The Good Doctor (2017) s03e02 Episode Script


1 Previously on "The Good Doctor" We had the clinic at the hospital.
Come back as President, and and we'll re-open it.
We need to go to HR and break up.
I have accepted your explanation and report.
Thank you.
But I don't believe it.
Traditionally, you don't get to lead surgeries until fourth year.
That will be changing.
When the right surgery comes along, it'll be yours.
I want you to meet our new attending, Dr.
Marcus Andrews.
Pleasure to meet you.
You had a date last night, didn't you? It was hard, uncomfortable, unpleasant, and I have no idea if she was happy, and I know I wasn't happy.
I don't like when you do that.
I know.
But I did it anyway because you need to snap out of it.
The moping it accomplishes nothing.
I'm not moping.
I'm eating.
Which is the only thing you're doing outside your room now.
You didn't even come out to tell me to turn down the Talking Heads.
It didn't bother me.
The walls were shaking.
I'm surprised the cops didn't show up.
You like Carly.
You need to get back in the saddle.
And luckily, you have a totally awesome roomie who's here to help you.
I'm not going on any more dates.
Shaun everyone gets it.
Dating is stressful.
But being alone is worse.
I'm not alone.
I have you.
I have Dr.
Yeah, friends are great, but everyone needs a special friend.
I don't.
Shaun I'm not like everyone! No one is like everyone.
We're all unique.
But we're also the same.
I had rent control.
The only way for them to jack the rent is to get me out, so they just make up a reason.
Said that I was playing my music too loud.
And the all-night parties, the fighting with the neighbors, the wandering around the parking lot without any clothes on? I had a robe on! And I wasn't wandering.
I was trying to take the trash out, but they moved the damn bins.
It was windy.
Mom, you were clearly off your meds and drinking.
" It was a temporary setback.
Okay, nobody's perfect, but it is all under control now.
People with things under control don't show up at their daughter's at 1:00 a.
looking for a place to stay.
I will be out of your hair before you even know.
Two weeks.
Three tops.
One! I don't have time to babysit a grown woman.
Well, it's three weeks until the end of the month.
You at least owe me that.
No, I don't, actually.
One week.
We need some help over here! Male, 30s, gaping 10-centimeter laceration to his left cheek.
Probable fractured temporal bone, maxilla, - definitely shattered mandible.
- What happened? He tried to stop some creeper from groping a woman on the subway.
Maniac ended up bashing his skull in with some kid's skateboard.
Wheels broke off, and the metal axle did that.
Okay, we need to secure his airway.
His mouth is filling up with blood.
Intubation cart.
He has a through-and-through oral defect, - [SUCTION.]
- and the mandible is crushed.
We need hemostats.
The woman? She's fine.
Cops arrived, tased the dude, took him away in cuffs.
Everybody's fine except for the hero.
We're gonna need to intubate through the neck.
Betadine, scalpel, 6-0 tube to place surgical cric.
Could you do me a huge favor and take this up to Lim's office? - Sure.
- I'm running late.
No problem.
Melendez is waiting.
Sorry, I had to help Kellan with a biology project this morning.
What's in the box? Ducati throw pillow.
You really think you can bribe Lim with a pillow? I'm not bribing her.
I'm being nice.
She's starting a new job in a new office.
Where she'll decide who gets the first lead surgery.
I'm not stupid enough to think I can influence her decision with a gift.
But it never hurts to have a good relationship with your boss.
And it's a damn cool pillow.
No signs of any post-op infection.
There's also no sign your surgery did any good.
How often is he vomiting? After every feeding.
This is obviously not the outcome we had hoped for, but a pyloric stenosis requires a cautious approach.
If we're too aggressive - [BABY VOMITS, CRIES.]
- [GASPS.]
It's okay, buddy.
I got you.
Shh, shh, shh, shh.
Our baby is in pain.
He can't eat.
And you don't seem to have any clue why.
I would be upset, too, if I were in your position.
But you're wrong.
We need to conduct some tests to confirm, but I am confident it's just a matter of going back in and making a tiny adjustment.
Your son's in good hands.
Thank you.
I'm sorry.
I'm just A father who loves his son.
You've got nothing to apologize for.
That was impressive.
Get an abdominal ultrasound to confirm it's just an incomplete pyloromyotomy.
You're wasting your ass-kissing.
First surgery isn't his decision.
He's just the one sleeping with the one making that decision.
Pupils are equal and reactive.
Do you know where you are? And do you know how you ended up here? Josh, you have multiple fractures in your cheek and jaw, and a large piece of your cheek tissue, skin, and underlying muscle was torn off.
