The Good Doctor (2017) s05e11 Episode Script

Previously on "The Good Doctor" Nira is half-blind because of you.
- You think I control Salen? - How about taking a stand? You could've worked with me to make things right.
Instead, you had to burn the building down.
She lit the match.
If you're gonna go through with this deal, you're gonna have to destroy me.
Good luck.
'Cause now this is all your problem.
Your "Unsave-the-date" card.
You're uninviting us to your wedding? We decided there will be no wedding for the foreseeable future.
We've canceled everything.
The way you're smiling, I feel like I should be congratulating you.
We're happy.
We just want to enjoy being happy.
We've had enough stress in our lives.
We're living in the moment.
- Mm-hmm.
- Good morning, everyone.
Thanks for coming.
As the new President, I'd like to acknowledge we've been through a challenging time, but St.
Bon's has never been about a logo or a fancy coffee selection.
We've always been about the people in this room and how we can help the people who come through these doors.
So we're gonna get back to what we've always done the best, and that's putting patients first.
You know what a world-class surgical center needs? It needs a world-class Chief of Surgery.
And that's why I am reinstating Dr.
Audrey Lim.
I'll also be hiring three new oncology nurses, so if you know some good people, let me know, okay? You okay with all this? No more board meetings.
Are you kidding? Plus, I get a lot more time with the clinic.
Doctors Reznick, Glassman, can I have a word with you two? We lost a clinic contract.
Our biggest.
Thanks to your confession of borderline malpractice to the person who runs their health plan.
Nira had the right to know the truth.
You're lucky it was an experimental procedure.
She's not pursuing a lawsuit.
But I'm closing the clinic.
I'm sorry.
I just can't justify the expense of keeping it open.
People need a way to get healthcare they otherwise can't afford.
How's this for justification - We can, and so we should.
- Exactly.
I've arranged for Bay Area Medical to take over their care.
Can I talk to you for one second? If I can just take a look at the budget, I can figure out a way to keep this clinic open.
I'm afraid you're gonna be busy in the O.
R.
Aaron, you're a gifted surgeon.
This hospital needs those skills.
Wow.
Okay.
Uh, let's talk trade.
I'll give you 20 hours a week, and we figure out a way to keep this clinic open.
So you can keep freezing plantar warts? See? Someone must need a really good neurosurgeon.
Family of three in a head-on collision.
Another ambulance is behind us with the occupant of the other vehicle.
Park, you're with me.
Bryan Liu.
40 years old.
Hypotensive in the field.
GCS ten.
Abdominal bruising, some distention, internal bleeding.
How's that leg look? We might be able to save his arm.
I need a vascular clamp.
Elaine hit her head on the dash.
GCS 15.
Vomited twice.
Elaine, I'm Dr.
Glassman.
- How bad was your headache? - Really bad.
Is my daughter okay? She was wearing her seatbelt.
She has pain and bruising in her chest.
- I'm right here, honey.
- Spleen's ruptured.
He's got about two liters of blood in his abdomen.
What's going on with my dad? Please don't talk.
Those doctors are taking care of him.
She has decreased left-sided breath sounds.
We need to insert a chest tube.
W-Why? What's wrong? A broken rib punctured her lung.
Left pupil's dilated.
Subdural? Elaine, you may have some bleeding around your brain.
We're gonna have to take you to the O.
R.
- Mommy? - I-I'm okay, sweetie.
We're all gonna be just fine.
You just need to Oh! His BP's tanking.
We have to get him to the O.
R.
now.
Mommy.
Daddy.
Splenic hilum is clamped.
His pressure's holding.
Below-knee amputation is complete.
The stump is covered and healthy.
Start working on his arm.
I'm not getting any circulation to his hand.
We could use Andrews' vascular reconstruction skills.
Try reducing the fracture to restore blood flow.
It's not helping.
I've got too much bleeding to help.
Try fasciotomies to relieve pressure.
There's too much upstream damage.
Page Andrews.
She has an SSS tear.
We'll have to open up her skull to find a fix, which I do not want to do.
I can stop the leak with a dural flap, wait till the swelling goes down, find a better fix.
Pressure's still dropping.
I got a tight seal.
No leaks.
Maybe we're looking in the wrong place.
I hear an early-diastolic murmur.
It's her heart.
Get me an echo.
Contact social work.
Make sure the daughter's not alone today.
She may be losing both her parents.
How bad are they? We won't know anything for sure until your parents get out of surgery.
The chest tube was successful.
