The Good Doctor (2017) s03e03 Episode Script
Claire
1 I'm Dr.
Browne.
I'll be performing your surgery today.
I'm Dr.
Browne.
I'll be performing your surgery today.
Dr.
Browne I'll be performing your surgery today.
It's a very simple procedure.
It's a straightforward procedure.
It was a successful surgery.
The surgery was a success.
We expect a full recovery.
I expect a full recovery.
Baby.
Where do you want this? Uh, thanks, Mom.
Uh, put it by my bag.
I'll have the hospital lab run it.
Nausea and severe abdominal pain after eating.
This patient could need a lap chole.
That would be an ideal first surgery.
Let's not get ahead of ourselves.
She may just need an antacid.
Hi, Michelle.
I understand your mother is on her way in.
- I'm Dr.
Browne.
- And I'm Dr.
Shaun Murphy.
You need to fix my sister.
What's your name? - Tisha.
- Hi, Tisha.
Well, that is exactly why we're here To help your sister.
Foster sister.
When did the pain start? About an hour ago.
It was on the bus.
My sister rides with me every day to school and back.
My brother and I used to live on a bus.
Cool.
Have you felt like this before? A few times.
Ow.
She has extreme upper-right quadrant tenderness.
That's consistent with cholecystitis.
As is her fever and elevated white count.
Your gallbladder probably needs to be removed.
You must be excited, Claire.
This is going to be your first surgery.
Has your urine changed color? Gotten darker? I hear Dr.
Browne might have landed her first lap chole.
It's not exactly a straightforward case.
The duct is massively dilated, the wall's inflamed, this scarring It's gonna limit visibility.
Well, the thickness of the gallbladder wall does pose a challenge.
What do you think? It's not her decision.
It's mine, as the attending.
Doesn't mean she shouldn't offer her opinion.
I think that, um, Dr.
Melendez is right.
With the limited visibility, I shouldn't be Only with a laparoscopic cholecystectomy.
Which I don't think we should do.
An open procedure would provide a clearer view of the gallbladder and the surrounding anatomy despite the inflammation.
Carly and I went on another date last night.
Mm.
What did you do? Dinner, movie We walked 12 minutes to a deli and had some food and talked.
Where are we going? Andrews is starting an open chole.
Sounds like it's going well with you and Carly.
Oh, yes.
She answered all of my questions.
How many did you ask? 83, although some had multiple parts.
"Do you want to have children? If yes, how many and when?" "Where do you plan to raise them? In what religious tradition?" Those are pretty intense.
They're good questions, Claire, about important topics.
Early on, people usually stick with lighter stuff Favorite movies, bands, hometowns.
Small talk.
Put some LAPs in the upper-right quadrant.
Here's the Bovie, Dr.
Andrews.
Isn't the point of dating to gather information to determine compatibility? Retract the omentum.
Sure.
Isn't that best achieved by finding out what's important to the other person? Hemostats.
It's a It's a process, Shaun, like peeling an onion.
People are more comfortable revealing their layers gradually, as opposed to getting sliced right down the middle.
I heard Dr.
Lim selected you for the first lead.
I'm guessing you drew a cholecystectomy.
Sponge on a stick.
What's your approach to dissecting Retrograde or antegrade? Antegrade.
Once I've located the porta hepatis.
I think Carly was comfortable.
Why does it matter what kind of questions are asked when? Aren't the answers what's important? - I'm sure you're right.
- Yes.
What is the plan for the next date? Hmm.
We didn't make another date.
Then I grasp gallbladder fundus - and elevate it which way? - S-Superiorly.
Is that significant? No follow-up date? Not necessarily.
How did the night end? Good-night kiss? I've exposed the triangle of Calot and ligated the cystic duct and artery.
What is the risk at this juncture? - Lacerating the liver during dissection.
- Correct.
We didn't kiss.
Ironically, a complication which I've inadvertently just demonstrated.
Hold direct pressure.
I need better exposure.
I sliced instead of peeled.
You are familiar with the Pringle procedure, Dr.
Browne? Yes, although I've never Clamp down the portal triad with an atraumatic hemostat clamp, then use a number 2 catgut suture.
Shaun, just go to her and explain.
If what I said made her uncomfortable, then saying more could make her more uncomfortable.
I sliced instead of peeled.
After Michelle's surgery, I will go and talk to Carly.
Good.
You can talk to her soon.
OR 2 had a cancellation.
Your surgery is in 45 minutes.
Hi, I'm Dr.
Browne.
I will be performing Michelle's surgery.
I will be removing her gallbladder.
It is a simple procedure.
We're gonna make sure your daughter is well taken care of.
