The Good Doctor (2017) s03e17 Episode Script

Fixation

Wes Keeler, 49, pricked in the upper right arm by a cactus four days ago.
Temp 102.
5.
Wound is seriously infected.
He was leading a camping trip on Mount Thayer.
We couldn't leave 'em up there alone.
BP's 86/51.
Tachycardic.
Rapid, shallow breathing.
Signs of sepsis.
You gonna have to cut his arm off? I'll be fine! We need to debride the wound stat! Shaun, I've been looking all over for you.
Hey, uh, h-how about getting some breakfast? Some pancakes? No.
I'm not hungry.
Okay.
Um how about coming over for dinner tonight? Is Debbie making lasagne? She could.
No, thank you.
Okay, Shaun.
Um, can we just stop and and talk for just a minute? Why are aren't you, uh, responding to my texts? Are you upset? - Are you sad because of Lea? - Yes.
Yes.
I am very sad.
But it will be okay.
Yeah, of course it'll be okay.
I'm still going to be with Lea.
Wait.
What? She said she loves me.
She also gave you a hundred reasons - why she can't be with you, Shaun.
- Yes.
Yes.
She gave me very specific reasons why we can't be together, but I've overcome other challenges - No, Shaun, it's not - to become a good doctor, a good friend.
It's not about overcoming challenges.
It's not about you.
It's about Lea.
I can't take two steps without falling down.
Is the issue balance or weakness? All of the above.
Fatigue, dizziness, light-headedness, headaches, occasional bouts of nausea.
And when d Five years ago, just after the birth of my daughter.
And there's no discernible fluctuation based on time of day or time of the month.
Temp 98.
2.
BP 111/78.
That'll drop to 80/50 when I'm upright.
I don't drink, smoke, or take drugs.
I haven't traveled outside of the country in the last 10 years.
And there's no family history of a similar condition.
You've been through this before.
17 times.
18 if you count the naturopath in Seattle.
Which I don't.
No one has been able to give me a diagnosis.
We need to do an EKG and stress test, get a CT of your chest, abdomen, and pelvis.
Let me save you some time.
Five years' worth of tests, labs, scans, reports my entire medical odyssey.
Fun.
Set up in the lounge and get me copies of each of those Claire! Dash.
Oh, my God! Why are you here? Uh, you changed your number.
Right.
Um, it's a long story.
Uh, Dash, you remember Dr.
Melendez, Dr.
Murphy? Yeah, of course.
Uh, you gave my wife six more good months.
We considered renaming our cat after you.
That would have been foolish.
Cats remember their names.
Sorry for your loss.
Wish we could've done more.
Let you two catch up.
Hi.
I think the infection spread quickly because of the underlying damage to your liver and kidney.
We'll need to keep you on a prolonged course of IV antibiotics.
Hey, you hear that, guys? Hep C and heroin aren't as much fun as they sound.
Although one was more fun than the other for a while.
Don't they have somewhere else to go? Not likely.
Most of them haven't seen their parents in years, so they're with me survivalist training program for at-risk youth.
We prefer "young adults with unrealized potential.
" I'm supposed to be teaching these yahoos responsibility and good decision-making.
Hell of an example.
Oof.
He's got a new murmur.
BP's dropping.
Wes, we need to take a look at your heart.
Wes, the infection's spread.
It's damaged your aortic valve.
You need emergency surgery.
Mm What about vasculitis? Or dysautonomia? Both are consistent with weakness and fatigue.
Her temporal artery biopsy was negative.
- That rules out vasculitis.
- Mm.
And I thought I saw something about dysautonomia in here.
There are 15 different causes of dysautonomia.
Seven have been ruled out.
The rest are inconsistent with Alice's symptoms or have no definitive diagnostic test.
How did you make Dr.
Lim fall in love with you after you had been friends for so long? I assume that's directed at you.
I don't think you make anyone fall in love with you, Shaun.
It unfolds naturally over time.
That's not true.
Everyone starts off not loving you.
Then you say and do things that make them love you.
Or not.
That's the point of romance.
But romance is harder if you're already friends with the person.
You can't hide the less attractive parts of yourself.
It can be an advantage.
You already know what pisses them off.
That's very true.
Shaun did Carly tell you she just wants to be friends? Or are you talking about someone else? Hey, sorry to interrupt.
