The Good Doctor (2017) s01e09 Episode Script
Intangibles
1 [Elevator bell dings.]
Very nice meeting you.
So, who was that? A housekeeper.
Leaving your place at 7:00 in the morning? I was interviewing her.
You're hiring a housekeeper for a studio apartment? I'm not hiring her.
Her clothes don't match.
Right.
Mm.
You're such an asshat, Shaun Murphy.
[Door opens.]
[Door closes.]
Today we realize a dream seeing our international humanitarian program come to fruition.
Our cardiothoracic surgeon, Dr.
Neil Melendez, in consultation with our head cardiologist, Dr.
Avi Mehta, evaluated children from Tanzania to Malawi to Guinea.
They screened over 100 candidates, each of them needing life-saving surgeries.
Ultimately, we decided on a particularly inspiring young boy named Gabriel, who hails from the Democratic Republic of Congo, with severe congenital heart anomalies.
[Applause.]
We identified three perfect candidates - children I can actually help.
- Hi.
Thank you.
- Gabriel wasn't one of them.
- Yes and no.
I signed off on your choices.
But I wouldn't have necessarily eliminated Gabriel based on the echo I saw.
A non-surgeon undermining a surgeon on his selection of surgical candidates.
It's healthy when colleagues challenge each others' decisions.
It doesn't make any sense.
We gave you good candidates.
You're not a doctor.
Why wouldn't you stick with the list? There were several intangibles.
Can you say hi to Dr.
Melendez? One of those intangibles, I'm guessing, is cuteness.
Family displaced during the war.
Mother took care of her husband until he died of yellow fever.
He bled out at home.
A month later, Gabriel was born.
People tend to give more when the cause is not only noble, but photogenic, Adorable kids and sympathetic moms may work on donors, but they won't work on me, and they certainly won't work on echo results.
Kinda working on me.
Before you say no, at least do your own work-up.
Winnie: Mommy, why can't I come? The hospital's worried that children bring in germs.
I won't, Mommy.
I promise.
I know, boo.
It's just It's the rules.
Okay, baby.
I have to go now.
Do what Aunt Maggie says.
I'll call you later, okay? I love you to the moon And back.
I can't imagine voice rest could be very easy with a 3-year-old.
Yeah.
Not very effective for my podcast audience either.
Of which, by the way, I'm a huge fan.
Grim irony, though, right? A podcaster who loses her voice.
Elizabeth, I'm sure the nodule will be benign and this'll be nothing more than an inspiration for another great episode.
If it's not benign, Isabel? Let's not get ahead of ourselves.
Today we're just focused on removing the nodule and doing the biopsy.
And you've done everything you could do.
And when the hoarseness started, you sought early care from the best.
And I sent you to the best.
You work perfectly together, kind of ping and pong-ish.
- [Both chuckle.]
- Claire: It's nice.
A lot of doctors who are married are more like miss and match.
[Laughs.]
Mrs.
Bangura, this is Dr.
Murphy and Dr.
Kalu.
They're gonna help me run some tests on Gabriel.
Jared: I heard that you and Gabriel have never been away from home before.
I was hoping that these would make him feel welcome.
Georgieta: Yes.
You are kind.
I brought one for myself, too.
Hey, how 'bout we all do some medicine? [Woman speaking indistinctly on P.
A.
.]
He really needs our help.
"He needs our help"? He sounds like he's got a blow dryer in his chest.
Exactly.
Which is why he needs our help.
This is the problem with cardiologists You're really good at telling people when something's broken, not so good at knowing when they can't be fixed.
If that kid is dying, I'm not gonna tell his mother that unless I'm damn sure.
You heard that heart.
I heard that heart.
And it sounded like crap.
But until we do a transesophageal echo, I don't know anything.
Do a transesophageal echo.
She has a master's degree in Sociology, impeccable credentials, excellent references, and you turned her away because "her clothes didn't match"? It's relevant.
If a life-skills coach can't select a complementing wardrobe, they lack life skills.
But she's not gonna pick out your clothes for you.
She's not a nanny.
She's there to help you with problem-solving, financial, social interactions.
You're doing this because I did not react well to a man with a gun robbing a store I was in.
Statistically, that is very unlikely to ever happen to me again.
Social interactions will happen again and again and again.
It's statistically irrefutable.
And if you learn how to get along with people a little bit better, you'll have a fuller life.
A happier life.
If you don't like this woman, we'll find somebody else.
I am happy.
You could be happier.
I don't think so.
My neighbor, Lea.
If she were ever in a fire, she'd be rescued first.
Why's that? Dr.
Melendez says attractive people have advantages.
[Laughs.]
Dr.
Melendez says that, does he? Why is that funny? I don't know.
It's just, um, some people consider Dr.
Melendez attractive.
So, how's it going with Lea? She doesn't like me.
Claire: Why do you say that? - She said I was an asshat.
- Yeah? What was she doing when she said that? Touching me.
She was flirting with you.
Sometimes people say the opposite of what they mean.
Um, they use teasing as a way of saying something they don't mean instead of saying something that they do.
I haven't seen any data on the use of antonyms as a flirting technique.
Okay.
Well, um, here's what to look for.
- You ready? - Yes.
Okay.
The pretentious giggle.
[Giggles.]
The, uh the squirm.
And the hair sweep.
I call it the flirting trifecta.
Hair scuffing is used in both animals and humans, Claire.
Secreting glands are located in the scalp and fur.
Scuffing sends hormones out into the environment to let a potential mate know they're interested.
Or it could be ringworm.
Yeah.
I suppose you have to factor for that possibility.
Nice touch.
Beauty increases happiness.
Happiness improves outlook.
Still on Mission Carpe Diem.
You might want to try it.
I'm doing fine.
We're having dinner at the sink.
No, we're enjoying dinner at the sink.
Although if you keep talking like that - [Cellphone ringing.]
- Mm.
Andrews.
Well, look again.
It has to be there.
Yeah.
Okay.
Who was that? The lab.
They misplaced Elizabeth's specimen.
- Oh, my God.
- Don't worry.
They'll find it.
Satisfied? - It's somewhere.
- Somewhere else.
I love how everyone in surgery is so fast to blame the lab.
Well, double-checking can't hurt.
Actually it can.
Because you are here when you should be double-checking surgery.
I saw the specimen go in the container.