Ow! Sir, we need to decapitate it.
No, don't.
I'm begging you.
Don't.
Please.
I can't get an image.
How did that I-Is that a swordfish? With that dorsal fin? It's a marlin.
I hooked him with a naked ballyhoo.
Battled me for over an hour.
Suddenly, he just leapt out of the water.
He came right at me.
Save the story for the bar, Quint.
Right now, we need to cut the damn thing in half.
No.
40-plus years I've been chasing a fish like this.
You can't just behead him! Can't leave his nose in your leg, either.
His bill.
Can't you just pull him out gently? I'll sign a waiver.
The pull-out method never works.
If any of your blood vessels are damaged, it gets messy.
Congrats.
I hear your surgery is on the schedule.
How's his distal pulse? A little thready, but still there.
We need to get him to an MRI.
I'm not going anywhere without Franklin.
I named him after my father.
You and Franklin both won't fit.
Aah! Oh! Oh! How? You said he was dead! I didn't take a pulse.
Go get something to kill it.
- No, it's dead! - It's moving! It's a postmortem response.
You guys are doctors.
Don't people do this? - No! - No! I'll help you review at lunch.
Surgery's in 20 minutes.
- Good luck.
- You, too.
I want to No, no, I haven't looked.
I want to be Great.
great Okay.
- or nothing.
- Nothing.
Got it.
I'll be back as soon as I can.
Hi.
You must be Michelle's mother.
I'm Dr.
Browne.
I'll be Yeah.
How long will she have to stay in here? Hospitals make me nervous.
Three days to a week, depending on Well, she's gonna miss a lot of school.
And she watches Tisha and her brothers in the afternoon.
Your daughter has a serious infection in her gallbladder.
She's been experiencing symptoms on and off for a while now.
She never told me that.
Why didn't you tell me that? - Mama - My point is, she's been ill for a while, so her recovery may take Mom.
Mom? P-Please, my my chest hurts.
What's wrong? Her oxygen levels are dropping.
She's tachycardic.
I need a chest CT, stat.
You had a blood clot in the artery that feeds your lungs.
It's called a pulmonary embolism.
This medicine broke it up.
How could that happen? According to our scan, it was part of a larger clot in your leg that broke off and traveled there.
As for why the larger one formed, when I asked you if you were taking birth control pills, you said no.
Was that the truth? You asked me in front of Tisha.
I'm doing it with my boyfriend, and I don't want babies, so I'm taking birth control pills.
How long have you been taking them? I don't know.
A year? I'm prescribing condoms for your boyfriend.
You need to go off the pill to prevent further clots.
Dr.
Browne is gonna place an IVC filter via your femoral vein, in case other parts of the clot break off.
Your gallbladder surgery's gonna have to wait till tomorrow.
What are you doing? This is where the catheter goes in.
How did you get these scars? I cut myself climbing a fence.
Those scars They're straight, in a row, all the same length.
I don't believe you got them from a fence.
I don't care what you believe.
Kids who cut, most of them are really sad, in a lot of pain, and they say cutting makes them feel better.
Is that how it is with you? I don't want to talk about it.
Okay.
My life sucks, okay? Tell me how.
Why? It won't change anything.
Talking might make you feel better, and maybe I can help.
I live in a foster home, but I'm not a foster kid.
I'm a whole mother, but I've never had a baby.
My mom brought three kids in our home, and now it's my job to take care of them Make breakfast, get the kids dressed, take them to school, go to school, pick them up, dinner, homework, laundry.
Repeat.
I barely ever leave the house without a kid attached to me.
Can you help me with that? Michelle wouldn't hurt herself on purpose.
Michelle is unhappy.
She feels pressure to look after her foster siblings, help out at home Yeah, her home life is fine.
I'll talk to her.
It might be helpful to have her speak with a psychiatrist.
My daughter is not crazy.
We We don't do psychiatrists.
You know that.
That needs to change.
When are you doing her surgery? - Tomorrow.
- Thank you.
I will speak to my daughter.
Don't.
It's your job to fix her gallbladder, not her life.
It's your first surgery.
Don't get distracted.
Have you talked to Carly? No.
Blood pressure is 62/31.
Your patient is in cardiac arrest.
I know.
You're practicing the Pringle maneuver in the event of a liver bleed? Yes.
- That was better.
- Thanks.
Now you can talk to Carly.
I need to practice.
Dr.
Lim says getting away from things every now and again, having balance in our lives can be just as important to our performance as practice.
Maybe you should get some balance by talking to Carly.
I don't know.
I'm nervous about my surgery, Shaun.
Practice will make me less nervous.