I'm I'm looking for my dad.
Mm.
I just I'm here visiting, and I locked mys Yes.
Okay.
Dr.
Park is not here, and we're discussing something important.
Right.
Sorry.
Kellan, your dad's in surgery.
It could be a couple hours.
Thanks.
Shaun.
That was a little harsh.
We're talking about your love life.
Talking about my love life is important.
It helps clear my head so I can focus on the medicine.
Intracranial hypotension.
It is consistent with Alice's headaches and dizziness getting worse when she's upright.
And a leak in spinal fluid can be triggered by severe intracranial pressure during childbirth.
To confirm I'm right, we need to insert a lumbar drain into Alice's spine, infuse her with fluid, and see if her symptoms improve.
But if you're wrong, she'll have an excruciating headache, massive brain pressure, temporary vision loss She'll give her consent.
It's a reasonable diagnosis, and the patient's desperate for an answer.
Can you do the procedure alone? Only one doctor is needed to insert a lumbar drain, and I have a time-sensitive matter to take care of.
Sure.
You okay? You look okay.
I'm fine.
Your text said it was urgent, a My text said it was "time sensitive.
" I have to get back to work before my lunch break is over.
I was at work, too, Shaun.
I know we left things in a weird place, but now is not a good time.
The pinto beans are next to the tomatoes.
That is not in alphabetical order.
There's more.
The toilet paper is in the wrong direction.
The way you like it.
You got angry when we were roommates because I sometimes couldn't accept your way of doing things.
But I can learn to accept things I'm not comfortable with.
This is not bothering me at all.
I can deal with your messiness and neediness and selfishness Stop.
Your way of proving that you're flexible and attentive to my needs is to pull me away from work with no notice make me drive all the way across town, just so you can show me you un-alphabetized your beans? Doesn't that seem a little inconsistent? Oh.
That is a good point.
I should have waited until evening, when you are done with work.
We can discuss this later.
I have to get back to the hospital.
Resecting necrotic tissue around the annulus.
Dr.
Reznick, trim down the patch from the pericardium.
The infection caused a fistula, and we need to remove it.
Repair the annular defect with a pericardial patch.
He's gonna have permanent heart damage.
The guy survives IV drugs, Hep C, hard time and gets taken down by a cactus spike on his road to redemption.
That's ironic.
Predictable.
He ignored dangerous symptoms because he wanted to be a tough guy for those kids.
He's trying to keep them from repeating his mistakes.
It's admirable.
Narcissistic waste of time.
You can't undo a lifetime of abandonment with a couple weeks in the woods.
The kids are all still here, aren't they? Finish the closure of the fistula tract with pledgeted sutures.
Park.
I need you to come with me.
Now? Go.
We got this.
Security agreed to let us keep this between us.
No need to call the cops.
Everyone needs to chill.
We weren't cooking meth in the dumpster.
You have any idea how many people die from vaping pot? What were you thinking? We'll give you two some space.
You.
With me.
You have asthma, Kellan.
I know you're not this stupid.
Heart rate's tachy at 148.
Systolic's in the 200s.
I removed the drain a half-hour ago.
I was wrong.
My idea made things worse.
We need to do a lumbar puncture to relieve the built-up fluid.
But it didn't make her worse the way it should have made her worse.
She should have a headache or upward brain herniation.
Heart rate should be low.
Something is causing her heart to beat too hard, too fast.
Mm.
I missed something Shaun, you need to give her a 10-milligram bolus of labetalol now, or she is going to die.
I missed something.
Shaun! Mommy? Alice? There was significant tissue damage from the infection, but it should be manageable with medication and some modifications to your diet.
So no more Flamin' Hot Cheetos? That's not a thing any self-respecting adult should eat.
You'll need long-term follow-up with a cardiologist, beta-blockers, ACE inhibitors What'd you do? Mr.
Reed was found vaping THC on hospital grounds.
I'm emancipated, so I'm basically an adult.
You're only emancipated 'cause your parents do even dumber stuff than you do.
Thanks for letting me know.
There'll be consequences for his behavior.
Starting with an apology.
And not some smartass one, either.
Uh, Mr.
Keeler, your hand is swollen.
I need to take a look at your feet.
Less than a hundred milliliters.
What's wrong with his piss? Max.
