The Good Doctor (2017) s01e06 Episode Script
Not Fake
1 Previously on "The Good Doctor" Is there something you're not telling me? When we're in meetings together, don't ever call my ideas "ridiculous.
" Come on.
I'm being serious.
So am I.
Merrill's son asked for personal advice.
- And he picked you.
- I know, right? A surgeon needs to communicate.
Can Dr.
Murphy do that? Can he do that under stress? Can he do that knowing that a human life literally hangs in the balance? Farrar: Thank you, Dr.
Kalu.
Jared: You're welcome.
It's a special blend.
I roast the beans myself.
Smells like leather.
Then none for you, Murphy.
I don't drink coffee.
[Mugs clink.]
It is dead in here.
That's why they call it the graveyard shift.
Oh, well, I call it paradise.
You my trauma virgins? Ah, Doctors Murphy, Kalu, Browne meet Dr.
Audrey Lim, your attending for the evening.
Hey.
Coffee? He roasts the beans himself.
Oh.
Kiss ass.
[Laughs.]
E.
R.
How long? Got it.
Listen up, everybody! We got a mass cas coming in.
It's a bus crash, two dozen passengers.
Transfer all patients waiting for beds up to the nursing units.
Have maintenance bring down cots.
We're gonna convert the waiting room into triage.
No one goes home till we're all clear! Dr.
Lim: Page everyone on call.
I don't care what department they are.
Tonight, everybody's trauma.
Glove up and line up.
EMTs will have triaged onsite, so the patients are gonna come in tagged.
I love these blank faces right before Armageddon.
Trauma color coding who knows it? Green walking wounded.
Yellow observation.
Red needs immediate attention.
And black go straight to the morgue.
[Sirens wail.]
All right, red tags, front of the line! Red tags, front of the line.
Wedding bus blew a tire and flipped! 26-year-old female.
Second-and third-degree burns to her neck, chest, and left arm.
Kalu, you're up.
- [Moaning.]
- Trauma Six.
EMT: Guy was ejected 30 feet from the vehicle.
Multiple chest contusions, acute respiratory distress on the scene, sluggish pupillary response.
- How long have you been doing CPR? - 12 minutes.
- Have you shocked him? - Three times.
We got to crack him.
Dr.
Browne, I got this.
You take the next one.
All right, Bay Five.
[Indistinct chatter.]
We secured the foreign object and staunched the bleeding, but didn't want to touch it otherwise.
- Good thing.
It nicked her carotid.
- What is it? Right now it's a little Dutch boy keeping her from bleeding out.
Pulse ox is dropping.
She's at 87.
O2 sats down to 83.
Forget about the neck, Claire.
Treat her like any other patient.
What are the first steps? Airway, breathing, circulation.
Good.
Grab a kit.
I need help here! Somebody, help! Murphy, go! [People groaning.]
Let's go.
Trauma Three.
[Woman speaks indistinctly over P.
A.
.]
I can't stop the bleeding.
[Monitor beeps rapidly.]
- He's bleeding out.
- Do something.
[Beeping continues.]
I need a urinary catheter, 14-gauge needle, arterial guide wire, occlusion balloon, and 20 cc of saline, stat.
[Monitor beeping rapidly.]
- EMT #2: What's he doing? - I have no idea.
Well, you don't have one, so I'm making a REBOA.
A what? A REBOA.
Is that even a word? A REBOA will occlude the damaged artery and stop the bleeding.
Release the pressure.
[Beeping slows.]
BP is stabilizing.
90 over 60.
[Beeping continues.]
Nice work, Dr.
Murphy.
I made a REBOA.
[Gasping.]
- Oxygen is dropping to 89.
- All right.
Light.
Open wide for me.
Throat's swollen from smoke inhalation.
Cric kit.
- Do you see soot in her mouth or nose? - No.
She doesn't need a cric.
She needs an escharotomy.
[Monitor beeping rapidly.]
[Gasps.]
[Beeping slows.]
Sats are going back up.
92 and rising.
Circumferential neck burns.
The shrinking charred skin is acting like a noose.
Escharotomy relieves the constriction.
Are you getting enough air now, ma'am? Yes.
Thank you.
Now get her out of this petri dish and into an isolation ward in the burn unit ASAP.
Yes, sir.
Your heart's a bit muffled.
Am I having a heart attack? No, but it's not completely good news.
Cardiac tamponade.
He needs a pericardiocentesis.
Yes, I'm aware of that.
18-gauge and 55 cc syringe, please.
We need a FAST ultrasound in here.
They're both in use.
[Monitor beeping rapidly.]
You don't have imaging.
You could puncture his heart.
Is the xiphoid in the same place as it was 20 years ago? [Beeping slows.]
[Chuckles.]
A REBOA.
Ballsy.
Could've gone really wrong.
Yes, well, it didn't.
It's a cowboy move something you would never even dream of trying.
How many times is Shaun gonna have to prove himself before you give him a shot? Woman over PA: Dr.
Rolendez, O.
R.
6.
[Monitor beeping slowly.]
What happened in the E.
R.
? Swan girl came in and you hesitated.
I wasn't hesitating.
I was thinking of a game plan.
Murphy was thinking of the game plan.
You got overwhelmed.
I wasn't.
First trauma it happens.
You have to think clearly, quickly, methodically.
You need to think a little more like Shaun.
A little more.
Not identically.
[Whimpering.]
[Screams.]
[Cries.]
[Exhales sharply.]
How you doing? Sorry.
Sorry.
That's a stupid question.
[Sobs.]
You're maxed out on morphine.
I'll hold off until it reloads.
[Shaky breathing.]
How bad is it? We're making good progress.
I'll have to, uh, debride any deroofed blisters to prevent a secondary nosocomial and then I need a mirror.
It's the least you can do since you can't even look me in the eye.
[Crying.]
Oh, my God.
[Exhales deeply.]
Do you know how many hideous $300 bridesmaid dresses I've had to buy in the last two years? I decided that when I got married, my bridesmaids are gonna wear black cocktail dresses so they can use them again, you know? [Sobs.]
But now now I-I'm Freddy Krueger.
[Inhales sharply.]
Who's gonna want to marry this? [Groaning.]
