The Good Doctor (2017) s01e18 Episode Script
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1 I want to be your friend again.
W-Why, Shaun? What happened? People need friends.
Well[CHUCKLES.]
Yeah, they do.
But you said you wanted me to stop interfering, remember? You wanted space.
You wanted to make your own mistakes.
I need a friend more than I need space.
You were a good mentor and a good friend.
Well, thank you, Shaun.
[CHUCKLES.]
You don't know how much it means to me to hear you say that.
But I-I think I think you may need a new mentor.
I'm dying.
12 to 18 months.
I'd appreciate it if you didn't tell anyone, okay? I-I will in my own time.
Okay.
Have you had a full work-up? Yes, of course.
It could be a secondary tumor metastasized to your brain from somewhere else.
It's the only tumor found.
It could be an inflammatory or infectious process.
It was a tumor, Shaun.
You should get a second opinion.
Shaun, I've been a neurosurgeon for 30 years.
I think that qualifies as a second opinion.
You should get a second opinion.
You have to know whether All right, all right, all right, all right, Shaun.
I'll get a second opinion.
Okay? Okay.
Can I go to work now? Okay, Doctor, what's your diagnosis? I'm drunk.
Not you.
Other doctor.
[CHUCKLES.]
Uh, well, given the degree of the rotation and the fact that the break is almost compound, I'd say we're dealing with a Bimalleolar or Trimalleolar fracture.
Very good.
What else? Um Color? Blood flow is restricted.
His foot's dying.
- Oh, no.
- Mm.
I'm gonna have to reset it now.
Hold his leg.
- No.
- No, it's Ok.
It just going to take a second I need you to count to three.
One - One, - two - [BONES CRACK.]
- Aah! [PANTING.]
[LAUGHS.]
Is Caden's leg gonna be okay? How long has his leg been like this and how exactly did it happen? Well, he's been like that since I found him.
He probably tripped over a curb or something because that's where he was.
Any reason you felt the need to tell me twice that you found him like this? LIM: Dr.
Park, boy's going to surgery.
You're going with.
Don't go anywhere.
Shouldn't I be asleep for this? Your blood alcohol level complicates anesthesia and we think you have a concussion, so we're gonna keep you responsive.
We did give you a regional nerve block, so you shouldn't feel anything.
Huh.
Cool.
Bend the ICP plate over two degrees on the proximal end.
PARK: Contouring pliers.
[FARTS.]
[LAUGHS.]
[MONITORS BEEPING.]
BP is dropping, heart rate's rising.
- Let's tube him.
- IV fluids and phenylephrine, stat.
We need to abort until we can get a handle on what else is going on.
Give me a full body CT, full blood panels, and an echo.
I think Jared and I may be able to dig up an answer quicker.
Great.
Get on it.
Come up with anything? Neither did I.
I had a friend, a neurosurgeon, at SF Muni.
She looked at the scans.
She came to the same diagnosis, Shaun.
I have an inoperable glioma.
Okay? I think you should go back to work, yes? I need to go to work.
Be reasonable.
Beg your pardon? Be reasonable.
I have no idea what you're talking about.
Oh, it'll be clear.
What the hell happened to Caden? - I I don't know.
- He twisted his ankle.
I You lied to me before.
You're lying to me now, you spoiled little coward.
Hey, hey.
Be reasonable.
His friend's hurt.
He's scared, and you're freaking him out.
[SIGHS.]
[INDISTINCT ANNOUNCEMENT OVER P.
A.
.]
[SIGHS.]
He's angry, but he's not wrong.
Caden's in bad shape, and we don't know why.
We need to know what happened.
No, no, don't don't worry about him.
Talk to me.
You tell me the truth.
You won't get in trouble.
You'll just help a friend.
All right.
We were pledging.
And there's there's this, uh, wheel of torture thing you got to do for initiation.
Torture? - But it's mos - it's mostly stupid stuff, dude.
It's, like, like, drink a cup of olive oil or eat a tablespoon of cinnamon.
And what did Caden land on? Laundry.
He had to do laundry? No, like, like, he had to, uh, eat th-those laundry things, as many as he could in 30 seconds.
Detergent? Eat detergent? And how many did he have? - I don't know.
- Like six, maybe seven, seven.
He ate detergent.
Could've burned a hole through his esophagus or his stomach and intestines.
[MONITOR BEEPING.]
Catch that bleeder, please.
Let's hope he doesn't breed.
What? He isn't an idiot? MELENDEZ: We have healthy bowel attached to healthy bowel.
Let's close him up.
Dr.
Melendez? The trauma S.
O.
D.
is asking for you in O.
R.
number 2.
We got an emergency thoracotomy.
Who can give me the remaining steps for closing? MORGAN: Cut anchoring sutures, clear laps, and reposition the bowel.
Remove clamps from the duodenal resection site, keeping clear of the underlying aorta, close the fascia using a looped O monofilament, close the dermal layer, then re-approximate the skin.
Also, you need to ensure no omentum is caught in the fascial suture line.
Close him up.
Murphy, you're lead.
Clearing laps.
I will hold the repaired segment in place while you run the bowel for me.
Bowel is clear and ready to be repositioned.
Shaun? Shaun, is everything all right? I lost something.
In the cavity? No.
But I know where it is now.
Shaun.
I left my scalpel here earlier today.
You should get Diffusion Tensor Imaging.
A DTI? Masses are difficult to diagnose accurately.
You should get more imaging.
People make mistakes.
That's not gonna happen, Shaun.
My scalpel isn't here.
[MONITORS BEEPING RAPIDLY.]
What happened this time? He's got a bleed somewhere.
I want a capsule endoscopy to check the entire length of the bowel for bleeding and leaks.
And get me a complete coagulation - and metabolic profile.
- On it.
Dr.
Glassman is dying.
What? What do you mean? He seemed fine.
They say he has a glioma.
That's a brain tumor.
And he won't do a DTI scan to confirm the diagnosis.
Did he get a second opinion? He has, but delayed or missed or incorrect diagnosis has an occurrence rate of 10% to 20%.
Doctors make mistakes.
Shaun, I don't know what you want me to do.
I-I want you to sit down.
That's what people say when they want to tell you something important.
