The Good Doctor (2017) s05e16 Episode Script

The Shaun Show

1 Morning.
- Oh.
I made pancakes.
- Mm.
Oh, your lips are very shiny.
It's just my normal lip gloss.
You don't normally have it on for breakfast.
Mmm, these are delicious.
Where is my apple? One of you moved my apple.
Oh, it was just blocking the shot.
Try not to look directly into camera.
So, tell me about how you two met and fell in love.
Uh First we were neighbors, then we became friends, then roommates.
We bonded over our love of pancakes and karaoke.
And before we knew it, we were having our first kiss.
We were drunk from tequila, and I vomited immediately after.
And Lea said we were just friends, and she said that was all we could be because of my autism, and I thought she was superficial and prejudiced.
But I was wrong about her, and she was, too.
She could be happy and in love with me.
So she asked me to marry her, and I said yes.
You sure did.
I have to go.
We need you to sign a release form.
I don't want to be on TV.
- Well, we can always just blur you out.
- Mm.
- You don't want to be blurred.
- It'll be fun.
We'll be the younger, more outrageous supporting characters in The Shaun Show.
It is not my show.
All this for you.
Oh, looks like Dr.
Andrews is hoping for "Special Appearance by" billing.
I didn't expect to make it - to California.
- Oh.
San Jose St.
Bonaventure Hospital has one of the most rigorous surgical training programs in the country.
Only a select few make it through this rigorous five-year residency, which traditionally culminates with a test to see if those residents are prepared to be attendings.
Did I say "rigorous" twice? I can take that again.
Uh, don't Don't worry.
You're doing great.
Can I get your autograph? Dr.
Murphy and Dr.
Park, today each of you will be put in charge of a surgical case and evaluated based on your O.
performance, your ability to delegate responsibility, to manage junior residents, and think on your feet.
The next surgical cases that come through the E.
will be all yours.
- Aah! - Dana Bradley, 34, burns to her head and left forearm.
At least 10% total body surface area.
I see areas of second-degree burns, forehead, scalp, and cheek with associated burn blisters, likely mid-to-deep dermal partial thickness burns.
Send blood for CBC, urea, electrolytes, lactate, and get EKG and chest film.
Okay, give one milligram of Dilaudid.
Dana, it's okay.
We're giving you something stronger for the pain.
Start IV antibiotics.
Capillary refill is sluggish.
She needs acute surgery to debride.
Let's go! Grant Ferlin, 44-year-old firefighter, level two trauma, multiple injuries from a fall.
What about burns? No burns.
He saved a woman from the fire, then he got pinned by a beam.
Sir, please go to the waiting room.
We'll keep you updated.
Park, this is your case.
Villanueva, we need all hands on deck.
He's tachycardic and hypotensive.
Could be bleeding into his abdomen.
Give me the ultrasound.
Give me the ultrasound! Intraperitoneal hemorrhage.
We need to open him up.
Let's go.
Excision knife.
Apply even pressure against the wound.
Starting the tangential sequential excision.
Shaun would be an asset to any hospital.
He views the world a bit differently and therefore sees patients a little bit differently.
But we accept him just as he is.
Did you always feel that way? There was a time where I didn't feel Shaun belonged at this hospital.
Luckily, I got my arm twisted.
Shaun's contributions have far outweighed his surgical gifts.
She's in v-tach.
Is he okay? Why is he stopping? Sometimes he gets these ideas, more like visions.
It's very effective.
I'm not sure what that is.
Your lights are in my eyes.
Please turn them off.
Step back.
She's hypothermic.
We need more aggressive fluid resuscitation.
I'll place a femoral line using a rewarming catheter.
We need to assess the duodenal rupture.
I'll run the bowel, rule out any other perforations.
Babcocks and OG tube to suction.
His surgical technique is really advanced.
He has such command over the room.
Shut up.
I found the bleeder.
Next I'll repair the rupture site.
Bleeding stopped.
Let's close him up, get a post-op CT to make sure we got everything.
I've heard that Shaun sometimes has visions? What are they like? Pretty good, huh? Mm-mmm.
It's more like Um, sorry, but you're no Shaun.
Nobody can do Shaun's vision thingies but him.
It's his superpower, like he has an X-Ray, MRI, and C all in his head all at the same time.
I'm never gonna be able to do that.
But what I've learned from watching Shaun is, figure out what you're good at and lean into that.
What's your superpower? How much time do you have? The surgery was a success.
We were able to eliminate all non-viable tissue and use autograft over the entire burn surface area.
What are they doing here? They are taping me.
They will blur out your face.