I'm gonna find a nurse, have her adjust your, uh your morphine drip.
[Moaning.]
Okay.
You hit your face.
Your jaw got stuck.
It hurts.
So, this shot I just gave you is gonna knock you out so that I can fix that.
Hang tight.
- Crash patients status check? - 23 people total.
One fatality on site, lost one in the E.
R.
Examined all the red tags.
Got 13 yellow and green still in the waiting room.
- I'll take whoever's up next.
- Marco Magallenes severed femoral artery, crushed femur.
I did the REBOA and then installed a temporary shunt.
Here are his CT and MRI results.
Find someone else for whoever's up next.
Oh, finally.
[Jaw cracks.]
[Woman crying.]
Excuse me.
Are you Marco's family? Ricardo: Yes.
We just found out that my cousin didn't survive the accident.
I'm sorry.
- It's a bit much.
- I'm so sorry.
I'm Dr.
Melendez, and this is Dr.
Murphy.
I'm Ricardo.
I'm M-Marco's father.
This is, uh, his mother, Lorena, and this is Sonia.
They were getting married tonight.
How's my son? Marco's femur was completely shattered, and his lower leg isn't getting enough blood.
Can you save his leg? Marco suffered too much bone fragmentation.
We can't fix it.
Our only choice is to amputate.
[Sobbing.]
Mija.
Bay Five needs a grade three hyphema.
Head CT and page ophthalmology? You read my mind.
Been a while.
How you holding up pulling an all-nighter? I'll manage, but if you can find me a caffeine IV, - Please move! - it'd be helpful.
- Melendez: Tough night.
- Jessica: Yeah.
Thanks for coming.
It's part of the job.
So, when's the big day? Uh, we haven't set it yet.
Oh, where is it gonna be? We'll figure it out.
Maybe a beach somewhere.
We should talk about this later.
What? I like beaches.
If you have a more romantic idea My family likes churches.
We should talk about this later.
Dr.
Lim, I think one of your yellows is about to turn red.
Hey.
Farrar: I've got my wedding all planned out.
I've got the dress, and I've got the flowers.
All I need is a groom.
You available, Dr.
Murphy? No.
You don't want some love? No.
No, I don't.
I don't want love.
Dr.
Glassman, neural consult, bay three.
Thank you.
[Woman speaks indistinctly over P.
A.
.]
Hey! I was here first.
Shaun.
Shaun! My patient's scans are very important.
Well, my patient's important, too.
I need to see my patient's scans.
Is your patient pre-op or post-op? Pre-op.
Okay, I'll give you the computer, but you need to apologize first.
Okay, I'm sorry.
Turn it on.
Why was Marco's family crying when Dr.
Melendez told them his leg would need to be amputated? Well, their son's leg is about to be cut off.
It's sad.
Crying is normal.
But when your options are amputation or death, amputation is good news.
People need time to adjust to big changes.
Marco's family didn't even get a chance to pray for a miracle.
Mm.
It's not possible.
The bone damage is too severe.
A rod implantation won't work.
There's nothing to anchor into, and the shunt won't last long enough to do reconstruction.
There are no other options.
What if we could replace the entire femur? We're making him a new femur.
With a 3D printer? 3D-printed bones have only successfully - been done with the mandible.
- We know.
- That's a fairly small bone.
- We know.
A femur has to support the weight of the entire body.
This one will be titanium.
It can work.
It's an interesting idea but I need to think on it.
Right now we still got seven yellow tags waiting.
What do you have to think about? - It's a good idea.
- It's a brilliant idea.
The kid has brilliant ideas.
That doesn't mean No, it was my idea, and I'm aware of the risks infection, clotting, hardware failure Death.
- It wasn't your idea.
- It was my idea! And the risks are significant, but isn't that their call? - Don't we have to - Maybe he said something, and then you said something, and together, you My idea.
Completely my idea.
The "brilliant" idea is 100% my brilliant idea.
Why is that a problem for you? Maybe because I've known you for six months.
Every day we learn new things.
Today, you learned I'm brilliant.
The idea was brilliant.
And it was mine.
And if anyone can do this brilliant surgery, it's you.
Flattery also brilliant.
[Door opens.]
Claire: Sleeping on the job? [Sighs.]
Just needed some fresh air.
Feels like I'm suffocating in there.
She's in pain, spilling her guts out, and every time I open my mouth, I sound like an idiot.
Dr.
Kalu unable to talk to women.
There's a first.
If you're not gonna be helpful, Claire, just leave.
You don't need to talk.
Just listen to her.
You get to come out here, clear your head.
She's trapped in there, alone with her thoughts, her fears.
You don't think she wants to get out? You are her escape.
You want to put a fake femur into Marco's leg? It's not fake.
It's real.
It's not a real bone.
We're making it out of titanium.
- It's still real.
- That's incredible.
And Marco will be able to walk, run, climb? And swim.
Hopefully.
That's the intention.
Well, have you done the surgery before? - I haven't.
- We'll be the first.
Well, nobody has ever attempted this surgery with a bone as large as the femur.
I believe it's a viable option, but there are risks.
Risks? Could Marco die? In my estimation, there's a 10% chance - he won't make it.
- Then no.
I'm not losing my son.
Wait.
If there's a chance we can save Marco's leg, we should at least discuss this some more.
That's what he'd want.
He'd want to live.
He'd want to have a life.
I know him.
He'd want to take the chance.
I will never forgive myself if Marco died because I made a reckless decision.
Whose decision is this? Does he have a healthcare proxy? I don't know what that is.
When the accident happened, were you on the way to your wedding or on the way back? We were headed to the wedding.
Marco's parents are the next of kin.
They decide.
Please amputate our son's leg.
[Sobs.]
Murphy.
[Sighs.]
Why is the primary closure on the stump so vital in amputation surgery? For a proper prosthetic fitting.
Why are you marrying Jessica? Why does anyone get married? I don't know.
I love her.
I don't understand why having someone to love is so important to everyone.
You have to stand down.
- You can't amputate Marco's leg.
- Why not? I filed an emergency injunction to stop the surgery.
You were in a car accident.
Your neck was punctured.
The repair surgery went well.
You're gonna have to stay put for a week before we can release you.
