The Good Doctor (2017) s03e06 Episode Script

45-degree Angle

1 Sorry, Dr.
Andrews.
I had a patient with some post-op arm pain.
How can I help you? What's happened to all the nurses? Hello.
My name is Dr.
Shaun Murphy, surgical resident year 3.
I will be assisted by Dr.
Claire Browne on today's open appendectomy.
I will not be putting on my number 7 sterile gloves myself, as I am lead surgeon.
Nurse Fletch, can you adjust the overhead light? How many degrees, Dr.
Murphy? Ah, yes.
I should be more specific.
A 35-degree angle.
Nurse Hawks, please hand me the 10 blade.
Straight clamp, please, Nurse Fletch.
Hello, Dr.
Andrews.
I'm going to try to pretend you're not here.
You have not pretended to scrub in and may not be here when here is there, there being O.
R.
2 later today.
You don't need a full surgical team to rehearse.
Some of this staff needs to get back to their stations.
No.
They can stay here.
Chief Lim has assigned me my second first surgery, and she assigned them all to me and told me to rehearse with all of them unless and until there's an emergency on their floor.
Dr.
Browne, please hand me the Bovie.
Dr.
Browne had a dental appointment this morning.
I'm doing my best to be annoyingly caring and empathetic in her stead.
There's the baby.
And there's the mass.
Way too close together.
A biopsy is out of the question.
Best course is to go in and remove the entire mass.
Will that be dangerous for the baby? The odds of your daughter being harmed are very low.
And what about recovery time? How long? Normal recovery is about three weeks.
We're opening a specialty toy store.
I need to be up and about in a week.
Tell 'em, Andre.
Sustainable natural toys.
Good for the kids, good for the world.
I don't really want to leave Andre to fight the crowds alone.
Well, a week is not realistic.
Too much stress on your body after the surgery could put the pregnancy at risk.
It's okay.
Andre worries.
Thought it was too much to start a business and a family all before our first anniversary.
Business and family are easy.
If I'd known it was business and family and cancer, I might have waited on one of them.
Let's just worry about the surgery right now.
Okay? Dr.
Lim.
Just came from Dr.
Murphy's improv class.
I don't remember Browne getting a full-team rehearsal before her first surgery.
Our residents are not homogeneous.
Each one requires different attention and training.
I agree.
And for Shaun, that means less training wheels and more scabbed knees.
Trust me, his knees will get scabbed.
I'm trying to prevent a decapitation.
If he's not ready Why don't you follow your own advice? You think this is the wrong option, stop telling me.
Let me fail and learn.
But be sure to apologize when you realize I was right.
The appendix can be removed in various ways, including suture ligation, purse-stringing, and inversion appendectomy.
I will be using the suture ligation technique.
Dr.
Browne, place a clamp just proximal to the distal ligature on the appendix.
How's it going with Carly? Divide sharply and cauterize the exposed mucosa.
Isn't dating life wonderful? Everything you hoped it would be? Please refrain from asking non-surgical questions, Morgan.
I need to concentrate on the next step in my O.
R.
management.
And I need to be Claire.
Is there any chance she's not gonna be concerned about your personal well-being and inquire? Repeatedly? Things are going well, Dr.
Browne.
We make out a lot.
Let's close the peritoneal cavity.
Did you guys have lots of fun on your last day off? - I went to the museum.
- Mm.
Nurse Hawks, please check the patient's vitals.
Everything looks normal.
You went alone? I called Carly at her house to see if she wanted to play Chinese checkers.
Close the external oblique fascia with a continuous 2-0 vicryl stitch.
Although they're not really Chinese.
It's actually a game of German origin called Sternhalma.
It's very fun.
I will use 4-0 monocryl subcuticular interrupted sutures for skin closure.
However, Carly said she could not hang out because she was busy.
If the wound was contaminated, we could leave in a Penrose drain and remove it two to three days later, but it is not.
She had friends over.
I could hear laughing in the background.
Dr.
Browne, approximate all split muscle layers.
That's odd.
Nothing is odd.
We just have two more steps and No.
That whatever she was doing, she didn't invite you.
Why? She isn't treating you like a boyfriend.
You don't exclude your significant other from a get-together.
That's not true.
It could have been a family thing.
Or maybe she thinks it's too early to introduce you to her friends.
It's also possible that there was no get-together at all.
I mean, maybe you just heard the television.
Maybe she just doesn't see you as her boyfriend.
Has she ever called you her boyfriend? We have practiced enough.
You had a dental appointment this morning.