That will improve my performance.
Okay.
Okay.
You should also practice not causing a liver bleed.
Planning on it.
Also, how you will recover if you cut the portal vein.
That's potentially fatal.
Or if you perforate the small bowel, which could cause sepsis, leading to death.
Or if you cut the common bile duct, - which would cause - I'm gonna go talk to Carly.
- Right now? - Right now.
- Aren't you still nervous? - Nope, all better.
What blade for the Kocher? What? Incision for the chole what blade? Uh - 10.
- Mm-hmm.
No, they won't both fit in the MRI.
Fish Boy doesn't buy it.
Location of the incision.
Why are you trying to help me? Lim picked you for the first surgery.
Everyone knows that makes you the front-runner for Chief Resident.
This is me sucking up.
I've never been big on pretense Are you okay? What the hell just happened? The marlin must have had metal in his body Lures and stuff.
I think a license plate flew by me.
Franklin! Oh, no! Franklin! Oh, it's okay.
Franklin's okay.
It all came out one side.
It won't show when I mount him.
Well, thank goodness for small miracles.
- Ooh.
- Oh! Ow! Oh! Ah! I've got his femoral.
Call the OR.
We're coming.
Hang on, Dr.
Browne.
Just need to make an incision above and below the arterial injury site.
We need to clamp the femoral proximal to the bleed without clipping the femoral nerve.
Got it.
I feel the nerve right above my index finger.
One down.
My hand is starting to cramp.
Lean over this way a little bit.
Rotate your wrist.
Just a little bit more.
Let's see if that holds.
Go get cleaned up.
We'll take it from here.
I wanted to check the patient's bloodwork.
He's negative for HIV, Hep B and C.
You don't need prophylactic meds.
I'm nervous about my surgery.
You'll be fine.
And don't ever say that again.
Why? Weren't you nervous before your first lead? If I was, I didn't volunteer that to the Chief of Surgery Or anyone.
We're women, we're not white, and we're surgeons.
Unicorns consider us a fabled species.
We don't get the luxury of public insecurity.
I will aspire to repressed stoicism in the future.
We don't need to be insecure, because every step of the way, we've had to be twice as good as everybody else.
Suck it up.
You got this.
Don't forget we have our session with Dr.
Donovan today.
I won't.
- Your patient.
- Mm-hmm.
What are they like? Man, woman, young, old? Woman.
Girl, actually.
She's tough, smart really sad.
Her mom has her taking care of three foster kids.
At least you were only stuck looking after me.
How old? Although she acts a lot older.
She's been having sex for almost a year.
Well, you were about that age when you were with Wayne.
- I didn't have sex with Wayne.
- What? He was in love with you, always sniffing around our place.
Maybe.
He didn't get any.
So, who? Junior prom guy Derek.
Der No.
I didn't lose my virginity until sophomore year of college.
What were you hoping for, a proposal? No.
I wanted it to be special.
Oh, good for you.
I mean, I wouldn't have held out - No.
- but good for you.
I thought for sure you and Wayne were doing it.
You were okay with that? You were so serious.
So restrained.
We talked about birth control.
I figured, "Good for her.
She's finally relaxing, having some fun.
" Well, I was so restrained and serious 'cause I never knew when you were gonna fall apart.
Got to get to work.
I'll be back before Michelle goes into surgery.
Have you had a chance to talk to her about her cutting? Oh, yeah, some fool friend of hers gave her the idea.
She's not unhappy.
It's just peer pressure.
She sounded unhappy to me.
She's upset I didn't let her go hang out with her friends.
It's typical teen drama.
She promised me she's done cutting.
Self-harming behavior doesn't just stop.
- Michelle might need - Dr.
Browne.
My daughter needs to have surgery and get out of this hospital.
You didn't tell your mom the truth about why you cut yourself, about how unhappy you are.
I tried.
She didn't want to hear it, just said that things aren't always gonna go my way and I need to be more responsible.
Like I'm not already.
Growing up, I had to take care of my mom.
What was wrong with her? She's mentally ill.
Bipolar disorder and a drinking problem, pills.
When things were bad, she'd forget to buy groceries or clean the trailer or pick me up.
Or she'd spend all our rent on something stupid.
And I thought if I could make her life easy enough If I cooked and cleaned and got good grades Then she'd get better.
But she never did.
And for the longest time, I thought it was my fault she was sick.
And I probably still would if a psychiatrist hadn't refused to believe me when I said I was fine.
You've been to a psychiatrist? But you're, like, a fancy surgeon.
I could have a therapist come by and see you before your surgery.
Okay.
He should be getting better.
It's got to be an infection from the marlin.
