The Good Doctor (2017) s06e13 Episode Script

Good morning.
Admissions percentages at top colleges
have dropped to record lows.
You thinking about going back to school?
No. No.
I'm thinking about our son's future.
As in starting a college fund
for the Peanut?
No, I have put the Peanut on a waitlist
for pre-kindergarten at McLelland Hall.
Isn't McLelland Hall that snobby
private school in Menlo Park?
It is one of the top
three feeder schools
for Stanford University.
So, you've not only decided
he's going to college,
you've also picked out which one.
Given our son's genetic makeup,
he will probably be very intelligent
and will require a challenging
academic curriculum.
Or he may not even enjoy academics.
Whatever he ends up doing
will be his call, not ours.
Whatever pre-kindergarten
he ends up attending
will be our call, not his.
Hmm.
Oh. No coffee.
Glassy still in his room?
No, I heard him leave at 6:14.
He's been so sad about losing his house.
How can you tell he's sad?
Have you noticed how quiet he's been?
Yes. It's been nice.
Guess he's just throwing
himself into his work.
Hmm.
Dr. Murphy, little help here?
Hmm.
Give tetanus booster, clean the wound
- with Betadine, administer
- No, we got that. It's
We wanted a second opinion.
Uh, Victor did.
Before these young pups
take a saw to our son's foot,
I'd like to talk to a supervisor.
The nail's bent.
I am their supervisor,
and we need the saw
to cut the nail, not his foot.
Are you good, Ricky?
You all know my angel
for the past 11 years,
- Dr. Lim.
- Oh.
Hey, Roses. And this is my resident,
Dr. Jordan Allen.
Hi! Roses?
My website's called
"More than 65 Roses."
It's what I called it
when I was diagnosed at five.
Sixty-five roses, cystic fibrosis.
Okay.
And welcome to vlog number 458,
going out all around the world.
And what does DLT stand for?
Oh,
that would be "double lung transplant."
Whoo! Whoo!
Your new lungs just arrived.
Oh.
I never should've agreed to let him go.
You didn't. You just stopped
fighting with me about it.
He's running a mild fever, 100.4.
Go where?
Church camping trip,
less than an hour away.
Camping can be very dangerous.
Thank you, Dr. Murphy.
You know, I had my first
fire-roasted s'more last summer,
so camping can also be very fun.
Thank you, Dr. Wolke.
Be careful, please.
Victor, he's a doctor.
Just try to trust
Trust that things will work out, yep.
I know.
You're a Warriors fan, huh?
You like Steph Curry?
I like Draymond.
A rebel. I like it.
Huh. Look at this beast.
Nice job, Ricky.
His temperature just jumped two degrees.
Let's get a CBC, blood cultures,
and a CT of his foot to check for
damage to the bones and muscles.
Dr. Park, how kind of you to join me.
You paged me.
Have a seat. And, yes,
they're Herman Miller.
Cappuccino, mochaccino, espresso, latte?
None of those are for you.
Okay, I was wrong.
This is the perfect job for you.
Your first study has,
what, 800 patients?
But since you've had
four whole days to hire
all the clinical trial nurses
you'll need,
should be easy.
I may be a little behind
and may already have
thirteen patients waiting,
but I will handle it.
With a lot of cappuccinos.
Thanks for your support.
Do you want me to give you a hand?
I have 90 minutes
before my next surgery.
In exchange for unlimited
use of your espresso machine.
We'll see.
Poor Ricky.
He probably just has a minor infection.
I meant the parents.
They went to two very different
schools of thought on child rearing.
It's hard on the marriage
but harder on the kid.
Everyone has
different opinions, Dr. Wolke.
Yeah, which they really need
to sort out before having kids.
My college roommate, who was Jewish,
married a wonderful Catholic woman.
They had three children
in quick succession,
started fighting about
how to parent them non-stop.
See, my parents never fought about us
because my dad didn't care,
as long as my mom got
me and my brother dressed
and out in time for chores.
Well
No hematoma or abscess.
No explanation for the fever.
My neck, it really hurts.
Okay.