That doctor said my mom was bleeding in her brain.
Did he stop it? They're trying.
She has one of the best neurosurgeons in the state.
Did they fix my dad's leg? I don't know yet.
And I understand how scary and confusing it must be not to have all the answers.
I just want to know what's happening.
Your dad's leg is likely unsalvageable.
He also had a severe splenic injury that caused catastrophic internal bleeding and hypovolemic shock.
Removing his spleen may stop the bleeding, but if not, they may need to remove his kidney, as well.
He may also lose his lower arm.
Dr.
Murphy, maybe Isla and I should chat alone for a few minutes.
It's okay.
You can stay.
You can go.
Thank you for talking to me.
Are you sure? Okay.
I'll check in later.
You can always have a nurse page me.
Could my parents die? It is too soon to say if either of them will survive their injuries.
I'll run outs her's patients, and the night nurse said Mr.
Jones is ready for discharge.
Um, my bowel obstruction in 4C, did he pass gas? Why do you think the nurses want him discharged? I'm hungry.
The nurse gave me a sandwich, but it has pickles.
They're gross.
They are.
I'd like something else, please.
I gotta discharge your windbag in 4C.
Nurse.
Will you find this patient something to eat without pickles? Sure.
She isn't just hungry.
She's scared.
She wants to spend time with you so she doesn't feel all alone.
Doctors need to maintain professional boundaries.
Convenient, since you don't want to get close to patients.
I think it's the most rewarding part of our job.
Oh, no.
Minimally invasive microvascular surgery is the most rewarding part.
I already treated her pneumothorax.
She's fine.
Subclavian artery's also damaged.
Yeah, brachial plexus nerves, too.
Thought you'd be a little more excited about being Chief again.
Hard to get too jubilant about being given a job I never should have lost in the first place.
One you were happy to step into.
BP's stabilizing.
This arm's a mess.
There's no distal blood supply, nerves shot, hand showing signs of ischemia.
I think I can save it.
I need to open up his chest, get access to proximal vessel for graft bypass.
That's a big, lengthy surgery with a catastrophic risk of bleeding.
Yeah, which may save his arm.
He's already lost too much blood from his other injuries.
We have to amputate.
Sorry to interrupt.
Dr.
Lim, there's major damage to Elaine's heart valve.
We need a trauma surgeon.
Go.
Dr.
Park can close up the abdomen.
Put a wound vac on the arm stump and run antibiotics post-op.
What are you doing? Practicing mindfulness.
I don't know what that means.
It helps you let go, not be self-obsessed, stressed out, utterly career-driven.
I still don't understand.
You're being mindful right now.
By letting go of your wedding plan.
- Being "in the moment" with Lea.
- Oh.
N-No, Lea and I are still getting married.
We're only "enjoying the moment" for now.
Good for you.
I suck at "the moment.
" I like making a plan, having a plan Following a plan.
Do you want my apple? You're acting very strangely.
Isla's hemoglobin dropped to nine, and there's blood in her chest tube.
Oh.
That's not good.
We'll take a few pictures to find out where the problem is.
Won't hurt at all.
Then you can stop the bleeding? Probably.
But it will likely require something that does hurt.
You need to remove that before the M.
R.
Angiogram.
No.
I can't.
It's a gum wrapper.
My dad gave it to me.
I wanted my birthstone, sapphire.
But we couldn't afford it.
So my dad made me this.
He called it a placeholder.
That's really sweet.
An MRI is a powerful magnet.
It will destroy your gum-wrapper ring, and it could burn your finger.
Promise you won't lose it? I promise.
Okay.
She damaged her aortic valve.
We'll need to open her up.
CP bypass is generally not a good chaser to a brain bleed.
She needs a functional valve.
You'll need to figure out a way to give her one without turning her into a vegetable.
I brought you here for your expertise.
Or would you rather I try to figure it out for you? Throwing up your hands and making someone else solve the problem is not leadership.
I'm gonna guess we're not talking about a heart valve.
When Ethicure took over, you just walked out, headed for Paradise.
I know you were going through a rough patch, but we were going through it here, too.
And you didn't bother to step up until it became a problem for Shaun.
You want me to apologize for my commitment to Shaun? That's not gonna happen.
I would never ask you to do that.
I just didn't realize how little the rest of us matter to you.
I can insert an aortic pump to support her heart.
That should buy me some time to fix her valve.
The chest trauma damaged a branch of her pulmonary artery.
The bleeding has stopped, but her artery could re-bleed at any time.
