The Good Doctor (2017) s01e02 Episode Script
Mount Rushmore
Autism a mental condition characterized by difficulty in communicating.
Does it sound like I'm describing a surgeon? You saved his life.
I'm Dr.
Shaun Murphy.
Never forget, you're the smart one and I'm proud of you, Shaun.
My brother went to Heaven in front of my eyes.
He's got a serious deficit.
We hire Shaun, and we give hope to those people with limitations that those limitations are not what they think they are, that they do have a shot! If Shaun doesn't live up to everything I know he can do, I will resign my position as president of this hospital.
Where to? San Jose St.
Bonaventure Hospital.
I'm a surgical resident.
Today is my first full day.
I meant floor.
Oh, ground floor.
I'm taking the bus.
This is Mitchell Brand, 55 years old, post-op day one from a radical prostatectomy.
Morning, Mitchell.
I'm Dr.
Melendez.
These are my residents Dr.
Browne and Dr.
Kalu.
Your surgery went perfectly.
Yeah.
Am I ever gonna walk again? Yes.
Of course.
This is Mitchell Brand.
I reviewed his chart.
He's 55 years old from Chicago, divorced with two children.
You did a radical prostatectomy on him yesterday.
There are many possible complications but none related to motor neurons.
There is no chance you won't be able to walk.
He he wasn't worried about his legs.
Oh, yes.
There's a significant chance of impotence.
Dr.
Murphy, you're late.
No, the bus was late.
The schedule was clear.
They post it online.
But the 4 bus was late which meant - You're late.
- Five minutes, we've all been On your first day, no less.
It is your responsibility to be here.
if you are not, you have failed in your responsibility, - which makes it your fault.
- Okay, how can it be my fault? - I did nothing wrong.
The bus - Yeah.
This is gonna work out great.
The board clearly made the right choice in hiring you.
Thank you.
Dr.
Melendez, we've got an emergent consult in the E.
R.
You should be fine if you can leave it alone for a couple days.
Four days of indigestion, bloating, constipation, and nausea.
And a lot of pain, apparently.
Yeah.
- Did you give her morphine? - Yeah, 10 milligrams.
Hasn't touched her pain.
You have time to get a CT? Yeah.
That's why I called you.
That's very big.
Yes, it is.
What are we looking at? It's definitely abutting the aorta and the left kidney.
Renal angiomyolipoma? - Do you see an extensive blood supply? - No.
Maybe some kind of neurogenic tumor.
Or maybe a lymphoma.
She has a sarcoma, a malignant tumor.
Malignant? - That means it's killing me, right? - Yes.
Not necessarily.
We're just speculating right now.
No.
It's definitely malignant.
If it weren't malignant - Please stop saying "malignant.
" - Should we talk outside? Give her more morphine.
As much as she wants.
Okay.
You scared her.
- Didn't need to be so blunt.
- Why? Her prognosis is terminal without immediate medical intervention.
Isn't that scary? Well That fear does her no good.
Does she have a malignant sarcoma? Are we gonna be doing a laparotomy? We need intra-operative staging for the biopsy, extensive dissection of the retroperitoneum, and excision of the mass with wide, clear margins.
I want in.
You do know you're drooling, right? About cutting open a 40-year-old woman.
Real person.
Right behind that door.
It's called bedside manner no such thing as outside-the-door manner.
It is exciting, Claire.
We'd be saving a life, and we'd be learning.
See? Dr.
Browne, you're my number two.
- With all due respect, doctor - Comments that start that way rarely come across that way.
- I was gonna say that's an excellent call.
- Thank you.
- Jared, prep the surgical team.
- Sir, what do I do? - Scut work.
- What's scut work? Today, I'm gonna need my surgeons to have no distractions.
So I'm gonna need you to handle those distractions.
All the work they do every day that they hate doing, you're handling it for them.
Make sure they know we still need a consent on that one.
Am I being punished for something? No.
Okay.
So that's it? You just accept my answer at face value? Why? You're very arrogant.
Arrogant people don't think they need to lie.
So you must be doing this to teach me.
I look forward to learning from scut work.
- Say "Ahh.
" - Ahhh.
How long will this be? Seven minutes.
Without any complications, it takes seven minutes to do a discharge examination properly.
Dr.
Dunsmuir has already cleared him to go - and we need the bed.
- Okay.
Protocol requires that the surgical department also clears him.
You have an ear infection.
Yes, that's why he's here.
My hearing's been a little muffled, and I've had some ringing.
They gave him amoxicillin.
And we're sending him home.
Which is why you're here.
To send him home.
I'd like an MRI of the head and internal auditory meatus.
I'm not being discharged? What do you think is wrong? I'll tell you when I know for sure.
I don't want to scare you.
Shaun.
What are you doing down here? I'm waiting for her to fart.
Flatulence.
But I'm using the word "fart" in front of the patient to be more casual.
But you're the president of the hospital, so I'll say "flatulence" to you.
Well, I appreciate that.
Why are you doing that? She had her deviated septum repaired.
Before we can release her, we have to be sure she isn't suffering from post-operative ileus.
Ah.
This is what Dr.
Melendez feels you'll be most useful doing today? Waiting for farts? - I'm not just waiting for farts.
- Thank goodness.
I'm doing all the scut work.
Well Welcome to your surgical residency.
Thank you.
There.
I think that was it.
I don't think so.
I'll wait a little longer.
This is important.
The procedure is called a laparotomy.
Mm.
Yeah, your heart sounds good.
So, we make a long incision down the middle of your abdomen, - expose the tumor - Am I going to die? Dr.
Melendez is the best surgeon I have ever seen Can this all wait? You have a very serious condition.
It's not advisable to Just a couple of weeks.
My son is getting married next weekend.
They look very happy.
After the initial incision They've been planning this for months.
If they have to reschedule Well well, this this is complicated surgery, but if all goes well, recovery is pretty easy.
No need to reschedule anything.
And if it doesn't? If it doesn't go well? My husband died in a car accident a couple of years ago.