Aeromonas or mycobacterium marinum.
Would've responded to the antibiotics.
Guys, I'm trying to focus.
What if he has an underlying autoimmune disorder? It could've been triggered by the surgery or even the initial fish stabbing.
It would explain why the leg ulcerations are progressing despite good arterial flow.
We could see if he responds to steroids.
Which could kill him if it is an infection.
But we could run an ANA, see if he's positive.
What about a parasite? Rhinosporidium seeberi or a gill worm.
Have you talked to Carly? Sorry.
I got sidetracked by a marlin.
Come in.
You wanted to see me? Ms.
Reynolds tells me that you went against her wishes and had her daughter speak with a psychiatrist.
Uh, Michelle asked to see a therapist.
Only after you talked her into it.
I'm gonna report you to the medical board.
You had no right Dr.
Browne, were you concerned that Michelle might be a serious danger to herself? Yes.
In that case, the consult was required.
That said, Dr.
Browne's failure to inform you was inappropriate.
You're off the case.
Dr.
Melendez will perform the surgery.
How are you doing? Claire? I understand today's a big day for you.
Your first surgery.
We don't need to talk about that.
Hmm, I think we do.
You've been taking care of your mother for a long time.
That's a pattern you both need to break out of.
I know I haven't always been there for you, and I just I I'm trying to change that.
I know, Mom.
I'm good.
Everything is fine.
And your first surgery? Is that this afternoon? It's Actually, it's not.
Um I arranged a psych consult without the mother's permission, so I got thrown off the case.
How could the hospital allow that? What is wrong with them? After how hard you've worked, I just It's okay, Mom.
They kind of had to.
That must be a big disappointment It is.
Anything else, Claire? I'm upset, humiliated, so, so mad at my patient's mother for not taking care of her daughter.
And I I'm relieved.
I'm so, so relieved to have that weight off of me, and that makes me feel like a fraud.
Don't you say that.
How can I be so scared to do something I've wanted for so long? Because things that matter are scary.
That's how I feel about coming here, talking about my life and our relationship.
What if I can't fix it? What if I can't make up for all the times I've let you down? And then I think "Just be like Claire.
" Because nothing stops you ever.
You see what you want, and you go after it with everything you've got.
You are an inspiration.
You're my inspiration.
Carly? Hi.
Do you have a second? OR 2 is waiting to learn the patient's mass wasn't cancerous so they can close.
I can come back after.
I'll be at the cafe? - Mm-hmm.
- Okay.
Anesthesiology, line 271.
Anesthesiology, call line 271.
Cancer.
The marlin guy has cancer.
CT chest, abdomen, and pelvis showed no masses.
It's in his leg.
It explains progressive ulcerations despite good arterial flow.
And why the antibiotics aren't working.
We'll send a tissue sample from the ulcerated area.
And when I'm Chief Resident, I'll remember this.
There's a problem with Michelle.
I'm not doing it! You need to calm down.
You don't get to tell me what to do! I want Dr.
Browne! Michelle? What's going on? I want you to do my surgery.
I want her, Mama, not somebody else.
Dr.
Melendez is gonna do your surgery.
He is a great doctor.
He's not you.
Y-You care about me.
Everybody here cares about you, Michelle.
Now, please sit down.
You could rupture your gallbladder.
I-I-I don't want to get better.
- Don't say that.
- It's the truth! Michelle, you need this surgery.
That is all that matters not whether I do it.
I'm gonna be there.
I will be watching from the gallery the whole time.
You just You need You need to sit down.
The kid okay? I had to pull you off.
If you made even the tiniest misstep during surgery, that mom would go from threat to lawsuit.
Is Patricia okay with me watching from the gallery? No.
You can't remove her gallbladder from the gallery.
What? You're doing Michelle's surgery.
How'd you get the mom to change her mind? I explained that, given Dr.
Browne's commitment to her daughter, she's the perfect choice to lead the surgery.
Especially with me over her shoulder the whole time.
Thank you for fighting for me.
That's what bosses do.
Let's go.
- You stood me up.
- Sorry about that.
What's up? Shaun's a little worried he may have freaked you out with his questionnaire the other night.
Oh, I thought it was cool.
Small talk bores the hell out of me.
Well, then, great.
I'll tell him.
Shaun got worried about that all on his own? That doesn't seem like him.
I may have mentioned that people don't usually ask deeply personal questions on an early date.
Claire, I like you, but we don't really know each other.
And yet you decided how I was going to react to Shaun's questions, which isn't your business.
And you were wrong Totally, totally wrong.
Shaun and I don't need you or anyone else to run interference on our relationship.
Butt out.