The reason you're late.
So brush extra well and don't forget to floss.
Thanks.
Don't take this the wrong way, but when did you get so slutty? I'm not.
Thank you for covering.
Now This smells like it's been dipped in Drakkar cologne.
Do you really care what I wear or what I do? I care when you're late.
I care about the amount of extra work I have to do covering for you.
I was an hour late.
How much extra work could that be? One hour's worth.
So, you can thank me by taking two hours off my hands.
Thank you.
Hey, Shaun.
Hello.
Waiting for Carly? I want to know why she did not invite me to her get-together.
Might have a better chance of finding out if you were physically closer to her.
Maybe later.
This prescription should help him feel a little bit better.
And if I may suggest, don't store the chocolate laxatives in the candy drawer.
- Hi.
- Hey.
I was wondering if you could get away for lunch.
Yeah.
Let me see if I can move some things around.
- Come on in.
- All right.
I got fired.
- What? - Mm-hmm.
What happened? I was giving away free coffee.
We work in a hospital, and I hear a lot of sad stories.
And sometimes when they're really, really sad, I like to give that person a free coffee, and it makes them smile.
And yes, okay, I know.
It's against policy.
But you'd think my asshat boss would give me more than two warnings before giving me the ax.
Okay.
What do you want me to do? You want me to beat him up? I want you to come home for lunch and I want to bitch about my ex-boss and I want someone there to listen.
Okay.
Use a tenaculum to grasp the lesion to create countertraction.
I'm gonna separate the mass from the underlying myometrium.
Damn it.
Let's get suction.
The mass has surrounded the uterine arteries.
We can't remove the mass without killing the baby.
Dr.
Reznick, if you were lead, how would you proceed? We're already in, so I'd biopsy the mass for testing.
Then I'd perform an embolization of the arteries feeding the tumor.
Very good.
Dr.
Park, what does that do? It should allow us to control the bleeding so we can close her up and leave the baby in place for two months.
That'll give the baby time to become viable outside the womb.
At that point, we go back in, safely take out the baby and the mass.
Sounds like the right call to me.
We'll be performing an embolization of the arteries feeding the tumor.
- I'll inform Chief Lim.
- Not necessary.
It's protocol to run all decisions about complex procedures by the Chief of Surgery.
There's only one clear path, which means there is no decision.
In my office, please.
I didn't think you'd mind.
We always complained about Andrews and his red tape.
Well, I hoped that our relationship was better than whatever you had with Andrews.
It is, but I know you're busy.
You don't need to be bothered You know how this makes me look? You know how this makes me look? This job was on your to-do list.
Lab must have made a mistake.
I'll deal with it.
We might have a bigger issue than you lying about the blood test.
I'm not lying.
Like I said, this is a bigger issue.
Shaun is distracted.
Well, why would he be Because you were at the dentist.
Nurse Hawks asked some questions.
Carly didn't invite Shaun to something, and now he's worried that they're not boyfriend and girlfriend.
So, did you talk to him? No.
That's what you do.
Think I put it on your list "be kind and care" so I don't have to.
Okay.
I'll talk to him.
Talk to Carly first.
You can do it when you drop off the blood vials and pretend it's the second time.
This is good.
It's good.
You were wasted there.
I was happy there.
I love that hospital.
I lo I love the staff and the patients.
It just felt like home.
Here's a thought.
What if I come work with you? I saw your waiting room.
You need the help.
We have an office manager.
She doesn't manage.
She's never there.
I-I was a nurse.
I could schedule your appointments.
I could, um, triage the walk-ins.
It's like a win-win.
I don't think we have the budget for for new employees.
Aaron, that's horse crap.
You're the president.
What's the real reason? I-I think couples that are apart now and then, it's a good thing.
Couples together 24/7? I mean, I don't want to get to the point where we come home and we run to opposite sides of the house.
Okay.
Just a thought.
I'm just gonna keep looking.
Hi, Carly.
Replacement vials.
For some reason, the bloodwork for Shaun's case was never processed.
Oh, that doesn't sound right.
Why is not all that important.
But if you could just put a rush on them.
If the tests get delayed any longer, then Shaun's surgery could get rescheduled.
There's no record of any bloodwork being dropped off for Shaun.
If the surgery gets rescheduled, then Shaun will lose his team, the team he's practiced with.
It might throw him, so if you could just Shaun doesn't get thrown by anything medical.
Shaun is already thrown.
For some reason, he has it in his head that you dissed him or something, that maybe there's a problem, and now he seems distracted, upset.