Mark is our only child.
I can't die right before his wedding.
I can't.
You're not gonna die.
You will be at the wedding.
Looking beautiful.
You're not supposed to make promises like that, Dr.
Browne.
Yeah, I told her what she needed to hear.
Officially, our legal department's policy is tell the ugly truth the uglier the better.
Is that what you did? I don't think that's what you did.
Yeah, well, it's a dumb policy.
She needs to have the surgery.
Scaring her would change nothing.
Right, because a much better policy would be to lie to all of our patients whenever it makes you feel better.
No, it doesn't make me feel better.
It makes her feel better.
I'm pathetic.
- What? - I am pathetic.
And here's my thinking, so just just bear with me, because it kind of insults both of us.
You met that woman an hour ago, and you lied to her.
A pity lie because you obviously care about her.
A pity lie that has absolutely zero upside for you, but I can't make you, the world's softest touch, care about me.
Hey.
I need a consult.
What? You have a question about this? This patient is perfectly healthy.
There's not even any artifact in these images.
Yeah, which in turn raises an interesting medical question why the hell did this patient get an MRI? I don't know anything about this.
Yeah.
Someone on your team ordered it.
It's your responsibility, which makes it your fault.
What How did you? It's my department.
It's my job to know everything.
Well, then, since I work for you, doesn't that make all of this actually your fault? Oh, I'm sorry, I stopped listening after "I work for you.
" Does that hurt? Yes.
Does that hurt? Yes.
Does that hurt? How much are we paying for this? She has a tummy ache.
- That's what they do they ache.
- Shh.
She's just trying to get out of school.
Again.
Where do you think she learned that from? You don't think she hears you calling in sick to work right before you go golfing? I like school.
Me too.
What did you eat for dinner last night? Cereal.
- I thought you made meatloaf.
- I did.
And it got cold while we were waiting for you.
I want D-dimer, lactate, and amylase What tests are you ordering? D-dimer, lactate, and amylase.
- For a tummy ache? Hmm? - Yes.
I'm concerned it may be Shall we talk outside? I told you something was wrong.
You're happy she might be sick? I'm happy you're wrong.
Yeah.
Let's talk outside.
Have they been bickering like that the whole time? I didn't notice.
They aren't sick.
- Yeah, they're what we call a vector.
- Hmm? A carrier.
A cause of disease.
- You mean the parents? - Yeah.
That little girl has a tummy ache because mommy and daddy won't stop fighting.
This isn't a medical issue.
Send them home.
Could be intestinal malrotation, which could quickly become fatal.
And every patient in this hospital could have malaria, but that doesn't mean we're gonna go around testing for every condition we think they could have.
For example, that MRI you ordered on the guy with the ear infection? Nice call, genius.
Thank you.
I was being sarcastic.
It's normal.
He's healthy.
Send him home, too.
Why are you smiling? Because you're right.
So you thought he was making a mistake and didn't say anything? Just stood by watching, taking notes while he wasted everybody's time? Is that your job? In my experience, doctors don't listen to nurses.
And they only talk to us to lecture us when they figure we screwed something up.
From now on, you don't run any tests you don't have to run.
How do I know if a test is needed until after I run it? She'll tell you.
Today, she's your boss.
I could never eat before surgery.
Puke? I could do that.
I get cranky if I don't eat.
- I hear Shaun made the call.
- Mm.
He's an excellent diagnostician.
You should get him a job in radiology.
He doesn't want to be a radiologist.
He wants to be a surgeon.
That's what we hired him to be.
That's what I worked damn hard to hire him to be.
Not a glorified orderly.
Every resident does scut work.
So you're treating him like anybody else? - Are you? - Yes, yes, I am.
He more than earned the right to be here.
He has had to get past people like you and their prejudices every step of the way.
- Prejudices? - Yeah, prejudices.
You have any idea how many patients he's scared the crap out of today? How many wasted tests he ordered? So teach him.
I'm doing that.
I'm teaching you both that he doesn't belong.
Okay.
You're gonna make me pull rank, I will pull rank.
This is my hospital.
But it's my team.
You can't tell me how to run my team.
Hey.
How are you doing? What's the point of sarcasm? Um Well, uh Like, sometimes, it's a way of critiquing people in a way that's funny so they don't feel quite so bad.
Isn't it just lying? Mm, well, it's not lying, because people know you're lying.
I'm not good at that.
You may remember me from last year.
We sell chocolate bars every year to pay for our class trip to Mt.
Rushmore.
Okay.
But this year we're not going to Mt.
Rushmore, because Kenny can't go.
He's got cancer.
So, Samantha had the idea that if he can't go, none of us would go, and we all thought that was a great idea.
So, we're gonna have a party at the hospital for him.
There are two Kennys in your class.
Is it Kenny L.
or Kenny M.
? No one's sick.
Well, you lied? - You weren't supposed to lie.
- Yeah.
And you and me aren't supposed to starve.
We need money for food.
Was any of that true? Yeah.
We're not going to Mt.
Rushmore.
I can't discharge people if I think they might still be sick.
Um, of course not.
Why would you? Dr.
Melendez made Nurse Fryday my boss today.
Should I speak to Dr.
Glassman? No.
What did you think this job was? To save people's lives.
No.
I mean, yeah, sometimes we do save lives.
But the job It's doing whatever Melendez asks us to do.
Paging Dr.
Browne.
Paging Dr.
Browne to the O.
R.
I'm Dr.
Claire Browne.
I'm first assist today, and I'll be leading the timeout.
Patient's name, Stephanie Willis.
Scheduled surgery? Excision of an indeterminate retroperitoneal tumor.
We don't anticipate any complications with the surgery.
Thank you, Dr.
Browne.
Ten blade.
Let's remove a tumor.
Excuse me.
No.
It might be infected.
- It's not.
- There is some discoloration.
He's 82 years old.
Everything is discolored.
Once we get through the muscle layer, proceed carefully.
Blood pressure, 120 over 70.
Heart rate 60.
She's holding steady.