When can I see my family? The nurse is bringing them.
They should be here shortly.
That hurts! You are on strong IV narcotics, and the grafts should still be numb.
Please stop.
Stop! It hurts! I am not touching you.
There is significant swelling and edema.
It is pulling on the graft anchor sites.
That doesn't make sense.
Mommy? Yes.
I'm here.
I want to go home.
I can't do this.
Okay, okay, okay.
Dana's autografts were procured, placed, and secured perfectly.
We started IV Ancef before surgery, continued post-op, and confirmed none of the tissues removed had positive cultures.
The grafts should not be failing.
Did you keep her wound dressings moistened? Yes, and her edema is getting worse, even after replacing dressings.
You need to go double-check her labs.
I know what I did.
I memorize all data in my patient charts.
Did you use proper sterile technique and prep on all autograft sites? Yes.
Adequate fluid resuscitation and replacement for losses? I checked urine output and central venous pressure every Hour, but she was really uncomfortable, so I skipped one, but I don't think No, you cannot skip steps.
Go review every vitals check, all urine output ins and outs, and every CVP.
My boys tell me you're a former brother in blue.
Walked the beat for 15 years.
Can we talk privately? Oh, we're all squad here.
Grant, your CT showed you have an unstable lumbar fracture.
You'll need extensive posterior fusion surgery to stabilize it.
How long before I'm back on the job? You'll be up and walking in a few days.
But after this kind of fusion, your spine You won't be able to be a firefighter anymore.
Then you need to figure out a different plan.
This is the safest surgery.
Your abdominal injury poses too many risks for us to We run into burning buildings for a living.
I'm not afraid of a risk.
I trust you to get me back to my team.
You okay? I'm just double-checking our patient's lab work.
That's some emotional lab work.
Shaun thinks I caused our patient's graft issues, and he said so on camera.
And I'm I'm so angry at myself for skipping a step.
But I don't think I caused the edema.
Sorry about this morning.
Rough day.
It happens.
I need approvals.
We implemented a new system last week.
You're working off the old one.
I'm sorry.
I didn't know.
You were late on training day.
Redo it.
And maybe cool it with the personal calls on the floor.
Please let this be an actual medical issue.
My patient's refusing posterior fusion surgery.
We need an alternative that will get him back on his feet.
Posterior fusion would get him on his feet.
He just wants to carry someone on his back.
We could try ventral surgery through his abdomen.
L3 is hard to get to ventrally, even if everything was perfect.
But if we try a transpedicular approach, we could do a posterior cage placement and short segment surgery.
There's a risk of catastrophic nerve injury or an uncontrollable bleed from placing too large a cage.
Would you try it? Your patient, your call.
What do I love most about Shaun? I can't choose.
He's brilliant, and he's so funny.
He makes me feel safe.
I know no matter what happens, he's there for me.
And he's super cute.
Shaun, what do you love the most about Lea? Shaun.
I love That her eyes crinkle when she is happy or sad or angry or worried.
And I know which one means what.
You know my eye crinkles? That one means she is happy.
I double-checked every recorded vital sign and hourly urine output.
All suggest adequate blood pressure to maintain graft profusion and no signs of fluid overload.
I don't know what caused it, but Dana's edema and graft issues are not my fault.
I need to see your footage.
Play it from there.
The grafts should not be failing.
Something must have gone wrong.
I need the answers to fix it.
Please rewind.
Play at half speed.
Right there.
When I pressed that burn area, she did not feel it.
If they were second-degree, mid-dermis burns, it would have hurt.
Dana has third-degree burns.
The tissue is dying under the grafts because I did not debride deep enough.
Dana's problem is my mistake.
Shaun has always been great with medicine, but romance, not so much.
I took him through boot camp, and then he and Lea got together.
I guess you could call me Cupid.
You don't get credit for Shaun and Lea getting together.
You barely get credit for us getting together.
I have to go practice my surgery.
Your first surgery did not work.
I didn't debride deep enough.
We need to fix it.
How's your pain level? I'm A monster.
No wonder Nicole ran away.
We have to do another surgery, or you could become septic.
Will it fix the way my face looks? No.
Your face will look worse because we have to debride deeper.
I can't.
We have to fix the mistake.
How you look doesn't impact your health.
Do you want me to get your husband? I'm sure he wants to see you before you go into surgery.
Nicole needs him.
That's not gonna work.
You need to get wider exposure and corpectomy before placing the cage.
There is an easier solution.
Tell your patient he's being an idiot.
It's not worth risking his life for his career.
I think he's right.
