The Good Doctor (2017) s04e04 Episode Script

Move from Bhujangasana into Adho Mukha Svanasana.
And hold that.
- Do you like this? - Mmm I'm not sure.
I like that you like it.
Time for work! Guess we'll finish Vinyasa flow Next time I come over.
You shouldn't come over anymore.
You should move in.
Things are different now.
You lived here before.
What's different? Everything is different.
Then, we were roomies, pals, buddies, and now we're a real thing.
A better thing, for sure, but also more complicated.
We're the same people in the same place doing the same things.
It's bigger than that, Shaun.
I hope it is.
I Living together means more commitment, more trust.
And I don't think we're quite there yet.
You don't trust me? No, I do.
It's just I need a bit more.
Copernicus1543.
It's my banking password.
Yes! I got you! - No! - Bow to your queen.
- No, bitch! No! - Yes! Argh! Where did you find the 10,000 hours that you put into that? - Phew! - I like filling my evenings - with numbing mindlessness.
- Mmm.
Oh.
Ugh! Morgan needs me to go in ASAP.
You figure she shouldn't page you? She can handle it on her own because she used to be a surgical resident? Be the bigger person.
It's an ingrown hair.
Mmm.
Definitely an ingrown hair.
Unfortunately, the ingrown hair caused an abscess that needs to be lanced.
By a surgeon.
Please give this man the VIP treatment.
I have another case to attend to, but don't worry.
I'll be checking in.
Such a nice lady.
So, how shall we proceed? I'm going with "drain the abscess and dress the wound".
Set it up.
Maybe we should do a biopsy? Well, it could be a cutaneous pili migrans or have a deep sinus tract or a creeping eruption caused by a parasitic disease.
Give him the VIP treatment.
Abdominal pain can be scary when you're pregnant.
But I wouldn't worry.
You have two rambunctious boys.
I know.
It's like a cage match in here.
Shaun, where's your first-year resident? I have two first-year residents, but I don't want to teach them.
They're very distracting.
You have a dizygotic, dichorionic, diamniotic pregnancy.
It just means your twins are fraternal and in separate amniotic sacs.
First-years aren't distractions.
They're godsends.
She has edema.
Not surprising for someone who's 26 weeks pregnant.
They'll do anything you want.
Scut work, follow-ups, coffee runs - I don't like coffee.
- laundry, apple runs.
I already did that.
- What was her BP? - Normal.
BP's no longer normal.
She's hypertensive.
What does that mean, Dr.
Murray? Is your vision blurred? A bit.
I'm tired.
Sounds like preeclampsia.
If we don't get your BP down ASAP, you could lose your pregnancy.
We need to start you on anti-hypertensive meds, but your edema makes it difficult to place an IV, so we need to run a central line.
Dr.
Jackson? Mind if I give a hand, Dr.
Murphy? Hmm.
Is there anyone you want us to call? Uh, my boyfriend decided his obligations ended at offering to pay for an abortion.
Soft man in a hard world.
Fetal heart rate's dropping.
But only one of them.
Did you have another birth? - No.
- Any pregnancy? Miscarriage, abortion, stillbirth? I had an abortion when I was 15.
It's not preeclampsia.
One fetus is Rh-positive, and the mother is Rh-negative, and her body is perceiving him as a threat and attacking him with antibodies.
Antibodies she could only have if she had an earlier pregnancy.
My body is trying to kill one of my babies? Yes.
Waiting on Billy's biopsy results? To confirm an ingrown hair? You grew up in a Hasidic family, right? How are they handling you being a doctor? I haven't spoken to them in four years, except one sister.
I chose not to live by their rules.
I I knew the consequences.
My dad was a real estate agent, obsessed with two completely unrelated things, teeth and taxes.
Thought I'd spend the rest of my life selling condos.
Now I'm a surfin' surgeon, but I still floss three times a day and pay my installments four times a year.
So, what's my dental floss? Fire and brimstone.
Mmm.
Actually, that is from the New Testament.
I don't even know what brimstone is.
I meant you fear disaster.
Your people's history is kind of filled with it.
Billy has cancer.
How are your first-years doing? Jordan talks too much, and Olivia talks too little.
And Olivia does not know where the jugular vein is.
You see her resume? Her grades and USMLE scores were nearly perfect.