I've opened the facia.
You kept your puke? Yeah, I thought you'd want to see it.
It looks like puke.
No.
No, no.
It's not the regular color.
Your puke has a regular color? Yeah.
It is a bit of an unusual color.
We could order some I'm sending you home.
You sure? It It's safe for me to go home? I don't know what to say.
You'll learn.
By doing.
Hi.
My brother said there's a kid named Kenny, and he's sick, and there might you should give us money.
So, am I okay? Am Am I okay? According to all hospital rules and direct instructions given to me, yes.
But Whoa.
We need a better exposure of this tumor.
Let's get the deep Balfour in here.
Deep Balfour retractor.
Let's get this thing open.
I've got to see where it's safe to cut.
Yeah.
Thanks.
I can't see anywhere where this tumor hasn't encased her arteries.
Claire, tell me you got something.
I've got nothing.
This tumor is way bigger than it looked on the scans.
II can't even see her aorta.
That's a problem.
Is that the girl with the bickering parents? Didn't we send her home four hours ago? Dr.
Murphy, Dr.
Melendez needs you in surgery.
That won't be necessary.
The tumor's entirely encased the large abdominal arteries.
That's very bad.
If it's in the artery walls, it's going to be impossible to cut out without killing her.
You should get a biopsy to determine where the margins are.
Thank you.
You're welcome.
I was being sarcastic again.
Oh, I-I see, because you are already know everything I said, and you already sent a biopsy to the lab? Yes, 'cause I'm a doctor, too.
Yes.
But you need me? Yeah, I need you to run down to the lab and hurry them along.
I'm Dr.
Shaun Murphy.
I'm a surgical resident.
Dr.
Melendez sent you a biopsy.
When will the results be ready? When I get to it.
It's very important.
They're all very important.
Let me see the other test orders.
I'll tell you which ones are most important, and you can do them in that order.
I'll be honest and fair.
That is not the way that it works.
Now go wait your turn.
Do it again.
- Get the hell away from me, you moron.
- Let's get out of here! Wait, wait, wait, wait! If you want to get anything in life, Shaun, there's one thing you got to do.
Never be afraid.
You're the moron! If you don't do Dr.
Melendez's test right now, I will throw a rock through your window.
Well, I wouldn't want that.
Go have a seat.
Your results will be ready in 15 minutes.
You got a minute? I have a patient lying in the O.
R.
waiting for lab results, and I'm sitting here trying to figure out what the hell I'm gonna do next, and I don't like any of my options, so yeah, unfortunately it seems I do.
Okay, we can talk another time.
Glassman talked to you? I don't have a problem with an autistic doctor.
No, you just have a problem with one working for you.
Really? That's how you see me? Let's not make this personal.
You're accusing me of prejudice.
I have a problem with the doctor who has a problem with communication.
Okay, let's make this personal.
Who do you respect at this hospital? You and Glassman.
And who do you not respect? And does it bother you that it looks like you're on the wrong team? If the tumor hasn't invaded into the arterial walls, we could create a plane of dissection.
Well, if it's a noninvasive liposarcoma we can work it off from the outside.
Blunt dissection and tissue forceps peel it off piece by piece.
It's a leiomyosarcoma.
Well, that sucks.
- Yes, it's sad.
- The surgery's impossible.
Well, might as well wake her up let her know she has three months to live, offer palliative care.
The surgery isn't impossible just, very, very, very difficult.
Yes, in the sense that we'll be operating blind.
Yes, because the left kidney is in the way.
- The healthy left kidney.
- Both kidneys are healthy, Jared.
She only needs one.
Without the left one, it's theoretically possible to access the tumor and remove it.
You're suggesting we cut out a perfectly healthy organ - just to get a better view? - Yes.
- But she might die anyway.
- Yes.
Quite probably.
I have to go.
I have a boil to lance.
I mean, it's a brilliant very, very, very terrible idea.
Close her up and wake her up.
Who wants to join me when I tell her she has six weeks left to live? There is one possibility.
If we removed the left kidney, we might be able to get a good enough view to successfully remove the mass.
Take out a healthy kidney to get a better view? That's insane.
A good view's half the battle in any operation.
Most likely outcome is we'd be depriving her of what little time she has left.
But if we succeed You want to do this 'cause it's exciting.
You want to be a hero.
But if you fail, this woman dies.
She misses her son's wedding.
Well, that's the issue, isn't it? You promised this woman she'll be okay.
She had to do this surgery.
I might as well tell her good things.
The reason we don't make patients promises isn't just for legal.
Jared's right.
Your judgment is compromised.
- I still think - You're not objective.
Who the hell is? We should at least wake her up, explain what we found, what we're hoping to do, - and get a new consent.
- What we're hoping to do is exactly what you told her we were going to do remove that tumor.
The only thing we'd be explaining is why you undersold the risks.
We're doing the surgery.
And, Jared, you're my new number two.
- Mayos.
- Mayos.
I'm going to open the fascia and expose the kidney.
You clamp the renal hilum.
- Clamp.
- Clamp.
We just cut off the blood supply to a perfectly healthy kidney.
If we needed color commentary, I would have hired Jeff Van Gundy.
Shaun, I believe you've met Trevor.
Yes.
I sent him home.
Yes, well, he didn't go home.
He actually came to the president of the hospital instead.
H-He said you sent him home even though you thought he was sick.
I specifically never said that.
- I made sure not to say that.
- No.
Oh.
What what the hell does that mean? - What does that mean, Shaun? - A-Am I healthy? - Probably.
- You're a doctor.
- You're you're supposed to know.
- No, we're not Nobody knows anything for sure.
Anybody could drop dead of a heart attack at any time.
Who is this guy? Am I Am I gonna have a heart attack? Shaun has some difficulty with certain social interactions, but if he says that I don't give a crap what he says.
W-What do you say? Am I healthy? I've reviewed your chart, and I can say with complete confidence that you are in peak physical condition.
Thank God.
Shaun, people need reassurance.
I told him he was safe to go home.