How do we get to it? It's surrounded by vital organs.
Thoracotomy, dissect from proximal to distal hilum, isolate the vessel, and reconstruct the vessel.
That's a big surgery for a small injury.
It's almost as risky as a re-rupture.
We need a safer plan.
I don't have one.
I need time to figure it out.
I'll need to monitor her around the clock in case she bleeds again.
Looks like Isla's getting some Q with Dr.
Murphy after all.
Are we done? I'm bored.
- Who's your friend? - She's not my friend.
She's my patient.
Isla Liu, 10-year-old female with a pseudo-aneurysm of a segmental branch of the left pulmonary artery.
I need to monitor her closely to make sure she does not bleed out.
This is my fiancee, Lea.
She's Head of the I.
T.
Department.
I need you to talk to her while I figure out how to fix her.
She talks a lot.
I do.
Where's your ring? He said you were his fiancee.
I proposed to him, and it was a spur of the moment kinda thing, so no ring.
- Very modern.
- Mm.
I asked out my last boyfriend, but it didn't work out.
When's your wedding? - We don't have a date.
- Did you pick a cake? My aunt had red velvet.
It was really good.
And her gown was super long.
They call it a train.
Do you have one of those? Trains can lead to tripping and orthopedic injuries.
I don't want a dress with a train.
You have no cake, no ring, no dress, and no date? We have a cake.
Then how are you his fiancee? Isn't it just, like, boyfriend and girlfriend? What's I.
T.
? Well, I.
T.
stands for "information technology," so I work with a lot of computers.
Increase the flow to P-eight and get a CT of her heart.
We need exact valve measurements.
Got some good news.
I restored blood flow to Bryan's arm.
You were supposed to amputate.
I didn't open his chest.
I rebuilt his vessels from under the clavicle.
Still got a large tissue defect, but I can cover that with a tissue flap.
I know a great neurosurgeon for the nerve repairs.
More surgery? He could bleed again.
I can handle that.
And what about the potential for post-transfusion clotting issues? Removing his arm is the only way to guarantee we save his life.
Losing two limbs would be devastating.
It's such a high cost to avoid a relatively small risk.
But it's not small to that little girl, whom you could orphan to serve your own ego.
Pretty harsh assessment, especially considering I just rescued you and our colleagues from your suicide mission.
You want a medal for finding your moral compass at the last possible moment? I was there when it counted.
You did her bidding, even after the baby died, and then leveraged the situation so you came out in charge.
I am in charge.
I'm saving this man's arm.
Hmm.
Are you stealing from children now? This stuff's been in here since my first year of residency.
Aren't you supposed to be in peer review? I'm tied up on this trauma case.
I thought you might want to sit in on it for me.
Dr.
Farber's leading it.
Chair of the Executive Ops Committee.
If you want to run a hospital one day Gotta go.
But thanks for thinking of me.
How can I resect a pseudo-aneurysm without cutting off blood flow to the upper lobe? What about arterial bypass? Isla's 10 years old.
The bypassed artery wouldn't grow with her lungs.
Do you think Lea and I are just boyfriend and girlfriend? No? Me neither.
But if we're not planning a wedding, then what are we doing? Are we moving backwards? Shaun, a wedding is just a symbol.
A very nice, very expensive one, but real stability comes from committing to each other every day.
What should I do? Uh, you and Lea will need to figure that out.
The older I get, the less everyone seems to know.
That's probably true.
Oh, have you considered an endovascular embolization for Isla's pseudo-aneurysm? Your medical advice is much better than your personal advice.
Self-retaining retractor.
Stay out of my nerve field, please.
I need better vessel exposure.
This muscle needs a nerve.
I feel bad about closing the clinic, but we can't help anyone if we can't keep the lights on.
It's not about helping anyone.
It's about making sure you can put your feet up on the biggest desk in the building.
You look down on me 'cause I want the big job, but it was your apathy towards it that made us vulnerable to Ethicure in the first place.
Nerves are attached.
Reconstructed vessel's blown.
- You want me to - No, I got it.
The embolization will be short.
It should prevent further bleeding in your chest.
Dr.
Park thinks you're wrong.
Lea is still my fiancee and a wedding is just a symbol.
Symbols are a super big deal.
They remind us what's important.
That's what my mom said when I wanted to return my confirmation cross and use the money to get my ears pierced.
Lie down.
I need to inject the anesthetic.
I hate needles.
I still make my mom hold my hand when I get shots.
You can squeeze my hand as hard as you want.