When I left the force, I felt more alone than any other time in my life.
I didn't just leave a job, I I left a family.
He wants to fight to keep his, so I'm gonna do what I can to help him.
I'll drill off the complete pedicle and L3 body.
You decompress on the lamina above and below.
It'll allow for a safer cage placement.
I don't think Dana is ready for the free tissue flap reconstruction.
We could start with daily tissue removal.
No, we should not wait.
Deeper debridement and temporoparietal fascia surgery will clear her edema.
It's a high-risk surgery with high risk of blood loss and flap necrosis.
Before we do another big procedure, she needs to recover psychologically.
She could develop infection and compartment syndrome if we wait.
You missed what the patient was feeling in your initial diagnosis, and it affected her outcome.
You could be wrong about this, too.
The free tissue flap surgery will correct the damage from her burns.
I am the attending.
This is my decision.
My patient N-No.
Shaun, what's going on? My patient has to have another surgery.
I thought she had second-degree burns.
She also has third-degree burns.
Okay, so do another surgery.
If I had not been distracted by the cameras, I do not think I would have missed her reaction.
Third-degree burns are always numb.
So you can do another surgery.
This is my test to prove I am ready to be an attending, okay? I made a mistake.
And you caught the mistake.
But I shouldn't have missed it, okay? It was my fault.
Okay, so it was your fault.
So? Just like it was my fault when I was attending that I-I missed a subdural empyema and Park punctured a fungal nodule and Claire missed a PE.
The patient didn't die, right? You can do another surgery.
So let's just focus on that.
I am different than you and Claire and Dr.
I do not get to make mistakes.
Is this because this video crew has been following you around wherever you go? Yes.
I made two mistakes The burns and letting them film me.
You know what? Get rid of them.
If you don't want them around, just get rid of them.
And another thing, Shaun, you can't expect to be perfect all the time.
It doesn't happen, ever, for anyone.
Again, it's helpful if you include the question in the answer.
What was the question? Do you see yourself as Shaun's protector? Oh, um No, I don't see myself as Shaun's protector anymore.
How does that feel? How does it feel? I don't know.
It feels great.
I'm proud of him and relieved that he's gonna make it.
What changed? He did.
He changed.
Can you elaborate? He grew up and met Lea.
Okay, we need to talk.
Turn the camera off.
Sorry, no.
Okay, then I'm gonna have to say what I have to say naked.
You can take five.
Thank you.
You need to back off Shaun a little bit.
It's my job to ask questions.
I was expecting wedding surprises, and instead I feel like you're exploiting his autism.
You knew Shaun's ASD was gonna be part of the show.
I didn't expect you to make a highlight reel out of his most spectrum-y moments.
I'm not manufacturing anything.
Shaun made a mistake on a very important case, and now that could end up on your show.
He's totally rattled.
I know you want to protect him.
This is not about protecting Shaun.
This is about the whole world seeing him as a collection of quirks and a single mistake.
But since that is good TV Dana has third-degree burns.
Dana has third-degree burns.
Dana has third-degree burns.
Her tissue is dying under the graft because I did not debride deep enough.
Dana's problem is my mistake.
I'm not gonna use any of the footage related to your mistake.
It's not relevant.
This is a wedding show.
Lea reminded me of that.
I do not want to be dishonest.
It's not dishonest.
It's focused on you and Lea and your relationship and your amazing career as a surgeon, surrounded by all of these people who support you.
That is what will give hope to people who feel different and alone.
That's why I'm doing this.
Grant's case file.
I've successfully completed the short-segment posterior fusion on the skills dummy simulator.
With a partner.
You've successfully done it on real people over 50 times.
You should take the lead.
Which would mean removing yourself as the attending on this case.
I'm not risking my patient's life to pass a test.
You're risking your own career to try to save his.
Grant deserves the best shot to get back to his crew.
Any cold feet? Shaun is my person.
I know that beyond a shadow of a doubt.
Do you think I should let Sophie remove my mistake from the show? I think that is up to you.
How do you feel about it? It feels like a lie, but is it more important to give people truth or hope? That's a tough question.
I say we stick to the two of you, who are getting married in just a few days.
Any nerves about that? Oh, no.
She is also my person.
I have known that for a long time.
I have to go prep for my surgery.
Okay, I have to go prep for my surgery.
It took you longer to be sure that Shaun was the one.
In fact, you said you couldn't get involved with him because of his ASD.
What changed? I offered to take out the mistake because you were right.
I crossed a line.
Instead of embarrassing Shaun, now you're zeroing in on me? I'm not trying to embarrass anyone.