What's going on? We're gonna need to run some additional tests.
We've done a lumbar puncture to remove the excess fluid and bring your spinal pressure back to normal.
When will she be able to go home? I'm not going home.
Honey, their test just about killed you.
In front of your daughter.
She wasn't supposed to be here.
That's because you told me you were visiting your sister.
Since when do we lie to each other, Alice? You have to stop doing this to yourself.
They're only gonna confirm the same diagnosis you've already been given.
You said you don't have a diagnosis.
They told her she has idiopathic dysautonomia six months ago.
It was confirmed by two other doctors.
You left it out of your medical records? "Idiopathic" is just a doctor's fancy way of saying that they don't know why I'm sick or how to fix it.
You haven't given the treatments a chance.
Because even on them, I can barely sit up most of the time.
Ruby deserves a mother who can teach her how to do a cartwheel and scoop her up when she's having a nightmare.
She deserves a mother who's around.
Ruby doesn't need to learn how to do a cartwheel.
She needs you to watch her, cheer her on.
And lay down next to her when she's scared.
And eat the cookies she bakes and pretend to be enjoying them.
You're a great mother.
And there's good in the life we have.
And you're missing it by constantly searching for something better.
Something that may not exist.
Are you feeling overheated? No.
Scared? No, I'm feeling sad that my husband thinks there's no hope.
You are sweating.
Sweat is a response to fear, not sadness.
Your temperature is normal.
You may have an adrenal tumor.
- Is that good? - Yes.
Tumors can be removed.
I'm not mad.
I'm a little mad.
But I want to understand what's going on.
Dad, not now.
I mean, it's not like you to be this reckless with your health, your future.
I can't Kel, are you having an asthma attack? Where's your inhaler? I don't It's It's not the asthma.
What is it? Tell me what you're feeling.
My heart's beating fast.
Do you feel dizzy? Like the walls are closing in? I think you're having a panic attack.
Take a deep breath.
1, 2, 3 Now out.
Keep breathing.
Good.
Does this happen a lot? I know vaping is stupid, but It helps this feeling go away.
Hey, give it back, asshat! Victor, Max! Cut it out.
Mr.
Keeler.
We have some test results we need to discuss.
In private.
Whatever you have to say to him, you can say to us.
Oh, wish you could.
Would love your input.
But, clearly, you're far too busy watching pimple-popping videos.
Go away.
The damage to your heart temporarily cut off blood flow to your kidneys.
They were already weak and couldn't handle the stress.
You've progressed to complete renal failure.
I'm sorry.
You'll need a transplant.
But dialysis can keep you going until a matching donor is found.
I'm guessing a guy with a bad heart and damaged liver, history of hepatitis isn't first up.
Your best bet is to find a living donor most likely, a family member.
I'm an addict who stole and lied like one and then went to prison.
My Christmas card list is pretty short.
We'll connect you with our transplant coordinator.
She'll help you reach out to family and answer any questions they may have.
Should've taken those twerps sailing.
Her husband's not wrong, Shaun.
Sometimes, people need to accept that things are as good as they're gonna get and make peace with it.
Wanting more can only lead to disappointment and heartbreak.
What good does it do to give up if you're already heartbroken? Hmm.
You were right.
No tumor.
Well, you were also right.
The bright color.
It means there is an increase in the uptake of radioactive material in the medullary space.
Which is enlarged and overproducing adrenaline, so the gland itself is acting like a tumor.
We have a new diagnosis.
The quiet is a nice change of pace.
I told the boys to get some air, try to avoid committing more criminal offenses on hospital grounds.
I know they can be annoying and loud and constantly in the way, but I can't make them leave.
Want me to give it a shot? I'd like to see that, actually.
Nah, they just scared.
They think if they leave, then I'll be the latest in a long line of people they didn't have a chance to say goodbye to.
Wes? Code blue! You do not have idiopathic dysautonomia.
You have a rare condition called bilateral adrenal medullary hyperplasia.
Unfortunately, Alice, there's only one cure for this condition, and that's to remove your adrenal glands.
You would need to be on steroid replacement therapy for the rest of your life.
And that comes with a whole new set of symptoms.
Fragile bones, high blood pressure, G.
I.
issues, mood disorders, increased chance of diabetes, serious infections.
I-I understand.