I practiced when Lea was pregnant.
You two have a baby? No.
Why not? There was a clot in the umbilical cord.
The baby died.
I'm injecting the anesthetic.
You can let go of my hand now.
That hardly hurt at all.
You're very good at your job.
Isla, the doctors are still taking care of your mom, but your dad's out of surgery.
He lost his leg, but he's gonna be okay.
You can see him as soon as you're done.
I don't want to see him.
Fluid's backed up in Elaine's brain.
75 mannitol.
Hopefully, that'll take the pressure off.
Elaine needs a shunt.
Can her heart take it? Not with just a pump keeping her alive, but she's got another problem.
She's got a big tear in her trachea and she could lose her airway any minute.
Know of any experts in tracheal reconstruction? Time to call the President.
This is Donald Adler.
He's had chest pain for the past few weeks.
I'm fine.
My son's taking me to the doctor.
The one who's postponed three times already? I tried to contact his GP.
No luck.
We need to rule out coronary artery disease.
Is he your patient? She's my chess partner at the home.
I beat her three times in a row.
Impressive.
She always kicks my ass.
He's much better than you are.
How long is this gonna take? We're having arts and crafts tonight.
She's teaching us how to decoupage.
Let's, uh, get you a cardiac CT.
Help Mr.
Adler into a gown.
You look a lot like my girlfriend, but she doesn't decoupage.
She mocks people who decoupage.
Well, she sounds like a real piece of work.
Hey.
I got this for Isla.
- How is she? - Hello.
I'm waiting on labs to see if the embolization repaired the artery in her chest.
I meant emotionally.
She's refusing to see her father.
We don't know why.
Well, shouldn't you find out? I am waiting on labs.
Jordan is talking to her.
I think we should pick a date for when we're going to start planning our wedding again.
June 8th? What happened to enjoying the moment? I'm not enjoying it.
Okay.
We had a plan.
Now, we don't have a plan, and you're okay with that, but I'm not.
We will figure it out, Shaunie.
How? I don't know yet.
No one has good advice anymore.
Isla's not talking to me.
We should page the social worker.
She's not going to open up to the social worker, Shaun.
Isla trusts you.
I can use a transcervical approach to reconstruct the airway.
If you use a retractor in her neck, I'll lose drainage from her brain.
I need to start her on heparin so I can get working on her heart.
You can't use heparin until I've placed the shunt.
Not while I'm working on her neck.
One wrong move, she'll need a lifelong trach.
If she bleeds again from her sagittal sinus, she'll be brain dead.
If she has catastrophic heart failure, she'll be dead-dead.
Okay.
Airway's priority one.
Once it's secure, you can fix the valve.
You're overruling my judgment again? Overruling? We Elaine's pump failed.
She's in total heart failure.
I'm prepping an O.
R.
Mm.
That is a very accurate drawing of a horse.
It's my dog, Abigail.
Oh.
She must look like a horse.
Is my dad in a lot of pain? No.
He is on very strong narcotics.
Why don't you want to see him? His residual limb is heavily bandaged, so you won't be able to see any Blood or tissue or bones.
I'm not afraid of that.
Okay.
I was kicking the back of the seat.
The driver's seat, which my dad hates.
He missed my choir concert, which made me mad, so I kicked his seat.
And he told me to stop, but I kept kicking and kicking, and then he turned around, told me to cut it out, and then I heard Mom scream, and there were sirens, and then we were here.
He's going to hate me because I'm selfish and stupid and it was all my fault.
It was My fault my brother Steve died.
But it was Steve's fault, too.
It was his idea to hide on the roof of the train.
He fell.
He broke his neck.
Your dad took his eyes off the road, and a car ran a red light and the airbags didn't deploy.
Those things are not your fault.
And even if it were Your parents would probably still love you, because of your shared experience in combination with the parental bonding hormone oxytocin.
Although, in my case, it wasn't enough.
My parents didn't like me.
I'm sorry about your brother.
And your parents.
And your baby.
You've had a lot of bad things happen to you.
I've had a lot of good things happen, too.
Okay.
I want to go see my dad.
Aah.
Isla? I need a rapid response team, stat.
She's bleeding in her chest! - BP is 65 over palp.
- Give another unit of blood.
We have to open her up, Shaun.
We could injure her bronchi and cause chronic respiratory failure or rupture her pulmonary artery.
She could bleed out.
If we don't operate now, she's gonna die.
Prep an O.
R.
for stat thoracotomy, and page Dr.