You're very lucky to be alive.
[Coughs.]
[Raspily.]
My wife, Jenna Hensel is she okay? Can I see her? She's not listed.
That's a good thing.
She's probably still in the waiting room.
I'll find her and bring her up.
She'll be relieved to know you're okay.
Okay.
What the hell am I supposed to do with an unconscious patient whose leg is a ticking time bomb? Judge Singh is en route.
She wants to hear from both parties and the doctors on the case.
I have to testify? - Hopefully not.
- Hopefully not.
I thought you would be happy.
You thought you could save the leg, and I didn't want that not happening because the parents are afraid to make a tough call.
It's their call to make.
And if the accident happened an hour later, it would be the wife's.
And she wants the fake leg.
It's not fake.
I thought you didn't believe in just blindly following protocol.
He's their son.
Nobody's gonna love him more than them.
Seriously? All parents love all children more than anybody else? People get divorced all the time.
How often do they give up their kids? So, if this was us, you'd want your parents to decide over me? - I didn't say that.
- You kind of did.
I was saying, there needs to be rules, that there needs to be bright red lines telling us who gets to make these calls.
It's the parents' call.
Not anymore.
Now it's the judge's.
How much time does Marco have left on the temporary shunt? Three hours, and then his leg will die.
- Okay.
- Mm.
Dr.
Torture returns.
Thought I'd scared you off for good.
Pick a movie.
You deserve to get out of this room for a little while, too.
You think "Groundhog Day" is gonna make a difference? "I'm torturing you, but, hey, you get to watch a funny movie.
" That is sort of what I was going for, yeah.
I'm sorry.
I wish there was something else I could do.
How do you know there isn't? This is protocol.
This is what they teach us.
I lucked out.
I got the world's greatest expert on burn victims? You know everything that can be done.
He loves to rock-climb, scuba dive, bungee-jump.
This is insane.
His leg is literally dying while we sit here reminiscing.
Please.
We're trying to figure out what your son would want.
- He would want to live.
- I want that, too, but if there's a way that we can save Marco's leg, he'd want me to do it.
Mija.
Do you know what he wanted most of all? He wanted to marry you.
He wanted to spend his life with you, have children with you.
Now, he can do all that.
He can be happy with a prosthetic leg.
He's young, and he's strong.
Mija, he can get through this.
- When we met - I don't care about your stories.
I don't care that you met rock-climbing or kayaking or whatever.
- I just want - We met in rehab.
[Man speaks indistinctly over P.
A.
.]
Hey, are either of you Jenna Hensel? I haven't seen Jenna since we took pictures at the hotel.
But she got on the bus? Yeah, she was sitting with Noomi.
I think she's still out there.
- Hey, guys! We've got to go back.
- Where? To the crash site.
Now.
He never wanted you to know.
He's an addict.
He replaced one addiction for another one a healthier one.
- But he needs - What? He needs to wakeboard or he'll drink himself to death? This is ridiculous.
No, it's not! We talked about it a lot.
It's pretty much all you do in rehab.
Marco has clarity for the first time in his life.
He knows what makes him happy.
He knows his weaknesses.
He's not as strong as you think.
And that's okay, but Marco cheated on you.
It was about a month ago.
He was overwhelmed with the wedding and the planning.
He ran into an ex-girlfriend.
It only happened once.
You're lying.
You're upset that he had secrets from you, so No, she's not lying.
Mija, he he was he was so upset.
He does love you.
Okay, maybe we're digressing here a little bit.
And we really don't have the time.
It matters.
She doesn't know him like maybe none of us do, but but we are his parents, and you're not his wife.
Yet.
[Siren wails.]
Okay.
Get the cops.
Check everywhere other side of the road, bushes, trees.
If she was ejected from the bus, she could be 40, 50 feet in any direction.
Claire: Jenna! I found her! I need some help! Okay, she's got a brain bleed.
We need to get her out of here now! Dr.
Andrews.
I think Celez may be eligible for an experimental bone treatment.
Sell it to me.
Well, I've been doing some digging.
San Diego Community Hospital's burn unit has been following a Brazilian hospital's protocol to wrap burns in tilapia skins.
Now Now, I know fish skins sound a bit crazy, but but I was thinking we could do the same thing here.
Dr.
Kalu, I applaud your thinking.
But we Tilapia skins contain more collagen proteins both types 1 and 3 than even human skin, which aids in tissue repair, negating the need for grafts.
- It's shown to accelerate healing, - Dr.
Kalu.
Dr.
Kalu.
would reduce the risk of infection and cut down on the patient's physical pain.
Are you finished, or would you like to cut me off again? Okay, let's follow this through, shall we? You have to come up with a proposal for the experimental treatment, get it approved by our institutional review board, get your hands on medical-grade tilapia skins, and then we Well, I thought you could help expedite the process.
[Scoffs.]
You think I could bring it down from three months to two hours? You finish the debridement? Okay, I'll take over from here.
- Okay.
- Hey.
Keep thinking outside the box.
Initiative is good.
[Police radio chatter.]
I'm in.
Bag her.
Did you get me the drill? The fire truck had one.
What's going on? Her pupil's blown.
She has a subdural hematoma, causing increased intracranial pressure.
If I don't alleviate it now, there's no way she makes it to the hospital alive.
[Drill whirrs.]
[Sighs.]
Okay.
[Drill whirrs.]
[Chuckles.]
Unconscious female.
Flail chest.
I had to do a burr hole in field.
Her sats are in the low 70s.
[Jenna gasping.]
She's good to go to the O.
R.
Subdural hematoma? She had decerebrate posturing, a blown left pupil.
When I passed the drill bit through her skull, a whole lot of blood pooled out.
Good call.
[Door opens.]
Uh, San Diego Community Hospital called.
They're sending the tilapia skins.
They're medevacing them in.
Should be here within the hour.
Celez you meet the criteria for an experimental treatment that I think will prevent you from having to undergo skin grafts.
Hold up.
How did this even happen? Well, I found out San Diego's trial allows for multi-site collaborations.
So, there's no need for us to get our own I.
R.
B.
They give us the skins, we provide the patient data.
- Fish skins? - [Chuckles.]