So, if it's not a lack of knowledge, what do you think it is? I think Olivia has the potential to be an exemplary doctor if you push her, give her a little extra attention.
Isn't that unfair to Jordan? Was it unfair to the applicant who didn't get your position because Dr.
Glassman thought that you needed some extra attention? Olivia just doesn't like being in the spotlight.
That's all.
Olivia's resume didn't say anything about not liking the spotlight.
Exactly.
Don't trust resumes.
Locate jugular vein.
Insert needle.
Get a venous blush.
Remove syringe, leaving needle in, - then thread - Thread wire into needle.
Remove needle.
Scalpel to skin, while being aware of a persistent left-sided superior vena cava placement, present in 4% of those with congenital heart disease.
Remove wire.
Suture in line to skin.
And done.
I guess you were nervous before.
Didn't you have first-case jitters? No.
The sick twin has gone into severe distress.
You have amelanotic melanoma.
Skin cancer.
But there's good news.
We should be able to remove all of it.
We can do it today.
Sorry.
Car trouble.
Hi, Dr.
Park.
Just telling Billy about his cancer.
I got a great mechanic for you.
If you tell her Billy sent you, she'll give you a friends-and-family.
Okay.
Thanks for that.
You have an amazing attitude.
You know, my wife used to tease me about that.
She died three years ago.
I'm sorry.
You know, on our second date, I got a flat.
Now, I think she thought I was gonna curse, but all I could say was, "Good timing.
Costco's got a sale on tires.
" It's Addy's Auto, Los Gatos and Gateway.
We are through the uterine wall.
Dr.
Jackson, what's our next step? Advance through the trocar 15 millimeters beyond the tip until the opening of the distal basket can be confirmed by ultrasound.
Exactly.
What would you like me to advance, Dr.
Jackson? Oh.
Yes.
Right.
Obviously, you would be advancing the double basket rocket catheter, not this.
Sorry.
Not your fault.
If a junior resident is ill-prepared, that's on the senior resident.
How is it fair that I get blamed for a first-year's mistake, and how can I help that person without being unfair to the other one? And how fair was the preferential treatment that you gave me? And how fair was it to the other first-year resident, who didn't get placed because you helped me? - And how fair was - Whoa, whoa, whoa, whoa, whoa, whoa.
Put the list down.
Only four questions at a time.
That's my limit.
What kind of mistake? Even though I went over the procedure with Olivia, she still gave Dr.
Andrews the pusher rod when he needed the rocket catheter, and he said it was my fault.
It was your fault.
You got to help her a little more.
That is not fair to Jordan.
What does fairness have to do with it? It's not about equality.
It's about figuring out what each person needs and then teaching them how to get it.
How do I know what they need? Well, you've taught them medicine, right? So, uh, maybe it's something else.
Maybe it's an emotional issue.
Well, then I definitely can't give them what they need.
You can ask them.
About their emotions? Yeah, ask them how they feel.
I don't care how they feel.
That's the beauty of it.
You don't have to care.
You just have to ask them how they really feel.
Then they start talking.
And some people love to talk.
- Oh.
- Mmm.
Have you been working out? I could only find mediums.
You know how many sets of large scrubs I had to hide? Thirty-one.
Injecting dye.
BP's dropping.
Diffuse skin flushing.
He's in anaphylactic shock.
- He's allergic to the dye.
- Ten cc epinephrine.
BP barely measurable.
We should intubate.
Initiate CPR.
You should cannulate his femoral vein to give pressers and volume.
Let's intubate and cannulate.
His jugular's distended.
Maybe he has cardiac tamponade from a pericardial effusion.
He might need open-heart surgery.
Worst-case scenario worked out for you the first time.
Really think lightning's gonna strike twice? Maybe not, but I'm still not gonna stand on a hill in a thunderstorm.
Let's call Lim.
Prep the patient for a pericardiotomy.
Two for two.
Okay, you can't do yoga at work.
I do it at home.
What's the difference? Work behavior is not the same as home behavior.
Ooh.
So you're saying context matters.
Of course.
Same way that two roommates living together is different from a couple living together.
Same people, same place, different context.
Once our feelings change, everything changes.
I still feel the same way when I'm with you.
Happy.
Kenzie's BP and edema have improved.
The fetus's echo shows improved heart function.
Catheter's working.