The part about him dying, that wasn't the important part? He won't listen to me.
He is stubborn.
- That he is.
- Stubborn.
He will listen to you.
Okay, you have known him longer, you're his friend, he trusts you.
Shaun, I can't make him do anything, either.
You Y-You're an attorney.
I'm not skilled at lying or manipulation.
So you want me to what? You want me to manipulate him? You want me to use our relationship and our history to trick him into doing this? Yes, please.
I knew you wouldn't let him die.
Our patient has Disseminated Intravascular Coagulation.
Can anyone tell me why that is very bad? Blood clots form throughout the blood vessels and rapidly deplete the body's clotting factors, thereby causing a systematic bleed.
It's also a catch-22.
If we treat the clotting, he might end up with a terminal bleed.
And if we treat the bleeding, he'll have a terminal clot.
So how do we treat it? We figure out the cause.
Treat the cause.
More damage from the detergent? Margins were clear.
It's not that.
He could have a crush injury from his ankle.
Or a bacterial infection he picked up before or during surgery.
It might have been set off by drug use.
Or we did this to him.
And by "we," I mean Shaun.
He spaced out in the O.
R.
when he was closing, kind of like he is now.
- I'm listening.
- Comforting.
He wasn't focused.
He could've nicked a vessel, which could've caused Okay, we're talking about Shaun.
Yeah, he's quiet, but he was focused.
He's always focused.
His stitches look like they came out of a sewing machine.
All right.
Complications happen.
The kid was in pretty bad shape when we got him.
Physician error is way down on the list of likely causes.
Crush trauma being top.
Get him started on fresh frozen plasma and crystalloid fluids.
[DOOR OPENS.]
[KNOCK ON DOOR.]
- Yeah? - [DOOR OPENS.]
You got a second? Well, that's an open question.
What can I do for you? I got a patient with DIC.
One of the possible causes is surgeon error.
Your patient, your error? Shaun's.
He got distracted during surgery, spaced out.
It's not like him.
One place he never misses a beat is the O.
R.
Is there anything going on that I should know about? He got some bad news.
About what? It's a personal matter.
Shaun was distracted by a personal issue? What, did Lea come back? She have a new boyfriend? His cable get cut off? I have an inoperable glioma.
18 months.
Aaron, I am so sorry.
Me, too.
Is there anything I can do? I wish.
You should've told me.
Or at least you shouldn't have told him.
His coagulation factors are still off.
Crush trauma isn't the issue.
And his tox screen came back clean.
- It's not drugs, either.
- We don't know that.
He's had so many transfusions, the blood in his veins isn't the same blood he came in with.
The drugs could still be in his organs causing I get that you don't want to think that this could be caused by your friend, but we have to The kid came directly from a frat hazing, hammered.
What are the odds he wasn't on drugs? We should start IV midazolam and sodium bicarbonate to counteract - That's the treatment for amphetamines.
- If you're wrong, that could cause a fatal arrhythmia.
I'll find out what drugs he's on.
You're going to find out by asking? Blake was honest with me before.
It's a lot easier to be honest when you're not confessing to a crime.
We don't have a lot of choice in the matter.
[SCOFFS.]
That's not true.
Thanks for doing this.
Yeah, no worries.
Noticed it was cut when I first saw you.
Figured it should get cleaned up.
Is it all right if I draw some blood? Just want to make sure you don't have any toxins or infections.
Sure.
So, uh, the nurse said that Caden has DIC.
Do you know what that is? Mnh-mnh.
Well, in short, his body is clotting and hemorrhaging at the same time.
If we can't figure out what's causing it, he'll die.
Just hold that there for me.
All done.
PARK: Blake, buddy, you're on something.
Your pupils are dilated, and you're sweating in a 68-degree room.
Now, I can hand this over to the cops or you can tell the truth about what Caden's on.
Molly.
I would've told you the truth if you'd asked.
I'm sorry.
You have time to talk? [DOOR CLOSES.]
Shaun told you.
He did.
Yeah.
I wish I would've heard it from you.
Yeah, I'm sorry.
- We're friends.
- I get it.
- I want to be there for you.
- [STAMMERS.]
What, are you mad at me? Yes.
I'm supposed to be there for you.
To do what? To do what exactly? Hold my hand? Yes, if that's what's needed.
Okay, well, what I need is to be left alone, okay? Well, you told Shaun, so that was a brilliant strategy.
Okay, okay, I get it.
Stupid, stupid, stupid, stupid, okay? Sometimes when people are told they are dying, they do stupid things! Sometimes people around them do stupid things! Shaun told you to come here to try to convince me to get more imaging, right?! Aaron, you can't stop fighting.
- Maddie wouldn't have wanted you to stop - Don't, don't, don't, don't you dare.
Don't you dare.
What are you gonna say, huh? That Maddie was a fighter? Huh? That she never quit? I'm sorry.
Thank you.
And you should get the DTI.
Not for you.
You've accepted your diagnosis.
Shaun hasn't.
He needs to.
[SNIFFLES.]
ANDREWS: Hey, Neil.
I heard there was a complication in one of your cases.
Caden Hauley? MELENDEZ: Heard or have you been monitoring all of Murphy's cases? I monitor all my department's cases.
18-year-old with DIC.
Any idea what set it off? Complications happen.
The kid was in pretty bad shape when he got to us.
I'm also wondering why you were in two surgeries at once.
You left three first-years unattended? You know we do this all the time.
We couldn't function efficiently if we didn't.
I hope Caden pulls through.
You got a very quick appointment.
I have connections, Shaun.
Why did you listen to Jessica but not me? Well, Jessica's pretty smart, too.
Yes, but what did she tell you? I don't think this is a good time.
When is a good time? I have a lot to learn from you, and if you're dying, less than two years to learn.
[FOOTSTEPS APPROACH.]
Sorry to keep you waiting.
There were some surprises on your images.
The previous diagnosis was incorrect.
You have a Glioblastoma Multiforme located in your pons.
I'm sure I don't need to tell you this, but it's the most aggressive form of brain cancer.
We estimate three, maybe four months.
I can have my assistant get in touch with you to refer you to a therapist when you're ready.
[SPEAKING INDISTINCTLY.]
[SOFT MUSIC PLAYING.]