Is everybody ready for a Time Out? Dr.
Claire Browne, lead surgeon.
Dr.
Neil Melendez, attending surgeon.
Dr.
Shaun Murphy, assisting.
Dr.
Jan Lancaster, anesthesia.
Donna Petringa, scrub nurse.
Shani Walden, circulating nurse.
Patient is Michelle Reynolds.
We will be performing an open cholecystectomy.
All tools I need are confirmed to be present.
Estimated blood loss, 100 cc.
Patient will go to the ICU after surgery.
Is everybody in agreement? Dr.
Murphy, have you ChloraPrepped the site? I have.
10 blade.
Sponge.
Top layer of abdominal muscle is exposed.
I'll need a Bovie to cut through.
Nice work, Dr.
Browne.
Bookwalter Retractor.
I see the liver, and I need to better expose the inferior surface.
Retract the duodenum inferiorly, please.
Gallbladder exposed.
Dr.
Browne? There is more scarring than the imaging suggested.
True.
Talk through your approach.
I grasp the gallbladder fundus forward and use a right-angle clamp in my suction to develop a plane around the gallbladder.
Kelly clamp, a right-angle clamp, and suction.
That was elegant use of the Kelly clamp.
I see the cystic duct and, behind it, the cystic artery.
I need my first assist to confirm that I have identified the common bile duct and it is out of the way.
Yes.
Cutting the duct would be Very, very bad.
Move the gallbladder cranially a little bit.
Titanium clip applier.
You sure you have a clear view? Making the cut.
She's hemorrhaging.
I can't see the source of the bleeding.
MAP is 45 and dropping.
What do you think is happening? Most likely, my scissors' tip nicked the right hepatic artery.
It happens.
It's happened to me.
I need to clamp the common hepatic artery, repair the arterial wall with running 6-0 Prolene sutures.
That's what I would do.
Hey, hey, hey.
Slow down.
Slow down.
No running.
No running.
Dr.
Browne, how's my daughter? The surgery was a success, and we expect a full recovery.
I wanna see her! Is that okay? - Yay! - Okay.
Michelle says she wants to be a doctor.
She would be a great one.
Uh, that therapist Michelle talked to could I get her card? - Hi, baby.
- Hey.
Okay.
Three, two, one.
You were right.
He had angiosarcoma of the leg.
Had to amputate, but the margins were clean.
- Hmm.
- What happened to the Franklin! Oh! Franklin, you amazing fish! You saved my life.
Come on, bring him bring him here.
Bring him Bring him in.
Oh.
Thank you, guys.
Group hug.
Do you prefer to work in a team or do you prefer to lead or follow command? Team and to lead.
What machine or appliance in your house aggravates you the most? The dishwasher.
Hey, I'm just leaving.
Who is this? From the greatest height Slow motion life You know I'd pay to leave these tears behind But it's fine I know we're all the same Slow motion pain Now it's all blood in the open But we're not scared Message received at 5:30 p.
m.
from Mom.
Hey, baby, I got your text.
See, I knew it was just a temporary setback.
We're gonna celebrate.
I made dinner.
And I'm gonna go get some dessert.
I'll see you soon.
I'm so proud of you, baby.
Slow motion life Slow motion life
Browne.
I'll be performing your surgery today.
I'm Dr.
Browne.
I'll be performing your surgery today.
Dr.
Browne I'll be performing your surgery today.
It's a very simple procedure.
It's a straightforward procedure.
It was a successful surgery.
The surgery was a success.
We expect a full recovery.
I expect a full recovery.
Baby.
Where do you want this? Uh, thanks, Mom.
Uh, put it by my bag.
I'll have the hospital lab run it.
Nausea and severe abdominal pain after eating.
This patient could need a lap chole.
That would be an ideal first surgery.
Let's not get ahead of ourselves.
She may just need an antacid.
Hi, Michelle.
I understand your mother is on her way in.
- I'm Dr.
Browne.
- And I'm Dr.
Shaun Murphy.
You need to fix my sister.
What's your name? - Tisha.
- Hi, Tisha.
Well, that is exactly why we're here To help your sister.
Foster sister.
When did the pain start? About an hour ago.
It was on the bus.
My sister rides with me every day to school and back.
My brother and I used to live on a bus.
Cool.
Have you felt like this before? A few times.
Ow.
She has extreme upper-right quadrant tenderness.
That's consistent with cholecystitis.
As is her fever and elevated white count.
Your gallbladder probably needs to be removed.
You must be excited, Claire.
This is going to be your first surgery.
Has your urine changed color? Gotten darker? I hear Dr.
Browne might have landed her first lap chole.
