dr, Faust, it's for you,
Thank you,
Brian Faust,
Brian, it's Audrey,
Oh, Hey,
Hey, Dr, Evans, how are you?
I,,, I have,,,
I need you to sneak me into CHOP,
Are you sure that's a good idea?
I need to get in,
Please,
This way,
Watch your step,
Got it?
Right over here,
Be careful here,
Brian, I,,, I promised I wouldn't miss dinner again,
Yeah,
Well, surprise,
Charlie Watson's tumor disappeared with no treatment,
What?
If we can finish the staging system
and figure out why Charlie's tumor went away,,,
There's still not enough data,
Well, actually, Keystone General sent over the files
that you requested,
I understand if you walk away,
I jeopardized everything we worked for,
I see that now,
No treatment at all?
None,
Gone?
The tumor regressed completely,
Wilms tumor was successfully removed,
Next time, we need to do a far better job
of ensuring that the blood supply is fully
ablated before the resection,
There's far too much abdominal bleeding for my liking,
Am I boring you?
Mia's tumor shrank,
Remarkable,
It's combination chemotherapy,
You're certain?
No other variables changed,
There's no other explanation,
But we caught it too late,
I see,
Damn,
What are you going to do with this?
Hmm,
So we've got stage one, where the tumor
is confined to one organ,
Good prognosis,
Stage two, the tumor spreads, but not
across the middle of the body,
Not so good prognosis, but still treatable,
Stage three, where the tumor spreads
beyond the middle of the body,
Not a great prognosis,
Stage four, the tumor goes across the middle of the body
and travels to places such as the brain and bone marrow,
Very bad prognosis,
And then this special fifth stage
that looks like stage four, but then the tumor
spontaneously regresses,
Like Charlie,
But this only applies to children under the age of one,
And if the cancer spreads, then it
must be contained to the liver, bone
marrow, skin, and/or lymph nodes,
but only on one side of the body,
That's right,
We should call it 4S for spontaneous regression,
Yes,
We did it,
That's it,
We did it,
My children count on me,
They laugh with me,
They cry with me,
And sometimes I'm the last person
they see before their journey to heaven,
They look to me to have all the answers,
But what am I supposed to do when I don't have them?
Should I just accept that that's how things are,
or do I fight with everything I've got to change that?
As sorry as I am for the trouble I've caused,
I'm not sorry for doing what I know is right for my children
because they're your children too,
And they're counting on us, each and every one of us,
to figure this out, to rise to the occasion
and figure this out,
We owe it to them to do just that,
After reviewing all the facts and the new data
provided by Dr, C, Everett Koop,
we have decided to allow you to resume your position here
on probation,
Good,
I hesitate to ask, but what new data?
It pertains to Mia McAlister most recent scans,
Is she OK?
Do you remember when we taught her how to ride a bike?
Hurry,
Go,
Mia,
It's Dr, Audrey,
Can you hear me?
Hello,
Hello, my dear,
I'm here too, my dear, just like I promised,
I'm not going anywhere,
After you,
Well, I hope you boys win all of the football
matches this season,
And thank you so much for coming,
Thank you, -Thank you,
It was a pleasure, -We'll speak soon,
Well done,
Well, brava,
I don't even know where to start,
Start from the beginning, please,
So the Eagles boys loved my house pitch from the gala,
Can you believe it?
Then Laurie's such a dear,
Set about this marvelous introduction and then
really bigged me up in the meeting,
What'd you lead with?
Imagine a British doctor teams up
with American footballers to buy
a house for families of sick children to stay for free,
Now, that's what I call a real home run,,,
no, touchdown,
Who could say no?
Oh, why, thank you,
Get your feet off my desk,
Goodness, I'm proud of you,
I'm proud of me too,
Hi,
Excuse me,
The test results have come back,
And the Johnson family would like
to speak to the both of you,
Shall we?
We shall,
Please,
You are right,
It is a bit dreary in here, isn't it?
Like I said, an aviary,
Birds around kids with compromised immunity?
What's wrong with the finch?
A finch is a nice bird,
Very pleased to meet you,
Hello, sir,
Hi,
What's your name? -Jaden,
Hi, Jaden,
I'm Dr, Audrey,
What have you got there? -These,
Oh, amazing,
And this is Dan,
He's a doctor too,
I like your sweater,
Thank you,
So we were thinking that you might like
to come into Dan's office, and we could talk
about how you've been feeling,
OK,
Is that OK?
Beep,
Did we find someone?
Shh,
Sorry,
Beep,
Did we catch the ghosts?
-Just missed them, -Oh, rats,
What about the fairies?
Not here either,
Oh, dear,
But there are more,
I'll follow,
She insisted on a meeting with the Eagles,
And I asked, how can we help?
She's really something,
Sure is,
Next thing you know, my buddy from McDonald's, Ed Rensi,
donates all the proceeds from The Shamrock Shake,
And here we are at the Ronald McDonald House,
Wow,
Congratulations,
I have an idea,
Go that way,
Maybe we could have an apple tree here,
Yeah,
And we'd have a bunch of apples,
Tomatoes, strawberries, blueberries,
What's another spice?
What?
Cinnamon? -Yes,
We can put cinnamon on our pies that we
bake with our strawberries and our blueberries,
You're making me hungry,
What color is this?
That's the important question,
Well, there's white roses and red roses,
Let me see,
Any nests?
Can you see any nests up there?
Where should we go to next?
♪ When you're down and troubled ♪
♪ And you need some love and care ♪
♪ And nothing ♪
♪ Nothing is going right ♪
♪ Close your eyes and think of me ♪
♪ And soon I will be there ♪
♪ To brighten up even your darkest night ♪
♪ You just call out my name ♪
♪ And you know wherever I am ♪
♪ I'll come running ♪
♪ To see you again ♪
♪ Winter, spring, summer or fall ♪
♪ All you have to do is call ♪
The story isn't about me,
It's about children,
It's about love of how you can make something
good come out of bad,
If by any chance, you should have a child that either is
born with cancer or gets cancer,
you probably will feel this the word of cancer
will just really kill you,
You think, what worse could happen to my child?
And if you see this movie, do remember that it's not the end,
♪ And call my name out loud ♪
♪ Soon you will hear me knocking ♪
♪ At your door ♪
♪ You just call out my name ♪
♪ And you know wherever I am ♪
♪ I'll come running, running ♪
♪ Yeah, yeah ♪
♪ To see you again ♪
♪ Winter, spring, summer or fall ♪
♪ All you have to do is call ♪
♪ And I'll be there ♪
♪ Yes, I will ♪
♪ Now, ain't it good to know ♪
♪ That you've got a friend ♪
♪ When people can be so cold? ♪
♪ They'll hurt you ♪
♪ Yes, and desert you ♪
♪ And take your soul if you let them ♪
♪ Oh, but don't you let them ♪
♪ You just call out my name ♪
♪ And you know wherever I am ♪
♪ I'll come running, running ♪
♪ Yeah, yeah ♪
♪ To see you again ♪
♪ Winter, spring, summer or fall ♪
♪ All you have to do is call ♪
♪ And I'll be there ♪
♪ Yes, I will ♪
♪ You've got a friend ♪
♪ Ain't it good to know you've got a friend? ♪
♪ Ain't it good to know ♪
♪ You've got a friend? ♪
♪ Oh, yeah, now ♪
♪ You've got a friend ♪
♪ Yeah, baby ♪
♪ You've got a friend ♪
♪ Oh, yeah ♪
♪ You've got a friend ♪