He still has low blood pressure and thin blood, which means the treatment for the MDMA didn't work.
So the Molly wasn't the problem? It certainly didn't help him, but now we think he Our best guess is Caden has a bacterial infection.
Thanks.
DIC? What happened there? Uh, we're not sure yet.
He was pretty sick when he came in.
I guess sometimes complications just happen.
Interesting choice of words.
Eerily similar to what Dr.
Melendez said to me.
Yeah, he said it during a differential.
I guess the phrasing just stuck with me.
It's not like Melendez to be that laissez-faire.
He usually likes to know exactly why things happen.
One of the traits I admire about him.
Yeah, well, we're trying to figure it out.
But so far, the cultures are negative.
Shaun's closing was textbook.
Drug use doesn't seem to be a problem.
I didn't realize Murphy did the closing.
Good for him.
[SIGHS.]
Oh, my God.
Shaun.
Yes, yes, there are many different explanations.
You asked me to get a second opinion.
I got a second opinion.
You asked me to get more imaging.
I got more imaging.
Shaun, you have to accept No, I don't accept.
I don't accept.
I was right.
No, you were not right.
I'm dying, Shaun.
- I said - doctors make mistakes - Yeah, they made a mistake.
- I have less time than we even thought! - and they made a mistake.
Shaun was right.
Shaun was right.
Imaging is unreliable.
The imaging that you asked me to get.
Imaging is subject to interpretation.
[SIGHS.]
Yes, studies have shown that experts rely on on on subjective measures based on experience rather than object No more.
Rather than objective No more, no.
- No.
- No, no.
No more.
No more.
- No more.
- Many theories consistent with You can't do a biopsy to confirm because many tumors look alike.
Some are treatable.
- Some are curable.
- Stop, will ya?! Some are curable.
They're curable.
Stop, please, will ya?! Stop, stop, stop talking! - Stop! - Okay.
Stop! I am not hurting you.
Oh, my God, stop.
I'm helping you.
No, you're not.
You're not helping.
I don't need theories.
I don't need white boards.
I don't need doctors! I don't want to think about the tumor! I don't want to think about dying! You know what I want? You know what I actually want? I want to I want to I want to go on a long drive somewhere.
[VOICE BREAKING.]
I want to I want to eat pancakes.
I want to watch football.
- It's not football season.
- Oh, my God.
I know it's not football season.
[SIGHS.]
Do you mean you want to have fun? Yeah.
I want to have fun.
So you can keep fighting.
Keep fighting if you want.
It's futile and it's stupid.
Or you can come with me.
[DOOR OPENS.]
[DOOR CLOSES.]
- [MONITORS BEEPING RAPIDLY.]
- How long has he been hypoxic? It came on suddenly five minutes ago.
He's on 100% high-flow oxygen, and his numbers aren't budging.
He's ventilating fine.
He must have thrombosed his pulmonary artery.
We need to dissolve this clot before his heart stops.
- Jared, prep for jugular access.
- On it.
50 milligrams T.
P.
A.
infusion now.
Let's go, let's go, let's go! [CAROUSEL MUSIC PLAYING.]
Is this fun? [MUSIC CONTINUES.]
The Saturday after Valentine's Day, her favorite day of the year, even more than her birthday.
The Chamber of Commerce would decorate this place and put out a crappy buffet meal, hire a deejay, and I'd put on a tux, and she'd put on a yellow Belle dress, and she'd pin my bow tie on me, and I'd pin a little yellow corsage on her.
And we'd come and we'd eat and we'd and we'd dance.
[JAMES TAYLOR'S "YOUR SMILING FACE" PLAYS.]
Whenever I see your smiling face I have to smile myself Because I love you Yes, I do I love you, sweetie.
I love you more.
Oh, you think so, huh? Well, I'll tell you what.
You can take how much you love me, which I know is quite a lot, and then you can double it, and then you can add 10, and that's how much I love you.
Tell me how much longer, if it grows stronger every day I love you more.
Oh, how much longer? I thought I was in love a couple of times before With the girl next door And I remember thinking, "This is the moment that I know will be in my mind when I when I when I close my eyes to die.
" Only I thought that she'd be sitting there, right next to me, and I'd hear her say it one more time.
I lost my toy scalpel.
The one that Steve gave me.
Yeah, I figured that was the one.
I have been looking for a whole day.
I think it may be gone forever.
Maybe I'll come here when you're dead.
Okay.
Are your memories of your daughter enough for you? Not even close.
[CELLPHONE CHIMES.]
Do you need me to listen to you anymore? No, Shaun, you should go.
Okay.
CLAIRE: Not all the cultures are back.
But since he's not responding to any antibiotics, we can rule out bacterial.
It was never a great fit.
It's a better fit than surgical error.
What if it is bacterial but resistant to all Then he's dead.
What about Paroxysmal Nocturnal Hemoglobinuria? PNH? The incidence is literally one in a million.
What's the odds of Murphy screwing up? - I'd put them about that.
- No, it's not PNH.
Caden had normal flow cytometry.
Exotic snake venom can trigger consumptive coagulopathies.
So can pre-eclampsia, but he's not pregnant and he wasn't charming snakes.
Murphy, any thoughts here? It is kind of your ass on the line.
I know why Caden has DIC.
I squeezed the artery between two clamps.
I must have ruptured the aortic wall, causing a pseudo-aneurysm.
It was my mistake.
And also I have to make a bowel movement.
He's lying.
He's gonna puke.
[SIGHS.]
He's going to Glassman.
I told Dr.
Melendez I had to make a bowel movement.
I think he believed me.
Color me proud.
I have the answer.
Shaun, I hope you're referring to your patient, but due to the fact that you're here, pretending to be in the bathroom, - I kind of doubt that.
- Yes, it's your answer.
We already We already have my answer, Shaun.
We can't do a biopsy on you because of the arteries in the way, like the arteries in Caden's abdomen, but we can't move the arteries in your brain because Why did we go to the carousel? Because you were sad.
What didn't I want to do? Do you not know the answers to these questions? I do know the answers, Shaun.
I don't think you know the answers to these questions.
You're not hearing me.
I'm dying.
There's still hope.
Shaun, look at me.
Look at me, please.
There is no hope for me.