It means it has to be here.
No, all that means is that it was put in a container.
It doesn't mean that that container was actually put in the surgery refrigerator or that it was actually picked up by the courier.
He's even worse than we thought.
Yeah.
Hypertrophic obstructive cardiomyopathy, atrial septal defect, abnormal insertion of the mitral valve leaflet.
I've never seen so many anomalies in one heart.
I'm sorry I pushed for additional testing.
That only got his mother's hopes up.
Any medication that'll help? Beta blockers.
Maybe metoprolol.
It's not like they'll get him playing soccer, but they might help him get to the field to watch.
For a couple of years, anyway.
Better than dying on a table tomorrow.
You tell Aoki.
I'll break it to the mom.
[Rhythmic pounding.]
Woman on P.
A.
: Dr.
Lippman to plastic surgery.
Dr.
Lippman to plastic surgery.
[Pounding continues.]
[Pounding continues, monitor beeping.]
It's called sakara, given by our shaman.
His heartbeat it follows the sound.
It reminds it to beat until you fix it.
Mrs.
Bangura, I've completed all the tests.
And I'm sorry that you've come all this way When Gabriel was in my belly, evil spirits came to him.
Invade his heart.
Our village shaman tried to rid them.
He could not.
Then a vision came to him.
A stronger healer would come.
You.
You will save Gabriel.
I don't know about evil spirits.
All I know is that your son was born with a heart that I can't fix.
I'm sorry.
I would not have come so far if I did not believe.
We'll give him medicine to make him feel better.
And then you can take him home.
[Woman speaking indistinctly on P.
A.
.]
Claire: We tell her we're sorry, we have no news yet, and then Nope.
You can't say that.
It's an expensive word.
- "Sorry"? - You can act sorry.
You can feel sorry.
In fact, you should feel sorry.
You just can't say it.
Okay, uh, "I feel bad for you - because we made a mistake and" - Nope.
A mistake isn't a mistake? Well, it's "an unanticipated outcome of an expected action.
" You can't use language that implies blameworthy conduct.
But if we did lose the specimen, isn't it actually a mistake, and aren't we sorry, and aren't we blameworthy? Yes.
Doesn't mean we can make it any easier for her attorney.
Hello, Elizabeth.
I'm Jessica Preston from Risk Management.
- How are you? - I don't like the sound of that.
I know.
I really need a new a new job title.
Seems that we've encountered an unexpected occurrence.
The laboratory has been unable to locate your tissue specimen.
We don't want you to be unnecessarily alarmed, but we want you to be fully aware of what's going on.
But ho How will I know if I have cancer if you don't find it? We are looking everywhere.
We will find it.
As long as it's in formalin or a refrigerator, everything will be fine.
For how long? At least 24 hours.
Maybe even 36.
Well, then you better find it.
Because I will be damned if I'm gonna have my voice box removed just because somebody screwed up.
I've implemented a proactive educational plan.
Well, that's terrific, Shaun.
Why are we talking about that here? I'm not stupid.
I didn't say you were stupid, Shaun.
Nobody said you were stupid.
But sometimes you lack common sense.
- I'm so sorry to have bothered you.
- This patient is deaf.
Oh.
I started flirting lessons yesterday.
Flirting lessons.
Wish they'd had that when I was young.
Yes, I learned about the flirting trifecta.
There's the pretentious giggle.
Shaun, what are you getting at? Flirting, it requires primarily nonverbal interactions.
Being perceptive in one social dimension translates well to other social skills.
You're studying flirting.
Are you lonely, Shaun? 'Cause you know there are There are websites now where you can I like being alone.
Yeah, well, being alone and being lonely are two different things.
Sometimes we're lonely, and we don't even know it.
How would I know it? Well, uh, loneliness, it's kind of a dull It's like a dark Are you lonely? Yeah, sometimes.
You know, sometimes very much.
You should learn the trifecta.
Hey.
Um, hey.
We're looking for a lost specimen that I am positive left the O.
R.
And I'm positive it didn't make it to the lab.
And since you're the link between the two, we wanted to ask you about your 3:00 run yesterday.
So, you took everything that was in the refrigerator in the O.
R.
? In the refrigerator, out of the refrigerator.
Everything that's meant to go, I took.
- Did you stop on the way? - No.
Straight from the surgery to the lab, just like the rules say.
Well, did you stop at the restroom or the the coffee machine, the cafeteria? You know, believe it or not, I can go a whole 30 minutes without stopping for a cream puff.
We're just desperate.
All we care about is the specimen and avoiding a full-on investigation.
Investigation? Yeah.
Yeah, yeah.
I-I-I-If we don't find it, then the legal department gets involved.
Everyone who was in contact with it, who might have been in contact with it goes under a magnifying glass.
I'm not looking forward to it.
You looking forward to it? She's not looking forward to it.
They're gonna check your social media, your computer.
- Blood tests.
- Blood tests.
But if you find it before then? Then life goes on.
The same as it always has.
I did stop.
At the cafeteria.
The cashier is smokin'.
I might have been distracted for a little while.
Okay.
Thanks.
[Toilet flushes.]
[Toilet flushes.]
[Toilet flushes.]
Water.
Always more water.
Even more.
[Sighs.]
I know.
It's scary.
You are good with children.
You are father? No.
- One day, I hope.
- [Monitor beeping rapidly.]
Page rapid response team, STAT.
Has he developed endocarditis? His echo didn't reveal vegetations on his valves or endocardium.
He has not developed a fever.
Let's be sure.
Get blood cultures.
- Order them times two, 15 minutes.
- It's in the wrong place.
It was in the wrong place.
Okay.
Times two.
15 minutes apart.
Hey.
Um, Leonard says that he stops by here to see you.
[Chuckles.]
Yeah.
He pretends the cafeteria is on his route.
Like I don't know where the lab is.
Yesterday around 3:00, Gwen.
Notice anything on the food trays that wasn't food? Around 3:00? [Blows.]
Just the usual uh, Tupperware, sunglasses, cellphones, a condom.
Around 4:00, I found a glass eye.
You see a biohazard bag? Uh, the ziplock bag with the red circles? Yeah.
C'mon.
You can move the mitral valve.
Thanks for the visual aid.
You can't move the mitral valve.
Now, if Mr.