I I wondered if you could speak with him, let him know everything's okay.
I'll make sure to put a rush on the blood tests.
Thank you.
My wife says that the Earth is a womb and that when you garden, you become part of its birthing process.
Not that I mind sharing hobbies with her.
It keeps us close.
And I don't mind the dirt in my eyes.
Just could do with a little less of the talking.
I feel you.
You don't by any chance possess the power of flight? Uh, what? You have a wing in your eye.
Sorry? Just hold still.
Ow.
Congratulations.
Your womb just gave birth to a bee.
Ugh.
Triplets, in fact.
Dr.
Glassman, I need to compartmentalize.
Hi, Shaun.
Nurse Hawks says girlfriends invite their boyfriends to get-togethers.
That means it's possible Carly did not invite me because I am not her boyfriend, but we make out and she wants to hold my hand and she lets me touch her breasts.
Those are things you do with a boyfriend.
Now all I think about is Carly, even when I'm supposed to be doing my job.
I do not like it.
I tried to talk to her, but I can't.
You can't talk to her? I can't.
I need to compartmentalize.
Well, Shaun, you're you're very good at compartmentalizing.
Were you wearing your white lab coat when you tried to talk to her? N-No, I was in my surgical scrubs.
Okay, see, we all struggle to to separate our work life with our personal life, right? That's why we wear uniforms.
It tells us, it tells the world, "This is what I have to focus on right now.
I can't worry about anything else.
" - That makes sense.
- Good.
So, when Carly's wearing her white lab coat, then she's just a co-worker, not a girl you happen to be seeing at the moment.
When you're wearing your white lab coat, then you say to yourself, "I'm a doctor, damn it.
I'm not gonna worry about everything else.
" Say to yourself, "I'm a doctor.
Romance doesn't matter.
" I'm a doctor.
Romance doesn't matter.
I'm a doctor.
Romance doesn't matter.
I am a doctor.
Romance doesn't matter.
I am a doctor.
Romance doesn't matter.
Um, you're wearing a white lab coat.
You want to be a doctor and get the other bees out of my eye? You make a fair point.
Looking for Murphy? Yep.
- Blood tests being expedited? - Yes.
Did you own your mistake or blame some innocent clerk? How did it feel? Is it eating at you? You mean, how do I live one moment behaving how you do constantly? At least I'm consistent, even when I'm going through my own issues.
Shaun? Why aren't you wearing your white coat? I am a civilian.
Medicine doesn't matter.
You're not leaving.
Your surgery is in six hours.
Did you speak to Carly? I need to talk to Carly.
Shaun, why did we practice this morning? Because I'm not good at communication.
Exactly.
But with practice, you can do it.
Talk to me.
Tell me the problem.
Tell me how you feel.
Okay.
I have to talk to Carly.
Shaun, stop.
You don't have to talk to Carly.
Everything is fine.
I talked to her earlier, and it was just all a misunderstanding.
Why did she not invite me over to meet her friends? There were no friends.
Uh, the laughing you heard she thinks it must have been a podcast she was listening to.
I need to get my lab coat.
Told you you're better at this than I am.
Though you could have jumped in earlier.
We were able to do a biopsy, and the mass is non-malignant.
We've stabilized it, but it does still need to be removed.
When? Two months.
By then, the baby will be viable outside the I don't feel well.
My vision's getting blurry.
Your blood pressure's tanking.
W Doctor, what's happening to her? Page Dr.
Melendez.
Hello.
My name is Dr.
Shaun Murphy, surgical resident year 3.
I will be assisted by Dr.
Claire Browne on today's open appendectomy.
I will not be putting on my number 7 sterile gloves myself, as I am lead surgeon.
Nurse Fletch, can you adjust the overhead light? Adjust to a 35-degree angle.
Nurse Hawks, please hand me the 10 blade.
The arterial embolization was rejected above the bladder.
The mass is seeping blood.
We have to go in again, or she'll slowly bleed to death.
We deliver the baby early, have an incubator and ventilator ready in the O.
R.
Even with maximal NICU support, the baby's chance of survival is around 15% to 20%.
Maybe we were wrong the first time.
Maybe we can leave the child and work around her.
We can suction-resect this friable lesion and control the bleeding better with the argon beam coagulator.
Very easy to go too far, cause a uterine rupture.
But if we don't screw up, the baby gets to stay in the womb and grow to term.
Nice.
I'll go book an O.
R.
Wait.
There's one more thing we need to do.
It's a good plan.
