The Good Doctor (2017) s03e08 Episode Script


1 - Okay.
This is terrifying! [BOTH SCREAMING.]
- Oh! Oh! - And very fun! - [SCREAMS.]
Are you ready to try lying down? Because I am ready, Shaun.
I am very ready.
Carly Mm.
600 thread count microfiber sheets.
A shredded memory foam pillow.
A 40-watt A19 incandescent bulb.
I'm sorry.
You didn't return my calls this weekend.
After a ride up Skyline Boulevard, 60 minutes of Muay Thai, and a 15-year reserve Scotch, I had a moment of clarity.
What you said about my objectivity in the Fields case wasn't about me.
You were in pain.
I was taking responsibility.
And asking you to take your share.
It was a good surgical plan.
You need to accept that, despite being a gifted surgeon, you are fallible.
I think I should run my procedures by Glassman from now on.
Audrey, we need some checks and balances.
I am checked and balanced.
And I'm the chief of this department.
You will continue to run your medical decisions past me.
ANDREWS: Browne, you're with Melendez today.
Murphy and Park, meet me in the E.
observation unit in 20.
I thought I was on E.
consults with Park today.
If I'm being bumped because I took off the other day, Dr.
Browne was every bit of First lead surgery.
Thank you.
Scheduled for tomorrow.
Study the images and prep your patient.
Yes! [LAUGHS.]
I rock, I rock! The surgery gods know it, I know it, and apparently, so does Andrews.
Boasting doesn't have the same impact when you're picked last.
He was obviously waiting for the right case to come along.
You're kidding me.
This is much better than my first surgery.
Damn right.
A med student could do an appy.
The carotid endarterectomy takes serious finesse.
Fair to say it's really a 5th-year procedure, but I don't have time to sit around debating semantics.
I have the Holy Grail of resident surgeries to prep for.
The tumor was found on my left lung at my medical fitness exam.
Tricky spot.
Curable, but tough to remove without taking the entire lung.
That's what they said.
And you didn't like that answer? I need my lung.
I'm going to the moon.
ANDREWS: When did the chest pain start? Around 9:00 this morning.
Okay, I'm gonna look at your heart.
This gel may be a little cold.
You see a cardiologist.
Did you use the nitro he prescribed? It usually relieves the angina, but not this time.
Are you the same Rosalind Elion who just published a study on IDH2 Inhibitors in Myeloid Leukemia in the Journal of Pediatric Oncology? - Yeah.
- Wow.
You're famous.
W I-I used an IDH2 on a kid with AML.
- I mean, he's doing great.
- Oh.
Your studies revolutionized leukemia treatment.
It's an honor to meet you.
That's kind of you to say.
Noticing anteroapical wall motion abnormalities.
Is your chest pain worsening? Yes.
How did you [INHALES SHARPLY.]
She's having a heart attack.
Contact her family, then meet us in surgery.
She needs a triple bypass.
- The moon? The moon.
In 2020.
It's a private venture partnership with NASA.
Floating in an expanse of uninhabitable emptiness 200,000 miles from the nearest Starbucks - Mm.
- not for me.
You never wanted to be an astronaut when you were a kid? Had enough challenges here on Earth.
Did you? - I was a Trekker.
All my friends had Spock ears.
I was all about McCoy.
There's our tumor.
It's embedded in the hilum.
NASA doctor was right.
We'd have to take the entire lung to get it out.
Not necessarily.
The tumor's grown into the upper lobe.
If we can remove it from the main bronchus, we can get a clean margin.
The rest of the lung can stay.
You'd have 80% of your If treatment reduces my lung volume at all, I'll be unfit for space travel.
The mass is too deep.
Major blood vessels, your airway, esophagus, and heart are right there.
The next opinion you get will be the same.
Or worse.
Thank you for your time.
What do you see at the apex? I see perfusion abnormalities.
Her LAD and PD are completely occluded.
She listed her husband as her medical proxy.
You'll need to update him as soon as he gets here.
The entire left side of her heart is compromised.
He's not coming.
They've been divorced for two years.
He hasn't spoken to her in almost that long.
Murphy, anastomose the internal mammary to the LAD.
Let's see if we can give her heart a blood supply.
I tracked down her sister in Santa Cruz.
She hasn't seen Rosalind in years, either.
That's a lot of legwork for a surgeon no social worker available? It's good that you didn't find anyone.
Family members are the least qualified people in the room to make medical decisions.
Judging by the state of her myocardium, there's only one choice, anyway.
She needs a new heart.
I think it's possible to spare her upper lobe using a surgical robot.
Wren Braxton came to see me.
You're her second opinion? Or fourth or whatever she's up to? I'm surprised you didn't offer the robotic option.
It's the type of surgery I usually send your way.