You're going to need extensive reconstructive surgery to save your jaw function.
You need to read these consent forms.
And if you have any questions, write them on this pad.
Was the woman on the subway a friend of yours? ANDREWS: He's a fool.
Trying to prove how macho you are can get you killed.
Clamp the branch of the inferior alveolar.
So, you would just stand by? Let a woman get groped? Apply manual compression.
Try and close the fracture gap.
You help every homeless drug addict you see on the subway? I don't.
And neither does Browne, which is why she ought not get so self-righteous.
I help my patients to the best of my ability because it's meaningful, and to me, the downside is purely financial.
For friends, I'll risk a little bit more, but the only people I'm risking life and limb for are my family.
Someone gropes my wife on the subway, they're gonna get whupped.
This isn't gonna work.
The mandibular ramus is just too shattered, and I can't get adequate stabilization.
We can't do any skin or muscle grafts if we can't fix the skeletal structures.
Alloplastic augmentation to bridge the gap? The span is too wide.
We're gonna have to wire him shut.
Wake him up.
He should know he's never gonna talk or eat solid food again.
Do you have any questions? I'm sorry.
The Cantrells want a new surgeon.
What can you tell me about the first surgery? Is this an M&M review? Not yet.
Is it possible you may have been a little too aggressive? Cut too deeply? Are you really asking me that? I need to know.
I definitely didn't go too deep.
We'll talk to the Cantrells.
Is this weird for you? A little.
You? I'm trying not to let it be.
Me too.
I'm here to pick up artificial dermal regeneration templates.
Let me get it.
Hey, Shaun.
I heard what happened to the guy.
Sounds horrible.
Is he gonna be okay? He won't be able to eat or speak normally ever again.
Thank you.
You seem a bit uncomfortable.
If it has anything to do with our date, I just want you to know, I had a really good time and hope we can do it again.
I had a horrible time and don't want to do that ever again.
Extensive swelling.
But within the acceptable range of post-op edema.
The very top of the range.
I think maybe Melendez did go too deep, injured the pylorus.
Well? The swelling is within the acceptable range for a post-op edema.
Got your muffins.
I'm glad you liked them.
I did.
Just kinda surprised you thought I could be bought with baked goods.
We're not trying to buy you off with muffins or a pillow.
Someone got me a pillow? No.
I wanted to show you my support for your promotion.
You're all gonna lead surgeries hundreds of them.
So it doesn't matter who does anything first.
The only thing that matters is that you do it right.
So, what was in the box? Sample marketing pamphlets.
My buddy owns a print shop, asked me to give Lim some samples.
Well played.
But it's all moot anyway.
It doesn't matter who goes first.
Just so I'm clear, that "right" was sarcastic, right? Right.
Since when does the President need to stock his own shelves? When it's a free clinic and you want it done right.
Thank you.
Have you ever had sex in the office? I'm not gonna answer that.
First of all, it's embarrassing if I say yes, and it's even more embarrassing if I say no.
I take the fifth.
If we're gonna get married, I need to know all your naughty SHAUN: I brought us lunch.
I know what you each like.
Melendez is not just our best surgeon.
He's one of the tops in the entire country, with the expertise to know that the best way to avoid a truly bad outcome in this procedure is to err on the side of caution.
- W-We hear all that.
- We do.
And we really appreciate you taking the time to explain everything.
But we would just be more comfortable having someone else take over from here.
You do understand? Of course.
I assume you'd be okay if I perform Braden's second surgery? Eh the Chief of the department? Eh Absolutely.
Thank you, Doctor.
Of course.
Nobody likes dating.
It's awkward and uncomfortable.
It's expensive.
That's why you proposed after two dates? To save money? I proposed after two dates because after one date, I realized how much I loved being around you and how much fun we'd have together.
He's right, Shaun, 'cause the fun can be so fun.
That didn't happen to me.
I have to go to surgery.
Whenever you're ready, you'll try again.
- What? - Whenever he's ready? He's got to go at his own pace.
He needs to be pushed.
I'm not gonna push him.
A man doesn't push another man into a date.
He pushed you.
Shaun doesn't know any better.
If you want him to find love, he literally needs to be pushed into it.
Literally? Shaun's not like other men.
Oh, he easily admits he's wrong? He easily changes course? If you don't talk to him, is anything gonna change? CLAIRE: No good deed goes unpunished.
Why does it always work out that way? It doesn't.
Most good deeds get rewarded.
And what do you base that on, Murphy? Certainly not the news or the Forbes 500.
CLAIRE: Or the Bible.
I base it on neuroscience.
Bad outcomes just implant deeper in our cerebral cortex.
