The Good Doctor (2017) s02e11 Episode Script

Quarantine Part Two

1 Previously on "The Good Doctor" I'm covering the E.
- Gonna be a madhouse.
- Yeah.
This emergency room and everyone in it is now under quarantine.
A serious respiratory virus has infected three patients.
Take me to the hospital.
We are going to your appointment and making sure your think-melon remains tumor-free.
I no longer have an immune system.
My donor's on his way, right? Why are you answering our donor's phone? Because he's here in quarantine.
My wife's in there.
I need to get in there.
If something happens to me, our son needs someone to take care of him.
Put your mask back on.
Why? Because I'm infected.
On the bright side, I think I'm growing on Morgan.
MELENDEZ: He doesn't need to die.
He signed a DNR.
He shouldn't have.
We're gonna get his donor's marrow.
You need surgery now.
There's no operating room.
We will have to improvise.
Use your finger to plug the hole.
Now what? Dr.
Lim? It's back.
Help my son! Help my son! [BUZZING, VOICES INTENSIFY.]
SHAUN: 311 bus.
Left on Blossom Hill Kellan! Right on Cottle Street [LOUD BUZZING.]
Murphy? Left on Santa Teresa I think there's something wrong with him.
- We'll get you a mask.
- Can we get a pregnant woman a mask? Kellan, can you hear me? Please! [WHEEZING.]
It's empty.
Kellan! Right on Meridian Dr.
Reznick needs you.
He's not answering.
Murphy Don't yell.
It'll only make it worse.
Okay what should I do? [INDISTINCT TALKING.]
Tell him about the surgery.
Give him every detail you can.
Santa Pete has a torn IMA.
He's hemorrhaging into his belly.
His BP at 87 over 54 and dropping.
A saphenous vein graft.
We can repair the IMA with a graft from the saphenous vein.
- We just - I don't need a diagnosis, I need an extra set of hands.
Get me a 2-0 silk, vascular clamps, and an 11 blade.
- MELENDEZ: Clear.
- Charge to 200 joules.
- Clear! [THUMP.]
- [SIGHS.]
We just saved his life and violated his rights.
We could lose our licenses.
You won't.
You were following instructions - given by an attending.
- No, I wasn't Let's get him stabilized so I can go to Andrews and talk to him about getting him some marrow so this wasn't a waste of time.
Keep your lips together and breathe like you're blowing out a candle.
I c I can't I-I can't.
Kel deep breaths.
Deep breaths.
You're a doctor, right? Any update on the virus - Do I have it? - No no rash, no fever.
This is your asthma When can we go home Your lungs are hyper-inflated They better send in more doctors, because that weirdo melted down Everybody shut up! Just shut the hell up.
We have multiple people in serious condition, including a senior doctor and my son.
Your questions are gonna have to wait.
I need a nebulizer.
It's in isolation with the infected patients.
I'll order one in from pharmacy No time.
- Making your own nebulizer? Something like that.
You broke in? No.
Dad I saw the Taser.
I didn't use it.
Just threatened to That was dumb.
Long, deep breaths.
ANDREWS: You got her on maximal oxygen? Yeah.
Her vitals have recovered slightly.
The CDC is sending a PCR test based off the virus in the Malaysian outbreak.
So what's their treatment protocol? Antivirals, steroids, inhaled nitric oxide and anti-TNF receptor antibodies.
That's what we did for the two plane patients.
And Tyler.
We got to Dr.
Lim sooner, that should make a difference.
How's Dr.
Murphy? He's fine.
I saw his breakdown on the security feed.
He's closing on Santa Pete.
Do you have a strategy for dealing with him? - Dr.
Park and I can - Park's in there? When did that happen? Just a few minutes ago.
He came in to help his son.
You're still here? What did they say? Very kind of you.
No wonder you and Shaun get along so well.
What did they say? Did the new tests show anything new? They need time to process the CT images, send them off to Dr.
So you might have been wrong about your cancer coming back? No.
No? How can you know you're not wrong if you don't know you're not wrong? This is how they do it.
First they tell you there might be something, and then they order new tests to test the previous tests only to inform you that it was what they suspected all along.