But the safest course of action is to deliver prematurely and remove the mass.
By "deliver prematurely," you mean terminate the pregnancy.
Not necessarily.
But yes.
To save her life.
If I place internal iliac artery balloon catheters, I can control most bleeding as it happens.
Most? I've performed surgeries that were a lot more complicated under much more difficult circumstances.
When you had no other option.
You have a choice here, a safer choice.
The mother's life takes precedence.
That's our policy.
Are we sure it's hers? Okay.
Go make your case.
Thank you.
Neil? Thank you for getting my approval.
It's your job.
I will now use electrocautery to incise through both the fascia and muscles.
Can I please get a measurement on the patient's pulse, blood pressure, and temperature? Pulse is at 65, pressure 118/82, and temp is normal, at 98.
6 degrees.
Thank you for hearing and responding.
The appendix can be removed in various ways.
I will be using the suture ligation technique.
Dr.
Browne, can you identify the ascending colon and its taenia coli? I see it.
Thank you.
Please free the appendix-mesoappendix complex from its adjacent tissue.
Babcock clamps.
We must have nicked an ileocolic branch of the SMA.
Get suction on it, Dr.
Browne.
Nurse Fletch, please use lap sponges to stem the bleed.
If she hemorrhages, she could die? That is a possibility.
But if you're successful, then I complete my pregnancy.
No.
It's too risky.
If Dr.
Melendez says he can do it Do the other surgery the one where you take the baby out and you save Patty.
I'm the one carrying the baby.
I'm the one going through the surgery.
It's not your choice to make.
I-I didn't want this baby.
Sorry.
I j Look, we can have another child some other time.
But I can't replace you.
I don't want another baby.
I want the one that's been giving me morning sickness for the last 23 weeks.
I want the one who's been giving me heartburn, constipation, and insomnia.
That's the baby that I want to hold.
And I couldn't live with the guilt if I killed our baby to save my own life.
Performing a suture ligation with two interrupted 2-0 vicryl sutures.
Dr.
Browne, cauterize the exposed mucosa.
I may owe Dr.
Lim an apology.
Continue.
Uh, yes.
We still need to copiously irrigate the wound with normal saline, grasp the peritoneum with two straight clamps, and close it all up with a continuous 3-0 vicryl stitch.
Irrigating.
Straight clamp, please, N-Nurse Straight clamp, please, Nurse Hawks.
You are handing them to me incorrectly.
I'm sorry? You are handing them to me incorrectly.
This is how I always do it.
You do it wrong.
- Shaun - I don't know how else to do it.
You can do it the right way.
What's the right way? - The efficient way.
- Efficient? Yes.
There is historical precedence to my preference.
Please just take the clamp.
- I can't.
- Of course you can.
Take the damn clamp.
You need to leave.
Nurse Hawks you need to leave the O.
R.
Leave now! Dr.
Reznick, please cauterize those bleeders with the argon coagulator.
I nicked an artery.
She's hemorrhaging! Hang 4 units on the rapid infuser.
Get me a vascular clamp.
The surgery was successful.
The patient's vital signs are stable You can't solve your interpersonal problems by making people go away.
There was a bleed.
You threw the nurse out of surgery because of a bleed? Yes.
Because we nicked the ileocolic branch of the SMA, Nurse Fletch was attending to the lap sponges, so Nurse Hawks had to hand me the straight clamp, and she did it wrong.
And she refused to do it right.
Did you tell her how to do it right? I wanted my straight clamp handed to me at a 45-degree angle so I do not have to bend my wrist as much to go from handoff to the surgical field.
Did you explain all of that to her? I told her to do it the efficient way.
I want you to apologize to Nurse Hawks.
N-No.
No.
Why would I apologize because she did not do it right? Because you didn't, either.
When you're lead surgeon, it means you're in charge, which means if anything goes wrong, it's your fault.
Do you understand? You've gotta make this right.
Okay.
You could have stepped in and kept the situation from escalating.
You have your way of dealing with Shaun, and so do I.
We need better control of the bleeding.
Clamp off the common iliac.
There's too much blood to see in here.
We have to take the baby out.
Page the on-call neonatologist.
Let them know they're gonna have a 23-week-old girl coming their way very soon.
Second time in as many days you've dropped by unexpectedly.
I'm starting to think you like me.
I got a job offer.
Well, there you go.
That was quick.
Let's go celebrate.
Well, I'm not gonna take the offer.
I want to come work here with you.
Well, we've already talked about that.
You talked.
I listened.
Now it's my turn to talk.