The tilapia skins have been cleaned and sterilized.
They're perfectly safe.
You'll do it? I'll do it.
Andrews: Well done, Dr.
Kalu.
Well done.
so help you God? Yes.
- Dr.
Melendez can tell you - He has.
But the fake femur is yours, though, right? - How confident are you in its design? - It's not fake! - Shaun, she needs to know - I know what she needs to know.
She needs to know will it work.
She needs to know how long it will last.
Yes.
Okay.
He's his doctor? He is a surgical resident.
He's very gifted.
Is he going to answer my questions? Shaun, I really need you to focus.
- Marco is running out of time! - Just let him answer! No, we already know the answer.
They don't know.
This thing has never been done before.
Be quiet! His toes are changing color.
He's clotting.
That's bad.
Page Dr.
Melendez stat! - Murphy, what do we got? - The shunt is clotting.
It's restricting blood flow.
It is failing.
All right, we need a decision now.
Are we cutting off the leg or replacing the bone? There's no doubt in my mind that Marco's parents and fiancée all love Marco, but it's become clear Now.
I need a decision now.
His parents know him as their child.
Sonia knows him as a man.
- Replace the femur.
- [Gasps.]
Let's go! Thank you! Thank you.
- And there's the bleed.
See it? - Yes, sir.
You ever clip an intracranial artery before? No, sir.
Go for it.
Just like every first time you're a little excited, a little nauseous.
Hopefully nobody gets hurt.
Is it good to go? It's very good.
Forceps.
[Inhales sharply.]
You ready? Yes.
Be careful the clip blades don't catch any perforated arteries.
I don't seen any vessels in the way.
Then what are you waiting for? Very nice.
Thank you.
Everything's dry.
Say goodbye and close the roof.
We need to get blood back into his leg in the next minute or so, or I'm gonna have to amputate after all.
Insulin's hanging, loaded him with calcium.
Best I can do.
Let's release the clamps.
Check for capillary refill.
Blood flow is restored.
EKG is normal.
Okay.
Kim, I want to hear words like "variability" and "Delta".
Give them to me.
I'm waiting patiently.
I'm not getting anything.
Show me.
Claire: Check the leads.
Still nothing.
Maybe there will be some neuroplasticity.
Her brain i-it could rewire itself.
No.
Zero brain activity.
I don't know why, but she's gone.
- [Sighs.]
- What? Your neurosurgery patient that died tonight there's something you should know.
What? Melendez: Now, Marco, I want you to try and move your toes.
[Breathing heavily.]
I can't.
- Is he okay? - We're not sure if the bone He's not gonna die? H-He's not gonna get an infection? - His body's not gonna reject - No, no.
We're monitoring him very closely.
- The biggest threat is behind - He moved.
He moved.
It worked.
You'll have a long recovery ahead months of physical therapy.
But for now, all you have to do is rest.
Thank you.
Thank you for saving my life for saving my leg.
- Thank you.
- You're welcome, sir.
Are you ready to finish what we started? Get well first.
There's plenty of time for a wedding.
- Thank you.
- You're welcome, sir.
Thank you.
You look good.
Tough.
Like Aquaman.
[Laughs.]
Mm.
I look like sushi.
Everybody loves sushi.
[Both laugh.]
It's only for six months.
Your new skin should have completely grown in by then.
Should have minor scarring.
Thank you.
I misjudged you.
You judged me just right.
[Knock on door.]
Is she still sleeping? You haven't told her yet? No.
Can I have a moment please? Of course.
How soon after you found Jenna at the crash site did you intubate her? Almost immediately.
I did a sternal rub.
Uh, she had decerebrate posturing.
Her left pupil was blown.
I knew she had a subdural hematoma, so I intubated, did the burr hole.
She also had a flail chest.
Did you check her breathing after you intubated her? Yes.
Well, at least I-I think I did.
Dr.
Lim told me that when Jenna came into the E.
R.
, she wasn't ventilating properly.
You inserted the tube too deep into her right main stem bronchus of her injured lung.
We had no way of knowing how long she was hypoxic before we gave her the EEG.
I drilled a perfect burr hole into her skull on the side of the road in the middle of the night, and I-I-I screw up her intubation? Yes.
It was tough conditions for anyone resident or not.
Any one of us could have made the same mistake.
I had a woman come into the E.
R.
once [Clears throat.]
a mother, 51 years old.
Francine Parker.
She had two boys.
She had a cough a bad one but a cough.
I checked her out, gave her some antibiotics, sent her home.
Six hours later, she was rolled into the E.
R.
She had had a heart attack, and I missed it, and she died.
Not one day goes by when I don't think about her.
She was your first.
My fourth, actually.
You're not gonna forget this.
You never forget.
But I don't know, maybe we're better off for it the next time around.
You got to find a way to keep going.
Yeah.
Go home.
Get some rest.
I haven't even told her yet.
You're not going to.
You made a mistake.
You're too close to this.
I'm not gonna allow you to talk to the family or anyone else outside this hospital about this.
Do we understand each other? Yes, sir.
I don't have all the words to say I'm still healing from my mistakes I'll take the weight if it makes you stronger I don't want to leave you in this place I called San Diego Community Hospital and thanked them for including us in their study.
They said they were happy to do it.
And they asked that I pass along their thanks to you for your very generous donation to their burn unit.
I know you come from a wealthy family.
I don't begrudge that, but you can't open your wallet every time a patient's in need.
The lines can get real blurry real fast.
Yes, sir.
[Elevator bell dings.]
Who am I to try and save you? I ain't gonna hide You have to fight today What's this? My healthcare proxy.
Jess, nothing's gonna happen.
Really? That's good to know.
I won't let you down I won't let you down No, no, no But I won't let you down I won't let you down No, no, no Well, that was quite a night.
[Chuckles.]
Been a doctor for a long while don't remember a night quite like that one.
Why did Nurse Farrar ask if I wanted love? 'Cause she's a nosy Shaun, you really don't want love? I loved Steve and my rabbit.
Not anymore.
You don't love them anymore? No, I don't.
They're dead.
You can't love someone if they're dead.
Well, I've lost people I love.
I miss them, and it hurts, but I still love them.
I don't want love.
Okay.