Very effective way of breaking bad news.
Okay And if your tumor really is back, what does that mean? It means that I had surgery and let them pump radiation into my brain for nothing.
It means that my memory loss is because my brain is dying.
It means that I probably have a year, maybe 14 months.
Enough meaning for you? What are we gonna tell Shaun? Nothing.
Bonaventure's opened up a room for family and friends.
You want to come? We expand the quarantine, we move our marrow donor and our patient into If the donor has the virus, his marrow will transmit it to your immunocompromised patient.
He'll be dead in hours.
As he will be without the transplant.
We create a sterile pathway from the E.
into this procedure room using polyethylene sheeting No, you won't.
The only people taking any risks here are my people, the patient, and the donor And this hospital and everyone in it if you screw anything up.
But my larger objection is it won't work.
That procedure room isn't negative pressure, which leaves the virus free to escape to the main vent system.
I'll figure something else Janitors' closets.
They're negative pressure because of the cleansers, sterilizing agents.
Don't want those odors and toxins to disperse to patient areas.
That closet doesn't have room for two patients.
We can do the extraction there, but not the transplant.
We could use this linen room, in the basement, which is also negative pressure and connects to the janitors' closet through this laundry chute.
Once the bone marrow is extracted, it'd travel through the laundry chute into the linen room.
Where you could do the transplant.
Murphy? Update me on patient status.
Santa Pete's vitals are stable, no sign of post-op infection.
Toby is in Bay 3 receiving an IV drip; Ester's ST PARK: I think you're overloading him.
When he's dealing with medicine, he's not distracted by everything else.
It helps.
Keep going, Shaun.
Ester's ST depressions have improved.
That should help, too.
Ester's ST depressions have improved, and Viola's water broke.
What? When? It appears quite recently.
Aaah! Aah Given you're only 36 weeks gestationally, and there's no sign of infection, the baby should be able to stay in utero for at least 24 hours.
If the quarantine is done before You're not gonna fall apart again, are you? I don't think so, Viola.
The buzzing is gone, and there is much less yelling.
Except you.
It was the buzzing and the yelling, not the fact that we're trapped with three people who have died from a highly infectious disease? That's not something to worry about.
I either have the virus or I don't, and, based on past national quarantine mortality rates, we have a very good statistical chance of surviving.
But I didn't know that I would "fall apart" the first time, so I may be wrong.
Here you go.
You always talk like that? Like what? Just say whatever you're thinking when you're thinking it? Yes.
It's good to be honest.
Wish my dad was like that.
Park is very honest.
He always shares his opinions.
There's opinions.
And then there's feelings.
Your dad doesn't tell you that he loves you? What? Well, he's just not really there for us.
He did just risk his life, and his career, to break into a quarantine to help you.
That's true.
But most kids want their dad there even when it's not life and death.
LIM: Sorry for your loss.
Status? O2 SAT is 92, respiratory rate is down to 16.
Your lungs sound clearer.
Keep pulmonary edema to a minimum with conservative fluid management.
Use furosemide so my CVP's under 8.
I love this place.
I always said I'd be doing this 'til the day I died.
We started your treatment early.
You'll be back to repairing late-night, drunken head injuries in no time.
I forgot to call my mom on her birthday.
I forgot to do a lot of stuff Tyler was sweet.
He was a good guy.
Best to put him out of sight.
It's not a healthy reminder for either of us.
Tyler's mask had a tear in it.
It's possible the virus is droplet-based, not airborne.
Blood or saliva could've made its way through his mask from the airline passengers.
Unfortunately, until we know for sure, we're still on lockdown.
But I'll let the CDC know.
Do you have a minute? Is it urgent? Not really.
Kel What's up? [VOICE BREAKING.]
Why'd you move away? I'm a resident, you go where the job takes you.
They don't need doctors in Phoenix? This was an excellent opportunity for me.
And it's less than a two-hour flight; I'm not You had my baseball schedule for months and you came for one game and you were on your computer the entire time.
I had exams the next day.
So why'd you bother coming? [SIGHS.]
Mm, good Slowly Good As delicious as these ice chips are, I think I'm ready for some solid food; did they send in any cookies? Dr.