Hey. I got you.
He has tick bites on his back.
Pink, plump, and spongy.
What's that?
Pneumonia?
In both lungs.
She's lucky if she has another week.
Ex vivo lung perfusion.
Maybe we can make
the lungs heal themselves.
That's usually used in cases
involving pulmonary edema.
Get the lungs. Meet me
in the Procedure Room.
Tick bites?
His fever, vomiting, and sore neck
- which could be neurological
- It's in his brain?
Possibly, but the blood tests
were inconclusive,
so we'd like to do a lumbar puncture
to check Ricky's cerebrospinal fluid.
This camp just keeps
getting better and better.
Can we not do this right now?
I just want to make sure
this never happens again.
And I don't?
I care about our son
every bit as much as you do.
And yet, you keep prioritizing
fun over safety.
Yes, I care about fun,
and socialization,
self-esteem, self-expression
Yeah, none of which are
as important as his safety.
I can't do this anymore.
Wh
Got through six so far.
Only one with a minor reaction.
- You?
- Me, too.
So, we are 12 down, one to go.
Mr. Riggs?
Mr. Riggs?
Sorry.
I just drifted off.
My fault for
keeping you waiting so long.
So, how are you feeling?
Aside from tired.
Uh, just a bit achy.
Especially my knees and elbows, hips.
And some mild jaundice.
Other than that, I feel pretty good.
- Hello.
- Oh.
We should sort out our
differences about child raising.
If this is about McLelland Hall, Shaun,
- it's not a big deal.
- Oh, no, I have made a list
of 37 other potential differences.
And I'd love to discuss them all,
but Andrews just approved
new EMR software
and wants me to run a beta test
on it in the next 24 hours.
- Have you talked to Glassy?
- No.
He didn't come to work today,
but I got a text.
He says that he is okay.
So where is he?
It is not over yet.
Lungs are remarkably resilient organs
when they are in a body.
Which is why we have to
convince them they still are.
We give them a blood supply
by hooking them up
to a perfusion machine,
an air supply by hooking
them up to a ventilator,
IV drips to feed them antibiotics,
and we might just be able
to con them back into viability.
The next six hours are crucial.
How will you know if they're viable?
Our main indicator is a
calculation called the P/F ratio.
When that reaches at least
400 millimeters of mercury,
those lungs are good to go.
Mom, relax, it's Dr. L.
Palpate to find the L3-4 interspace.
Maybe Lea and I will not be
able to sort out our differences
about child raising and become
angry like Victor and Shelley.
You and Lea are nothing like
Victor and Shelley.
They come from completely
different worlds,
have vastly different outlooks
Lea and I are very different, too.
Insert the spinal needle.
And who knows
how much they love each other.
You and Lea, on the other hand,
I know you do. A lot.
And that's all that matters.
At least, according to
the Hallmark Channel.
I'm in.
Whoa, whoa. Whoa, whoa, whoa.
The infection has elevated
his intracranial pressure.
Intubate and load him with
levetiracetam and dexamethasone
before his brain herniates.
CSF confirmed a very rare infection
called Naegleria fowleri.
It's a brain-eating amoeba that's
caused serious cerebral swelling.
We need to put Ricky
in a barbiturate-induced coma
and surgically place a port
into the center of his brain.
Then we will flood it with antibiotics,
which will hopefully reduce the edema.
And he contracted this from a tick?
Oh, no, it's contracted via
contaminated water through the nose.
So So he got it from
the swimming hole at camp?
That's a good guess.
But Ricky's way too anxious around water
to ever put his head under,
let alone get water up his nose.
Naegleria Fowleri has also been found
in untreated swimming pools,
- nasal rinses, water heaters
- Nasal rinses?
If unboiled tap water is used.
I gave him a nasal rinse
the morning he left for camp.
He had a runny nose.
That is a better guess.
Excuse me.
Riggs has fatigue, joint pain,
impaired mental acuity,
tachycardia, and mild liver failure.
- Thanks.
- Maybe he has a pre-existing condition.
In which case he should've
been eliminated
by any remotely competent
screening process.