Potato Head had an atrial septal nose - and hypertrophic obstructive - I believe I believe the abnormal insertion - of the mitral valve can be - Stop.
Follow me.
Pretty sure I saw a biohazard bag in here yesterday.
You're lucky you came when you did.
It's due to get dumped in two hours.
Ugh, dentures.
They're the worst.
You know, every patient gets a denture cup with their name on it.
So, tell me, why are the dentures never in the cup? And if they are, it's the wrong cup? One of life's mysteries.
Biohazard bag sighting.
A biohazard bag for a coin purse? Really? [Sighs.]
Finally, a septal myectomy will open the outflow tract, and the mitral valve can be re-implanted into a more normal position.
Thank you.
That's my idea.
Can you do this procedure on Gabriel? No.
It's a terrible idea, and it won't work.
So, what was the point of this dog and pony show? 'Cause you seemed keen on making medical decisions for me.
So just insubordination? And we were probably gonna wind up coming to you anyway.
Once Dr.
Murphy gets an idea, he stays with it, regardless of what anyone says.
This can work.
Yes, this can work.
And it would be a great idea if the boy had two hours to live.
Is fear of failure a good reason not to do this? No.
But you know what is? The thought that he might have a few more birthdays or make a best friend.
And I don't know.
I'm not sending him home in a box.
[Cellphone vibrates.]
We got to go.
Gabriel's arrhythmia, it's gotten worse.
Elizabeth: You still haven't found it? I can get Ms.
Preston to address any questions She wasn't in the surgery.
You were.
She is the point person for all therapeutic misadventures.
Are you kidding me? I may lose my voice for absolutely no reason, and you are using canned jargon.
That sample cup doesn't have toothpaste or socks or sunblock in it, okay? It has my life! I'm sorry.
Thank you.
[Sighs.]
- Good for you.
- Yeah, right.
- just broke about eight rules.
- Maybe.
"Ms.
Preston" won't hear about it from me.
[Chuckles.]
You should go find that sample, though.
Thanks.
The meds aren't working.
The question is why.
M-Maybe the arrhythmia is just another manifestation of Gabriel's L.
V.
dysfunction.
We should still be seeing at least a modest decline - in his ectopy.
- Maybe his gradient is worse.
We could try calcium channel blockers.
There's a much simpler explanation.
Melendez: Good news about his endocarditis heart inflammation.
His tests are normal.
But we still are concerned.
For some reason, his medication isn't helping.
Our best explanation is he hasn't been taking his medication.
I am trying to save his life.
But withholding his medicine? By keeping him here.
If he takes the medicine and becomes better, you send him to die.
But there is nothing else that we can do for him here.
You do not understand where I live, what it is like.
I don't know your village.
But I do know what it's like to be poor.
I grew up with nothing.
My sister was disabled.
My parents couldn't afford her meds or treatments.
And it killed them, and me, to watch her suffer.
But when nothing can be done, nothing can be done.
You became a doctor? You did not accept being poor.
No.
Then you do not understand at all.
We want for everything food.
Peace.
Medicine.
But our greatest want is hope.
If we leave here, we leave hope behind.
Okay.
I'll do what I can.
I dropped by to see Elizabeth.
Not surprisingly, she's very upset.
There wasn't much I could offer in the way of comfort.
If only people did their jobs.
Which people? Scrub nurses, couriers, lab techs That's a curiously limited list.
I did the surgery correctly.
I don't think it's too much to expect others to do their jobs correctly, as well.
So, not your fault, not your problem.
What are you trying to do, make me feel guilty? Yes.
I want you to feel horrible.
That's the only thing that's gonna make you change.
- Into what? - The guy I married.
The guy who cared more about patients than politics.
Ah, okay, I get it.
This is about me vying for president of the hospital.
Which we discussed at length, which you said you were 100% behind me on.
I didn't realize how far behind.
You think I've left you behind? Hmm.
Uh, Tuesday "Capital expenditures meeting delayed.
Will be late.
" Wednesday "Fundraising event ran over.
Don't wait up.
" - Thursday - Iz, there are things about my job Right.
"Not your fault.
" Shaun: Hello.
Hey.
Did you know that specimens in formalin go to one place, exempt specimens somewhere else, aerobic and anaerobic cultures two different places? Um, radioactive, medical device, forensic specimens all different? And all handled by different staff? Did you know that? Yes.
Oh.
I made a chart, too.
A qualitative observation log of what you taught me.
What did I teach you? Flirting.
Every time I saw someone flirt, I noted it and cross-referenced the subject, object, and nonverbal gestures.
[Chuckles.]
I knew it.
Gwen, the cashier.
She made out that it was all the courier, but That's my name.
Yes.
You made flirting gestures.
- No, I didn't.
- Yes, you did.
You brushed your hair back.
Right hand, side sweeping.
At Dr.
Melendez? No, I don't think so.
Shaun.
- No.
- Yes.
You were at the nurses station, and he said, "Good for you," and you said, "Yeah, right.
I just broke about eight rules," and smiled and giggled and brushed your hair back.
"Ms.
Preston" won't hear about it from me.
[Chuckles.]
It's possible you have ringworm.
Shaun, sometimes people toss their hair just 'cause it's in their face.
Melendez: Murphy.
I'd like you to elaborate on your idea.
Mm, my terrible idea? That's the one.
[Chuckles.]
You can move the anterior leaflet of the valve and reattach it.
No, we can't.
This is an exact replica of the kid's heart, and there's no anchor point to reattach it.
So that part of your idea is still terrible.
Okay.
But the rest of it? We're dealing with a huge septum 25 millimeters.
What would that number be in a healthy kid? About 8.
If we go anywhere near that number, we won't have enough support for the valve.
But let's say we took that down to 20 [Chuckles.]
That won't be enough to relieve the outflow obstruction.
Okay.
Okay.
Let's take him off bypass.
[Flatline.]
He's dead.
Again.
16.
Claire: I'm really tired.
I used to think that I wanted to be the best surgeon in history.
But my new goal? Is just not to get washed out of my residency.
[Footsteps approaching.]
Claire: You have a surgery now? No.
I'm here to see how I can help.
The Chief of Surgery joining the search party? Should I take a selfie, show my friends that this really happened? This is a team problem.
- It should be a team solution.
- How do you get a boss like this? What do we know so far? Let's take him off bypass.
[Monitor beeping.]