It's not exactly a straightforward case.
The duct is massively dilated, the wall's inflamed, this scarring It's gonna limit visibility.
Well, the thickness of the gallbladder wall does pose a challenge.
What do you think? It's not her decision.
It's mine, as the attending.
Doesn't mean she shouldn't offer her opinion.
I think that, um, Dr.
Melendez is right.
With the limited visibility, I shouldn't be Only with a laparoscopic cholecystectomy.
Which I don't think we should do.
An open procedure would provide a clearer view of the gallbladder and the surrounding anatomy despite the inflammation.
Carly and I went on another date last night.
Mm.
What did you do? Dinner, movie We walked 12 minutes to a deli and had some food and talked.
Where are we going? Andrews is starting an open chole.
Sounds like it's going well with you and Carly.
Oh, yes.
She answered all of my questions.
How many did you ask? 83, although some had multiple parts.
"Do you want to have children? If yes, how many and when?" "Where do you plan to raise them? In what religious tradition?" Those are pretty intense.
They're good questions, Claire, about important topics.
Early on, people usually stick with lighter stuff Favorite movies, bands, hometowns.
Small talk.
Put some LAPs in the upper-right quadrant.
Here's the Bovie, Dr.
Andrews.
Isn't the point of dating to gather information to determine compatibility? Retract the omentum.
Sure.
Isn't that best achieved by finding out what's important to the other person? Hemostats.
It's a It's a process, Shaun, like peeling an onion.
People are more comfortable revealing their layers gradually, as opposed to getting sliced right down the middle.
I heard Dr.
Lim selected you for the first lead.
I'm guessing you drew a cholecystectomy.
Sponge on a stick.
What's your approach to dissecting Retrograde or antegrade? Antegrade.
Once I've located the porta hepatis.
I think Carly was comfortable.
Why does it matter what kind of questions are asked when? Aren't the answers what's important? - I'm sure you're right.
- Yes.
What is the plan for the next date? Hmm.
We didn't make another date.
Then I grasp gallbladder fundus - and elevate it which way? - S-Superiorly.
Is that significant? No follow-up date? Not necessarily.
How did the night end? Good-night kiss? I've exposed the triangle of Calot and ligated the cystic duct and artery.
What is the risk at this juncture? - Lacerating the liver during dissection.
- Correct.
We didn't kiss.
Ironically, a complication which I've inadvertently just demonstrated.
Hold direct pressure.
I need better exposure.
I sliced instead of peeled.
You are familiar with the Pringle procedure, Dr.
Browne? Yes, although I've never Clamp down the portal triad with an atraumatic hemostat clamp, then use a number 2 catgut suture.
Shaun, just go to her and explain.
If what I said made her uncomfortable, then saying more could make her more uncomfortable.
I sliced instead of peeled.
After Michelle's surgery, I will go and talk to Carly.
Good.
You can talk to her soon.
OR 2 had a cancellation.
Your surgery is in 45 minutes.
Hi, I'm Dr.
Browne.
I will be performing Michelle's surgery.
I will be removing her gallbladder.
It is a simple procedure.
We're gonna make sure your daughter is well taken care of.
Ow! Sir, we need to decapitate it.
No, don't.
I'm begging you.
Don't.
Please.
I can't get an image.
How did that I-Is that a swordfish? With that dorsal fin? It's a marlin.
I hooked him with a naked ballyhoo.
Battled me for over an hour.
Suddenly, he just leapt out of the water.
He came right at me.
Save the story for the bar, Quint.
Right now, we need to cut the damn thing in half.
No.
40-plus years I've been chasing a fish like this.
You can't just behead him! Can't leave his nose in your leg, either.
His bill.
Can't you just pull him out gently? I'll sign a waiver.
The pull-out method never works.
If any of your blood vessels are damaged, it gets messy.
Congrats.
I hear your surgery is on the schedule.
How's his distal pulse? A little thready, but still there.
We need to get him to an MRI.
I'm not going anywhere without Franklin.
I named him after my father.
You and Franklin both won't fit.
Aah! Oh! Oh! How? You said he was dead! I didn't take a pulse.
Go get something to kill it.
- No, it's dead! - It's moving! It's a postmortem response.
You guys are doctors.
Don't people do this? - No! - No! I'll help you review at lunch.
Surgery's in 20 minutes.
- Good luck.
- You, too.
I want to No, no, I haven't looked.
I want to be Great.
great Okay.
- or nothing.
- Nothing.
Got it.
I'll be back as soon as I can.
Hi.
You must be Michelle's mother.
I'm Dr.
Browne.
I'll be Yeah.