Can you please slow down? As a little person, the world doesn't accommodate me.
That's why representation matters, but when it's real.
I'm not asking you to make us look like a fairy tale.
Fairy tales have obstacles and conflict.
The story you want me to tell, you two met and fell in love and everything's great, it's boring.
So you want me to play the wicked witch.
You are are not defined by your lowest moment, but you can't deny it, either.
I am here to tell the real story of you as a couple.
Do you still trust me to do that? Your vitals are good, and your volume status is stable.
A nurse will come get you for surgery soon.
I'm so sorry the cameras added to your pain.
I was gonna have to see myself eventually.
My daughter will have to look at me every day and pretend she doesn't see a monster.
She won't see you that way forever.
Other people will.
Other kids will tease and bully her because of what her mother looks like.
People have teased and bullied me my whole life, and it hurt for a long time, and I was too ashamed to tell anyone.
I finally told my mom.
She taught me how to stick up for myself.
You can be an example of how to get back up when life knocks you down.
Your strength will make her more compassionate than most people and more powerful than any bully.
I'll come get you as soon as your mom is awake.
I don't want to see her, Daddy.
It's okay to be scared.
You know what helps me whenever I'm scared? A big hug.
The best ones are from my mom.
Do your mom's hugs make you feel better? I know Mommy looks different, but her hugs are the same.
They're full of the same love as always.
We are doing Dana's fascial flap surgery.
Are you here because I am the attending or because you trust my judgment? Mostly the latter.
Even after my earlier mistake? You're a great doctor.
I hope one day I'm even close to as good as you.
Your mistake just made you more Inspirational.
It gave me the confidence that I'll find my superpower, too.
You cannot film this surgery.
I cannot be distracted while I am working.
Let's go.
I've drilled most of the pedicle and vertebral body.
What's next? We need to place the cage.
Good decompression.
One above, one below.
Placing the expandable cage.
Heart rate's way up.
BP's dropping.
Vessel's torn.
It's detracted away from the field.
What about giving T.
and bipolar to pull the vessel into view? BP still dropping.
BP's 41 over 23.
He'll arrest if we don't stop things now.
Vascular clip.
We could try completing the corpectomy from the other side.
It's not working.
We're changing course.
Let's do the long segment L1-5 without a cage.
You sure? My patient, my call.
Excision knife.
I need more sponges and the suctions turned up.
She's losing too much blood.
She's severely tachycardic, blood pressure dropping.
This holding pressure isn't durable.
She's gonna bleed out.
We have to debride deeper.
The excision blade is causing too much bleeding.
Should we try the micro dissection electrocautery? Electrocautery won't work.
We need to preserve as much normal tissue as we can.
A VERSAJET will debride the appropriate plane with less bleeding.
We repaired your lumbar fracture.
But we had to switch surgeries.
You can't do the job anymore.
Your body was giving out.
I couldn't let you die.
I trusted you.
The surgery was a success.
He had one of his visions, saved the day again.
Oh, and I missed it! I'll do the imitation again.
You can use all your footage, even my mistake.
Great surgeons can make mistakes and still be inspirational.
Close the door.
You're writing me up? Is this about the charts? And coming in late.
And taking personal calls, calling off last-minute.
I need to be able to count on you, and right now, I can't.
I haven't been my best.
Things at home If If I don't answer his calls, he gets mad.
He checks my mileage and my phone and how much makeup I wear.
I helped a patient go through a domestic violence checklist and realized It was me, too.
We'll figure this out.
My re-grafting surgery was a success.
With restorative surgery, you'll have an adequate aesthetic outcome.
Mommy? I look different, huh? Your eyes are the same.
They look like mine.
I saw Lim.
You passed your test.
For a long time, I didn't think I could be with someone like Shaun.
I thought we were too different, that I would have to compromise too much.
And I worried about what people would think of us.
Of me.
And I didn't want to be seen as different.
What changed? Me.
Because of how Shaun saw me, he made me believe that I am stronger than I give myself credit for.
And that together, we are enough.
More than enough.
That was very nice.
Is it time for the surprise? And take 'em off! Surprise! Oh.
Sophie, it's beautiful.
The lights are very soothing, and I like karaoke.
This is a very nice surprise.
Hi! Are you sure you're okay? I'm okay.
Congratulations, Shaun and Lea.
This song is for you guys.
Every step I take ♪ Every move I make ♪ Every single day since I went away I've been missing you ♪ Thinkin' of the day ♪ When you went away ♪ Congratulations! What a life to take What a bond to break ♪ I'll be missing you ♪ It's Claire!
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