Those protocols were in place
before you came on board.
I'll remind the CRO of that
when I tell them, on my first day
that their $4 million trial
needs to be trashed.
How about you save
the doomsday predictions
until after the blood panel results?
Lab is on the way to the OR.
It hasn't been six hours yet, has it?
Six and a quarter.
You want company?
Thanks.
Hello. Where is Victor?
Beating himself up somewhere.
I just wish that made a difference.
Do you love each other?
Yeah. Of course.
We've always been oil and water.
That's how my dad describes us.
Victor grew up in Belgrade,
I grew up in Berkeley.
Different religions, politics,
socio-economic status.
But when I got pregnant,
we knew we had
a lot of issues to work out.
And we did.
And then Ricky was born, and
we suddenly started arguing over
when can he safely eat tree nuts?
How high should he climb
on the jungle gym?
When can he stay with a babysitter?
Those little things were the ones
we could never work out.
But, yes, we still love each other.
It's just that
I'm not sure love is enough anymore.
Still waiting, still hoping.
That's kinda what we do,
isn't it, Roses?
And the wait is over.
I'm sorry.
We've put you back on the list.
You're at the very top.
I deserved this.
I wanted those lungs.
I wanted someone to die.
Brecka.
Honey, should we Should we finish?
No.
- Hello, Dr. Glassman.
- Geez! Man!
Shaun, you might try knocking next time,
although, you know,
that might be a little tough.
What are you looking for?
Oh, you know
my life.
Just my life.
Not yet.
I think I'm gonna keep at it for a bit.
Okay.
No. This is on me. You can head home.
Thanks.
I will miss your big-screen LED TV.
It was old.
It had a pixel line down the right side.
Did you love Ilana?
What? Did I love Ilana?
Yeah, of course.
Did you love Debbie?
Yeah, I loved Debbie.
Where is this going, Shaun?
That wasn't enough for you
to get over your differences.
How do I know if love will be enough
for me and Lea to get over
our differences?
Well, you won't know.
I mean, how can you know?
You can't know.
I do not like worrying about this.
Well, look, I mean,
Lea had some doubts
a little while ago, right?
And you both got over that.
Yes, because I was very supportive.
Okay, well, there you go.
But differences about
child raising seem to be bigger
- than normal differences.
- Well, yeah.
I mean, having a child,
I mean, that's big.
That's huge. That's a shift.
It shifts everything,
marriage, everything.
I do not want a shift in our marriage.
Well, maybe it'll shift for the better.
Aardy's eye.
The first thing I ever bought
Maddie was a stuffed aardvark.
Back in the day,
I performed a 21-hour surgery.
I removed an astrocytoma
from the medulla of the brainstem.
It was heroic. It put me on the map.
My elective surgeries
were booked out for a year.
I was in a zone,
like playing scratch golf.
And then Ilana got pregnant.
She didn't want to stop working.
She had a real-estate thing.
She was doing very well.
I didn't want to stop working.
I wanted to stay on the map.
And then we brought Maddie home.
That first night
everything changed.
Hmm.
Go talk to Lea.
I tried.
She had to run a beta test
on new EMR software.
Well, then, you'll have to wait
until she's done.
All I had on my DVR
was a marathon of Shark Tank.
Can't say I was in the mood
to be staring
at Mr. Wonderful's bald head,
so why not entertain myself
by watching some
hot lung perfusion action?
I'm not one to kink shame.
Coffee and cronuts from Chaz's Bakery.
I'm happy for the company.
Noomie's not much
of a conversationalist.
N-Noomie?-My pet name for them.
From the Greek word
for lungs, pneumonas.
I thought it was better than Lung-ie.
Yeah, I may be losing it.
Cronut.
- Mmm.
- Any progress?
Negligible.
I keep doing the same thing
over and over,
hoping for a different outcome.
Yeah, I'm definitely losing it.
Then do something different.
Okay.
Doubling up on antibiotics,
and we can add steroids.
This will either
hammer out the infection
or the lungs.
How's Glassy?
Very sore and very sooty.