I didn't offer it because with the robot, if I nicked her pulmonary artery, she'd likely bleed out before I have a chance to open her up to control it.
She's just gonna keep looking until someone gives her the answer she wants.
And then what? What do you think her odds of survival are if some hack tries to cut the tumor out, leaving the lungs intact? Roughly zero.
I agree.
And with you? With the robot? Still lousy.
You can do this.
You're overestimating the risk, and I know why.
And you're doing exactly what you did last time.
Assuming that I can do anything.
So everyone else is biased except for you? The one who just had a patient die on him? If it's had any effect, it's to make my judgment more acute.
I won't risk having Wren leave here the same way that Patty Fields did.
People risk things to make their dreams come true.
If you don't want to help her, I'll do it myself.
PARK: The intra-aortic balloon pump will support your heart until we find a donor.
And when might that be? SHAUN: A heart is the most difficult organ to procure.
But since yours is so badly damaged, you are very high on the list.
I suppose that's a good thing.
Not really.
The We're doing everything we can.
Thank you.
PARK: Is there anyone you want us to call? Yes.
My lab assistant.
The next few days are crucial to my monoclonal antibody study.
Hannah needs to stay with the cultures around the clock.
I don't want five years of work to go to waste.
Can I ask why you listed your ex-husband as your medical proxy? I had to name someone.
Leo is the only person I ever discussed my medical issues with.
Now, if you don't mind, I have a lot of work to do, which, as you've indicated, I may not have a lot of time to do it.
How are you, Shaun? These are STAT cardiac labs.
I have to go.
I hope you're not embarrassed about last night.
I want to have sex with you.
That's nice.
I think about it very often.
Even when I'm supposed to focus on more pressing matters.
Like 15 minutes ago when I was filling out that lab requisition, I almost forgot to add a BNP.
That's good.
No, it's not.
We need a BNP to monitor her cardiac function on the balloon pump.
I've been thinking about you, too.
Sometimes when I shouldn't.
- That's bad.
- Not really.
I've been doing some research.
I came across this therapy psychologists use to treat phobias.
Apparently, it works in people with autism, too.
If you're game, we could try tonight.
I'm game.
MORGAN: I need a different first surgery.
There a problem with your patient? The plaque dissection is too advanced for a third-year resident.
I was nervous as hell for my first surgery.
And it was only a tonsillectomy.
I could take out a pair of tonsils blindfolded.
It's not nerves.
This is more like a fifth-year procedure.
You're setting me up to fail.
This is why I picked you.
You come to me scared, and you couch it in arrogance.
It's rare that a resident has what you have the aggressiveness, the work ethic, and talent to be a leader.
I'm not setting you up to fail.
I'm setting you up to shine.
Or am I wrong about you? No, sir.
I want you to do my surgery.
The one Dr.
Lim suggested.
It was Dr.
Lim's idea.
She's an excellent surgeon and my superior.
And you think I'm an idiot.
I am afraid of this surgery.
And I'm afraid of going to the moon.
It's not about the moon.
It's about the fear.
It's about getting beyond that.
That's how great things happen how they've always happened because someone took a chance.
From what I've read about you, you're exactly the kind of person I need in my corner.
Exactly the kind of person I would've thought would understand.
Fear is also what keeps us alive.
What do you think the odds are of you not coming back from the moon? The reason it's heroic, the reason it's exciting is because you don't know what to expect.
You can't anticipate everything.
1%, 2%, maybe 5%.
This surgery, if I were doing it, there is a 60% chance that you die on the table.
It's called exposure therapy.
We'll lie down on the bed side-by-side, fully clothed and not touching for 15 seconds.
When this timer goes off, you'll go into the other room for a three-minute break, and then we'll go again for 20 seconds.
Over time, we will progress to longer intervals and start to lie closer together.
This seems like a good approach.
Whenever you're ready.
Are you okay? What What are you feeling? I I I don't know.
I don't I don't know.
I don't know why it didn't work! It's okay, Shaun.
We'll try again.
No! No.
No No, I can't.
W-We'll try for less time.
I can't do this! Go.
What? Go.
Get outta here.
We can watch the end I got the sheets, [SNIFFLES.]
The pillow, the damn lightbulb.
I read 18 psych journals.
And you give up after eight seconds? You're right.
This isn't going to work.
Go home.
How are things with Carly? I lasted eight seconds.
She kicked me out of her house.
First time is difficult.
I'm sure she didn't We tried timed exposure therapy to get physically closer, but I couldn't do it.
So try something else.
When I lie close to her, I feel diaphoretic, my heart rate is elevated, and mouth gets dry.
I don't know how to not feel that way.
You want this, Shaun? Yes.
Very much.
Then rely on your strengths.
Treat it like a surgical problem.
Do your research.