So, evolution agrees with me.
Our brains encourage us to be selfish.
Which makes it strange that people keep being unselfish.
You were.
You saved my job.
And now you're an attending instead of the President.
Screws and wire ligature.
We're not doing this.
We can do better.
There is no other procedure.
We'll invent one.
Truce during surgery.
What about procedures? Imaging is fair game.
Anything invasive, we go to our corners.
I left my keys in my locker.
- Losing my mind.
I'll see you tomorrow.
- Night.
CLAIRE: What about a muscle graft from the temporalis? That wouldn't address deep mucosa or bone.
Unless we took an osseocutaneous free flap from the radial forearm.
We'd need approximately 2 inches and could use the natural concavity of And he could lose the use of his hand.
That seems like a reasonable trade-off.
I'm not telling this guy that we can restore his speech and all it'll cost is his hand.
Because he's a hero? What he did has nothing to do with it.
It's what we can do that matters.
What we can do is what we were doing.
That's the protocol.
Aren't we risking more damage by leaving him in an ICU bed while we try to invent a new treatment? How about attaching two free flaps on vessels on either side of his neck? Heard from Claire you're having an all-hands-on-deck sesh.
Happy to join.
How about Park? He left.
Said he had a thing with his son.
Thankfully, I don't have kids, so extra hours not a problem.
Have you considered an allograft augmentation or a Heard y'all were working late, so I got some coffee.
Any way I can help? [CLEARS THROAT.]
MELENDEZ: I want to talk about our meeting with the Cantrells.
On date night? Can it wait 10 1/2 hours? I guess.
Thank you.
Have you ever been to The French Laundry? No.
We should do a weekend in Napa.
I know this great little B&B just south of St.
Helena It's not about the Cantrells.
It's about what you said to them.
Has it been 10 1/2 hours already? I "erred on the side of caution.
" Caution is a good thing.
Err isn't.
I didn't err not at all.
I was going to bat for you.
I think that maybe you're so afraid of appearing to favor your boyfriend that you're overcompensating.
Given I think you may have erred, I'd say I was incredibly supportive.
In which case, you went against your better professional judgment to favor your boyfriend.
So, I'm too supportive or not supportive enough? Should I change the reservation to two tables for one? I've had plenty of first dates that were actual disasters.
Took one woman to a Coyotes game, saw four minutes of it, spent the rest of the night in the ER while she got 17 stitches after being hit by a puck.
We got married eight months later.
Then you divorced her.
It was worth it.
We don't have a choice.
Evolution needs us to propagate, so it gives us a shot of happiness every now and again to suck us in like idiots.
To keep us in a game that we know we're gonna lose almost every time.
Because the upside's like nothing else.
But if Shaun really doesn't need to play, then good for him.
We've officially turned into an episode of "The Bachelor.
" Everyone go home.
I'm not tired.
I am.
There are still a number of possibilities.
Murphy, you are smart and you're creative, but there are things you can't do.
You can't do miracles.
You can't fix the unfixable.
Hey, baby.
You work way too hard.
Yes, I do.
Uh let me get you something to eat, 'cause I made some pulled pork and some peanut coleslaw.
No, thanks, Mom.
Did you find a place? I saw one, but it was nasty.
Y-You must be hungry.
You saw one, and then you came home and cooked? Yes.
I came home and cooked dinner for my daughter.
I'm trying, Claire.
Okay, I'm taking my meds.
I'm seeing Dr.
I am doing my best.
I've heard that before.
You got six days.
Shaun, you need sleep.
Your neurons will be sparkier in the morning.
There are 640 muscles and 206 bones in the body, but only 284 and 72 of those are of sufficient size for our grafts, but that still leaves 20,448 possible permutations.
It's not unfixable until I rule out every So, some anatomy problem, you won't give up on, but after one date, you think you've explored all the possible permutations? Stop distracting me.
I'm distracting you? By talking about you? By talking about love? Yes.
I I need to concentrate.
I'll shut up.
You're still talking.
Good night, Shaun.
You're still We only have 206 bones? - Still talking.
- Oh [SIGHS.]
CARLY: Shaun? I think we should talk.
So did Lea.
But I have to find a solution for an oromandibular defect that doesn't involve titanium plates, 356 of our muscles, or 134 of our bones.
I don't think you never want to see me again.
I have to find a solution for an oromandibular We have to talk.
You owe me that much.
Why do I owe you that much? Because I thought we had a nice time.
And I thought you were a nice guy an honest guy and I still think you are, and I'm confused about how you feel and about how I feel about how you feel, and I just need to talk about it.