Mmm.
We need to talk.
About our 37 differences?
I thought of two more.
Shaun, as you know,
I'm kinda busy right now,
so you'll have to settle
for me agreeing that,
yes, we'll have many, many differences,
but in time, we'll be able
to work them out and
That's what Victor and Shelley thought,
and now they are talking
about separating.
I don't know who Victor and Shelley are.
But in any event, I have at least
two more hours of work to do tonight.
Okay.
- You're waiting, aren't you?
- Yes.
I am very patient.
You are very patient
and very understanding.
And you were so good with me
on our babymoon.
If you could just channel
some of that
On our babymoon,
I thought love was enough.
That's
kind of a big thing to drop on me
this late at night.
You were too busy to discuss it
in the morning,
so I talked to Dr. Glassman about it,
and he said having a child
will shift our dynamics.
And if it does,
we can talk about it then.
So if we can't talk
about our dynamics now,
how about our differences?
Apparently we have 39 of them,
so we're gonna need
a serious chunk of time,
and I'm pretty sure they'll keep,
because we're kinda committed
to having a kid together,
whether love is enough or not.
Shaun, I'm just
I'm way too tired to have
a productive conversation
about this right now, okay?
Okay.
It's time to call it.
I had a half an hour left on my call
when she first came to the ER,
coughing blood, vitals on the floor.
When we opened her up,
her lungs looked like
they belonged to a 70-year-old.
Didn't think she'd make it
through the night.
She was eight.
I couldn't go home.
I stayed with her that night.
And then, the next morning, she just
opened her eyes, looked at me,
and told me she liked my French braid.
Once I call it
I have to go up there
and tell her I failed her.
Got Riggs' latest test results.
Turns out he did have
a pre-existing condition
hemochromatosis.
So the jerk lied about it
to get into the study.
That's your assumption?
He got $3,500 to participate.
I think it's a pretty sound assumption.
But whether he lied or not,
it means the screeners are incompetent.
That's gotta take a toll.
Expecting the worst of everybody.
I'd rather be pleasantly surprised
than bitterly disappointed.
And that's the worldview you
want to impart to your future child,
"Assume the worst of everyone"?
Help!
We need help in here!
What's happening?
Add a milligram of lorazepam.
He's seizing.
Because his ICPs are in the 40s.
Cerebral edema's gotten worse.
If we don't open up
Ricky's skull immediately,
he will die.
Removing large hemicrani skull flap.
Performing wide dural opening.
Look at the monitor.
EEG's all over the place.
He's still seizing.
Place an additional EVD
and increase propofol to burst suppress.
Eh, but he's maxed out.
If we give him any more
propofol, we could kill him.
If we don't, the seizures
will definitely kill him.
Oh. We can remove the damaged cortex
in the left anterior temporal lobe
using ECoG and pre-op imaging
to guide us.
Cut out part of his brain?
That's a little extreme.
It is the area
that's causing the seizures.
It'll just be a
tough sell to his parents.
Which is why you will help.
Okay, please keep him stabilized
with iced LR to the cortical surface.
Uh
"The country flew past
as if they were seeing it
from the windows of an express train.
Faster and faster they raced,
but no one got tired or out of breath."
We can save the last chapter for later.
There is no later.
Where's Dr. L?
She wasn't ready to give up
on your lungs.
There's still a chance?
Dr. Lim thinks so.
Let's finish.
"Chapter 16.
Farewell to the Shadowlands."
We would cut out
a small piece of his cortex.
It's already been damaged
by the infection.
Removing it may be the only way
to keep him alive.
But how would that affect him?
There are areas of the brain
that are significantly
less essential than others.
This part only impacts
his speech and memory,
probably not long-term.
So he might not be able
to talk or know who we are?
We wouldn't be able to fully
assess him until he wakes up.
Ricky's skull is open.
We should do it.
Uh, th-this is a very good hospital,
these are very smart doctors.
And someone very wise
once told me that, uh,
"Sometimes you just have to
trust that things will work out."
Okay.
Hmm.
Hemochromatosis?
You never noticed
the symptoms until now?