[Monitor beeping.]
His outflow is perfect at 13 millimeters.
- Which is irrelevant - [Flatline.]
the mitral valve doesn't have enough support to close.
He's dead.
Again.
Jessica: Dr.
Browne.
Any reason you assumed responsibility on behalf of the hospital told Elizabeth you were "sorry"? Because I was.
Well, I hope we don't see the price tag on that.
And I think you're out of time.
Let's take him off bypass.
[Monitor beeping.]
Yes.
14 millimeters.
Exactly.
Yeah.
Exactly.
Our margin of error is exceedingly low.
Good luck.
You believe in luck? It's something people say in difficult situations.
Neither do I.
Again.
Isabel: The reality is, even if we found your specimen now, it's unlikely that it'd still be viable.
You don't know if I have cancer, and there's no way to find out.
So my choices are surgery I may not need that will leave me without speech, or I do nothing and maybe die.
Unfortunately, yes.
Oh That ancient light, weigh Mm-mm-mm - Mm-mm-mm-mm-mm - On your shoulders And the river of time Love is all that's left to lose Love is all that's left to lose Oh-oh-oh, oh-oh-oh Oh-oh-oh-oh, oh-oh Oh-oh-oh, oh-oh-oh Oh-oh-oh-oh, oh-oh Lust, love I'm not alone anymore Lust, love I'm not alone anymore This ancient life - This ancient life - Knife.
Mm-mm-mm 3 hours, 30 minutes.
You didn't want him on bypass any longer than five hours.
"Wynken and Blynken are two little eyes, and Nod is a little head, and the wooden shoe that sailed the skies is a wee one's trundle-bed.
[Voice breaking.]
So shut your eyes while Mother sings Melendez: How's it look, Dr.
Murphy? 14 millimeters.
Exactly.
Perfect.
His septal tissue It's stiffer than I anticipated.
I don't think this is gonna be enough for adequate outflow.
I'm taking the septum down to 13.
Okay, the valve wasn't supported at 13.
The patient died.
That was a model, not a patient.
We're at five hours and three minutes.
We're taking him down to 13.
Field.
All quiet for the time-out.
Patient is Elizabeth McLaren.
No known allergies.
We'll be doing a total laryngectomy with a Gluck Sorenson U-shaped incision.
Is everyone in agreement? Antibiotics in? One gram of cefotaxime has been infused.
We anticipate a specimen.
I've requested labels be printed.
Pen.
Prepare to intubate.
Dentures.
You've gotta hold the surgery.
Uh just give me a little time.
That's 13.
Dammit.
[Breathes deeply.]
Too thin? The valve doesn't have adequate support.
It won't be able to close.
I was wrong.
Whoa.
There's a reattachment point.
We must not have seen it at 14 'cause it was obscured by the subvalvular tissue.
We can use that as an anchor point and move the valve.
Your terrible idea just got a hell of a lot better.
Stitch.
5 hours, 23 minutes.
Hey.
Dentures.
They always end up in the wrong cup, which is why they're so hard to get back to the owner.
- Okay.
- Right.
What if the label on the specimen was wrong? What What if the nodule is here, but the container has the wrong name on it? Okay, I'm reconciling the operative records to the surgery schedule to the specimen.
I'll read the cases, check the containers, and feel like a jerk for judging you.
Well, you're only a jerk if I'm right.
Pump time? 6 hours, 48 minutes.
Get Mehta in here.
Let's take him off bypass.
12 seconds.
Should I get the paddles? Not yet.
Come on, Gabriel.
How long has he been on bypass? Nearly two hours too long.
We need to jump-start Not yet! [Monitor beeping slowly.]
Yeah.
Yes! [Sighs.]
Dr.
Murphy, close him up.
[Allman Brown's "Sons and Daughters" plays.]
- And I will hold you tight - [Pounding.]
Like the moon in the arms of the sky [Pounding continues.]
And I will keep you warm I will build a fire in this house It's beating just fine on its own.
And I'll build a fire You fetch the water, and I'll lay the table And in our hearts, we still pray for sons and daughters Marcus.
And all those evenings out in the garden The red, red wine These quiet hours turning to years [Breathing shakily.]
There was a specimen cup in the O.
R.
prior to your surgery.
It was supposed to be used for a bullet removal, but they left the bullet in the body, and the cup was used accidentally for your specimen.
Not only was it in formalin, but it was refrigerated and fresh as a daisy.
Elizabeth, you don't have cancer.
[Crying.]
Thank you.
Doctor.
And I'll build a fire You fetch the water, and I'll lay the table And in our hearts, we still pray for sons and daughters [Laughs.]
And all those evenings out in the garden Intangibles.
The red, red wine These quiet hours turning to years Hello.
Hello.
- I had a very good day today.
- Yes, you did.
- That was a hell of an operation.
- Yes.
And I caught Claire flirting.
With you? - Shaun, I think you might be mis - With Dr.
Melendez.
- Ah, Dr.
Melendez.
- I conducted observations, successfully interpreted them, and logged them.
Romance in a spreadsheet.
I love it.
I was aware of the cues even when Claire wasn't.
I think she needs a life-skills coach.
Extrapolating.
I like that, too.
That's great, Shaun.
You're paying attention.
You're learning.
And when we find you a life coach, one with a fashion sense, then you're gonna be learning better, you're gonna be learning faster.
Are you giving up on me? What? No.
I haven't given up on you.
I don't want a stranger helping me.
I know, Shaun.
But And I can't [Sighs.]
I can't always be there.
I-I I can't always help you the way you need to be helped, the way you deserve to be helped.
I don't want a stranger helping me.
[Door opens.]
[Door closes.]
Claire: Congratulations.
You too.
On your mad sleuthing skills.
Something to fall back on if this surgery thing gets old.
[Laughs.]
Jessica: You did a nice job, Claire.
- Thanks.
- And here is our price tag.
We've been served.
But we found it.
Elizabeth's fine.
I know.
But we put her through two days of hell, and she wants to make sure it doesn't happen to anybody else.
I mean, good for her.
What is this? Gabriel's pacemaker.
I heard you were brilliant again today.
I got lucky.
Do you think Armen would kill me if I got a pet hedgehog? I mean, I read that they're actually pretty - Lea.
- Yes, Shaun? You look absurd in that sweater.
I have apples.