How do you feel? Okay.
How do you really feel? Um Really okay? You want to know why I'm so nervous all the time? Uh I don't know.
I've always been very terrified of firsts.
First day of school, camp, church, all the new faces watching me, just waiting for me to screw up.
First day of fifth grade, when Mrs.
Deloitte asked me what 6 times 9 was, I told the whole class it was 45.
Yeah, I can still hear them laughing at me.
And two nights ago, I dreamt I was standing in front of Mrs.
Deloitte's class again.
Couldn't wait to wake up.
But when I did, I realized that if I got the answer wrong today, no one will laugh, but someone may die.
The kids laughed at me, too.
Even though I knew 6 times 9 was 54.
One of the amniotic sacs ruptured.
The strong twin's.
It's metastasized to his liver.
So, what do we do? Laparoscopic radiofrequency ablation.
Short recovery time, but a significant chance his cancer returns.
Care to rebut? I think we should consider a hepatic lobectomy and lymph node dissection.
Remove the affected area of the liver, all the surrounding tissue, and every swollen node we find.
And that's the aggressive approach.
Longer recovery time, high risk of complications, and, uh, admittedly, the best shot at beating the cancer.
By "complications", you mean a barely functioning liver, a persistent threat of fatal bleeds, and chronic pain.
As surgeons, you can gut him, but as his primary doctor, I have to find the balance between longevity and quality of life.
Last week, you were trying to perform surgery from the gallery, and now you hate surgeons.
Pick a side.
A piecemeal approach is not going to work with Billy.
Every time we try to solve a problem, we discover another one.
You may have left your religion in Brooklyn, but you keep looking for meaning in random events.
The dice have no memory.
I'm not looking for meaning.
I'm looking for patterns.
Maybe he's got some underlying condition.
I agree with Asher.
The dice have no memory, but they can be loaded.
So safe and seriously compromised or aggressive and possibly dead? Your case, Dr.
Browne.
Your call.
How you feeling? You sacrificed a lot.
Your hands, your career.
And you're taking it out on me and Claire and the whole surgical profession.
I get it.
It hurts.
You're pathetic.
You're worried about me because I'll never be a surgeon? Boo-hoo.
You're worried about me because I took pleasure in screwing with you and Claire? That's who I am.
The question is, who are you? You don't show up late with lame-ass excuses, and when you get dissed, you diss back, so How are you feeling? Forget I asked.
He's lost most of his amniotic fluid.
Won't last very long in utero.
In helping the weak, we hurt the strong.
C-section? If we do a C-section to save the strong baby, there's a 90% chance the weak baby will die.
But if we do an amnioinfusion to save the weak baby, there's an 85% chance that strong baby will die.
It's the better option.
5% to decide which baby lives? Kenzie's body has already made that choice.
If there's a strong baby and a weak baby, it's pretty clear which one we save.
Survival of the fittest.
Sorry.
It's just That's not really what we're about, is it, as a civilization? Aren't the strong morally obligated to help the weak? And if they don't, isn't everybody ultimately worse off? Neither baby has to die.
Delayed interval delivery.
We induce labor, deliver the strong twin, then stop the labor to keep the weak twin in utero until his lungs mature.
The chances of stopping labor are very slim.
That's true.
There's about a 70% chance that both babies would die.
Which makes it the worst possible choice.
- We need to ask Kenzie.
- No, we don't.
Once she hears there's the slightest chance of saving both babies, she won't listen to any alternatives.
Statistically, it's a terrible option.
But it is an option.
No.
No, you can't seriously be asking me this.
I know that this is something no mother should ever have to decide.
There are no good options here, but there is one that'll most likely make you the mother of a healthy baby boy.
Okay.
Prep for an amnioinfusion Have you named them? Dr.
Allen.
Braydon and Landon.
No.
No, I can't do this.
You have to save both of them.
We're at the tumor.
Unipolar ablation probe? Pretty cool to think that we diagnosed Billy with metastatic melanoma on Tuesday and send him home on a Thursday.
Well, let's wait till Friday to congratulate ourselves.
Current at 480 hertz, please.
Wait.
We got a leak.
Bile duct.
Suction, suture, linear stapler, stat.
I believe she made the right choice.
She made a choice any mother would make because the alternative is unthinkable.