Lim.
The old fart needs angioplasty and a stent.
You may have just saved this guy's life.
I'm gonna be late for arts and crafts.
Does this have anything to do with Nira? Hey, you made one bad call.
You're not a bad person.
Uh, that is not what you said last week.
I may have overreacted.
I've woken up every morning my whole life wanting to conquer the world, and then I hurt someone, and I almost lost I almost lost everything.
So now, I am going to cultivate virtuous intentions and generally not be so awful.
If you want to meditate and volunteer and save random old guys, go ahead.
But don't become a totally different person.
I would miss you.
The world needs people who wake up every morning wanting to conquer it.
Those kinds of people land on the moon and cure cancer and Drag grumpy, old men into the E.
R.
And trample innocent souls along the way.
Yeah, don't do that part.
I'll be around to remind you.
I'll prep a suite for Old Fart.
Take much longer and she'll have a cardiac arrest.
Trach is secure.
Go ahead.
Advancing the catheter to the ascending aorta.
Bring down her CO2.
Retract the neck muscles so there's Yeah, no, I got it.
The death of that baby kept me up at night.
It still does.
I should have taken a stand then, but Salen told me it kept her up at night, too.
She promised to make changes to ensure that it never would happen again, and I believed her because I cared for her.
A lot.
But my eyes were closed, and I should have stepped up sooner.
Because this place is my home, and you pains-in-the-ass are my family.
Together, we can fix this woman's heart, her brain, and neck.
We can do great things for all our patients If we don't kill each other first.
Shunt's through.
You can go ahead with the trach repair.
She's crashing.
Dr.
Cain will be here in 20 minutes.
We don't have 20 minutes.
I have to open her chest now.
Get an attending out of surgery.
She has critical bradycardia, but the valve is well-positioned.
Drain two cc's of CSF every minute.
That should buy me ten minutes.
I'll remove the delivery valve.
I'll put in a temporary pacer.
But I still don't know what's tanking her heart rate.
I do.
The tracheal injury compressed her carotid.
It's lowering her heart rate.
Try removing the retractor.
Push atropine.
No good.
Heart rate's in the 30s.
She's gonna arrest.
Gonna try to decompress the carotid bulb.
Shaun needs one of you in O.
R.
three.
Isla's pulmonary vessel ruptured.
He's cracking her chest.
I need ten minutes.
Tell Shaun to use every bit of his Shaun-ness to keep her alive till I get there.
Andrews can be here in ten minutes.
I've located the bleeding vessel.
If I clamp too close to the pulmonary artery, I'll extend the injury and she will bleed out.
If I get too close to the hilum, I could cause a pulmonary infarct.
She'd need a ventilator for the rest of her life.
I need Andrews' help.
She's going into shock.
You can do this, Shaun.
I need Metz, stay sutures, and a needle driver.
BP's climbing.
Well done, Dr.
Murphy.
Want me to take over? Yes.
We're all going to be okay.
Except for the severe chest pain you will both experience for several weeks.
And there is a 1% chance of a recurrent pseudo-aneurysm.
But yes, you will most likely be okay.
Thank you, Dr.
Murphy.
We'll give you all some time.
I didn't lose it.
Thank you, Dr.
Murphy.
Personal connections aren't so bad, are they? Mm.
No.
They are not so bad.
But I do not want to do it again.
I have to go home.
I think I can save the clinic.
Dr.
Reznick, it's been a long day.
I talk fast.
Old people.
They need care the most and they have the least access.
Telemedicine services for nursing homes.
I just brought in a patient who needed a $100,000 angio, entirely paid for by Medicare.
That alone would cover the cost of three uninsured clinic patients.
It's a good idea, but ideas aren't your problem.
I know.
I made a mistake And followed it up with another.
You've bungled your opportunity from every direction.
I know.
Which is why Dr.
Glassman should be in charge of the clinic.
I'm not ready, but I will be.
Someday.
And you're gonna need people like me if you're gonna save this place.
And you know I'm right, because you wake up every morning wanting to conquer the world, too.
What is all of this? I got you something.
I made it myself.
Lea Dilallo will you make a bond of shared experience and oxytocin and love with me for the rest of our lives? Of course.
It's a placeholder.
It's perfect.
I left a bottle of Scotch around here somewhere after the first time you stole my job.
Did you drink all my fizzy water? There's a cucumber one left in the back.
They're disgusting.
It's refreshing and delicious.
Agree to disagree.
Yep.
Found it.
Why not?