I mean, hope? What What What What is hope? You hope the 49ers find a defense.
You hope the number 4 bus comes on time.
Doesn't mean they magically learn how to tackle.
Doesn't mean the bus driver suddenly drives faster.
Hope is irrelevant for me.
Hope is painful.
I don't want to spend what's left of my life chasing my tail around in a circle.
You understand? Okay.
Okay.
Your tumor is located at the base of your skull.
An open cranial biopsy would tell us what's wrong.
But there are blood vessels in the way.
The biopsy would cause an aneurysm or a bleed.
But if we go through your nasal cribriform plate, we can cross the tentorium on the contralateral side and avoid all those blood vessels.
We can do a biopsy through your nose.
You can't die, too.
I have to throw up.
[DOOR OPENS.]
MORGAN: So how do we do this? Do we file a report? Talk to Andrews personally? You want to report Shaun? I don't want to.
I think we have to.
No, you want to.
And we'd certainly have to if our sole agenda would be to take down Shaun and to give you one less person to compete against.
And certainly, we'd absolutely "have to" cover up and bury a possible fatal medical error if our sole agenda was to protect a friend? Protocol would seem to favor the bitch over the friend.
Thanks? [DOOR OPENS.]
I threw up.
We have a duty to report errors so they won't happen again.
The process saves lives.
And exactly what errors are we trying to avoid a repeat of? You worried about the next time an autistic surgeon operates on a drugged-up frat kid after finding out his mentor is dying of brain cancer? Dr.
Melendez told us, Shaun.
We're really sorry.
It's okay.
It's okay.
I think he's going to be okay.
The protocol exists so that we don't ask questions like that.
That seems like a bad idea.
You trust your judgment.
Do you trust Morgan's judgment? Do you trust the judgment of all the doctors in this building? If you can make judgment calls, so can they.
That's why we need these rules.
No, the protocol is fine for everyone in this building, except for Shaun.
They'd reprimand any one of us, but they will fire him.
Okay.
We report it.
We get the investigation, make sure nothing like this ever happens again.
But we tell them I did it.
They'd fire you, too.
MORGAN: It's not a terrible idea.
Jared's out the door either way.
Can we get back to the medicine? Caden is still alive.
If we can keep it that way, there won't be an M&M review.
Which means no one will be asking questions, and no one will have to give answers.
It all goes away.
If Caden dies, we tell the truth and we face the consequences together.
SHAUN: No.
No.
I thought I'd found my toy scalpel.
We need you to come back to the group, Murphy.
Get me imaging on that pseudo-aneurysm.
[KNOCK ON DOOR, DOOR OPENS.]
Hey.
What's up? Do you still feel the same way about Dr.
Murphy as when he got here? Dr.
Glassman gave us certain assurances.
"If Shaun proves anything less than excellent, if Shaun doesn't live up to everything I know he can do, he will be immediately released, and I will resign my position as president of the hospital.
" And you wrote it down.
I made sure it was in the minutes.
Shaun has exceeded my expectations.
Mine, as well, and? And my feelings about Dr.
Glassman have not changed.
Thank you.
MELENDEZ: We need to cut him open.
PARK: We cut him open and he dies.
He'll bleed out before we can even get the artery exposed.
If we don't cut him open, he dies.
Don't cut him open.
Murphy, if we don't We should insert an endovascular graft through his leg instead.
Fix it from the inside out.
I've done that for large abdominal aorta dilations, but this is a lengthy dissecting pseudo-aneurysm.
It's safer.
The aortic wall is already compromised.
Could rupture completely.
Caden could die as soon as deflate the balloon - inside the graft.
- But doing nothing will kill him.
Not definitely.
There's still a chance Caden will simply come out of this without any surgical intervention.
5%, 10% maybe.
PARK: Not nothing.
And we're doubling down on Shaun after we know he caused this problem.
How's that gonna look at an M&M? I trust Shaun's idea.
He makes mistakes no one else would make, but he also makes saves none of us would have ever thought of.
Thank you.
You're welcome.
I still don't think you should be working here.
I don't think the trade-off is worth it.
Well, let's prep him for surgery.
Pull the guide wire, Reznick.
I'm passing in the graft.
[MONITORS BEEPING.]
You're right over the pseudoaneurysm now.
Inflating the balloon to deploy the graft.
Deflating.
Can I do it? It's delicate.
No, it's not.
And it will either work or it won't work.
If my idea is wrong, he'll die as soon as we complete this next step.
You shouldn't have to live with that.
Everything that happens in this room is my responsibility.
We'll do it together.
Deflating.
Nobody's going home.
I am proud of this team and what we accomplished today.
Drinks are on me at Harry Hopes.
We're celebrating? Today was a disaster, and we got lucky.
You're right.
But when you get lucky, you celebrate.
Let's go.
At some point in your career, you're going to kill someone.
And I hope for your sake there's a doctor out there who still believes in you when you do.
It was there all along.
I have to go drinking, but I wanted you to know Uh Is that from an IV? You did the biopsy.
I did.
I have a low-grade glioma.
Not a GBM? I told you Cancer, Shaun.
It's still cancer.
I have to undergo brain surgery, which is really scary because I'm not the one performing it.
Five days a week for six weeks of radiation, 10 more weeks of chemotherapy.
And then? And then with a little luck you and I can go to the Super Bowl next season.
You're going to live.
There's hope.
Now go.
Go have some fun with your friends.
Yes.
First I have to tell Dr.
Andrews about the mistake I made.
Shaun, y-you can't.
Protocol is clear, and reporting saves lives.
And I hear Caden is on the road to recovery, so your mistake couldn't have been too bad.
No, I made a mistake.
Shaun, I understand that.
But Dr.
Andrews will use this.
And do you remember the commitment that Dr.
Glassman made when you were hired? I promised you'd be excellent, right, Shaun? And you have been excellent.
You can't give Dr.
Andrews this excuse.
I was not excellent.
This time, I was bad.
And surgeons have to be excellent every time.
Right, Shaun? You agree with him? I'm not gonna ask him to lie to save my job.
Don't do this.
It's up to Shaun.
I trust your judgment.
I'm not doing this to hurt you.
I know.
We are friends.
Yes, we are.
I love you.
I know.
I love you, too.