- I was very clear.
- W-With your words Your actions said something completely different.
No, they didn't.
My actions were completely silent.
When you reassure someone, they have to receive it.
You have to gauge whether they actually are reassured.
You understand? When did you review Trevor's chart? I didn't.
It's not really a lie.
If you say that he is safe to go home, then I know for a fact that he's safe to go home.
I sent a girl home today.
How often do people develop stomach issues because of their brain? Based on my personal experience? Every single day.
I want D-dimer, lactate, and amylase for a 10-year-old girl, Martine LaDuff.
She might have a tummy ache caused by stress.
Or she might not.
Hi, Shaun.
Hi, Carly.
That's a lot of tests for an upset stomach.
You could get in trouble.
That's definitely true.
- Remove the kidney.
- All right.
Let's get in there with some suction, Claire, so we can get a better view of what we're dealing with.
There it is.
It's a mess.
Yes, it is.
But now it's a mess we can see.
Everything is within normal range.
Hmm.
Slightly elevated lactate and amylase, and she's very small.
Normal should be lower.
Normal should be lower.
What do you think she has? Thank you.
W-What the hell? It it's after 1:00.
I ran tests.
The results were ambiguous.
I think Martine has intestinal malrotation and that a volvulus has occurred.
Ambiguous tests told you this.
It's a genetic condition.
The symptoms are very similar to stress.
Call us in the morning.
Okay, she may not be alive in the morning.
Does your boss know you're here? No, I think he'd be upset with me for being here.
I am not waking my daughter up in the middle of a school night because of some freak.
And you don't need to call me in the morning, because I'll be calling your boss in the morning.
Were you being sarcastic? - How hard is it to get rid of someone.
- I told him You're right.
I'm weird.
Part of my weirdness is that I perseverate.
That means I keep thinking about things.
So I will keep knocking on your door until I know Martine is okay.
Martine.
Martine.
Martine.
Martine, you need to wake up! - Honey? - Martine? - She vomited.
- I-I can't wake her! - I'll call 911.
- N-No.
There's no time.
- Do you have a car? - Yeah.
Shaun what's wrong? What's wrong? Hey, hey.
You called me.
What's wrong? Hey, look at me.
Look at me! What's You don't have to say the whole thing, okay? Just one thing, okay? - One thing, - My my brother.
Hold on, Shaun.
Hold on now, hold on.
Her pulse is too weak to perfuse her organs.
What? What does that Jerry! Please hurry.
Watch your back! Patient is a 10-year-old female.
She has bradycardia with hypovolemic shock.
- She needs oxygen, IV adrenaline - Go! and a liter of saline.
- Wide open, please! - Coming through! Her pulse is better.
She needs an ultrasound.
That is it.
Wow.
I think you got it all.
- You "think"? - No.
You definitely did.
- I just can't quite believe it.
- It was your idea.
You should have more confidence.
Nice work, Doctor.
There.
The small bowel is twisted around the superior mesenteric artery.
Martine needs surgery immediately.
We need to confirm with Dr.
Melendez.
N-No.
Dr.
Melendez is in surgery.
Part of Martine's bowel is dying - and killing her with it.
- No.
You cannot make these calls on your own.
Dr.
Melendez was very clear.
He was very clear.
It's past midnight, which means it's tomorrow, which means you're no longer my boss.
Is this the O.
R.
scheduler? Yes, this is Dr.
Murphy.
Prepare an O.
R.
for surgery.
Ten blade.
I'll take it from here.
Nice diagnosis.
I'll handle the repair work.
Is Stephanie okay? Yes.
Jared had an excellent idea, and she's gonna be fine.
- Light.
- Light.
Would you like me to assist? Mm, pretty basic I think I can take this one on my own.
Go home.
Get some sleep.
Let him stay.
Dr.
Andrews, I believe our opinions on the wisdom of hiring Dr.
Murphy That battle is lost.
Shaun is here, and we have to accept it, and we will treat him like any other resident.
- Sir, it's my team.
- And it's my department.
Dr.
Murphy.
Back on suction congratulations.
Whoo! I am gonna get a drink.
I'm way too wound up to sleep.
You care to join me? For either? Don't think so.
Seriously? We were just part of something amazing.
We reached into that woman, and we healed her.
And you're what? Cranky? Maybe you could learn something from me.
Like what? To steal credit? Make yourself a hero with Shaun's idea? No, but I fought for it.
I went out on a limb for him.
I deserve credit for that.
Why didn't you rat me out as soon as I brought it up? - It seemed beside the point.
- No, you didn't rat me out 'cause you thought the idea was crazy.
You were letting me take the fall.
Is that fair? My idea if it fails, but Shaun's if it succeeds? But I'll tell you what I'll accept that you're right.
I'll apologize to the whole team if you prove to me that you're not a hypocrite.
How am I supposed to prove something like that? Our patient's about to come out of anesthesia.
Tell her the truth.
When she wakes up and hears what we did, how we miraculously saved her life, be honest with her about credit.
Tell her you didn't want to do it.
Tell her that you wanted to send her home to die.
I hear you got Shaun off scut and back into surgery.
I heard you tried.
You're welcome.
Just a friendly warning I know you have no interest in helping Shaun.
You figure you'll give him a little authority, he'll screw something up, and then you'll be done with him, and then you'll be done with me.
You're right about me.
I am getting old and maybe a little emotional.
Maybe I over-committed.
But you're wrong about Shaun.
He's gonna handle anything you throw at him.
Either way, if he succeeds, I'm the guy who just backed him.
And if he fails, I'm the president.
Everything went great.
Thank you.
Thank you.
- Thank you.
- There were complications - But I'm okay? - Yeah, but the surgery I don't care.
You saved me.
Thank you.
My son's going to be here soon.
I told him you said it would be okay, but he flew in anyway.
You saved me.
You're gonna be a beautiful mother of the groom.
Go on and take a bow.
You've earned it.
Why does it matter who gets credit? It matters because the people who get credit, they don't have to do scut work.