You want breakfast? Can I have four pancakes instead of three? You can have five.
I only want four.
Okay.
Okay.
" Come on.
I'm being serious.
So am I.
Merrill's son asked for personal advice.
- And he picked you.
- I know, right? A surgeon needs to communicate.
Can Dr.
Murphy do that? Can he do that under stress? Can he do that knowing that a human life literally hangs in the balance? Farrar: Thank you, Dr.
Kalu.
Jared: You're welcome.
It's a special blend.
I roast the beans myself.
Smells like leather.
Then none for you, Murphy.
I don't drink coffee.
[Mugs clink.]
It is dead in here.
That's why they call it the graveyard shift.
Oh, well, I call it paradise.
You my trauma virgins? Ah, Doctors Murphy, Kalu, Browne meet Dr.
Audrey Lim, your attending for the evening.
Hey.
Coffee? He roasts the beans himself.
Oh.
Kiss ass.
[Laughs.]
E.
R.
How long? Got it.
Listen up, everybody! We got a mass cas coming in.
It's a bus crash, two dozen passengers.
Transfer all patients waiting for beds up to the nursing units.
Have maintenance bring down cots.
We're gonna convert the waiting room into triage.
No one goes home till we're all clear! Dr.
Lim: Page everyone on call.
I don't care what department they are.
Tonight, everybody's trauma.
Glove up and line up.
EMTs will have triaged onsite, so the patients are gonna come in tagged.
I love these blank faces right before Armageddon.
Trauma color coding who knows it? Green walking wounded.
Yellow observation.
Red needs immediate attention.
And black go straight to the morgue.
[Sirens wail.]
All right, red tags, front of the line! Red tags, front of the line.
Wedding bus blew a tire and flipped! 26-year-old female.
Second-and third-degree burns to her neck, chest, and left arm.
Kalu, you're up.
- [Moaning.]
- Trauma Six.
EMT: Guy was ejected 30 feet from the vehicle.
Multiple chest contusions, acute respiratory distress on the scene, sluggish pupillary response.
- How long have you been doing CPR? - 12 minutes.
- Have you shocked him? - Three times.
We got to crack him.
Dr.
Browne, I got this.
You take the next one.
All right, Bay Five.
[Indistinct chatter.]
We secured the foreign object and staunched the bleeding, but didn't want to touch it otherwise.
- Good thing.
It nicked her carotid.
- What is it? Right now it's a little Dutch boy keeping her from bleeding out.
Pulse ox is dropping.
She's at 87.
O2 sats down to 83.
Forget about the neck, Claire.
Treat her like any other patient.
What are the first steps? Airway, breathing, circulation.
Good.
Grab a kit.
I need help here! Somebody, help! Murphy, go! [People groaning.]
Let's go.
Trauma Three.
[Woman speaks indistinctly over P.
A.
.]
I can't stop the bleeding.
[Monitor beeps rapidly.]
- He's bleeding out.
- Do something.
[Beeping continues.]
I need a urinary catheter, 14-gauge needle, arterial guide wire, occlusion balloon, and 20 cc of saline, stat.
[Monitor beeping rapidly.]
- EMT #2: What's he doing? - I have no idea.
Well, you don't have one, so I'm making a REBOA.
A what? A REBOA.
Is that even a word? A REBOA will occlude the damaged artery and stop the bleeding.
Release the pressure.
[Beeping slows.]
BP is stabilizing.
90 over 60.
[Beeping continues.]
Nice work, Dr.
Murphy.
I made a REBOA.
[Gasping.]
- Oxygen is dropping to 89.
- All right.
Light.
Open wide for me.
Throat's swollen from smoke inhalation.
Cric kit.
- Do you see soot in her mouth or nose? - No.
She doesn't need a cric.
She needs an escharotomy.
[Monitor beeping rapidly.]
[Gasps.]
[Beeping slows.]
Sats are going back up.
92 and rising.
Circumferential neck burns.
The shrinking charred skin is acting like a noose.
Escharotomy relieves the constriction.
Are you getting enough air now, ma'am? Yes.
Thank you.
Now get her out of this petri dish and into an isolation ward in the burn unit ASAP.
Yes, sir.
Your heart's a bit muffled.
Am I having a heart attack? No, but it's not completely good news.
Cardiac tamponade.
He needs a pericardiocentesis.
Yes, I'm aware of that.
18-gauge and 55 cc syringe, please.
We need a FAST ultrasound in here.
They're both in use.
[Monitor beeping rapidly.]
You don't have imaging.
You could puncture his heart.
Is the xiphoid in the same place as it was 20 years ago? [Beeping slows.]
[Chuckles.]
A REBOA.
Ballsy.
Could've gone really wrong.
Yes, well, it didn't.
It's a cowboy move something you would never even dream of trying.
How many times is Shaun gonna have to prove himself before you give him a shot? Woman over PA: Dr.
Rolendez, O.
R.
6.
[Monitor beeping slowly.]
What happened in the E.
R.
? Swan girl came in and you hesitated.
I wasn't hesitating.
I was thinking of a game plan.
Murphy was thinking of the game plan.
You got overwhelmed.
I wasn't.
First trauma it happens.
You have to think clearly, quickly, methodically.
You need to think a little more like Shaun.
A little more.
Not identically.
[Whimpering.]
[Screams.]
[Cries.]
[Exhales sharply.]
How you doing? Sorry.
Sorry.
That's a stupid question.
[Sobs.]
You're maxed out on morphine.
I'll hold off until it reloads.
[Shaky breathing.]
How bad is it? We're making good progress.
I'll have to, uh, debride any deroofed blisters to prevent a secondary nosocomial and then I need a mirror.
It's the least you can do since you can't even look me in the eye.
[Crying.]
Oh, my God.
[Exhales deeply.]
Do you know how many hideous $300 bridesmaid dresses I've had to buy in the last two years? I decided that when I got married, my bridesmaids are gonna wear black cocktail dresses so they can use them again, you know? [Sobs.]
But now now I-I'm Freddy Krueger.
[Inhales sharply.]
Who's gonna want to marry this? [Groaning.]
I'm gonna find a nurse, have her adjust your, uh your morphine drip.
[Moaning.]
Okay.