Do you want an apple? Yeah.
[Lock disengages, door opens.]
Very nice meeting you.
So, who was that? A housekeeper.
Leaving your place at 7:00 in the morning? I was interviewing her.
You're hiring a housekeeper for a studio apartment? I'm not hiring her.
Her clothes don't match.
Right.
Mm.
You're such an asshat, Shaun Murphy.
[Door opens.]
[Door closes.]
Today we realize a dream seeing our international humanitarian program come to fruition.
Our cardiothoracic surgeon, Dr.
Neil Melendez, in consultation with our head cardiologist, Dr.
Avi Mehta, evaluated children from Tanzania to Malawi to Guinea.
They screened over 100 candidates, each of them needing life-saving surgeries.
Ultimately, we decided on a particularly inspiring young boy named Gabriel, who hails from the Democratic Republic of Congo, with severe congenital heart anomalies.
[Applause.]
We identified three perfect candidates - children I can actually help.
- Hi.
Thank you.
- Gabriel wasn't one of them.
- Yes and no.
I signed off on your choices.
But I wouldn't have necessarily eliminated Gabriel based on the echo I saw.
A non-surgeon undermining a surgeon on his selection of surgical candidates.
It's healthy when colleagues challenge each others' decisions.
It doesn't make any sense.
We gave you good candidates.
You're not a doctor.
Why wouldn't you stick with the list? There were several intangibles.
Can you say hi to Dr.
Melendez? One of those intangibles, I'm guessing, is cuteness.
Family displaced during the war.
Mother took care of her husband until he died of yellow fever.
He bled out at home.
A month later, Gabriel was born.
People tend to give more when the cause is not only noble, but photogenic, Adorable kids and sympathetic moms may work on donors, but they won't work on me, and they certainly won't work on echo results.
Kinda working on me.
Before you say no, at least do your own work-up.
Winnie: Mommy, why can't I come? The hospital's worried that children bring in germs.
I won't, Mommy.
I promise.
I know, boo.
It's just It's the rules.
Okay, baby.
I have to go now.
Do what Aunt Maggie says.
I'll call you later, okay? I love you to the moon And back.
I can't imagine voice rest could be very easy with a 3-year-old.
Yeah.
Not very effective for my podcast audience either.
Of which, by the way, I'm a huge fan.
Grim irony, though, right? A podcaster who loses her voice.
Elizabeth, I'm sure the nodule will be benign and this'll be nothing more than an inspiration for another great episode.
If it's not benign, Isabel? Let's not get ahead of ourselves.
Today we're just focused on removing the nodule and doing the biopsy.
And you've done everything you could do.
And when the hoarseness started, you sought early care from the best.
And I sent you to the best.
You work perfectly together, kind of ping and pong-ish.
- [Both chuckle.]
- Claire: It's nice.
A lot of doctors who are married are more like miss and match.
[Laughs.]
Mrs.
Bangura, this is Dr.
Murphy and Dr.
Kalu.
They're gonna help me run some tests on Gabriel.
Jared: I heard that you and Gabriel have never been away from home before.
I was hoping that these would make him feel welcome.
Georgieta: Yes.
You are kind.
I brought one for myself, too.
Hey, how 'bout we all do some medicine? [Woman speaking indistinctly on P.
A.
.]
He really needs our help.
"He needs our help"? He sounds like he's got a blow dryer in his chest.
Exactly.
Which is why he needs our help.
This is the problem with cardiologists You're really good at telling people when something's broken, not so good at knowing when they can't be fixed.
If that kid is dying, I'm not gonna tell his mother that unless I'm damn sure.
You heard that heart.
I heard that heart.
And it sounded like crap.
But until we do a transesophageal echo, I don't know anything.
Do a transesophageal echo.
She has a master's degree in Sociology, impeccable credentials, excellent references, and you turned her away because "her clothes didn't match"? It's relevant.
If a life-skills coach can't select a complementing wardrobe, they lack life skills.
But she's not gonna pick out your clothes for you.
She's not a nanny.
She's there to help you with problem-solving, financial, social interactions.
You're doing this because I did not react well to a man with a gun robbing a store I was in.
Statistically, that is very unlikely to ever happen to me again.
Social interactions will happen again and again and again.
It's statistically irrefutable.
And if you learn how to get along with people a little bit better, you'll have a fuller life.
A happier life.
If you don't like this woman, we'll find somebody else.
I am happy.
You could be happier.
I don't think so.
My neighbor, Lea.
If she were ever in a fire, she'd be rescued first.
Why's that? Dr.
Melendez says attractive people have advantages.
[Laughs.]
Dr.
Melendez says that, does he? Why is that funny? I don't know.
It's just, um, some people consider Dr.
Melendez attractive.
So, how's it going with Lea? She doesn't like me.
Claire: Why do you say that? - She said I was an asshat.
- Yeah? What was she doing when she said that? Touching me.
She was flirting with you.
Sometimes people say the opposite of what they mean.
Um, they use teasing as a way of saying something they don't mean instead of saying something that they do.
I haven't seen any data on the use of antonyms as a flirting technique.
Okay.
Well, um, here's what to look for.
- You ready? - Yes.
Okay.
The pretentious giggle.
[Giggles.]
The, uh the squirm.
And the hair sweep.
I call it the flirting trifecta.
Hair scuffing is used in both animals and humans, Claire.
Secreting glands are located in the scalp and fur.
Scuffing sends hormones out into the environment to let a potential mate know they're interested.
Or it could be ringworm.
Yeah.
I suppose you have to factor for that possibility.
Nice touch.
Beauty increases happiness.
Happiness improves outlook.
Still on Mission Carpe Diem.
You might want to try it.
I'm doing fine.
We're having dinner at the sink.
No, we're enjoying dinner at the sink.
Although if you keep talking like that - [Cellphone ringing.]
- Mm.
Andrews.
Well, look again.
It has to be there.
Yeah.
Okay.
Who was that? The lab.
They misplaced Elizabeth's specimen.
- Oh, my God.
- Don't worry.
They'll find it.
Satisfied? - It's somewhere.
- Somewhere else.
I love how everyone in surgery is so fast to blame the lab.
Well, double-checking can't hurt.
Actually it can.
Because you are here when you should be double-checking surgery.
I saw the specimen go in the container.
It means it has to be here.
No, all that means is that it was put in a container.