Dr.
Murphy, thank you so much.
Thank you!
Does it sound like I'm describing a surgeon? You saved his life.
I'm Dr.
Shaun Murphy.
Never forget, you're the smart one and I'm proud of you, Shaun.
My brother went to Heaven in front of my eyes.
He's got a serious deficit.
We hire Shaun, and we give hope to those people with limitations that those limitations are not what they think they are, that they do have a shot! If Shaun doesn't live up to everything I know he can do, I will resign my position as president of this hospital.
Where to? San Jose St.
Bonaventure Hospital.
I'm a surgical resident.
Today is my first full day.
I meant floor.
Oh, ground floor.
I'm taking the bus.
This is Mitchell Brand, 55 years old, post-op day one from a radical prostatectomy.
Morning, Mitchell.
I'm Dr.
Melendez.
These are my residents Dr.
Browne and Dr.
Kalu.
Your surgery went perfectly.
Yeah.
Am I ever gonna walk again? Yes.
Of course.
This is Mitchell Brand.
I reviewed his chart.
He's 55 years old from Chicago, divorced with two children.
You did a radical prostatectomy on him yesterday.
There are many possible complications but none related to motor neurons.
There is no chance you won't be able to walk.
He he wasn't worried about his legs.
Oh, yes.
There's a significant chance of impotence.
Dr.
Murphy, you're late.
No, the bus was late.
The schedule was clear.
They post it online.
But the 4 bus was late which meant - You're late.
- Five minutes, we've all been On your first day, no less.
It is your responsibility to be here.
if you are not, you have failed in your responsibility, - which makes it your fault.
- Okay, how can it be my fault? - I did nothing wrong.
The bus - Yeah.
This is gonna work out great.
The board clearly made the right choice in hiring you.
Thank you.
Dr.
Melendez, we've got an emergent consult in the E.
R.
You should be fine if you can leave it alone for a couple days.
Four days of indigestion, bloating, constipation, and nausea.
And a lot of pain, apparently.
Yeah.
- Did you give her morphine? - Yeah, 10 milligrams.
Hasn't touched her pain.
You have time to get a CT? Yeah.
That's why I called you.
That's very big.
Yes, it is.
What are we looking at? It's definitely abutting the aorta and the left kidney.
Renal angiomyolipoma? - Do you see an extensive blood supply? - No.
Maybe some kind of neurogenic tumor.
Or maybe a lymphoma.
She has a sarcoma, a malignant tumor.
Malignant? - That means it's killing me, right? - Yes.
Not necessarily.
We're just speculating right now.
No.
It's definitely malignant.
If it weren't malignant - Please stop saying "malignant.
" - Should we talk outside? Give her more morphine.
As much as she wants.
Okay.
You scared her.
- Didn't need to be so blunt.
- Why? Her prognosis is terminal without immediate medical intervention.
Isn't that scary? Well That fear does her no good.
Does she have a malignant sarcoma? Are we gonna be doing a laparotomy? We need intra-operative staging for the biopsy, extensive dissection of the retroperitoneum, and excision of the mass with wide, clear margins.
I want in.
You do know you're drooling, right? About cutting open a 40-year-old woman.
Real person.
Right behind that door.
It's called bedside manner no such thing as outside-the-door manner.
It is exciting, Claire.
We'd be saving a life, and we'd be learning.
See? Dr.
Browne, you're my number two.
- With all due respect, doctor - Comments that start that way rarely come across that way.
- I was gonna say that's an excellent call.
- Thank you.
- Jared, prep the surgical team.
- Sir, what do I do? - Scut work.
- What's scut work? Today, I'm gonna need my surgeons to have no distractions.
So I'm gonna need you to handle those distractions.
All the work they do every day that they hate doing, you're handling it for them.
Make sure they know we still need a consent on that one.
Am I being punished for something? No.
Okay.
So that's it? You just accept my answer at face value? Why? You're very arrogant.
Arrogant people don't think they need to lie.
So you must be doing this to teach me.
I look forward to learning from scut work.
- Say "Ahh.
" - Ahhh.
How long will this be? Seven minutes.
Without any complications, it takes seven minutes to do a discharge examination properly.
Dr.
Dunsmuir has already cleared him to go - and we need the bed.
- Okay.
Protocol requires that the surgical department also clears him.
You have an ear infection.
Yes, that's why he's here.
My hearing's been a little muffled, and I've had some ringing.
They gave him amoxicillin.
And we're sending him home.
Which is why you're here.
To send him home.
I'd like an MRI of the head and internal auditory meatus.
I'm not being discharged? What do you think is wrong? I'll tell you when I know for sure.
I don't want to scare you.
Shaun.
What are you doing down here? I'm waiting for her to fart.
Flatulence.
But I'm using the word "fart" in front of the patient to be more casual.
But you're the president of the hospital, so I'll say "flatulence" to you.
Well, I appreciate that.
Why are you doing that? She had her deviated septum repaired.
Before we can release her, we have to be sure she isn't suffering from post-operative ileus.
Ah.
This is what Dr.
Melendez feels you'll be most useful doing today? Waiting for farts? - I'm not just waiting for farts.
- Thank goodness.
I'm doing all the scut work.
Well Welcome to your surgical residency.
Thank you.
There.
I think that was it.
I don't think so.
I'll wait a little longer.
This is important.
The procedure is called a laparotomy.
Mm.
Yeah, your heart sounds good.
So, we make a long incision down the middle of your abdomen, - expose the tumor - Am I going to die? Dr.
Melendez is the best surgeon I have ever seen Can this all wait? You have a very serious condition.
It's not advisable to Just a couple of weeks.
My son is getting married next weekend.
They look very happy.
After the initial incision They've been planning this for months.
If they have to reschedule Well well, this this is complicated surgery, but if all goes well, recovery is pretty easy.
No need to reschedule anything.
And if it doesn't? If it doesn't go well? My husband died in a car accident a couple of years ago.
Mark is our only child.
I can't die right before his wedding.
I can't.