Isn't that exactly what made it the right choice? She has to live with it.
The safe choice is not always the best choice.
If it were, I'd be on an army base in Germany, married to 1st Lieutenant Dwayne Buckman.
Dr.
Andrews, you wanted to see me? Yes, Dr.
Jackson.
Please come in.
"Dr.
Jackson".
I cannot say those two words without grinning! I know.
So? Uh, just checking in with you, Livy.
Like you do with all your first-years? You wanted hands off.
You're getting hands off.
But I can still say hi to my niece.
It looks like you're settling in pretty well.
No, the way you spoke up yesterday I mean, that's a tough case, tough crowd, but you held your own.
I'm getting there.
Dr.
Murphy's been very supportive.
Murphy? Yeah, I'm glad to hear it.
I'm sure he sees your potential.
- But if you need anything, you - Mmm.
ask anyone but me.
Very hands off.
Hmm.
Shaun, this is not an argument I ever thought I'd have to have with a boyfriend, whether moving in together matters.
It so obviously does.
It so obviously changes everything.
But one of the reasons I'm in this relationship Is because of that.
You are different.
And when I think about us, say, a year from now, I can't imagine us not living together.
So, if it's inevitable Shaun, I am moving in with you.
Does that mean you think we have enough commitment and trust? Honestly I'm not sure.
So, you want to do it just because it's inevitable? Mmm.
That makes it sound terrible.
But that is kind of how I feel, so, yeah.
You're moving back in! My girlfriend is moving in with me.
We need additional venous access to start the oxytocin.
I'll insert a 16-gauge IV.
How do you feel? Good.
Insert a 16-gauge IV.
Okay.
All right.
There's gonna be a pinch.
Very good.
Once we start that drip, at least one baby will be born.
I understand.
Okay.
Where are you going? Kenzie's only two centimeters dilated, and even though I'm not a surgeon, I have other important things to do.
You were wrong.
First-years aren't godsends.
They're a lot of work.
But I fixed Olivia.
Wonderful.
Now fix Jordan.
She's the one you have a problem with.
No.
I I don't.
Well, technically, she has a problem with you and anyone in authority.
You need to rein her in.
Okay, how do I do that? How'd you fix Olivia? No new paint, no new parts.
No way you took this to a shop.
So, there is something up with you.
Something personal.
Something you don't care about.
That goes without saying.
Except, it's messing with my games.
I just wanna humiliate you without feeling like I'm punching a kitten.
I was finalizing my divorce.
I thought you were already Not until yesterday.
And we didn't wanna deal with a formal custody arrangement for Kellan, but now that he's 18, it's official.
I know it's been over for years, but when it's really over, it hurts.
And I'm pissed at myself for being hurt, and, uh, now I'm pissed at myself for admitting that to the coldest person I know.
My place has two masters with en suites, and it's rent-controlled, so it's still probably cheaper than your motel.
But staying with me will cost you.
Kitty gotta punch back.
Thanks.
But I'm good.
She's at 10 centimeters.
Prepare packed red blood cells for possible transfusion.
Prepare forceps, clamps, and scissors.
How do you feel? Really feel? I feel fine.
Why do you have a problem with authority? Seriously? I have a problem with you not acting like an authority.
You're not doing the one thing any junior needs from their supervisor.
If I'm screwing up Not now.
Not gonna screw up now.
I need to know you're at least watching.
I need to know you got my ass covered.
The leak in your bile duct has caused an infection that could lead to peritonitis.
We've got you on multiple aggressive antibiotics, but this infection acts very quickly, sometimes in a matter of hours.
Well, I feel fine.
Dopey, but fine.
Billy, do you understand what I just told you? I might die tonight.
I get it.
What How do you do it? I've had worse days.
The day after Linda died I went to buy a gun.
Never used one before, but I figured, "How hard could it be "to put it in my mouth and pull the trigger?" On my way to the store, I saw a car parked on the side of the road with a flat.
Couple of kids who clearly didn't know what the heck they were doing.
And for some reason, I pulled over and changed their tire.
As I was leaving, I told them, "Good timing.
"Costco's got a sale on tires.
" That's when I heard Linda's laugh.
"Hey, dummy.
"If you kill yourself, "who's gonna change the next tire?" That's what saved my life.
Just wanting to help people.
Makes life worthwhile.