It doesn't mean that that container was actually put in the surgery refrigerator or that it was actually picked up by the courier.
He's even worse than we thought.
Yeah.
Hypertrophic obstructive cardiomyopathy, atrial septal defect, abnormal insertion of the mitral valve leaflet.
I've never seen so many anomalies in one heart.
I'm sorry I pushed for additional testing.
That only got his mother's hopes up.
Any medication that'll help? Beta blockers.
Maybe metoprolol.
It's not like they'll get him playing soccer, but they might help him get to the field to watch.
For a couple of years, anyway.
Better than dying on a table tomorrow.
You tell Aoki.
I'll break it to the mom.
[Rhythmic pounding.]
Woman on P.
A.
: Dr.
Lippman to plastic surgery.
Dr.
Lippman to plastic surgery.
[Pounding continues.]
[Pounding continues, monitor beeping.]
It's called sakara, given by our shaman.
His heartbeat it follows the sound.
It reminds it to beat until you fix it.
Mrs.
Bangura, I've completed all the tests.
And I'm sorry that you've come all this way When Gabriel was in my belly, evil spirits came to him.
Invade his heart.
Our village shaman tried to rid them.
He could not.
Then a vision came to him.
A stronger healer would come.
You.
You will save Gabriel.
I don't know about evil spirits.
All I know is that your son was born with a heart that I can't fix.
I'm sorry.
I would not have come so far if I did not believe.
We'll give him medicine to make him feel better.
And then you can take him home.
[Woman speaking indistinctly on P.
A.
.]
Claire: We tell her we're sorry, we have no news yet, and then Nope.
You can't say that.
It's an expensive word.
- "Sorry"? - You can act sorry.
You can feel sorry.
In fact, you should feel sorry.
You just can't say it.
Okay, uh, "I feel bad for you - because we made a mistake and" - Nope.
A mistake isn't a mistake? Well, it's "an unanticipated outcome of an expected action.
" You can't use language that implies blameworthy conduct.
But if we did lose the specimen, isn't it actually a mistake, and aren't we sorry, and aren't we blameworthy? Yes.
Doesn't mean we can make it any easier for her attorney.
Hello, Elizabeth.
I'm Jessica Preston from Risk Management.
- How are you? - I don't like the sound of that.
I know.
I really need a new a new job title.
Seems that we've encountered an unexpected occurrence.
The laboratory has been unable to locate your tissue specimen.
We don't want you to be unnecessarily alarmed, but we want you to be fully aware of what's going on.
But ho How will I know if I have cancer if you don't find it? We are looking everywhere.
We will find it.
As long as it's in formalin or a refrigerator, everything will be fine.
For how long? At least 24 hours.
Maybe even 36.
Well, then you better find it.
Because I will be damned if I'm gonna have my voice box removed just because somebody screwed up.
I've implemented a proactive educational plan.
Well, that's terrific, Shaun.
Why are we talking about that here? I'm not stupid.
I didn't say you were stupid, Shaun.
Nobody said you were stupid.
But sometimes you lack common sense.
- I'm so sorry to have bothered you.
- This patient is deaf.
Oh.
I started flirting lessons yesterday.
Flirting lessons.
Wish they'd had that when I was young.
Yes, I learned about the flirting trifecta.
There's the pretentious giggle.
Shaun, what are you getting at? Flirting, it requires primarily nonverbal interactions.
Being perceptive in one social dimension translates well to other social skills.
You're studying flirting.
Are you lonely, Shaun? 'Cause you know there are There are websites now where you can I like being alone.
Yeah, well, being alone and being lonely are two different things.
Sometimes we're lonely, and we don't even know it.
How would I know it? Well, uh, loneliness, it's kind of a dull It's like a dark Are you lonely? Yeah, sometimes.
You know, sometimes very much.
You should learn the trifecta.
Hey.
Um, hey.
We're looking for a lost specimen that I am positive left the O.
R.
And I'm positive it didn't make it to the lab.
And since you're the link between the two, we wanted to ask you about your 3:00 run yesterday.
So, you took everything that was in the refrigerator in the O.
R.
? In the refrigerator, out of the refrigerator.
Everything that's meant to go, I took.
- Did you stop on the way? - No.
Straight from the surgery to the lab, just like the rules say.
Well, did you stop at the restroom or the the coffee machine, the cafeteria? You know, believe it or not, I can go a whole 30 minutes without stopping for a cream puff.
We're just desperate.
All we care about is the specimen and avoiding a full-on investigation.
Investigation? Yeah.
Yeah, yeah.
I-I-I-If we don't find it, then the legal department gets involved.
Everyone who was in contact with it, who might have been in contact with it goes under a magnifying glass.
I'm not looking forward to it.
You looking forward to it? She's not looking forward to it.
They're gonna check your social media, your computer.
- Blood tests.
- Blood tests.
But if you find it before then? Then life goes on.
The same as it always has.
I did stop.
At the cafeteria.
The cashier is smokin'.
I might have been distracted for a little while.
Okay.
Thanks.
[Toilet flushes.]
[Toilet flushes.]
[Toilet flushes.]
Water.
Always more water.
Even more.
[Sighs.]
I know.
It's scary.
You are good with children.
You are father? No.
- One day, I hope.
- [Monitor beeping rapidly.]
Page rapid response team, STAT.
Has he developed endocarditis? His echo didn't reveal vegetations on his valves or endocardium.
He has not developed a fever.
Let's be sure.
Get blood cultures.
- Order them times two, 15 minutes.
- It's in the wrong place.
It was in the wrong place.
Okay.
Times two.
15 minutes apart.
Hey.
Um, Leonard says that he stops by here to see you.
[Chuckles.]
Yeah.
He pretends the cafeteria is on his route.
Like I don't know where the lab is.
Yesterday around 3:00, Gwen.
Notice anything on the food trays that wasn't food? Around 3:00? [Blows.]
Just the usual uh, Tupperware, sunglasses, cellphones, a condom.
Around 4:00, I found a glass eye.
You see a biohazard bag? Uh, the ziplock bag with the red circles? Yeah.
C'mon.
You can move the mitral valve.
Thanks for the visual aid.
You can't move the mitral valve.
Now, if Mr.
Potato Head had an atrial septal nose - and hypertrophic obstructive - I believe I believe the abnormal insertion - of the mitral valve can be - Stop.