Joint pain, fatigue, mental fuzziness?
Well, I turn 58 next week.
I mean, I haven't felt
a day over 30 until now.
It is very unlikely your hemochromatosis
went from 0 to 60 in a week.
Is it possible you gave the
screeners someone else's blood?
You think I cheated? For the money?
No, Mr. Riggs, I'm just trying to
You're a blood donor
in the 20-gallon club?
Yeah, regular donor, last 30 years.
When was the last time you donated?
Two months ago, just before
I started this trial.
And you're not allowed to
donate while you're in the trial.
Well, see, that's the downside.
I actually enjoy those cookies.
I'll make sure you get all the
cookies you want, Mr. Riggs.
Don't you think it's time to come home?
No.
Well, in that case
I wanted to make you something delicious
like you've made us,
but I'm not a very good cook,
and everything's closed.
So, I hope you like
hot-dog-flavored potato chips
and Nutty Buddies.
Mmm.
Yeah.
Nail polish?
Father-daughter time.
Maddie insisted that
she paint my fingernails
a sparkly rainbow color.
The next day, my first patient
was very uncomfortable.
That's when I realized I
forgot to remove the nail polish.
That's a nice memory.
Oh, sit. No, sit, sit, sit.
So many memories.
The Halloween
Maddie wanted to go as a ham
because we'd just seen
To Kill a Mockingbird.
But she wanted the ham to
be made out of an actual ham.
And then, one night,
the wind was blowing so hard,
it blew her bedroom door shut.
She was convinced that
her grandmother's ghost
had come back to visit her.
Wanted to sleep in our bed
for the next two weeks.
You didn't come here just to
feed me junk food, did you?
I thought you might need
someone to talk to.
I'm fine.
Hmm.
I know someone you should talk to.
I know.
But this was easier.
Mmm.
Hot dogs should not be a flavor.
"All their life in this world
and all their adventures in Narnia
had only been the cover
and the title page.
Now, at last, they were
beginning chapter one
of the great story
which no one on earth has read,
which goes on forever,
in which every chapter is
better than the one before."
Checking in.
Need me to up your morphine?
Couldn't hurt.
Hey, I changed my mind.
About the vlog.
Wonderful.
Go for it.
Hey, Roses.
I'm back.
The DLT didn't really work out,
so
this is gonna be my last update.
I wasn't even gonna do this.
I was gonna flip off Dylan Thomas
and go gently into that good night.
But
I couldn't leave without saying goodbye.
And that
it's okay to be hurt
I am
that my life's been cut short.
But the upside to all of this
is that I feel something
I never thought I would.
It's gratitude.
I'm grateful to my sweet mother
and
to the people who keep hope alive.
Like Dr. L and
Crash cart!
She's in full respiratory failure.
- We need to intubate her.
- No.
We need to let her go.
Noomie hit 402. Get Brecka to the OR.
The lungs are good.
We should intubate.
Yes.
- Ricky?
- Dr. Murphy!
Ricky, can you hear us?
Hello.
Do you know where you are?
Do you know your name?
I'm Ricky Pavlovic.
I'm in the hospital
because I stepped
on a rusty nail at church camp.
But I would still like to go
back there next year.
Welcome home, Noomie.
So Riggs is a lifelong blood donor.
Which totally eliminated his symptoms.
Until he started this trial.
He's not allowed to donate
till it's over,
so there was nothing wrong
with the protocols,
nobody was incompetent,
and Riggs isn't a big fat liar.
In fact, he's a legit hero.
Maybe my worldview does need
a little adjustment.
I prefer Italian roast.
Noted.
Ready to take Noomie for a test run?
That's what she named your lungs.
It was a weird night.
Start small.
Thanks for coming.
We should talk.
Number 39,
dietary restrictions.
Other than breast milk
Oh, I felt a kick.
Oh!
This is very exciting.
Come here.
Think of all the new memories
waiting to be made.
Hey, let's go home.
Number 39, other than breast milk,
I don't think that Peanut
should have any dairy products
before six months.
Easy peasy. Number 38?