We got married to be here for each other, even when the other one didn't know they need it.
You're so busy with your patients, you don't see that the clinic is starting to suffer.
Right now, it's double-booked appointments.
Next, it could be the wrong medication prescribed.
I would never let that happen.
I'm a good partner.
I'm good at home, on the weekends.
I could be equally as good here in this office.
Okay, if it doesn't work out, I'll quit.
Or you can fire me.
No harm, no foul.
Uh, nothing is ever as simple as "No harm, no foul.
" Got a résumé? Well, I was hoping to avoid that.
Mm.
I read a study that said sharing a cup of coffee with colleagues promotes professionalism.
My cup is empty because I do not like the way coffee makes me feel.
I've had a long day.
Can I just enjoy my lunch? Chief Lim asked me to apologize to you.
Okay.
Okay.
The earliest known drawing of a pivoting surgical instrument dates back to 1500 B.
C.
on a tomb at Thebes, Egypt This does not sound like the beginning of an apology.
I want to explain why I prefer the straight clamp handed to me at a 45-degree angle.
Putting it in historical context will help.
You need to stop.
In the ninth century, Albucasis, known as "the father of surgery" You need to go away.
No.
I need you to understand because if you see why I'm right, you will see there is no reason for me to apologize.
She's gone into unstable v-tach.
Dr.
Reznick, we're gonna need the defibrillator.
Charging.
Clear.
Continue compressions.
Give me one milligram of epinephrine.
She's gone into v-fib.
Shock again.
Charging.
Clear.
All right, crack her chest.
I'm gonna do an open-heart massage.
Heart's exposed.
Starting the massage.
Internal cardiac paddles.
Charging.
Clear.
Again.
Charge.
Clear.
Again! Charge.
Clear.
Let's open the uterus and get the baby.
All you had to do was say you're sorry.
I tried to explain why the straight clamp N-No, I-I don't hear the word "sorry" in there.
I-I don't hear any taking of responsibility.
You said I had to make this right.
An apology seemed to be just one possible way Shaun, she filed a complaint.
- No.
No! - Yes.
Yes.
- You have a problem with communication.
- I was Yes, but I am So I'm going to make this very, very clear.
You screwed up.
- No.
- Yes.
Yeah, you were wrong.
- No! - You are wrong.
You screwed up.
This incident will be noted in your file.
And if this or anything like this happens again, that will be the end of your residency.
Now, what do you have to say? You're sorry? I failed.
I'm sorry.
Good.
Now go say those words to Nurse Hawks.
And mean them.
I spoke to Carly.
You're a terrible fairy godmother.
You swoop in, you enchant the hero with a lie, and then you carry on like you made his world a better place.
Shaun was about to talk to Carly.
That's what he needed to do.
I think Carly's pissed at him.
Fine.
Then she's pissed at him.
They deal with it.
Shaun's problem is communication.
You made it worse.
Shaun needed to get his head straight before his first solo surgery.
That is what I did.
I fixed the problem.
You buried a problem.
Which seems to be your general approach to life right now.
Hey, Shaun.
Hello.
We need to talk.
You're mad at me.
Yes.
Because whenever you have a problem, I hear it from Glassman or Claire or Morgan anyone but you.
I'm sorry.
Good.
Shaun, stop! This is the problem.
You have to tell me what's bothering you.
Why did you not invite me to your get-together last Sunday? I had some old friends over.
We were gonna drink and play a little poker.
My friends are snarky.
They tease and play practical jokes on each other.
And I knew that you wouldn't like that and that it would get weird, so I decided not to invite you.
That's it.
The whole story.
My father always sent me to my room when he would play poker with his friends.
They were loud, and they would tease me.
They said I talked funny.
Is that what your friends were going to say? No, Shaun.
Of course not.
Then what were they going to do? Nothing, I guess.
It's just sometimes when you bring the guy that you're dating into the mix, that relationship changes.
It can be a disaster.
Was it a disaster every time you brought a date to meet your friends? No.
Some fit right in.
Then how did you know? How did you know it would be a disaster with me? I didn't.
I made an assumption.
And I shouldn't have done that.
I'm sorry, too.
Can you forgive me? I wasn't a great girlfriend.
Girlfriend? You're my girlfriend? Yeah.
Does that mean I'm your boyfriend? You are.
I forgive you.
Can I kiss you? Okay.
I'm glad we talked.
Me too.
I'll introduce you to my friends next week.
No, thank you.
I would not like to meet your friends.
- Okay.
- Okay.