You hit your face.
Your jaw got stuck.
It hurts.
So, this shot I just gave you is gonna knock you out so that I can fix that.
Hang tight.
- Crash patients status check? - 23 people total.
One fatality on site, lost one in the E.
R.
Examined all the red tags.
Got 13 yellow and green still in the waiting room.
- I'll take whoever's up next.
- Marco Magallenes severed femoral artery, crushed femur.
I did the REBOA and then installed a temporary shunt.
Here are his CT and MRI results.
Find someone else for whoever's up next.
Oh, finally.
[Jaw cracks.]
[Woman crying.]
Excuse me.
Are you Marco's family? Ricardo: Yes.
We just found out that my cousin didn't survive the accident.
I'm sorry.
- It's a bit much.
- I'm so sorry.
I'm Dr.
Melendez, and this is Dr.
Murphy.
I'm Ricardo.
I'm M-Marco's father.
This is, uh, his mother, Lorena, and this is Sonia.
They were getting married tonight.
How's my son? Marco's femur was completely shattered, and his lower leg isn't getting enough blood.
Can you save his leg? Marco suffered too much bone fragmentation.
We can't fix it.
Our only choice is to amputate.
[Sobbing.]
Mija.
Bay Five needs a grade three hyphema.
Head CT and page ophthalmology? You read my mind.
Been a while.
How you holding up pulling an all-nighter? I'll manage, but if you can find me a caffeine IV, - Please move! - it'd be helpful.
- Melendez: Tough night.
- Jessica: Yeah.
Thanks for coming.
It's part of the job.
So, when's the big day? Uh, we haven't set it yet.
Oh, where is it gonna be? We'll figure it out.
Maybe a beach somewhere.
We should talk about this later.
What? I like beaches.
If you have a more romantic idea My family likes churches.
We should talk about this later.
Dr.
Lim, I think one of your yellows is about to turn red.
Hey.
Farrar: I've got my wedding all planned out.
I've got the dress, and I've got the flowers.
All I need is a groom.
You available, Dr.
Murphy? No.
You don't want some love? No.
No, I don't.
I don't want love.
Dr.
Glassman, neural consult, bay three.
Thank you.
[Woman speaks indistinctly over P.
A.
.]
Hey! I was here first.
Shaun.
Shaun! My patient's scans are very important.
Well, my patient's important, too.
I need to see my patient's scans.
Is your patient pre-op or post-op? Pre-op.
Okay, I'll give you the computer, but you need to apologize first.
Okay, I'm sorry.
Turn it on.
Why was Marco's family crying when Dr.
Melendez told them his leg would need to be amputated? Well, their son's leg is about to be cut off.
It's sad.
Crying is normal.
But when your options are amputation or death, amputation is good news.
People need time to adjust to big changes.
Marco's family didn't even get a chance to pray for a miracle.
Mm.
It's not possible.
The bone damage is too severe.
A rod implantation won't work.
There's nothing to anchor into, and the shunt won't last long enough to do reconstruction.
There are no other options.
What if we could replace the entire femur? We're making him a new femur.
With a 3D printer? 3D-printed bones have only successfully - been done with the mandible.
- We know.
- That's a fairly small bone.
- We know.
A femur has to support the weight of the entire body.
This one will be titanium.
It can work.
It's an interesting idea but I need to think on it.
Right now we still got seven yellow tags waiting.
What do you have to think about? - It's a good idea.
- It's a brilliant idea.
The kid has brilliant ideas.
That doesn't mean No, it was my idea, and I'm aware of the risks infection, clotting, hardware failure Death.
- It wasn't your idea.
- It was my idea! And the risks are significant, but isn't that their call? - Don't we have to - Maybe he said something, and then you said something, and together, you My idea.
Completely my idea.
The "brilliant" idea is 100% my brilliant idea.
Why is that a problem for you? Maybe because I've known you for six months.
Every day we learn new things.
Today, you learned I'm brilliant.
The idea was brilliant.
And it was mine.
And if anyone can do this brilliant surgery, it's you.
Flattery also brilliant.
[Door opens.]
Claire: Sleeping on the job? [Sighs.]
Just needed some fresh air.
Feels like I'm suffocating in there.
She's in pain, spilling her guts out, and every time I open my mouth, I sound like an idiot.
Dr.
Kalu unable to talk to women.
There's a first.
If you're not gonna be helpful, Claire, just leave.
You don't need to talk.
Just listen to her.
You get to come out here, clear your head.
She's trapped in there, alone with her thoughts, her fears.
You don't think she wants to get out? You are her escape.
You want to put a fake femur into Marco's leg? It's not fake.
It's real.
It's not a real bone.
We're making it out of titanium.
- It's still real.
- That's incredible.
And Marco will be able to walk, run, climb? And swim.
Hopefully.
That's the intention.
Well, have you done the surgery before? - I haven't.
- We'll be the first.
Well, nobody has ever attempted this surgery with a bone as large as the femur.
I believe it's a viable option, but there are risks.
Risks? Could Marco die? In my estimation, there's a 10% chance - he won't make it.
- Then no.
I'm not losing my son.
Wait.
If there's a chance we can save Marco's leg, we should at least discuss this some more.
That's what he'd want.
He'd want to live.
He'd want to have a life.
I know him.
He'd want to take the chance.
I will never forgive myself if Marco died because I made a reckless decision.
Whose decision is this? Does he have a healthcare proxy? I don't know what that is.
When the accident happened, were you on the way to your wedding or on the way back? We were headed to the wedding.
Marco's parents are the next of kin.
They decide.
Please amputate our son's leg.
[Sobs.]
Murphy.
[Sighs.]
Why is the primary closure on the stump so vital in amputation surgery? For a proper prosthetic fitting.
Why are you marrying Jessica? Why does anyone get married? I don't know.
I love her.
I don't understand why having someone to love is so important to everyone.
You have to stand down.
- You can't amputate Marco's leg.
- Why not? I filed an emergency injunction to stop the surgery.
You were in a car accident.
Your neck was punctured.
The repair surgery went well.
You're gonna have to stay put for a week before we can release you.
You're very lucky to be alive.
[Coughs.]
[Raspily.]