Brady.
His lungs are also underdeveloped.
He needs to be placed on a ventilator.
Let's get him to the NICU.
Starting magnesium sulfate.
That's to stop your labor.
I also need to ligate the umbilical cord and return it to your uterus.
Okay, I have to focus on the patient and I have to focus on Jordan and I also have to focus on you.
I don't know how to do that.
Clamp.
Don't worry about me.
I appreciate you noticing I needed help, but I'll be fine.
I didn't.
Dr.
Andrews? Your uncle.
Absorbable sutures.
He told you? Not that part.
I googled that.
I couldn't trust your resume.
How do you feel? I feel like my uncle doesn't think I can hack it.
I feel sick.
She's having another contraction.
Adding terbutaline and calcium channel blockers.
Am I gonna lose Landy? Am I gonna lose both of them? I don't know.
She's still in labor? BP's 95 over 60.
Kenzie, we need to do a C-section.
No, no.
If he comes out, he'll die.
If he doesn't, you both will.
- No.
- 69 over 40.
We're doing a C-section.
- No! - Let's prep and drape her.
No.
I can't.
I can't lose Landy.
No! We need to restrain her.
Landy's going to be just fine.
- Landy is not - Shh! Kenzie, just listen to my voice, okay? Just focus.
What's your favorite board game? No! No! Okay, restraints, please.
Look at me.
Don't look at them.
Board game.
- Uh - Mmm-hmm? - Scrabble.
- A classic.
Nice! Eight years from now, Landy hits a triple word score with the word "breathe".
Try it.
Breathe.
Good.
What's Brady doing? Uh He's He's mad that his brother just schooled him.
Of course he is.
100 over 65.
Contractions are stopping.
Words with "X" and "Z".
Only way you're gonna beat them.
I better brush up.
Delayed interval twin delivery? - That's awesome.
- I can't teach.
Did you ask the first-years how they feel? Yes.
Unhappy.
Okay, that's great.
Not that they're unhappy, but that you asked them, they confided in you, and you learned something.
I learned that Olivia needed help, so I helped her, and now she feels sick because I helped her.
Morgan says Jordan needs help, but Jordan says she doesn't need help, but Jordan's mad because I didn't help her.
Okay, that sounds tricky.
That was my point.
You know what? You'll figure it out.
And even if you don't this time, that's okay.
You'll learn something.
And you know what? You're a wonderful teacher.
I've been learning from you since the first day we met.
How's he doing? Well, either he wakes or he lapses into a coma and slowly fades away.
Beautiful day.
You call Addy about your car? Not yet.
Been a little busy.
Helpers aren't so good at asking for help.
Kinda glad I did, though.
Congratulations.
You helped save a life today.
Despite the bickering.
Opposing points of view are great, as long as you actually listen to the other point of view.
You're carrying baggage that is affecting your decisions.
And you saw that because you're good at reading people.
Other people.
Figure out what you're carrying.
It's a list of all the things you did right on this case.
You can hack it.
It's a list of all the things you did wrong on this case.
I'm covering your ass.
But don't be late if you don't want no bloody nose.
Would you do me a favor, Harry? What? Drop dead.
Great to see you've started your own clothing line, the official gear of those who've given up.
By "en suite", I meant there's a trash can in your closet.
Hey.
Want a ride? Murphy told you.
You never knew your Great-aunt Winn.
She moved in with us when I was eight.
Your grandparents weren't getting along, lot of fighting.
But whenever it got really bad, Auntie Winn would take your mom and me into the kitchen, make cupcakes, something out of papier-mache, or teach us a card game.
I've always wanted to be that kind of person for you.
You have been.
But now I need to know that you think I can do this.
Accepting your help Makes me feel like garbage.
- Livy, I'm sorry.
I - I know.
I I love you, too.
But I have to make this work.
Feels like home.
Again.
It feels like home again to me, too.
Maybe you're right.
Maybe things are the same.
No.
You were right.
It's not the same.
It's better.
Have you ever done this before? Its actually only my first day.
Am I your first? I told you you have to trust them.
Code blue! You told me to back off.
I didn't tell you to abdicate responsibility.
You are not very good at your jobs and I'm not very good at teaching you.
Did we break him? GET INTO AN ALL NEW GOOD DOCTOR.
ONLY ON CTV.