You're not gonna die.
You will be at the wedding.
Looking beautiful.
You're not supposed to make promises like that, Dr.
Browne.
Yeah, I told her what she needed to hear.
Officially, our legal department's policy is tell the ugly truth the uglier the better.
Is that what you did? I don't think that's what you did.
Yeah, well, it's a dumb policy.
She needs to have the surgery.
Scaring her would change nothing.
Right, because a much better policy would be to lie to all of our patients whenever it makes you feel better.
No, it doesn't make me feel better.
It makes her feel better.
I'm pathetic.
- What? - I am pathetic.
And here's my thinking, so just just bear with me, because it kind of insults both of us.
You met that woman an hour ago, and you lied to her.
A pity lie because you obviously care about her.
A pity lie that has absolutely zero upside for you, but I can't make you, the world's softest touch, care about me.
Hey.
I need a consult.
What? You have a question about this? This patient is perfectly healthy.
There's not even any artifact in these images.
Yeah, which in turn raises an interesting medical question why the hell did this patient get an MRI? I don't know anything about this.
Yeah.
Someone on your team ordered it.
It's your responsibility, which makes it your fault.
What How did you? It's my department.
It's my job to know everything.
Well, then, since I work for you, doesn't that make all of this actually your fault? Oh, I'm sorry, I stopped listening after "I work for you.
" Does that hurt? Yes.
Does that hurt? Yes.
Does that hurt? How much are we paying for this? She has a tummy ache.
- That's what they do they ache.
- Shh.
She's just trying to get out of school.
Again.
Where do you think she learned that from? You don't think she hears you calling in sick to work right before you go golfing? I like school.
Me too.
What did you eat for dinner last night? Cereal.
- I thought you made meatloaf.
- I did.
And it got cold while we were waiting for you.
I want D-dimer, lactate, and amylase What tests are you ordering? D-dimer, lactate, and amylase.
- For a tummy ache? Hmm? - Yes.
I'm concerned it may be Shall we talk outside? I told you something was wrong.
You're happy she might be sick? I'm happy you're wrong.
Yeah.
Let's talk outside.
Have they been bickering like that the whole time? I didn't notice.
They aren't sick.
- Yeah, they're what we call a vector.
- Hmm? A carrier.
A cause of disease.
- You mean the parents? - Yeah.
That little girl has a tummy ache because mommy and daddy won't stop fighting.
This isn't a medical issue.
Send them home.
Could be intestinal malrotation, which could quickly become fatal.
And every patient in this hospital could have malaria, but that doesn't mean we're gonna go around testing for every condition we think they could have.
For example, that MRI you ordered on the guy with the ear infection? Nice call, genius.
Thank you.
I was being sarcastic.
It's normal.
He's healthy.
Send him home, too.
Why are you smiling? Because you're right.
So you thought he was making a mistake and didn't say anything? Just stood by watching, taking notes while he wasted everybody's time? Is that your job? In my experience, doctors don't listen to nurses.
And they only talk to us to lecture us when they figure we screwed something up.
From now on, you don't run any tests you don't have to run.
How do I know if a test is needed until after I run it? She'll tell you.
Today, she's your boss.
I could never eat before surgery.
Puke? I could do that.
I get cranky if I don't eat.
- I hear Shaun made the call.
- Mm.
He's an excellent diagnostician.
You should get him a job in radiology.
He doesn't want to be a radiologist.
He wants to be a surgeon.
That's what we hired him to be.
That's what I worked damn hard to hire him to be.
Not a glorified orderly.
Every resident does scut work.
So you're treating him like anybody else? - Are you? - Yes, yes, I am.
He more than earned the right to be here.
He has had to get past people like you and their prejudices every step of the way.
- Prejudices? - Yeah, prejudices.
You have any idea how many patients he's scared the crap out of today? How many wasted tests he ordered? So teach him.
I'm doing that.
I'm teaching you both that he doesn't belong.
Okay.
You're gonna make me pull rank, I will pull rank.
This is my hospital.
But it's my team.
You can't tell me how to run my team.
Hey.
How are you doing? What's the point of sarcasm? Um Well, uh Like, sometimes, it's a way of critiquing people in a way that's funny so they don't feel quite so bad.
Isn't it just lying? Mm, well, it's not lying, because people know you're lying.
I'm not good at that.
You may remember me from last year.
We sell chocolate bars every year to pay for our class trip to Mt.
Rushmore.
Okay.
But this year we're not going to Mt.
Rushmore, because Kenny can't go.
He's got cancer.
So, Samantha had the idea that if he can't go, none of us would go, and we all thought that was a great idea.
So, we're gonna have a party at the hospital for him.
There are two Kennys in your class.
Is it Kenny L.
or Kenny M.
? No one's sick.
Well, you lied? - You weren't supposed to lie.
- Yeah.
And you and me aren't supposed to starve.
We need money for food.
Was any of that true? Yeah.
We're not going to Mt.
Rushmore.
I can't discharge people if I think they might still be sick.
Um, of course not.
Why would you? Dr.
Melendez made Nurse Fryday my boss today.
Should I speak to Dr.
Glassman? No.
What did you think this job was? To save people's lives.
No.
I mean, yeah, sometimes we do save lives.
But the job It's doing whatever Melendez asks us to do.
Paging Dr.
Browne.
Paging Dr.
Browne to the O.
R.
I'm Dr.
Claire Browne.
I'm first assist today, and I'll be leading the timeout.
Patient's name, Stephanie Willis.
Scheduled surgery? Excision of an indeterminate retroperitoneal tumor.
We don't anticipate any complications with the surgery.
Thank you, Dr.
Browne.
Ten blade.
Let's remove a tumor.
Excuse me.
No.
It might be infected.
- It's not.
- There is some discoloration.
He's 82 years old.
Everything is discolored.
Once we get through the muscle layer, proceed carefully.
Blood pressure, 120 over 70.
Heart rate 60.
She's holding steady.
I've opened the facia.
You kept your puke? Yeah, I thought you'd want to see it.