How long will she have to stay in here? Hospitals make me nervous.
Three days to a week, depending on Well, she's gonna miss a lot of school.
And she watches Tisha and her brothers in the afternoon.
Your daughter has a serious infection in her gallbladder.
She's been experiencing symptoms on and off for a while now.
She never told me that.
Why didn't you tell me that? - Mama - My point is, she's been ill for a while, so her recovery may take Mom.
Mom? P-Please, my my chest hurts.
What's wrong? Her oxygen levels are dropping.
She's tachycardic.
I need a chest CT, stat.
You had a blood clot in the artery that feeds your lungs.
It's called a pulmonary embolism.
This medicine broke it up.
How could that happen? According to our scan, it was part of a larger clot in your leg that broke off and traveled there.
As for why the larger one formed, when I asked you if you were taking birth control pills, you said no.
Was that the truth? You asked me in front of Tisha.
I'm doing it with my boyfriend, and I don't want babies, so I'm taking birth control pills.
How long have you been taking them? I don't know.
A year? I'm prescribing condoms for your boyfriend.
You need to go off the pill to prevent further clots.
Dr.
Browne is gonna place an IVC filter via your femoral vein, in case other parts of the clot break off.
Your gallbladder surgery's gonna have to wait till tomorrow.
What are you doing? This is where the catheter goes in.
How did you get these scars? I cut myself climbing a fence.
Those scars They're straight, in a row, all the same length.
I don't believe you got them from a fence.
I don't care what you believe.
Kids who cut, most of them are really sad, in a lot of pain, and they say cutting makes them feel better.
Is that how it is with you? I don't want to talk about it.
Okay.
My life sucks, okay? Tell me how.
Why? It won't change anything.
Talking might make you feel better, and maybe I can help.
I live in a foster home, but I'm not a foster kid.
I'm a whole mother, but I've never had a baby.
My mom brought three kids in our home, and now it's my job to take care of them Make breakfast, get the kids dressed, take them to school, go to school, pick them up, dinner, homework, laundry.
Repeat.
I barely ever leave the house without a kid attached to me.
Can you help me with that? Michelle wouldn't hurt herself on purpose.
Michelle is unhappy.
She feels pressure to look after her foster siblings, help out at home Yeah, her home life is fine.
I'll talk to her.
It might be helpful to have her speak with a psychiatrist.
My daughter is not crazy.
We We don't do psychiatrists.
You know that.
That needs to change.
When are you doing her surgery? - Tomorrow.
- Thank you.
I will speak to my daughter.
Don't.
It's your job to fix her gallbladder, not her life.
It's your first surgery.
Don't get distracted.
Have you talked to Carly? No.
Blood pressure is 62/31.
Your patient is in cardiac arrest.
I know.
You're practicing the Pringle maneuver in the event of a liver bleed? Yes.
- That was better.
- Thanks.
Now you can talk to Carly.
I need to practice.
Dr.
Lim says getting away from things every now and again, having balance in our lives can be just as important to our performance as practice.
Maybe you should get some balance by talking to Carly.
I don't know.
I'm nervous about my surgery, Shaun.
Practice will make me less nervous.
That will improve my performance.
Okay.
Okay.
You should also practice not causing a liver bleed.
Planning on it.
Also, how you will recover if you cut the portal vein.
That's potentially fatal.
Or if you perforate the small bowel, which could cause sepsis, leading to death.
Or if you cut the common bile duct, - which would cause - I'm gonna go talk to Carly.
- Right now? - Right now.
- Aren't you still nervous? - Nope, all better.
What blade for the Kocher? What? Incision for the chole what blade? Uh - 10.
- Mm-hmm.
No, they won't both fit in the MRI.
Fish Boy doesn't buy it.
Location of the incision.
Why are you trying to help me? Lim picked you for the first surgery.
Everyone knows that makes you the front-runner for Chief Resident.
This is me sucking up.
I've never been big on pretense Are you okay? What the hell just happened? The marlin must have had metal in his body Lures and stuff.
I think a license plate flew by me.
Franklin! Oh, no! Franklin! Oh, it's okay.
Franklin's okay.
It all came out one side.
It won't show when I mount him.
Well, thank goodness for small miracles.
- Ooh.
- Oh! Ow! Oh! Ah! I've got his femoral.
Call the OR.
We're coming.
Hang on, Dr.
Browne.
Just need to make an incision above and below the arterial injury site.
We need to clamp the femoral proximal to the bleed without clipping the femoral nerve.
Got it.
I feel the nerve right above my index finger.
One down.
My hand is starting to cramp.
Lean over this way a little bit.
Rotate your wrist.
Just a little bit more.