I love you more.
[KNOCK ON DOOR.]
W-Why, Shaun? What happened? People need friends.
Well[CHUCKLES.]
Yeah, they do.
But you said you wanted me to stop interfering, remember? You wanted space.
You wanted to make your own mistakes.
I need a friend more than I need space.
You were a good mentor and a good friend.
Well, thank you, Shaun.
[CHUCKLES.]
You don't know how much it means to me to hear you say that.
But I-I think I think you may need a new mentor.
I'm dying.
12 to 18 months.
I'd appreciate it if you didn't tell anyone, okay? I-I will in my own time.
Okay.
Have you had a full work-up? Yes, of course.
It could be a secondary tumor metastasized to your brain from somewhere else.
It's the only tumor found.
It could be an inflammatory or infectious process.
It was a tumor, Shaun.
You should get a second opinion.
Shaun, I've been a neurosurgeon for 30 years.
I think that qualifies as a second opinion.
You should get a second opinion.
You have to know whether All right, all right, all right, all right, Shaun.
I'll get a second opinion.
Okay? Okay.
Can I go to work now? Okay, Doctor, what's your diagnosis? I'm drunk.
Not you.
Other doctor.
[CHUCKLES.]
Uh, well, given the degree of the rotation and the fact that the break is almost compound, I'd say we're dealing with a Bimalleolar or Trimalleolar fracture.
Very good.
What else? Um Color? Blood flow is restricted.
His foot's dying.
- Oh, no.
- Mm.
I'm gonna have to reset it now.
Hold his leg.
- No.
- No, it's Ok.
It just going to take a second I need you to count to three.
One - One, - two - [BONES CRACK.]
- Aah! [PANTING.]
[LAUGHS.]
Is Caden's leg gonna be okay? How long has his leg been like this and how exactly did it happen? Well, he's been like that since I found him.
He probably tripped over a curb or something because that's where he was.
Any reason you felt the need to tell me twice that you found him like this? LIM: Dr.
Park, boy's going to surgery.
You're going with.
Don't go anywhere.
Shouldn't I be asleep for this? Your blood alcohol level complicates anesthesia and we think you have a concussion, so we're gonna keep you responsive.
We did give you a regional nerve block, so you shouldn't feel anything.
Huh.
Cool.
Bend the ICP plate over two degrees on the proximal end.
PARK: Contouring pliers.
[FARTS.]
[LAUGHS.]
[MONITORS BEEPING.]
BP is dropping, heart rate's rising.
- Let's tube him.
- IV fluids and phenylephrine, stat.
We need to abort until we can get a handle on what else is going on.
Give me a full body CT, full blood panels, and an echo.
I think Jared and I may be able to dig up an answer quicker.
Great.
Get on it.
Come up with anything? Neither did I.
I had a friend, a neurosurgeon, at SF Muni.
She looked at the scans.
She came to the same diagnosis, Shaun.
I have an inoperable glioma.
Okay? I think you should go back to work, yes? I need to go to work.
Be reasonable.
Beg your pardon? Be reasonable.
I have no idea what you're talking about.
Oh, it'll be clear.
What the hell happened to Caden? - I I don't know.
- He twisted his ankle.
I You lied to me before.
You're lying to me now, you spoiled little coward.
Hey, hey.
Be reasonable.
His friend's hurt.
He's scared, and you're freaking him out.
[SIGHS.]
[INDISTINCT ANNOUNCEMENT OVER P.
A.
.]
[SIGHS.]
He's angry, but he's not wrong.
Caden's in bad shape, and we don't know why.
We need to know what happened.
No, no, don't don't worry about him.
Talk to me.
You tell me the truth.
You won't get in trouble.
You'll just help a friend.
All right.
We were pledging.
And there's there's this, uh, wheel of torture thing you got to do for initiation.
Torture? - But it's mos - it's mostly stupid stuff, dude.
It's, like, like, drink a cup of olive oil or eat a tablespoon of cinnamon.
And what did Caden land on? Laundry.
He had to do laundry? No, like, like, he had to, uh, eat th-those laundry things, as many as he could in 30 seconds.
Detergent? Eat detergent? And how many did he have? - I don't know.
- Like six, maybe seven, seven.
He ate detergent.
Could've burned a hole through his esophagus or his stomach and intestines.
[MONITOR BEEPING.]
Catch that bleeder, please.
Let's hope he doesn't breed.
What? He isn't an idiot? MELENDEZ: We have healthy bowel attached to healthy bowel.
Let's close him up.
Dr.
Melendez? The trauma S.
O.
D.
is asking for you in O.
R.
number 2.
We got an emergency thoracotomy.
Who can give me the remaining steps for closing? MORGAN: Cut anchoring sutures, clear laps, and reposition the bowel.
Remove clamps from the duodenal resection site, keeping clear of the underlying aorta, close the fascia using a looped O monofilament, close the dermal layer, then re-approximate the skin.
Also, you need to ensure no omentum is caught in the fascial suture line.
Close him up.
Murphy, you're lead.
Clearing laps.
I will hold the repaired segment in place while you run the bowel for me.
Bowel is clear and ready to be repositioned.
Shaun? Shaun, is everything all right? I lost something.
In the cavity? No.
But I know where it is now.
Shaun.
I left my scalpel here earlier today.
You should get Diffusion Tensor Imaging.
A DTI? Masses are difficult to diagnose accurately.
You should get more imaging.
People make mistakes.
That's not gonna happen, Shaun.
My scalpel isn't here.
[MONITORS BEEPING RAPIDLY.]
What happened this time? He's got a bleed somewhere.
I want a capsule endoscopy to check the entire length of the bowel for bleeding and leaks.
And get me a complete coagulation - and metabolic profile.
- On it.
Dr.
Glassman is dying.
What? What do you mean? He seemed fine.
They say he has a glioma.
That's a brain tumor.
And he won't do a DTI scan to confirm the diagnosis.
Did he get a second opinion? He has, but delayed or missed or incorrect diagnosis has an occurrence rate of 10% to 20%.
Doctors make mistakes.
Shaun, I don't know what you want me to do.
I-I want you to sit down.
That's what people say when they want to tell you something important.
The part about him dying, that wasn't the important part? He won't listen to me.
He is stubborn.