My wife, Jenna Hensel is she okay? Can I see her? She's not listed.
That's a good thing.
She's probably still in the waiting room.
I'll find her and bring her up.
She'll be relieved to know you're okay.
Okay.
What the hell am I supposed to do with an unconscious patient whose leg is a ticking time bomb? Judge Singh is en route.
She wants to hear from both parties and the doctors on the case.
I have to testify? - Hopefully not.
- Hopefully not.
I thought you would be happy.
You thought you could save the leg, and I didn't want that not happening because the parents are afraid to make a tough call.
It's their call to make.
And if the accident happened an hour later, it would be the wife's.
And she wants the fake leg.
It's not fake.
I thought you didn't believe in just blindly following protocol.
He's their son.
Nobody's gonna love him more than them.
Seriously? All parents love all children more than anybody else? People get divorced all the time.
How often do they give up their kids? So, if this was us, you'd want your parents to decide over me? - I didn't say that.
- You kind of did.
I was saying, there needs to be rules, that there needs to be bright red lines telling us who gets to make these calls.
It's the parents' call.
Not anymore.
Now it's the judge's.
How much time does Marco have left on the temporary shunt? Three hours, and then his leg will die.
- Okay.
- Mm.
Dr.
Torture returns.
Thought I'd scared you off for good.
Pick a movie.
You deserve to get out of this room for a little while, too.
You think "Groundhog Day" is gonna make a difference? "I'm torturing you, but, hey, you get to watch a funny movie.
" That is sort of what I was going for, yeah.
I'm sorry.
I wish there was something else I could do.
How do you know there isn't? This is protocol.
This is what they teach us.
I lucked out.
I got the world's greatest expert on burn victims? You know everything that can be done.
He loves to rock-climb, scuba dive, bungee-jump.
This is insane.
His leg is literally dying while we sit here reminiscing.
Please.
We're trying to figure out what your son would want.
- He would want to live.
- I want that, too, but if there's a way that we can save Marco's leg, he'd want me to do it.
Mija.
Do you know what he wanted most of all? He wanted to marry you.
He wanted to spend his life with you, have children with you.
Now, he can do all that.
He can be happy with a prosthetic leg.
He's young, and he's strong.
Mija, he can get through this.
- When we met - I don't care about your stories.
I don't care that you met rock-climbing or kayaking or whatever.
- I just want - We met in rehab.
[Man speaks indistinctly over P.
A.
.]
Hey, are either of you Jenna Hensel? I haven't seen Jenna since we took pictures at the hotel.
But she got on the bus? Yeah, she was sitting with Noomi.
I think she's still out there.
- Hey, guys! We've got to go back.
- Where? To the crash site.
Now.
He never wanted you to know.
He's an addict.
He replaced one addiction for another one a healthier one.
- But he needs - What? He needs to wakeboard or he'll drink himself to death? This is ridiculous.
No, it's not! We talked about it a lot.
It's pretty much all you do in rehab.
Marco has clarity for the first time in his life.
He knows what makes him happy.
He knows his weaknesses.
He's not as strong as you think.
And that's okay, but Marco cheated on you.
It was about a month ago.
He was overwhelmed with the wedding and the planning.
He ran into an ex-girlfriend.
It only happened once.
You're lying.
You're upset that he had secrets from you, so No, she's not lying.
Mija, he he was he was so upset.
He does love you.
Okay, maybe we're digressing here a little bit.
And we really don't have the time.
It matters.
She doesn't know him like maybe none of us do, but but we are his parents, and you're not his wife.
Yet.
[Siren wails.]
Okay.
Get the cops.
Check everywhere other side of the road, bushes, trees.
If she was ejected from the bus, she could be 40, 50 feet in any direction.
Claire: Jenna! I found her! I need some help! Okay, she's got a brain bleed.
We need to get her out of here now! Dr.
Andrews.
I think Celez may be eligible for an experimental bone treatment.
Sell it to me.
Well, I've been doing some digging.
San Diego Community Hospital's burn unit has been following a Brazilian hospital's protocol to wrap burns in tilapia skins.
Now Now, I know fish skins sound a bit crazy, but but I was thinking we could do the same thing here.
Dr.
Kalu, I applaud your thinking.
But we Tilapia skins contain more collagen proteins both types 1 and 3 than even human skin, which aids in tissue repair, negating the need for grafts.
- It's shown to accelerate healing, - Dr.
Kalu.
Dr.
Kalu.
would reduce the risk of infection and cut down on the patient's physical pain.
Are you finished, or would you like to cut me off again? Okay, let's follow this through, shall we? You have to come up with a proposal for the experimental treatment, get it approved by our institutional review board, get your hands on medical-grade tilapia skins, and then we Well, I thought you could help expedite the process.
[Scoffs.]
You think I could bring it down from three months to two hours? You finish the debridement? Okay, I'll take over from here.
- Okay.
- Hey.
Keep thinking outside the box.
Initiative is good.
[Police radio chatter.]
I'm in.
Bag her.
Did you get me the drill? The fire truck had one.
What's going on? Her pupil's blown.
She has a subdural hematoma, causing increased intracranial pressure.
If I don't alleviate it now, there's no way she makes it to the hospital alive.
[Drill whirrs.]
[Sighs.]
Okay.
[Drill whirrs.]
[Chuckles.]
Unconscious female.
Flail chest.
I had to do a burr hole in field.
Her sats are in the low 70s.
[Jenna gasping.]
She's good to go to the O.
R.
Subdural hematoma? She had decerebrate posturing, a blown left pupil.
When I passed the drill bit through her skull, a whole lot of blood pooled out.
Good call.
[Door opens.]
Uh, San Diego Community Hospital called.
They're sending the tilapia skins.
They're medevacing them in.
Should be here within the hour.
Celez you meet the criteria for an experimental treatment that I think will prevent you from having to undergo skin grafts.
Hold up.
How did this even happen? Well, I found out San Diego's trial allows for multi-site collaborations.
So, there's no need for us to get our own I.
R.
B.
They give us the skins, we provide the patient data.
- Fish skins? - [Chuckles.]
The tilapia skins have been cleaned and sterilized.
They're perfectly safe.
You'll do it? I'll do it.