It looks like puke.
No.
No, no.
It's not the regular color.
Your puke has a regular color? Yeah.
It is a bit of an unusual color.
We could order some I'm sending you home.
You sure? It It's safe for me to go home? I don't know what to say.
You'll learn.
By doing.
Hi.
My brother said there's a kid named Kenny, and he's sick, and there might you should give us money.
So, am I okay? Am Am I okay? According to all hospital rules and direct instructions given to me, yes.
But Whoa.
We need a better exposure of this tumor.
Let's get the deep Balfour in here.
Deep Balfour retractor.
Let's get this thing open.
I've got to see where it's safe to cut.
Yeah.
Thanks.
I can't see anywhere where this tumor hasn't encased her arteries.
Claire, tell me you got something.
I've got nothing.
This tumor is way bigger than it looked on the scans.
II can't even see her aorta.
That's a problem.
Is that the girl with the bickering parents? Didn't we send her home four hours ago? Dr.
Murphy, Dr.
Melendez needs you in surgery.
That won't be necessary.
The tumor's entirely encased the large abdominal arteries.
That's very bad.
If it's in the artery walls, it's going to be impossible to cut out without killing her.
You should get a biopsy to determine where the margins are.
Thank you.
You're welcome.
I was being sarcastic again.
Oh, I-I see, because you are already know everything I said, and you already sent a biopsy to the lab? Yes, 'cause I'm a doctor, too.
Yes.
But you need me? Yeah, I need you to run down to the lab and hurry them along.
I'm Dr.
Shaun Murphy.
I'm a surgical resident.
Dr.
Melendez sent you a biopsy.
When will the results be ready? When I get to it.
It's very important.
They're all very important.
Let me see the other test orders.
I'll tell you which ones are most important, and you can do them in that order.
I'll be honest and fair.
That is not the way that it works.
Now go wait your turn.
Do it again.
- Get the hell away from me, you moron.
- Let's get out of here! Wait, wait, wait, wait! If you want to get anything in life, Shaun, there's one thing you got to do.
Never be afraid.
You're the moron! If you don't do Dr.
Melendez's test right now, I will throw a rock through your window.
Well, I wouldn't want that.
Go have a seat.
Your results will be ready in 15 minutes.
You got a minute? I have a patient lying in the O.
R.
waiting for lab results, and I'm sitting here trying to figure out what the hell I'm gonna do next, and I don't like any of my options, so yeah, unfortunately it seems I do.
Okay, we can talk another time.
Glassman talked to you? I don't have a problem with an autistic doctor.
No, you just have a problem with one working for you.
Really? That's how you see me? Let's not make this personal.
You're accusing me of prejudice.
I have a problem with the doctor who has a problem with communication.
Okay, let's make this personal.
Who do you respect at this hospital? You and Glassman.
And who do you not respect? And does it bother you that it looks like you're on the wrong team? If the tumor hasn't invaded into the arterial walls, we could create a plane of dissection.
Well, if it's a noninvasive liposarcoma we can work it off from the outside.
Blunt dissection and tissue forceps peel it off piece by piece.
It's a leiomyosarcoma.
Well, that sucks.
- Yes, it's sad.
- The surgery's impossible.
Well, might as well wake her up let her know she has three months to live, offer palliative care.
The surgery isn't impossible just, very, very, very difficult.
Yes, in the sense that we'll be operating blind.
Yes, because the left kidney is in the way.
- The healthy left kidney.
- Both kidneys are healthy, Jared.
She only needs one.
Without the left one, it's theoretically possible to access the tumor and remove it.
You're suggesting we cut out a perfectly healthy organ - just to get a better view? - Yes.
- But she might die anyway.
- Yes.
Quite probably.
I have to go.
I have a boil to lance.
I mean, it's a brilliant very, very, very terrible idea.
Close her up and wake her up.
Who wants to join me when I tell her she has six weeks left to live? There is one possibility.
If we removed the left kidney, we might be able to get a good enough view to successfully remove the mass.
Take out a healthy kidney to get a better view? That's insane.
A good view's half the battle in any operation.
Most likely outcome is we'd be depriving her of what little time she has left.
But if we succeed You want to do this 'cause it's exciting.
You want to be a hero.
But if you fail, this woman dies.
She misses her son's wedding.
Well, that's the issue, isn't it? You promised this woman she'll be okay.
She had to do this surgery.
I might as well tell her good things.
The reason we don't make patients promises isn't just for legal.
Jared's right.
Your judgment is compromised.
- I still think - You're not objective.
Who the hell is? We should at least wake her up, explain what we found, what we're hoping to do, - and get a new consent.
- What we're hoping to do is exactly what you told her we were going to do remove that tumor.
The only thing we'd be explaining is why you undersold the risks.
We're doing the surgery.
And, Jared, you're my new number two.
- Mayos.
- Mayos.
I'm going to open the fascia and expose the kidney.
You clamp the renal hilum.
- Clamp.
- Clamp.
We just cut off the blood supply to a perfectly healthy kidney.
If we needed color commentary, I would have hired Jeff Van Gundy.
Shaun, I believe you've met Trevor.
Yes.
I sent him home.
Yes, well, he didn't go home.
He actually came to the president of the hospital instead.
H-He said you sent him home even though you thought he was sick.
I specifically never said that.
- I made sure not to say that.
- No.
Oh.
What what the hell does that mean? - What does that mean, Shaun? - A-Am I healthy? - Probably.
- You're a doctor.
- You're you're supposed to know.
- No, we're not Nobody knows anything for sure.
Anybody could drop dead of a heart attack at any time.
Who is this guy? Am I Am I gonna have a heart attack? Shaun has some difficulty with certain social interactions, but if he says that I don't give a crap what he says.
W-What do you say? Am I healthy? I've reviewed your chart, and I can say with complete confidence that you are in peak physical condition.
Thank God.
Shaun, people need reassurance.
I told him he was safe to go home.
- I was very clear.
- W-With your words Your actions said something completely different.