Murphy was very clear no food until you fart.
Just imagine they're straight from the North Pole.
- Bob, you ready? - Of course.
I'm doing a bone marrow extraction, and I need an extra set of hands to handle some bloody stuff separating bone and fat from stem cells.
Who here isn't freaked out by what I just said and can help? Ester's a doctor.
You're a doctor? Why haven't you Veterinarian.
Blood is blood.
Follow us.
Fetal heart rate is still between 130 and 140 BPM.
Contractions 17 minutes apart.
What's happening? Is it my baby? Viola's BP is 180 over 100.
She may have preeclampsia and an oncoming seizure.
We need to induce labor.
He's not being born in here.
We are waiting for quarantine to end.
Your placenta isn't getting enough blood flow.
We need to get him out.
This is going to be your first baby.
And mine.
MORGAN: Start bronchodilators.
Lim can you hear me? NURSE VILLANUEVA: - O2 SATs are still dropping.
Push paralytics.
Starting intubation.
MORGAN: I'm getting resistance bagging.
NURSE VILLANUEVA: I gave her hyoscine.
Hello? What's going on? What's going on? Lim's O2 SATs are crashing.
Her lungs aren't inflating.
They're filled with fluid and secretions.
- Pick up the phone.
- I've got my hands full.
Villanueva, pick up the phone.
Okay, show me what's going on.
She's in full respiratory failure.
She needs more pulmonary support.
Get her on BiPAP.
That might buy us some time.
Or we take her lungs out of the equation.
We put her on ECMO, oxygenate her blood outside her body her lungs will have time to heal.
We can't do ECMO in the E.
We aren't supposed to do abdominal surgery in the E.
, either.
Please, walk me through it.
Prep an area over her femoral vein.
That's very loud.
Any crowning, Dr.
Murphy? No, she's dilated at 6 centimeters, and I don't feel the head.
It's been seven hours since her water broke.
The baby's stuck.
Use Leopold's maneuvers to identify the location of the baby.
The fetus is transverse.
He's lying roughly thirty degrees to the left side.
We can't deliver the baby.
What?! Why not? We need to turn the baby.
We need to do an external cephalic version.
Or a C-section.
I have assisted on several In operating rooms with an experienced attending.
We are not doing a C-section here.
Tilt her bed.
I'll grab the gel.
- Mm.
- Okay.
So when? What? [CLEARS THROAT.]
When what? I get not telling him when he's in quarantine.
He's got enough on his plate, but Never.
You told him when you were first diagnosed.
Yes, and that was a mistake.
He forced you take tests that saved your life.
Well, no, as it turns out, it didn't.
And he became so obsessed and distracted that he nearly killed a patient.
He's your friend.
I'm his mentor.
It's not his job to take care of me.
Make sure you turn the needle so you're getting marrow from all sides.
Aspirate slower.
If you pull fast, it's more painful.
Hang in there, Bob.
I deserve a little pain.
You're his dad.
You're saving his life.
I took off before my son even knew who I was, traveled in crappy vans to s-stay at crappy hotels and play crappy music, all so I could earn enough to get high.
You're here now.
By the time I got up the nerve to face them, my ex was dying.
God willing I did it in time to save my son.
Melendez, Chris's vitals are bottoming out.
His secretions and lung sounds are worse.
I don't know how much longer we can wait.
Administer Levophed, and prep him for transplant.
Park, Chris's in hypotensive crisis.
- Go faster! - Fast as I can.
You ready, Dr.
Murphy? Yes.
I can feel the head.
We need to rotate in the same direction.
Deep breaths, Viola.
Oh, I can't I can't do this! Squeeze my arm hard as you can.
The fetus is moving.
The head is facing the cervix.
One more push.
- We just need - Stop! Placental abruption.
She's hemorrhaging.
Baby's heart rate is decelerating.
I need 2 large-bore I.
lines and start 2 units PRBC.
Then please page an OB-GYN to supervise my first solo surgery.
VIOLA: This is terrible.
This is not how it's supposed to This is excellent.
Garcia will be supervising me for the C-section.
She's the director of Obstetrics and Gynecology here.