- That he is.
- Stubborn.
He will listen to you.
Okay, you have known him longer, you're his friend, he trusts you.
Shaun, I can't make him do anything, either.
You Y-You're an attorney.
I'm not skilled at lying or manipulation.
So you want me to what? You want me to manipulate him? You want me to use our relationship and our history to trick him into doing this? Yes, please.
I knew you wouldn't let him die.
Our patient has Disseminated Intravascular Coagulation.
Can anyone tell me why that is very bad? Blood clots form throughout the blood vessels and rapidly deplete the body's clotting factors, thereby causing a systematic bleed.
It's also a catch-22.
If we treat the clotting, he might end up with a terminal bleed.
And if we treat the bleeding, he'll have a terminal clot.
So how do we treat it? We figure out the cause.
Treat the cause.
More damage from the detergent? Margins were clear.
It's not that.
He could have a crush injury from his ankle.
Or a bacterial infection he picked up before or during surgery.
It might have been set off by drug use.
Or we did this to him.
And by "we," I mean Shaun.
He spaced out in the O.
R.
when he was closing, kind of like he is now.
- I'm listening.
- Comforting.
He wasn't focused.
He could've nicked a vessel, which could've caused Okay, we're talking about Shaun.
Yeah, he's quiet, but he was focused.
He's always focused.
His stitches look like they came out of a sewing machine.
All right.
Complications happen.
The kid was in pretty bad shape when we got him.
Physician error is way down on the list of likely causes.
Crush trauma being top.
Get him started on fresh frozen plasma and crystalloid fluids.
[DOOR OPENS.]
[KNOCK ON DOOR.]
- Yeah? - [DOOR OPENS.]
You got a second? Well, that's an open question.
What can I do for you? I got a patient with DIC.
One of the possible causes is surgeon error.
Your patient, your error? Shaun's.
He got distracted during surgery, spaced out.
It's not like him.
One place he never misses a beat is the O.
R.
Is there anything going on that I should know about? He got some bad news.
About what? It's a personal matter.
Shaun was distracted by a personal issue? What, did Lea come back? She have a new boyfriend? His cable get cut off? I have an inoperable glioma.
18 months.
Aaron, I am so sorry.
Me, too.
Is there anything I can do? I wish.
You should've told me.
Or at least you shouldn't have told him.
His coagulation factors are still off.
Crush trauma isn't the issue.
And his tox screen came back clean.
- It's not drugs, either.
- We don't know that.
He's had so many transfusions, the blood in his veins isn't the same blood he came in with.
The drugs could still be in his organs causing I get that you don't want to think that this could be caused by your friend, but we have to The kid came directly from a frat hazing, hammered.
What are the odds he wasn't on drugs? We should start IV midazolam and sodium bicarbonate to counteract - That's the treatment for amphetamines.
- If you're wrong, that could cause a fatal arrhythmia.
I'll find out what drugs he's on.
You're going to find out by asking? Blake was honest with me before.
It's a lot easier to be honest when you're not confessing to a crime.
We don't have a lot of choice in the matter.
[SCOFFS.]
That's not true.
Thanks for doing this.
Yeah, no worries.
Noticed it was cut when I first saw you.
Figured it should get cleaned up.
Is it all right if I draw some blood? Just want to make sure you don't have any toxins or infections.
Sure.
So, uh, the nurse said that Caden has DIC.
Do you know what that is? Mnh-mnh.
Well, in short, his body is clotting and hemorrhaging at the same time.
If we can't figure out what's causing it, he'll die.
Just hold that there for me.
All done.
PARK: Blake, buddy, you're on something.
Your pupils are dilated, and you're sweating in a 68-degree room.
Now, I can hand this over to the cops or you can tell the truth about what Caden's on.
Molly.
I would've told you the truth if you'd asked.
I'm sorry.
You have time to talk? [DOOR CLOSES.]
Shaun told you.
He did.
Yeah.
I wish I would've heard it from you.
Yeah, I'm sorry.
- We're friends.
- I get it.
- I want to be there for you.
- [STAMMERS.]
What, are you mad at me? Yes.
I'm supposed to be there for you.
To do what? To do what exactly? Hold my hand? Yes, if that's what's needed.
Okay, well, what I need is to be left alone, okay? Well, you told Shaun, so that was a brilliant strategy.
Okay, okay, I get it.
Stupid, stupid, stupid, stupid, okay? Sometimes when people are told they are dying, they do stupid things! Sometimes people around them do stupid things! Shaun told you to come here to try to convince me to get more imaging, right?! Aaron, you can't stop fighting.
- Maddie wouldn't have wanted you to stop - Don't, don't, don't, don't you dare.
Don't you dare.
What are you gonna say, huh? That Maddie was a fighter? Huh? That she never quit? I'm sorry.
Thank you.
And you should get the DTI.
Not for you.
You've accepted your diagnosis.
Shaun hasn't.
He needs to.
[SNIFFLES.]
ANDREWS: Hey, Neil.
I heard there was a complication in one of your cases.
Caden Hauley? MELENDEZ: Heard or have you been monitoring all of Murphy's cases? I monitor all my department's cases.
18-year-old with DIC.
Any idea what set it off? Complications happen.
The kid was in pretty bad shape when he got to us.
I'm also wondering why you were in two surgeries at once.
You left three first-years unattended? You know we do this all the time.
We couldn't function efficiently if we didn't.
I hope Caden pulls through.
You got a very quick appointment.
I have connections, Shaun.
Why did you listen to Jessica but not me? Well, Jessica's pretty smart, too.
Yes, but what did she tell you? I don't think this is a good time.
When is a good time? I have a lot to learn from you, and if you're dying, less than two years to learn.
[FOOTSTEPS APPROACH.]
Sorry to keep you waiting.
There were some surprises on your images.
The previous diagnosis was incorrect.
You have a Glioblastoma Multiforme located in your pons.
I'm sure I don't need to tell you this, but it's the most aggressive form of brain cancer.
We estimate three, maybe four months.
I can have my assistant get in touch with you to refer you to a therapist when you're ready.
[SPEAKING INDISTINCTLY.]
[SOFT MUSIC PLAYING.]
He still has low blood pressure and thin blood, which means the treatment for the MDMA didn't work.