So, if you have any feelings for me at all, you'll help me understand.
My little sister, Andie, has autism.
We're not all the same.
I know.
I think growing up with Andie helps me understand you.
But it also makes me wonder about myself.
And did I date you to prove something? Did I date you to somehow make things better for Andie? I don't think I did, but My point is I have questions, too, Shaun.
Trying to figure out what we want and why we want it and is it good for us are good questions.
And they can't all be answered over one dinner.
I have to go.
Murphy I've I've got it! I've got it! We take a vascularized free flap and suture it to the facial artery and vein, then flip up the pectoralis.
It's a great idea.
We're not doing it.
It's never been tried before.
Risk 1 graft failure brings infection and he loses the other half of his face.
Risk 2 sepsis and he dies.
Risk 3 Yeah, yeah, yeah, risk whatever.
We do the standard procedure, the guy never speaks or eats again.
Murphy, could you please give us a minute? Why do you want to do this? You've been my boss for a few hours, and you're already questioning my motivations? You fell on your sword for Shaun, and your reward for your act of heroism was getting fired.
And now you're back here, answerable to me.
I imagine you've been asking yourself if it was worth it.
Your issues with the procedure are valid, but at least let me put them before the patient.
He'll say yes.
I won't sugarcoat the risks.
He'll say yes anyway.
He wants to believe things will work out.
That's why he's a hero.
Sometimes the hero loses.
Which is why he's got to learn when to stand back when there's nothing he can do to help.
Are you going to order me to stand back? No.
Hey, Shaun? You got a minute? Okay.
Debbie wanted me to talk to you.
To tell you not to give up on love.
Don't give up on love.
Do you want me to let her know you told me? Yes, please.
Hey, Shaun? I know this, uh, dating thing can be scary.
You're good at dating.
Well, before Debbie, the last time I went on a date, "Wake Me Up Before You Go-Go" was the big hit.
'Cause a-a-after Maddie and the divorce, I kind of shut down for a while.
Yeah, I and it felt better to be in a place where I couldn't get hurt.
But then, last year, I got my diagnosis, I thought I was gonna die, and Debbie came into my life, and I said to myself, "I-I-I don't want to be safe anymore.
" You know? I want to I want to I want to feel alive.
And And if I get hurt, I get hurt.
That's part of the deal.
Morgan says it's biological, that it doesn't make sense.
Morgan's right.
So I'm right? No.
Look, i it's wonderful, this love thing.
Why should it make any sense? When I think about the reasons I-I'm in love with Debbie, okay, she's she's kind, she's funny, she's she's loving.
But that's not it.
Not really.
Don't tell her this, but there are other people in the world that are kinder, that are funnier, that are more loving than she is, but she makes me happy just being around her.
It makes absolutely no sense, but I wouldn't trade it for anything.
I have an ethical dilemma.
I was going through state regulations for medical staff specifically, residents and their new guidelines have raised an issue for me.
The state caps residents at 80 hours a week, but I don't think that's nearly enough.
I work over 100, and I don't plan on cutting back, so I'm wondering how I should be reporting my hours.
Park offered to co-write a paper with me.
What a suck-up.
I said yes.
It's an interesting case.
It should be written up.
So he's Gonna do a lot of work for nothing.
Except for the good of the medical community.
And I'm gonna tell you what I told him if you come to me with one more favor, one more humblebrag, if I suspect either of you have your lips puckered, you're going to the bottom of the list.
Yes, ma'am.
Lim? Do you ever think about what it means, me doing all this? Means you've underestimated me.
But it also means that I care.
That getting the first surgery means something to me enough for me to go out and really overspend on designer desserts and then to spend even more time trying to make them look homemade.
If I'm putting that much effort into muffins, imagine how hard I'll work to make the most of this opportunity if it's given to me.
With considerable physio and speech therapy, this graft would allow you to not only chew and swallow whole foods, but it would enable you to talk again.
It's an untested procedure with not-insignificant risks.
CLAIRE: If the graft doesn't take, more skin and bone could become infected, possibly necrotic.
We need to know you understand.
It's an experimental procedure.
In addition to all of the usual surgical risks, there are all of the unknowns bleeding out, permanent graft loss, stroke death.
Good for you, Josh.
Get him prepped.
LIM: Infuse carbon dioxide.
Grasping duodenum just distal of the pylorus.
Look at that.
That's not good.
Page Dr.
An intussusception.
The telescoped bowel is causing a blockage.
The baby had two unrelated conditions causing the same symptom.
We only know about the second condition because of the first surgery.
Treatment protocol is a barium enema, but not for someone Braden's age.
An air enema might work.
Unless the intestine's torn.