Carly came up with a solution, it didn't work, but that doesn't mean the next one won't.
Give me some good news.
I had a potential donor in San Diego, but the heart was just too damaged.
I'm at the GE junction now.
Now she has complete right-sided failure, too.
It's time to discuss a DNR.
She's got one day left in this world.
Let's keep her comfortable.
60%? That number is grossly exaggerated.
I spent an hour convincing my patient I'm not trying to kill her.
She came to me.
I gave her my surgical opinion.
I I could fire you for this.
Because I contradicted your opinion after you contradicted my opinion? I gave her an option you were too afraid to present.
No, you proposed a potentially deadly surgery to a woman who was desperate for any option, no matter how crazy.
- You don't have the authority - Authority? I thought we were talking about the patient It was unprofessional, disrespectful - I don't - If anyone showed a lack of respect Doctors.
My office.
I wouldn't want to be kept alive on life support.
Not if there was no hope for a recovery.
There wouldn't be.
As your heart failure worsens, you may get short of breath from fluid build-up.
We can use diuretics and vasodilators to help control that.
I recommend both of those.
Of course.
If that doesn't help, we could insert a catheter in your chest to drain the fluid.
The procedure does risk a lung puncture, which would worsen your symptoms.
You should give us every option to keep you breathing easy.
And we'll be on call all night to make sure you're as comfortable as possible.
Thank you.
I went through this with my mom when she was dying of leukemia.
I'm so sorry.
Was that recent? I was 10.
I remember feeling so helpless You should reach out to Leo.
It's too late.
I don't believe that.
There were, uh, things between my wife and I that I thought we could never get past.
But last Christmas we almost lost our son.
And when I reached out, Mia was there.
Leo always made me feel pressured to choose between my research and him.
Eventually, I realized he was right.
So I chose to go - where I was needed the most.
To call him now would be hypocritical and unfair.
It took a lot of time and dedication to push our understanding of leukemia as far as you did.
I'm glad I have treatment options for my patients.
You made a good choice.
Sorry to keep you waiting.
I assume that some of this is professional, the other 90% is personal.
Am I right? Well, it's a very difficult case.
We're both just overly invested.
Actually, I'd love for you to weigh in on this one.
Lim, are you confident in the surgical plan? - Good luck.
- Thank you.
You didn't even look at the case.
- The pulmonary - Dr.
Lim is my Chief of Surgery.
I trust her judgment.
I'm sorry things got out of hand.
It won't happen again.
It better not happen again.
If you two can't control your interpersonal squabblings, I'm gonna have to lose one of you at least.
We need an endoscopy suite to fetch the spoon out of this guy's stomach.
How's the intimacy research going? Dr.
Elion has had a very successful life without a relationship.
So can I.
Success and happiness aren't the same thing.
You need to decide what will make you happy in the end.
I don't know if it's being a great surgeon or being close to Carly.
But I'm better at surgery than I am with her.
Elion is wrong.
You don't have to choose.
I fly to Phoenix every other weekend to spend time with Mia and Kellan.
Then you won't be great at either.
I think Dr.
Elion is afraid.
I think it was never about the journals and the lives she could save.
I think she's always been afraid afraid she might lose Leo just like she lost her mother.
And you, you lost the person you loved the most when your brother died.
Your elevated heart rate, sweaty palms they're not about your sensory issues, Shaun.
It's what we all feel fear.
W-Why would anyone want to feel afraid? Because the thought of ending up alone is scarier.
I don't think Dr.
Elion refuses to call Leo because it's hypocritical.
I think she's afraid he won't come.
Can you handle the spoon? Yes.
- Good morning, Dr.
- Morning.
Which shoulder would you like to hurt for the next 24 hours? I'm not here for a vaccine.
Wrist and thumb joint pain.
I need cortisone shots.
Surgery's in two hours.
Can I ask you something? If a patient say, a violinist who concertized three or four times a week were to come to you with achy joints, would you give them a cortisone shot or tell them to lay off for a while? [CHUCKLES.]
Better question if he or she came to you with achy joints and pretended they needed a vaccination, what would you do then? It's [INHALES DEEPLY.]
It's because I wanted you to know and no one else.
I saw a rheumatologist last month.
I have rheumatoid arthritis.
I'm sorry to hear that.
My My mom had it, too.
It It destroyed her wrist and finger joints.
LIM: Maybe I should leave St.
Berkeley's chief is retiring this year.
I could apply to replace him.
We're entitled to have differing opinions.
We can argue Apparently we can't.
I love you.
I want our relationship to work.
And I want to be chief.
If we can't find a way to work together with me as your boss, then something has to change.
Looks like you caught it early, without any noticeable erosion of the joints.
That's good.
What's your D-MARD dose? 20 milligrams, but Dr.
Baxter just [INHALES SHARPLY.]
started it.