So the Molly wasn't the problem? It certainly didn't help him, but now we think he Our best guess is Caden has a bacterial infection.
Thanks.
DIC? What happened there? Uh, we're not sure yet.
He was pretty sick when he came in.
I guess sometimes complications just happen.
Interesting choice of words.
Eerily similar to what Dr.
Melendez said to me.
Yeah, he said it during a differential.
I guess the phrasing just stuck with me.
It's not like Melendez to be that laissez-faire.
He usually likes to know exactly why things happen.
One of the traits I admire about him.
Yeah, well, we're trying to figure it out.
But so far, the cultures are negative.
Shaun's closing was textbook.
Drug use doesn't seem to be a problem.
I didn't realize Murphy did the closing.
Good for him.
[SIGHS.]
Oh, my God.
Shaun.
Yes, yes, there are many different explanations.
You asked me to get a second opinion.
I got a second opinion.
You asked me to get more imaging.
I got more imaging.
Shaun, you have to accept No, I don't accept.
I don't accept.
I was right.
No, you were not right.
I'm dying, Shaun.
- I said - doctors make mistakes - Yeah, they made a mistake.
- I have less time than we even thought! - and they made a mistake.
Shaun was right.
Shaun was right.
Imaging is unreliable.
The imaging that you asked me to get.
Imaging is subject to interpretation.
[SIGHS.]
Yes, studies have shown that experts rely on on on subjective measures based on experience rather than object No more.
Rather than objective No more, no.
- No.
- No, no.
No more.
No more.
- No more.
- Many theories consistent with You can't do a biopsy to confirm because many tumors look alike.
Some are treatable.
- Some are curable.
- Stop, will ya?! Some are curable.
They're curable.
Stop, please, will ya?! Stop, stop, stop talking! - Stop! - Okay.
Stop! I am not hurting you.
Oh, my God, stop.
I'm helping you.
No, you're not.
You're not helping.
I don't need theories.
I don't need white boards.
I don't need doctors! I don't want to think about the tumor! I don't want to think about dying! You know what I want? You know what I actually want? I want to I want to I want to go on a long drive somewhere.
[VOICE BREAKING.]
I want to I want to eat pancakes.
I want to watch football.
- It's not football season.
- Oh, my God.
I know it's not football season.
[SIGHS.]
Do you mean you want to have fun? Yeah.
I want to have fun.
So you can keep fighting.
Keep fighting if you want.
It's futile and it's stupid.
Or you can come with me.
[DOOR OPENS.]
[DOOR CLOSES.]
- [MONITORS BEEPING RAPIDLY.]
- How long has he been hypoxic? It came on suddenly five minutes ago.
He's on 100% high-flow oxygen, and his numbers aren't budging.
He's ventilating fine.
He must have thrombosed his pulmonary artery.
We need to dissolve this clot before his heart stops.
- Jared, prep for jugular access.
- On it.
50 milligrams T.
P.
A.
infusion now.
Let's go, let's go, let's go! [CAROUSEL MUSIC PLAYING.]
Is this fun? [MUSIC CONTINUES.]
The Saturday after Valentine's Day, her favorite day of the year, even more than her birthday.
The Chamber of Commerce would decorate this place and put out a crappy buffet meal, hire a deejay, and I'd put on a tux, and she'd put on a yellow Belle dress, and she'd pin my bow tie on me, and I'd pin a little yellow corsage on her.
And we'd come and we'd eat and we'd and we'd dance.
[JAMES TAYLOR'S "YOUR SMILING FACE" PLAYS.]
Whenever I see your smiling face I have to smile myself Because I love you Yes, I do I love you, sweetie.
I love you more.
Oh, you think so, huh? Well, I'll tell you what.
You can take how much you love me, which I know is quite a lot, and then you can double it, and then you can add 10, and that's how much I love you.
Tell me how much longer, if it grows stronger every day I love you more.
Oh, how much longer? I thought I was in love a couple of times before With the girl next door And I remember thinking, "This is the moment that I know will be in my mind when I when I when I close my eyes to die.
" Only I thought that she'd be sitting there, right next to me, and I'd hear her say it one more time.
I lost my toy scalpel.
The one that Steve gave me.
Yeah, I figured that was the one.
I have been looking for a whole day.
I think it may be gone forever.
Maybe I'll come here when you're dead.
Okay.
Are your memories of your daughter enough for you? Not even close.
[CELLPHONE CHIMES.]
Do you need me to listen to you anymore? No, Shaun, you should go.
Okay.
CLAIRE: Not all the cultures are back.
But since he's not responding to any antibiotics, we can rule out bacterial.
It was never a great fit.
It's a better fit than surgical error.
What if it is bacterial but resistant to all Then he's dead.
What about Paroxysmal Nocturnal Hemoglobinuria? PNH? The incidence is literally one in a million.
What's the odds of Murphy screwing up? - I'd put them about that.
- No, it's not PNH.
Caden had normal flow cytometry.
Exotic snake venom can trigger consumptive coagulopathies.
So can pre-eclampsia, but he's not pregnant and he wasn't charming snakes.
Murphy, any thoughts here? It is kind of your ass on the line.
I know why Caden has DIC.
I squeezed the artery between two clamps.
I must have ruptured the aortic wall, causing a pseudo-aneurysm.
It was my mistake.
And also I have to make a bowel movement.
He's lying.
He's gonna puke.
[SIGHS.]
He's going to Glassman.
I told Dr.
Melendez I had to make a bowel movement.
I think he believed me.
Color me proud.
I have the answer.
Shaun, I hope you're referring to your patient, but due to the fact that you're here, pretending to be in the bathroom, - I kind of doubt that.
- Yes, it's your answer.
We already We already have my answer, Shaun.
We can't do a biopsy on you because of the arteries in the way, like the arteries in Caden's abdomen, but we can't move the arteries in your brain because Why did we go to the carousel? Because you were sad.
What didn't I want to do? Do you not know the answers to these questions? I do know the answers, Shaun.
I don't think you know the answers to these questions.
You're not hearing me.
I'm dying.
There's still hope.
Shaun, look at me.
Look at me, please.
There is no hope for me.
I mean, hope? What What What What is hope? You hope the 49ers find a defense.