Follow me.
Pretty sure I saw a biohazard bag in here yesterday.
You're lucky you came when you did.
It's due to get dumped in two hours.
Ugh, dentures.
They're the worst.
You know, every patient gets a denture cup with their name on it.
So, tell me, why are the dentures never in the cup? And if they are, it's the wrong cup? One of life's mysteries.
Biohazard bag sighting.
A biohazard bag for a coin purse? Really? [Sighs.]
Finally, a septal myectomy will open the outflow tract, and the mitral valve can be re-implanted into a more normal position.
Thank you.
That's my idea.
Can you do this procedure on Gabriel? No.
It's a terrible idea, and it won't work.
So, what was the point of this dog and pony show? 'Cause you seemed keen on making medical decisions for me.
So just insubordination? And we were probably gonna wind up coming to you anyway.
Once Dr.
Murphy gets an idea, he stays with it, regardless of what anyone says.
This can work.
Yes, this can work.
And it would be a great idea if the boy had two hours to live.
Is fear of failure a good reason not to do this? No.
But you know what is? The thought that he might have a few more birthdays or make a best friend.
And I don't know.
I'm not sending him home in a box.
[Cellphone vibrates.]
We got to go.
Gabriel's arrhythmia, it's gotten worse.
Elizabeth: You still haven't found it? I can get Ms.
Preston to address any questions She wasn't in the surgery.
You were.
She is the point person for all therapeutic misadventures.
Are you kidding me? I may lose my voice for absolutely no reason, and you are using canned jargon.
That sample cup doesn't have toothpaste or socks or sunblock in it, okay? It has my life! I'm sorry.
Thank you.
[Sighs.]
- Good for you.
- Yeah, right.
- just broke about eight rules.
- Maybe.
"Ms.
Preston" won't hear about it from me.
[Chuckles.]
You should go find that sample, though.
Thanks.
The meds aren't working.
The question is why.
M-Maybe the arrhythmia is just another manifestation of Gabriel's L.
V.
dysfunction.
We should still be seeing at least a modest decline - in his ectopy.
- Maybe his gradient is worse.
We could try calcium channel blockers.
There's a much simpler explanation.
Melendez: Good news about his endocarditis heart inflammation.
His tests are normal.
But we still are concerned.
For some reason, his medication isn't helping.
Our best explanation is he hasn't been taking his medication.
I am trying to save his life.
But withholding his medicine? By keeping him here.
If he takes the medicine and becomes better, you send him to die.
But there is nothing else that we can do for him here.
You do not understand where I live, what it is like.
I don't know your village.
But I do know what it's like to be poor.
I grew up with nothing.
My sister was disabled.
My parents couldn't afford her meds or treatments.
And it killed them, and me, to watch her suffer.
But when nothing can be done, nothing can be done.
You became a doctor? You did not accept being poor.
No.
Then you do not understand at all.
We want for everything food.
Peace.
Medicine.
But our greatest want is hope.
If we leave here, we leave hope behind.
Okay.
I'll do what I can.
I dropped by to see Elizabeth.
Not surprisingly, she's very upset.
There wasn't much I could offer in the way of comfort.
If only people did their jobs.
Which people? Scrub nurses, couriers, lab techs That's a curiously limited list.
I did the surgery correctly.
I don't think it's too much to expect others to do their jobs correctly, as well.
So, not your fault, not your problem.
What are you trying to do, make me feel guilty? Yes.
I want you to feel horrible.
That's the only thing that's gonna make you change.
- Into what? - The guy I married.
The guy who cared more about patients than politics.
Ah, okay, I get it.
This is about me vying for president of the hospital.
Which we discussed at length, which you said you were 100% behind me on.
I didn't realize how far behind.
You think I've left you behind? Hmm.
Uh, Tuesday "Capital expenditures meeting delayed.
Will be late.
" Wednesday "Fundraising event ran over.
Don't wait up.
" - Thursday - Iz, there are things about my job Right.
"Not your fault.
" Shaun: Hello.
Hey.
Did you know that specimens in formalin go to one place, exempt specimens somewhere else, aerobic and anaerobic cultures two different places? Um, radioactive, medical device, forensic specimens all different? And all handled by different staff? Did you know that? Yes.
Oh.
I made a chart, too.
A qualitative observation log of what you taught me.
What did I teach you? Flirting.
Every time I saw someone flirt, I noted it and cross-referenced the subject, object, and nonverbal gestures.
[Chuckles.]
I knew it.
Gwen, the cashier.
She made out that it was all the courier, but That's my name.
Yes.
You made flirting gestures.
- No, I didn't.
- Yes, you did.
You brushed your hair back.
Right hand, side sweeping.
At Dr.
Melendez? No, I don't think so.
Shaun.
- No.
- Yes.
You were at the nurses station, and he said, "Good for you," and you said, "Yeah, right.
I just broke about eight rules," and smiled and giggled and brushed your hair back.
"Ms.
Preston" won't hear about it from me.
[Chuckles.]
It's possible you have ringworm.
Shaun, sometimes people toss their hair just 'cause it's in their face.
Melendez: Murphy.
I'd like you to elaborate on your idea.
Mm, my terrible idea? That's the one.
[Chuckles.]
You can move the anterior leaflet of the valve and reattach it.
No, we can't.
This is an exact replica of the kid's heart, and there's no anchor point to reattach it.
So that part of your idea is still terrible.
Okay.
But the rest of it? We're dealing with a huge septum 25 millimeters.
What would that number be in a healthy kid? About 8.
If we go anywhere near that number, we won't have enough support for the valve.
But let's say we took that down to 20 [Chuckles.]
That won't be enough to relieve the outflow obstruction.
Okay.
Okay.
Let's take him off bypass.
[Flatline.]
He's dead.
Again.
16.
Claire: I'm really tired.
I used to think that I wanted to be the best surgeon in history.
But my new goal? Is just not to get washed out of my residency.
[Footsteps approaching.]
Claire: You have a surgery now? No.
I'm here to see how I can help.
The Chief of Surgery joining the search party? Should I take a selfie, show my friends that this really happened? This is a team problem.
- It should be a team solution.
- How do you get a boss like this? What do we know so far? Let's take him off bypass.
[Monitor beeping.]
[Monitor beeping.]
His outflow is perfect at 13 millimeters.