I want to do it.
Medullary hyperplasia is not terminal or progressive.
You could have a normal life expectancy in your current condition.
My "current condition" is pathetic.
I'm having the surgery.
Alice.
This could kill you.
I love you.
I won't risk your life.
If you insist on going through with this Ruby and I are leaving.
If you love her, you shouldn't leave her.
It's not her fault she's sick.
And she just wants to make things better.
- It isn't fair.
- Shaun.
There is nothing worse than losing the person you love.
I'm sorry.
This isn't Dr.
Murphy's call.
Nor is it mine.
We'll give you two some time.
He's right.
I-I can't lose you and Ruby.
I won't do it.
I won't I won't do the surgery.
Wes suffered major cardiac damage.
We can't solve one problem with this guy before the next one hits.
He's stable now, but his heart can't handle the fluid volume shifts of standard dialysis.
So the only thing keeping him alive will also kill him.
We could put him on low-flow dialysis.
Keep him in the ICU 'round the clock.
That'll buy him a little time.
Very little.
Call UNOS.
See if they'll move him up the list.
Where are we with family members? Two of Wes' cousins agreed to be tested.
- We're waiting on the results.
- Good.
Get on the phone with any other family you can find.
Tell them if their man doesn't get a kidney in the next couple days, they should make arrangements to say their goodbyes.
New kicks won't help you outrun me.
Um they're recipes.
From Dash.
Well, from Kayla.
Kayla by way of Dash.
It's complicated.
He asked me on a date.
What did you say? Nothing.
I stammered, and then I fled.
What did you want to say? Ohhh.
I don't know.
Shaun was right.
Coming home to an empty apartment really sucks.
I used men to make me feel better.
Most of them didn't mind.
But I don't trust myself not to hurt someone I care about.
Claire, it's not that complicated.
You lit up this morning when you saw him.
He seems to make you happy.
You deserve to be happy.
Mmm.
How you feeling? I'm not high, if that's what you're asking.
It's not.
You know, earlier in the car, I pushed too hard, made you feel cornered.
I'm sorry.
You didn't know.
I, uh I talked to your mom.
Is she totally freaking out? She's concerned.
And we talked about finding a therapist in Phoenix who specializes in treating anxiety.
So you're pawning me off on a total stranger? No.
No.
I I thought you'd be more comfortable talking to someone who's not She said you've been pretty withdrawn lately.
I know things between your mom and I are a little Screwed up? Unsettled.
Is that making you feel anxious? No.
It's not you.
It's nothing.
It's It's okay.
No, it's obviously not.
Some of this is on you.
You know, every time we talk, you don't tell me anything about your life.
That's because you don't want to know anything.
That's not true! You're busy saving patients a hundred hours a week.
You don't want to feel guilty about being a thousand miles away.
You just want to know that I'm okay.
So I say I'm okay.
Ewwww! That's annoying.
Can you do that some place else? I'm trying to find a better solution for my patient.
Your patient is being discharged.
I'm trying to get a kidney for a dying guy.
You're watching gross videos.
I'm waiting to hear back from UNOS.
Ewww! Do you prefer being called or texted? Neither.
Do you like surprises or do you find them irritating? I find this irritating.
It's research.
Lea said we can't be together because she is too needy and selfish to deal with my issues.
You are the most selfish person I know, so you are a good subject.
Lea's right.
She is needy and selfish.
Find someone who loves you the way you are.
People always say that, but shouldn't we be with someone who makes us a better version of ourselves? Maybe.
But trying not to be autistic won't make you better.
I'm sorry you still don't feel good, Mommy.
Well, I'll feel better when I'm home.
Eating those delicious cookies that you make for me.
You don't have to go home.
I invented a better surgery.
Instead of removing both your adrenal glands, we can just squeeze out the hyperplastic medullary part like popping a pimple.
You "invented" a surgery? Dr.
Murphy's come up with a surgical plan that could curb overproduction of your hormones while leaving you some adrenal function.
What are the chances it'll work? Oh, we don't know.
Since it's never been done before, it's difficult to predict the outcome, but it is a safe and viable treatment option.
Is Wes dying? We're doing everything we can to help him.
I snuck a look at his chart when no one was around.
You know that's a crime, right? Only a misdemeanor.
You should talk to Wes.
We all got tested.