- Morgan, reposition the scope to get a better look at the intestinal wall around the intussusception site.
There's too much swelling and edema to be sure.
With the risk of infection, we don't have time to find out.
You're gonna have to open him up.
You should.
The Cantrells made their wishes clear.
Well, that's when I made them think you'd erred, which you did not not on the side of caution not at all.
We do the surgery together.
Who's the lead? I think you know.
Pulling rank? Absolutely.
As Chief of Surgery, I designate you.
ANDREWS: It's like a puzzle.
You secure to the artery, then the vessel just won't quite stretch to the vein.
CLAIRE: You could mobilize the recipient vessel.
Repeat that, Dr.
Mobilize the recipient vessel to create more slack.
You saw Carly again.
How was it? Inconvenient.
But despite her intrusion, I was still able to concentrate on medicine.
That wasn't an intrusion.
That was a date.
It was walking.
Walking with someone you like who likes you, too, is a non-date date.
Some of the best dates that I have had did not involve flowers and restaurant reservations.
Just sharing a bag of chips and sitting on a couch.
ANDREWS: Secured.
Remove clamps.
Blood flow to and from graft.
Let's move on to the pectoralis flap.
- Blood pressure's dropping.
Heart rate is up.
Push IV fluids, give epinephrine 1 milligram, then start a drip.
There's intestinal wall perforation.
Repairable? [SIGHS.]
There's too much tissue damage.
Infection? No sign of peritonitis, but we'll need to remove this section of bowel.
- He's tachy.
- Hypotensive.
Push vasopressors and antibiotics.
- Check an iSTAT hematocrit, ABG.
Give two units PRBCs.
I don't see any major bleeding.
Push more fluids, start an inotrope.
Check all vessels we worked on for clots with the Doppler.
Large clot in the carotid.
Clamps back on, performing carotid arteriotomy.
Will try to aspirate out the clot.
Stand by with heparin.
Carotid clot removed.
EEG looking good.
Resuming pectoralis flap dissection.
Good work, everybody.
ANDREWS: Go ahead say something.
Yeah, you can talk.
Maybe not too much at first give the jaw a chance to heal.
Thank you.
On behalf of all of us, you're very welcome.
The woman who was being accosted when you intervened is here.
Is she all right? CLAIRE: She's not here as a patient.
She's been waiting to see you.
Okay? Hello.
I am so sorry this happened.
Me too.
You look When the swelling goes down, he'll look a lot better.
It's okay.
My face was never my fortune.
What made you do it? Why did you step in? I don't know.
You needed help.
Olivia, by the way.
We'll let you two get acquainted.
It didn't matter who got the first lead surgery to me.
But it's recently been brought to my attention how much it might mean to some of you.
Seems I'd forgotten how important this decision is when you've been dreaming about it for years.
You're all excellent candidates, each deserving, and will all get your turn.
Starting with Dr.
Yes! Thank you.
- Congratulations.
- CLAIRE: Thanks.
What the hell was that? I was happy for a colleague.
You weren't campaigning for you to win.
You were campaigning for me to lose.
Do you dislike me that much? I just wouldn't want you supervising me as Chief Resident.
You'd be a nightmare of a boss.
Lim thought my motives for fighting this hard for this patient were miscalculated.
She was right.
We shouldn't have saved his face? We have limited resources, and we're even more limited in our personal capacity to determine who is deserving, so we make a choice to treat everyone the same.
So why did you treat this patient differently? Because I was angry.
I made a sacrifice to save you.
I lost my job, I took a substantial demotion.
And I thought I was a fool.
The cost was way too high.
I resented you, and I kind of resented the universe.
But today you made me proud of my sacrifice.
Thank you.
You're welcome.
Very few things that are worthwhile in life come without a cost, Shaun.
This is tricky.
I feel like we were just tested and both of us failed.
But we'll get better at this.
BREEZE: Hey, honey.
I'll make you a plate, and you can take it to your room.
I saw three more apartments today.
One was kind of nice, but it's not ready until a week from this Tuesday, which puts me over your deadline by three days.
Three days? Come on.
You can stay here.
For a little while, until you're a bit better.
But you have to stay on your meds.
And keep away from other drugs and alcohol.
I'm testing your urine every two days.
Don't miss any appointments with Dr.
Can you live with that? [SQUEALS, LAUGHS.]
Do you have a couch? You held the balance of the time That only blindly I could read you But I could read you It's like you told me Go forward slowly It's not a race to the end Well, you look like yourself But you're somebody else Only, it ain't on the surface Well, you talk like yourself No, I hear someone else, though Now you're making me nervous
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