- Which is irrelevant - [Flatline.]
the mitral valve doesn't have enough support to close.
He's dead.
Again.
Jessica: Dr.
Browne.
Any reason you assumed responsibility on behalf of the hospital told Elizabeth you were "sorry"? Because I was.
Well, I hope we don't see the price tag on that.
And I think you're out of time.
Let's take him off bypass.
[Monitor beeping.]
Yes.
14 millimeters.
Exactly.
Yeah.
Exactly.
Our margin of error is exceedingly low.
Good luck.
You believe in luck? It's something people say in difficult situations.
Neither do I.
Again.
Isabel: The reality is, even if we found your specimen now, it's unlikely that it'd still be viable.
You don't know if I have cancer, and there's no way to find out.
So my choices are surgery I may not need that will leave me without speech, or I do nothing and maybe die.
Unfortunately, yes.
Oh That ancient light, weigh Mm-mm-mm - Mm-mm-mm-mm-mm - On your shoulders And the river of time Love is all that's left to lose Love is all that's left to lose Oh-oh-oh, oh-oh-oh Oh-oh-oh-oh, oh-oh Oh-oh-oh, oh-oh-oh Oh-oh-oh-oh, oh-oh Lust, love I'm not alone anymore Lust, love I'm not alone anymore This ancient life - This ancient life - Knife.
Mm-mm-mm 3 hours, 30 minutes.
You didn't want him on bypass any longer than five hours.
"Wynken and Blynken are two little eyes, and Nod is a little head, and the wooden shoe that sailed the skies is a wee one's trundle-bed.
[Voice breaking.]
So shut your eyes while Mother sings Melendez: How's it look, Dr.
Murphy? 14 millimeters.
Exactly.
Perfect.
His septal tissue It's stiffer than I anticipated.
I don't think this is gonna be enough for adequate outflow.
I'm taking the septum down to 13.
Okay, the valve wasn't supported at 13.
The patient died.
That was a model, not a patient.
We're at five hours and three minutes.
We're taking him down to 13.
Field.
All quiet for the time-out.
Patient is Elizabeth McLaren.
No known allergies.
We'll be doing a total laryngectomy with a Gluck Sorenson U-shaped incision.
Is everyone in agreement? Antibiotics in? One gram of cefotaxime has been infused.
We anticipate a specimen.
I've requested labels be printed.
Pen.
Prepare to intubate.
Dentures.
You've gotta hold the surgery.
Uh just give me a little time.
That's 13.
Dammit.
[Breathes deeply.]
Too thin? The valve doesn't have adequate support.
It won't be able to close.
I was wrong.
Whoa.
There's a reattachment point.
We must not have seen it at 14 'cause it was obscured by the subvalvular tissue.
We can use that as an anchor point and move the valve.
Your terrible idea just got a hell of a lot better.
Stitch.
5 hours, 23 minutes.
Hey.
Dentures.
They always end up in the wrong cup, which is why they're so hard to get back to the owner.
- Okay.
- Right.
What if the label on the specimen was wrong? What What if the nodule is here, but the container has the wrong name on it? Okay, I'm reconciling the operative records to the surgery schedule to the specimen.
I'll read the cases, check the containers, and feel like a jerk for judging you.
Well, you're only a jerk if I'm right.
Pump time? 6 hours, 48 minutes.
Get Mehta in here.
Let's take him off bypass.
12 seconds.
Should I get the paddles? Not yet.
Come on, Gabriel.
How long has he been on bypass? Nearly two hours too long.
We need to jump-start Not yet! [Monitor beeping slowly.]
Yeah.
Yes! [Sighs.]
Dr.
Murphy, close him up.
[Allman Brown's "Sons and Daughters" plays.]
- And I will hold you tight - [Pounding.]
Like the moon in the arms of the sky [Pounding continues.]
And I will keep you warm I will build a fire in this house It's beating just fine on its own.
And I'll build a fire You fetch the water, and I'll lay the table And in our hearts, we still pray for sons and daughters Marcus.
And all those evenings out in the garden The red, red wine These quiet hours turning to years [Breathing shakily.]
There was a specimen cup in the O.
R.
prior to your surgery.
It was supposed to be used for a bullet removal, but they left the bullet in the body, and the cup was used accidentally for your specimen.
Not only was it in formalin, but it was refrigerated and fresh as a daisy.
Elizabeth, you don't have cancer.
[Crying.]
Thank you.
Doctor.
And I'll build a fire You fetch the water, and I'll lay the table And in our hearts, we still pray for sons and daughters [Laughs.]
And all those evenings out in the garden Intangibles.
The red, red wine These quiet hours turning to years Hello.
Hello.
- I had a very good day today.
- Yes, you did.
- That was a hell of an operation.
- Yes.
And I caught Claire flirting.
With you? - Shaun, I think you might be mis - With Dr.
Melendez.
- Ah, Dr.
Melendez.
- I conducted observations, successfully interpreted them, and logged them.
Romance in a spreadsheet.
I love it.
I was aware of the cues even when Claire wasn't.
I think she needs a life-skills coach.
Extrapolating.
I like that, too.
That's great, Shaun.
You're paying attention.
You're learning.
And when we find you a life coach, one with a fashion sense, then you're gonna be learning better, you're gonna be learning faster.
Are you giving up on me? What? No.
I haven't given up on you.
I don't want a stranger helping me.
I know, Shaun.
But And I can't [Sighs.]
I can't always be there.
I-I I can't always help you the way you need to be helped, the way you deserve to be helped.
I don't want a stranger helping me.
[Door opens.]
[Door closes.]
Claire: Congratulations.
You too.
On your mad sleuthing skills.
Something to fall back on if this surgery thing gets old.
[Laughs.]
Jessica: You did a nice job, Claire.
- Thanks.
- And here is our price tag.
We've been served.
But we found it.
Elizabeth's fine.
I know.
But we put her through two days of hell, and she wants to make sure it doesn't happen to anybody else.
I mean, good for her.
What is this? Gabriel's pacemaker.
I heard you were brilliant again today.
I got lucky.
Do you think Armen would kill me if I got a pet hedgehog? I mean, I read that they're actually pretty - Lea.
- Yes, Shaun? You look absurd in that sweater.
I have apples.
Do you want an apple? Yeah.
[Lock disengages, door opens.]