You hope the number 4 bus comes on time.
Doesn't mean they magically learn how to tackle.
Doesn't mean the bus driver suddenly drives faster.
Hope is irrelevant for me.
Hope is painful.
I don't want to spend what's left of my life chasing my tail around in a circle.
You understand? Okay.
Okay.
Your tumor is located at the base of your skull.
An open cranial biopsy would tell us what's wrong.
But there are blood vessels in the way.
The biopsy would cause an aneurysm or a bleed.
But if we go through your nasal cribriform plate, we can cross the tentorium on the contralateral side and avoid all those blood vessels.
We can do a biopsy through your nose.
You can't die, too.
I have to throw up.
[DOOR OPENS.]
MORGAN: So how do we do this? Do we file a report? Talk to Andrews personally? You want to report Shaun? I don't want to.
I think we have to.
No, you want to.
And we'd certainly have to if our sole agenda would be to take down Shaun and to give you one less person to compete against.
And certainly, we'd absolutely "have to" cover up and bury a possible fatal medical error if our sole agenda was to protect a friend? Protocol would seem to favor the bitch over the friend.
Thanks? [DOOR OPENS.]
I threw up.
We have a duty to report errors so they won't happen again.
The process saves lives.
And exactly what errors are we trying to avoid a repeat of? You worried about the next time an autistic surgeon operates on a drugged-up frat kid after finding out his mentor is dying of brain cancer? Dr.
Melendez told us, Shaun.
We're really sorry.
It's okay.
It's okay.
I think he's going to be okay.
The protocol exists so that we don't ask questions like that.
That seems like a bad idea.
You trust your judgment.
Do you trust Morgan's judgment? Do you trust the judgment of all the doctors in this building? If you can make judgment calls, so can they.
That's why we need these rules.
No, the protocol is fine for everyone in this building, except for Shaun.
They'd reprimand any one of us, but they will fire him.
Okay.
We report it.
We get the investigation, make sure nothing like this ever happens again.
But we tell them I did it.
They'd fire you, too.
MORGAN: It's not a terrible idea.
Jared's out the door either way.
Can we get back to the medicine? Caden is still alive.
If we can keep it that way, there won't be an M&M review.
Which means no one will be asking questions, and no one will have to give answers.
It all goes away.
If Caden dies, we tell the truth and we face the consequences together.
SHAUN: No.
No.
I thought I'd found my toy scalpel.
We need you to come back to the group, Murphy.
Get me imaging on that pseudo-aneurysm.
[KNOCK ON DOOR, DOOR OPENS.]
Hey.
What's up? Do you still feel the same way about Dr.
Murphy as when he got here? Dr.
Glassman gave us certain assurances.
"If Shaun proves anything less than excellent, if Shaun doesn't live up to everything I know he can do, he will be immediately released, and I will resign my position as president of the hospital.
" And you wrote it down.
I made sure it was in the minutes.
Shaun has exceeded my expectations.
Mine, as well, and? And my feelings about Dr.
Glassman have not changed.
Thank you.
MELENDEZ: We need to cut him open.
PARK: We cut him open and he dies.
He'll bleed out before we can even get the artery exposed.
If we don't cut him open, he dies.
Don't cut him open.
Murphy, if we don't We should insert an endovascular graft through his leg instead.
Fix it from the inside out.
I've done that for large abdominal aorta dilations, but this is a lengthy dissecting pseudo-aneurysm.
It's safer.
The aortic wall is already compromised.
Could rupture completely.
Caden could die as soon as deflate the balloon - inside the graft.
- But doing nothing will kill him.
Not definitely.
There's still a chance Caden will simply come out of this without any surgical intervention.
5%, 10% maybe.
PARK: Not nothing.
And we're doubling down on Shaun after we know he caused this problem.
How's that gonna look at an M&M? I trust Shaun's idea.
He makes mistakes no one else would make, but he also makes saves none of us would have ever thought of.
Thank you.
You're welcome.
I still don't think you should be working here.
I don't think the trade-off is worth it.
Well, let's prep him for surgery.
Pull the guide wire, Reznick.
I'm passing in the graft.
[MONITORS BEEPING.]
You're right over the pseudoaneurysm now.
Inflating the balloon to deploy the graft.
Deflating.
Can I do it? It's delicate.
No, it's not.
And it will either work or it won't work.
If my idea is wrong, he'll die as soon as we complete this next step.
You shouldn't have to live with that.
Everything that happens in this room is my responsibility.
We'll do it together.
Deflating.
Nobody's going home.
I am proud of this team and what we accomplished today.
Drinks are on me at Harry Hopes.
We're celebrating? Today was a disaster, and we got lucky.
You're right.
But when you get lucky, you celebrate.
Let's go.
At some point in your career, you're going to kill someone.
And I hope for your sake there's a doctor out there who still believes in you when you do.
It was there all along.
I have to go drinking, but I wanted you to know Uh Is that from an IV? You did the biopsy.
I did.
I have a low-grade glioma.
Not a GBM? I told you Cancer, Shaun.
It's still cancer.
I have to undergo brain surgery, which is really scary because I'm not the one performing it.
Five days a week for six weeks of radiation, 10 more weeks of chemotherapy.
And then? And then with a little luck you and I can go to the Super Bowl next season.
You're going to live.
There's hope.
Now go.
Go have some fun with your friends.
Yes.
First I have to tell Dr.
Andrews about the mistake I made.
Shaun, y-you can't.
Protocol is clear, and reporting saves lives.
And I hear Caden is on the road to recovery, so your mistake couldn't have been too bad.
No, I made a mistake.
Shaun, I understand that.
But Dr.
Andrews will use this.
And do you remember the commitment that Dr.
Glassman made when you were hired? I promised you'd be excellent, right, Shaun? And you have been excellent.
You can't give Dr.
Andrews this excuse.
I was not excellent.
This time, I was bad.
And surgeons have to be excellent every time.
Right, Shaun? You agree with him? I'm not gonna ask him to lie to save my job.
Don't do this.
It's up to Shaun.
I trust your judgment.
I'm not doing this to hurt you.
I know.
We are friends.
Yes, we are.
I love you.
I know.
I love you, too.
I love you more.
[KNOCK ON DOOR.]