You're gonna have to postpone your first lead surgery for a while, see how you respond.
I-I'd have to explain why to Andrews and Lim.
As you should.
A cortisone shot is just a temporary fix.
Do you know what the chances are the D-MARD can maintain the dexterity you need to perform an operation in the long run? 45%.
I-It'll change the way they see me.
Yeah, you have a condition a medical condition.
They'll expect less from me.
They'll be looking for me to fail.
Th That's why I'm confiding in you instead of them.
You advocated for Shaun when everybody else thought he couldn't be a surgeon.
I'm sorry, you're comparing arthritis to autism? I'm comparing people's assumptions, people's prejudices.
I'm asking for a chance to prove myself.
In this surgery today, you're gonna have to create a plane as thin as paper between two delicate layers of tissue without disrupting the major blood flow to the brain.
If you miss by 1/10th 1/10th of a millimeter, the patient will suffer permanent brain damage or worse.
Right now, it's a matter of pain, not function.
You think I would put a patient's life at risk? That's insulting.
I'm sorry.
Without the pain, I can do this.
You believed in Shaun.
I need someone to believe in me, too.
Leo Adan? That's me.
I'm Alex Park.
I'm Rosalind's doctor.
She's dying.
She wants to see you.
Then why didn't she call me? Why'd she send you? She doesn't know I'm here.
Even when we were married, I never topped her to-do list.
She wasn't cheating on you.
She wasn't doing anything except saving lives.
She deserves to be cut a little slack.
She was saving the whole damn world.
She's a saint.
I made partner, she wasn't there, everybody understood.
My mother died, she wasn't there, everybody understood.
Well, I didn't.
Look, maybe I was a selfish jerk for wanting my wife to be around, but I did.
She didn't send you.
Good for her.
She's not a hypocrite.
At least that hasn't changed.
Assistant port is secured.
Load the forceps and electrocautery.
My chief's doing a difficult surgery.
I'm here to help in any way I can.
Instruments are ready.
Time of initial incision, 11:32.
- How is she? - She's really short of breath.
I gave her vasodilators and diuretics, but she's not settling.
She has bilateral pulmonary edema.
She needs 40 milligrams of furosemide.
I'll push two lorazepam, too.
I can't c-catch my breath You've got fluid in your chest.
This medication should help ease your breathing.
She should be improving, but she's not.
Maybe we should insert a drain.
Shaun, this isn't about the fluid.
She's scared.
Rosalind, I know this is frightening, but you are not alone.
I'm here, and I am not going anywhere.
As long as you need me.
I see the base of the tumor.
There's a lot of bleeding teasing off the pulmonary vein.
Put a bipolar electrocautery instrument on the right arm.
It's way more friable than it looks.
The tumor's invaded the vessel wall.
I need to load more hemostatic matrix.
If I keep going, I'll end up with a bleed I can't control.
I need to take the lung.
Prep her for an open thoracotomy.
I need a prostatectomy kit.
Prostate cancers tend to grow along the surrounding nerves.
The equipment's designed to dissect the tumor without injuring the nerves.
Substitute arteries for nerves, and you've got our situation.
Load the hot shears.
Unclamp the proximal and distal end.
You have good shunt flow.
Forceps and dissector.
Is there a problem, Dr.
Nice work, Dr.
Did you? We got it all.
And you'll still need that flight suit.
Thanks, Doc.
He might've helped out a little, too.
The tumor was more entangled in your arteries than it appeared, but Dr.
Melendez pulled off a remarkable win for us.
This is the reason you still have two complete lungs.
Sign it.
Both of you.
I'm gonna leave it on the moon.
NURSE PETRINGA: She's very close.
I'll pronounce her.
I'd like to do it.
Thank you.
I hope it's not too late.
It's fine.
Come in.
You were right.
That was a crazy surgery.
But not as crazy as I thought.
It wouldn't have even happened if it wasn't for you.
You were right, too.
I'm not objective when it comes to you.
I blew off your concerns about the risks 'cause I thought you'd lost your mojo.
We're both right.
And we found a way to work together.
And our patient's better off for it.
What about the next time? We won't make the same mistakes.
I'm not sure they were mistakes.
I think they might have just been our nature.
I don't think I can give you the unconditional support you deserve from a partner and the objectivity you need from a chief.
And I don't want to give up on my dream.
I love you.
But it's not enough.
Goodnight, Neil.
Thank you for your support.
My pain is 90% better than it was.
The shots helped.
Well, you did a remarkable job.
I'm fine.
I did extensive further research on intimacy treatment for autism.
And? And I found nothing.
You were right.
Exposure therapy is the most effective option.
You're very smart and thorough.
Thank you.
I'd like to try again.
It's time to take a break.
I know.
This is terrifying.
And very nice.

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