I'm sure she's much more qualified than your personal OB-GYN.
You're gonna be fine.
What's the status? Nerve block is in, and I gave her a liter bolus of saline.
Throw some ChloraPrep down and make a five centimeter Pfannenstiel incision.
CLAIRE: Chris's prepped.
Inserting central line now.
MELENDEZ: How's he doing? Pressure is 90 over 50, O2 SATs are 85, heart rate is at 110.
Ready when you are.
One more and we're good to go.
I'm on my way.
I'm scrubbing in.
Call me the second you're ready for the drop.
SHAUN: Abdomen is open.
Baby's BPM is 110 and dropping.
What's happening? Dr.
Murphy, do you see the uterine wall? [GASPS.]
Blood pressure is dropping.
Murphy, the uterine wall.
Murphy? You need to make a gradual shallow incision and cut through it.
You do not want to nick the baby.
- VIOLA: What's happening? - NURSE PETRINGA: BPM is 95.
Murphy, please! [ECHOING.]
Murphy, should we turn up her oxygen? [ECHOING.]
Murphy, you need to make the cut.
- Dr.
- Dr.
No! Quiet! Everyone quiet! I need to concentrate! [BEEPING CONTINUES.]
I can see the head.
Is my baby okay? He's not breathing.
We need to start CPR now.
GARCIA: - Get a pediatric Ambu-bag and start two-finger chest compressions.
There's something wrong with Viola.
She's hypotensive and tachycardic.
She's bleeding out.
You should tell him.
Look at that.
Another reason why you two are so good together.
Neither one of you are willing to drop a thing.
He deserves to know.
Deserves? Is that how things work in your world? People get what they deserve? Shaun deserves to be toyed with? - Who's toying with him? - You.
I'm his friend.
You whisk him away on a road trip, kiss him and then leave town.
Now you pop back into his life, move in with him.
Shaun's not some hamster you get to play with and then not think twice about it when you forget to feed him.
You're gonna hurt him again.
You know that.
I know that.
I'm gonna let that slide because you're dying.
I'm gonna take this outside.
Bubble wrap? Need to make sure it doesn't break on the trip.
Or the landing.
Melendez, we're ready.
Deposit the marrow now.
The marrow is intact.
We're good to go.
My chest - It really hurts.
He's going into cardiac arrest.
- What can I do? - His I.
is blown.
The tip broke off.
It must be in his heart.
Come on.
Murphy, the rules of medical priority are clear.
Focus on saving the mother.
Murphy, you need to stop now.
Murphy? We can save them both.
Get me a liter of saline, a plastic bag, some surgical tape and Kerlix gauze, please.
Who knows CPR? [LOUDLY.]
Who knows CPR? - Um, in Health, they ma - Come with me.
Okay, two fingers right here in the middle of his chest.
Press down twice per second, every fifteen seconds, stop and squeeze the bag.
Twice Yes, don't press too hard, or you'll crush his heart.
You're making a Bakri tamponade balloon for Viola's bleed? - Yes.
- What is that supposed to do? It will control the bleeding by applying pressure - from the inside.
- How's the baby? I don't know if this is working.
- I just - Don't stop.
Are you ready, Dr.
Murphy? Feed the end of the pack slowly through her cervix.
Once you reach the fundus of the uterus, start inflation.
- Clear.
- That's the fourth one.
- I have to crack his chest.
- Here? - Get me rib spreaders and a ten blade from the crash cart.
CLAIRE: Marrow's in.
Heart rate's 84, BP's 100 over 60 vitals look good.
I'm sorry about before.
Are you gonna tell Shaun you got some good news? What makes you think it's good news? Because you apologized.
The cancer's not back.
- That's great.
- It's not great.
It's okay.
It's not great.
I have meningitis from a CSF leak in my head.
I have to have surgery pretty much immediately.
And, no, I am not telling Shaun.
You're right about one thing.
You're not his friend.
Because friends tell each other everything.
And you're a lousy mentor.
Friends are there for each other, and mentors teach.
They don't hide the truth.
I'm just looking out for him.
He's not like you.
He's not like everybody el No, he's not, but he's also not some helpless child who constantly needs protection.