Andrews: Well done, Dr.
Kalu.
Well done.
so help you God? Yes.
- Dr.
Melendez can tell you - He has.
But the fake femur is yours, though, right? - How confident are you in its design? - It's not fake! - Shaun, she needs to know - I know what she needs to know.
She needs to know will it work.
She needs to know how long it will last.
Yes.
Okay.
He's his doctor? He is a surgical resident.
He's very gifted.
Is he going to answer my questions? Shaun, I really need you to focus.
- Marco is running out of time! - Just let him answer! No, we already know the answer.
They don't know.
This thing has never been done before.
Be quiet! His toes are changing color.
He's clotting.
That's bad.
Page Dr.
Melendez stat! - Murphy, what do we got? - The shunt is clotting.
It's restricting blood flow.
It is failing.
All right, we need a decision now.
Are we cutting off the leg or replacing the bone? There's no doubt in my mind that Marco's parents and fiancée all love Marco, but it's become clear Now.
I need a decision now.
His parents know him as their child.
Sonia knows him as a man.
- Replace the femur.
- [Gasps.]
Let's go! Thank you! Thank you.
- And there's the bleed.
See it? - Yes, sir.
You ever clip an intracranial artery before? No, sir.
Go for it.
Just like every first time you're a little excited, a little nauseous.
Hopefully nobody gets hurt.
Is it good to go? It's very good.
Forceps.
[Inhales sharply.]
You ready? Yes.
Be careful the clip blades don't catch any perforated arteries.
I don't seen any vessels in the way.
Then what are you waiting for? Very nice.
Thank you.
Everything's dry.
Say goodbye and close the roof.
We need to get blood back into his leg in the next minute or so, or I'm gonna have to amputate after all.
Insulin's hanging, loaded him with calcium.
Best I can do.
Let's release the clamps.
Check for capillary refill.
Blood flow is restored.
EKG is normal.
Okay.
Kim, I want to hear words like "variability" and "Delta".
Give them to me.
I'm waiting patiently.
I'm not getting anything.
Show me.
Claire: Check the leads.
Still nothing.
Maybe there will be some neuroplasticity.
Her brain i-it could rewire itself.
No.
Zero brain activity.
I don't know why, but she's gone.
- [Sighs.]
- What? Your neurosurgery patient that died tonight there's something you should know.
What? Melendez: Now, Marco, I want you to try and move your toes.
[Breathing heavily.]
I can't.
- Is he okay? - We're not sure if the bone He's not gonna die? H-He's not gonna get an infection? - His body's not gonna reject - No, no.
We're monitoring him very closely.
- The biggest threat is behind - He moved.
He moved.
It worked.
You'll have a long recovery ahead months of physical therapy.
But for now, all you have to do is rest.
Thank you.
Thank you for saving my life for saving my leg.
- Thank you.
- You're welcome, sir.
Are you ready to finish what we started? Get well first.
There's plenty of time for a wedding.
- Thank you.
- You're welcome, sir.
Thank you.
You look good.
Tough.
Like Aquaman.
[Laughs.]
Mm.
I look like sushi.
Everybody loves sushi.
[Both laugh.]
It's only for six months.
Your new skin should have completely grown in by then.
Should have minor scarring.
Thank you.
I misjudged you.
You judged me just right.
[Knock on door.]
Is she still sleeping? You haven't told her yet? No.
Can I have a moment please? Of course.
How soon after you found Jenna at the crash site did you intubate her? Almost immediately.
I did a sternal rub.
Uh, she had decerebrate posturing.
Her left pupil was blown.
I knew she had a subdural hematoma, so I intubated, did the burr hole.
She also had a flail chest.
Did you check her breathing after you intubated her? Yes.
Well, at least I-I think I did.
Dr.
Lim told me that when Jenna came into the E.
R.
, she wasn't ventilating properly.
You inserted the tube too deep into her right main stem bronchus of her injured lung.
We had no way of knowing how long she was hypoxic before we gave her the EEG.
I drilled a perfect burr hole into her skull on the side of the road in the middle of the night, and I-I-I screw up her intubation? Yes.
It was tough conditions for anyone resident or not.
Any one of us could have made the same mistake.
I had a woman come into the E.
R.
once [Clears throat.]
a mother, 51 years old.
Francine Parker.
She had two boys.
She had a cough a bad one but a cough.
I checked her out, gave her some antibiotics, sent her home.
Six hours later, she was rolled into the E.
R.
She had had a heart attack, and I missed it, and she died.
Not one day goes by when I don't think about her.
She was your first.
My fourth, actually.
You're not gonna forget this.
You never forget.
But I don't know, maybe we're better off for it the next time around.
You got to find a way to keep going.
Yeah.
Go home.
Get some rest.
I haven't even told her yet.
You're not going to.
You made a mistake.
You're too close to this.
I'm not gonna allow you to talk to the family or anyone else outside this hospital about this.
Do we understand each other? Yes, sir.
I don't have all the words to say I'm still healing from my mistakes I'll take the weight if it makes you stronger I don't want to leave you in this place I called San Diego Community Hospital and thanked them for including us in their study.
They said they were happy to do it.
And they asked that I pass along their thanks to you for your very generous donation to their burn unit.
I know you come from a wealthy family.
I don't begrudge that, but you can't open your wallet every time a patient's in need.
The lines can get real blurry real fast.
Yes, sir.
[Elevator bell dings.]
Who am I to try and save you? I ain't gonna hide You have to fight today What's this? My healthcare proxy.
Jess, nothing's gonna happen.
Really? That's good to know.
I won't let you down I won't let you down No, no, no But I won't let you down I won't let you down No, no, no Well, that was quite a night.
[Chuckles.]
Been a doctor for a long while don't remember a night quite like that one.
Why did Nurse Farrar ask if I wanted love? 'Cause she's a nosy Shaun, you really don't want love? I loved Steve and my rabbit.
Not anymore.
You don't love them anymore? No, I don't.
They're dead.
You can't love someone if they're dead.
Well, I've lost people I love.
I miss them, and it hurts, but I still love them.
I don't want love.
Okay.
You want breakfast? Can I have four pancakes instead of three? You can have five.
I only want four.
Okay.
Okay.