I'm a match.
I'm gonna give Wes my kidney.
We've discussed your offer at length, Max.
It's incredibly admirable and generous.
But you're 16.
Living donors have to be 18 years old.
I'm emancipated.
I can give consent for myself.
But it's still up to the hospital to decide if this is a good idea.
We don't feel this is in your best interest.
Max.
The surgery's much harder on the donor than the recipient.
You could have postoperative bleeding or infection.
And it's incredibly painful.
I've been through more crap than any of you.
I can handle it.
There are also long-term consequences high blood pressure, renal failure.
If something happens to your other kidney, you don't have a spare.
I know how to subtract.
I'm cool with it.
And the recovery is long and hard.
You would need someone to help you get dressed and bathe and make sure you take all your medications.
I've been taking care of myself just fine for a long time.
Actually, Max you've been in juvie and on drugs.
You're not taking care of yourself.
Okay, I get it.
I'm a screw-up.
But Wes isn't.
He's bailed me out of jail.
He's picked me up in the middle of the night when I was too messed up to drive.
He's cleaned me up after fights.
He came with me to my sister's funeral.
If I manage to stay out of jail, it's because of Wes.
If I'm a halfway decent father someday if I'm not a lost cause it's because Wes never gave up on me.
He shouldn't die because I made dumb-ass decisions.
It's your surgery.
And we have the exact same amount of experience with this.
Free up the medulla along the inner cortical surface.
Careful not to penetrate the cortex.
Mm.
Nothing's coming out.
Try using your fingers to pinch the gland.
Use a circular motion to coax it out.
I've popped my share of pimples.
That's cool.
One down, one to go.
Wes is like a father to Max.
If he were his actual father, we wouldn't hesitate to let him do it.
I think we should.
Me, too.
The little punk got to me.
We've explained all the risks.
Max was unwavering.
I vote yes.
One admirable decision doesn't wipe away a lifetime of bad ones.
It's three against one.
This isn't a democracy.
I'll tell the patient.
One of the boys get into trouble again? No.
No, they've given you a reason to be proud.
They all got tested to see if they were a match.
Max is.
He wants to give you his kidney.
That little turd is full of surprises.
I can't approve the transplant, Wes.
I'm sorry.
Max is a good kid.
He's gonna make a good man one day, thanks to you.
But, for now, he still needs grown-ups to have his back.
The risks to his health It's okay.
It It's the right call.
It's my job to save those kids.
Not the other way around.
You're still on the UNOS list.
We'll keep reaching out to your family.
We're not giving up.
I need you to do one other thing for me.
Sorry to interrupt.
It's okay.
No one's probably listening anyway.
Your kidney's not a match.
They said I was.
Your blood and tissue type were good.
But the serum crossmatch showed that Wes produces antibodies in reaction to your cells.
His body would reject your kidney.
I'm sorry.
Figures.
I can't do one stupid thing right.
That's not true.
You did everything you could.
Wes is so proud of you.
Any dizziness or nausea? No.
No headaches, either.
You need to try getting out of bed to see if your symptoms return.
She ready for that? No cartwheels yet, but hopefully.
How's it feel? Room's not spinning.
Mommy! You're all better! Whoa! Careful, sweet pea.
Mama's still recovering.
I'm okay.
Ooh! Here's the Big Dipper.
If you extend a straight line through these two, this bright star is Polaris.
All of our phones have compass apps.
Hey, just shut up and listen.
This crap's important.
Polaris is your true north.
You keep your eye on that, you're gonna find your way out of whatever mess you've gotten into.
O kay.
- All right.
- Mm.
That's, uh Even worse than it looks.
It's so bad.
It's so bad! - Mm.
- Cooks, we are not.
I think we should go on a date.
A real date.
Shaun, I already said no.
Yes, because you think there are problems that can't be fixed.
But I am very good at solving problems.
I saved a woman today who nobody thought I could save.
I don't need saving, Shaun.
Okay.
I understand.
I can fix this.
Yes.
You have to give me a chance.
You need to let me try.
No.
I don't need to do anything.
You need to listen to me.
- No.
No - This is only proving my point.
I have I have a plan.
I can fix it! I-I will fix it! Shaun, you're autistic.
You can't fix that.
You are who you are.
And I am who I am.
And the two of us will never work.

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