No, they didn't.
My actions were completely silent.
When you reassure someone, they have to receive it.
You have to gauge whether they actually are reassured.
You understand? When did you review Trevor's chart? I didn't.
It's not really a lie.
If you say that he is safe to go home, then I know for a fact that he's safe to go home.
I sent a girl home today.
How often do people develop stomach issues because of their brain? Based on my personal experience? Every single day.
I want D-dimer, lactate, and amylase for a 10-year-old girl, Martine LaDuff.
She might have a tummy ache caused by stress.
Or she might not.
Hi, Shaun.
Hi, Carly.
That's a lot of tests for an upset stomach.
You could get in trouble.
That's definitely true.
- Remove the kidney.
- All right.
Let's get in there with some suction, Claire, so we can get a better view of what we're dealing with.
There it is.
It's a mess.
Yes, it is.
But now it's a mess we can see.
Everything is within normal range.
Hmm.
Slightly elevated lactate and amylase, and she's very small.
Normal should be lower.
Normal should be lower.
What do you think she has? Thank you.
W-What the hell? It it's after 1:00.
I ran tests.
The results were ambiguous.
I think Martine has intestinal malrotation and that a volvulus has occurred.
Ambiguous tests told you this.
It's a genetic condition.
The symptoms are very similar to stress.
Call us in the morning.
Okay, she may not be alive in the morning.
Does your boss know you're here? No, I think he'd be upset with me for being here.
I am not waking my daughter up in the middle of a school night because of some freak.
And you don't need to call me in the morning, because I'll be calling your boss in the morning.
Were you being sarcastic? - How hard is it to get rid of someone.
- I told him You're right.
I'm weird.
Part of my weirdness is that I perseverate.
That means I keep thinking about things.
So I will keep knocking on your door until I know Martine is okay.
Martine.
Martine.
Martine.
Martine, you need to wake up! - Honey? - Martine? - She vomited.
- I-I can't wake her! - I'll call 911.
- N-No.
There's no time.
- Do you have a car? - Yeah.
Shaun what's wrong? What's wrong? Hey, hey.
You called me.
What's wrong? Hey, look at me.
Look at me! What's You don't have to say the whole thing, okay? Just one thing, okay? - One thing, - My my brother.
Hold on, Shaun.
Hold on now, hold on.
Her pulse is too weak to perfuse her organs.
What? What does that Jerry! Please hurry.
Watch your back! Patient is a 10-year-old female.
She has bradycardia with hypovolemic shock.
- She needs oxygen, IV adrenaline - Go! and a liter of saline.
- Wide open, please! - Coming through! Her pulse is better.
She needs an ultrasound.
That is it.
Wow.
I think you got it all.
- You "think"? - No.
You definitely did.
- I just can't quite believe it.
- It was your idea.
You should have more confidence.
Nice work, Doctor.
There.
The small bowel is twisted around the superior mesenteric artery.
Martine needs surgery immediately.
We need to confirm with Dr.
Melendez.
N-No.
Dr.
Melendez is in surgery.
Part of Martine's bowel is dying - and killing her with it.
- No.
You cannot make these calls on your own.
Dr.
Melendez was very clear.
He was very clear.
It's past midnight, which means it's tomorrow, which means you're no longer my boss.
Is this the O.
R.
scheduler? Yes, this is Dr.
Murphy.
Prepare an O.
R.
for surgery.
Ten blade.
I'll take it from here.
Nice diagnosis.
I'll handle the repair work.
Is Stephanie okay? Yes.
Jared had an excellent idea, and she's gonna be fine.
- Light.
- Light.
Would you like me to assist? Mm, pretty basic I think I can take this one on my own.
Go home.
Get some sleep.
Let him stay.
Dr.
Andrews, I believe our opinions on the wisdom of hiring Dr.
Murphy That battle is lost.
Shaun is here, and we have to accept it, and we will treat him like any other resident.
- Sir, it's my team.
- And it's my department.
Dr.
Murphy.
Back on suction congratulations.
Whoo! I am gonna get a drink.
I'm way too wound up to sleep.
You care to join me? For either? Don't think so.
Seriously? We were just part of something amazing.
We reached into that woman, and we healed her.
And you're what? Cranky? Maybe you could learn something from me.
Like what? To steal credit? Make yourself a hero with Shaun's idea? No, but I fought for it.
I went out on a limb for him.
I deserve credit for that.
Why didn't you rat me out as soon as I brought it up? - It seemed beside the point.
- No, you didn't rat me out 'cause you thought the idea was crazy.
You were letting me take the fall.
Is that fair? My idea if it fails, but Shaun's if it succeeds? But I'll tell you what I'll accept that you're right.
I'll apologize to the whole team if you prove to me that you're not a hypocrite.
How am I supposed to prove something like that? Our patient's about to come out of anesthesia.
Tell her the truth.
When she wakes up and hears what we did, how we miraculously saved her life, be honest with her about credit.
Tell her you didn't want to do it.
Tell her that you wanted to send her home to die.
I hear you got Shaun off scut and back into surgery.
I heard you tried.
You're welcome.
Just a friendly warning I know you have no interest in helping Shaun.
You figure you'll give him a little authority, he'll screw something up, and then you'll be done with him, and then you'll be done with me.
You're right about me.
I am getting old and maybe a little emotional.
Maybe I over-committed.
But you're wrong about Shaun.
He's gonna handle anything you throw at him.
Either way, if he succeeds, I'm the guy who just backed him.
And if he fails, I'm the president.
Everything went great.
Thank you.
Thank you.
- Thank you.
- There were complications - But I'm okay? - Yeah, but the surgery I don't care.
You saved me.
Thank you.
My son's going to be here soon.
I told him you said it would be okay, but he flew in anyway.
You saved me.
You're gonna be a beautiful mother of the groom.
Go on and take a bow.
You've earned it.
Why does it matter who gets credit? It matters because the people who get credit, they don't have to do scut work.
Dr.
Murphy, thank you so much.
Thank you!