He's an adult; a very smart, caring adult.
And you could really use someone like that right now.
It's not working.
She's still bleeding.
Keep injecting saline.
Vitals are 80 over 60.
Heart rate's 110.
Stop CPR.
I need to see if he can breathe on his own.
Is everything okay? No.
His lungs are filled with fluid.
He's drowning.
Get the pediatric laryngoscope stat.
Andrews, she's still It's not Andrews.
Can I see her? Map is holding steady at 65, but she was dipping into serious hypoxia for a short bit.
Can I see her? [BREATHES DEEPLY.]
Good work, taking care of her.
Thank you.
The baby has meconium aspiration.
Suction catheter.
Is that bad? NURSE PETRINGA: Fecal matter has settled in his lungs.
It's blocking his airway.
Did I do something wrong? You most likely dislodged some of it.
Without that, he would've suffocated by now.
SHAUN: Clearing his airway.
It's the most important moment of my life.
And I'm not there with Viola.
This is the way it used to be done.
The men waiting outside.
Now we know better.
Now we know it matters.
Do you think your grandfather loved your father - any less just beca - GLASSMAN: Shut up.
Ignore him.
He's just a grouch.
- Shh.
- [SIGHS.]
I think you've got yourself a new alarm clock.
Congratulations! [APPLAUSE.]
I'm a dad.
He is okay.
A Christmas miracle.
Thank you.
It's Lim.
Could I get some water? - [EXHALES SHARPLY.]
ECMO? That was a ballsy move.
- [SIGHS.]
Ester Blum, Pete Bailey your PCR and serology came back negative for the virus.
You're officially cleared.
We're going home.
Only Ester can go home.
You're going to post-op recovery for another day.
I'll keep you company.
There's someone I want to see up there anyway.
On Dasher, on Dancer, on Prancer and Vixen.
You are stable; no sign of marrow rejection.
We will be monitoring you over the next few weeks, but remission is a very real possibility.
I don't know how to thank you enough.
Guess I should thank my dad too.
Is he here? There was a complication during extraction.
Bob's heart stopped.
And we did everything we could to revive him, but he died.
What? We're so sorry for your loss.
Are you Chris Santos? My name is Ester.
I was with your father when he He mentioned that he had a lot of regrets.
But it meant a lot to him that he could help you.
Heard you were a big help during that delivery.
They needed extra hands.
You asked me why I let you and your mom go, why I didn't fight harder.
It's because I wasn't a good person.
I wasn't a good father.
My dad had this mantra Be like stone; never cry.
If I got emotional or upset he'd repeat it: be like stone; never cry.
It made me stronger which wasn't always a good thing.
Spent my life living behind a wall which meant your mom got to live with that wall as well, and When we split up, I felt like a failure.
Moving away helped me hide from that.
My father's voice is still in my head.
But I'm working on getting it to be quiet.
I love you, Kellan.
Always will.
MIA: Kellan! KELLAN: Mom! Are you okay? I'm fine.
I, uh I helped deliver a baby.
- Oh.
He was amazing.
It's good to see you, Mia.
How was it in there? The guy I worked on didn't make it.
Merry Christmas.
I don't think I'll forget this one.
Me neither.
The idea of you not being around wasn't okay with me.
Who would I drink bourbon with? I think my bourbon days are behind me for a little while.
I'll wait.
Shaun! Hi.
You must be exhausted.
And hungry.
All the sandwiches they gave us had pickles in them.
Oh, that's no good.
How about we go to that 24-hour breakfast place and get some pancakes? I would like that very much.
- Hello, Dr.
- Hello.
- I delivered a baby.
- Yes, we heard.
I'm sorry I couldn't drive you to your appointment.
How did it go? I have meningitis.
I have to have surgery later today to fix the CSF leak in my head.
I thought you should know.
That's good.
Meningitis is definitely not as bad as cancer.
It also explains your memory loss.
Now you can get your license back.
Shaun, would you mind if Glassy gave you a hug? I think that would be very nice.
Very proud of you.
Have yourself a merry little Christmas Let your heart be light From now on, our troubles will be out of sight
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