Let's see if that holds.
Go get cleaned up.
We'll take it from here.
I wanted to check the patient's bloodwork.
He's negative for HIV, Hep B and C.
You don't need prophylactic meds.
I'm nervous about my surgery.
You'll be fine.
And don't ever say that again.
Why? Weren't you nervous before your first lead? If I was, I didn't volunteer that to the Chief of Surgery Or anyone.
We're women, we're not white, and we're surgeons.
Unicorns consider us a fabled species.
We don't get the luxury of public insecurity.
I will aspire to repressed stoicism in the future.
We don't need to be insecure, because every step of the way, we've had to be twice as good as everybody else.
Suck it up.
You got this.
Don't forget we have our session with Dr.
Donovan today.
I won't.
- Your patient.
- Mm-hmm.
What are they like? Man, woman, young, old? Woman.
Girl, actually.
She's tough, smart really sad.
Her mom has her taking care of three foster kids.
At least you were only stuck looking after me.
How old? Although she acts a lot older.
She's been having sex for almost a year.
Well, you were about that age when you were with Wayne.
- I didn't have sex with Wayne.
- What? He was in love with you, always sniffing around our place.
Maybe.
He didn't get any.
So, who? Junior prom guy Derek.
Der No.
I didn't lose my virginity until sophomore year of college.
What were you hoping for, a proposal? No.
I wanted it to be special.
Oh, good for you.
I mean, I wouldn't have held out - No.
- but good for you.
I thought for sure you and Wayne were doing it.
You were okay with that? You were so serious.
So restrained.
We talked about birth control.
I figured, "Good for her.
She's finally relaxing, having some fun.
" Well, I was so restrained and serious 'cause I never knew when you were gonna fall apart.
Got to get to work.
I'll be back before Michelle goes into surgery.
Have you had a chance to talk to her about her cutting? Oh, yeah, some fool friend of hers gave her the idea.
She's not unhappy.
It's just peer pressure.
She sounded unhappy to me.
She's upset I didn't let her go hang out with her friends.
It's typical teen drama.
She promised me she's done cutting.
Self-harming behavior doesn't just stop.
- Michelle might need - Dr.
Browne.
My daughter needs to have surgery and get out of this hospital.
You didn't tell your mom the truth about why you cut yourself, about how unhappy you are.
I tried.
She didn't want to hear it, just said that things aren't always gonna go my way and I need to be more responsible.
Like I'm not already.
Growing up, I had to take care of my mom.
What was wrong with her? She's mentally ill.
Bipolar disorder and a drinking problem, pills.
When things were bad, she'd forget to buy groceries or clean the trailer or pick me up.
Or she'd spend all our rent on something stupid.
And I thought if I could make her life easy enough If I cooked and cleaned and got good grades Then she'd get better.
But she never did.
And for the longest time, I thought it was my fault she was sick.
And I probably still would if a psychiatrist hadn't refused to believe me when I said I was fine.
You've been to a psychiatrist? But you're, like, a fancy surgeon.
I could have a therapist come by and see you before your surgery.
Okay.
He should be getting better.
It's got to be an infection from the marlin.
Aeromonas or mycobacterium marinum.
Would've responded to the antibiotics.
Guys, I'm trying to focus.
What if he has an underlying autoimmune disorder? It could've been triggered by the surgery or even the initial fish stabbing.
It would explain why the leg ulcerations are progressing despite good arterial flow.
We could see if he responds to steroids.
Which could kill him if it is an infection.
But we could run an ANA, see if he's positive.
What about a parasite? Rhinosporidium seeberi or a gill worm.
Have you talked to Carly? Sorry.
I got sidetracked by a marlin.
Come in.
You wanted to see me? Ms.
Reynolds tells me that you went against her wishes and had her daughter speak with a psychiatrist.
Uh, Michelle asked to see a therapist.
Only after you talked her into it.
I'm gonna report you to the medical board.
You had no right Dr.
Browne, were you concerned that Michelle might be a serious danger to herself? Yes.
In that case, the consult was required.
That said, Dr.
Browne's failure to inform you was inappropriate.
You're off the case.
Dr.
Melendez will perform the surgery.
How are you doing? Claire? I understand today's a big day for you.
Your first surgery.
We don't need to talk about that.
Hmm, I think we do.
You've been taking care of your mother for a long time.
That's a pattern you both need to break out of.
I know I haven't always been there for you, and I just I I'm trying to change that.
I know, Mom.
I'm good.
Everything is fine.
And your first surgery? Is that this afternoon? It's Actually, it's not.
Um I arranged a psych consult without the mother's permission, so I got thrown off the case.
How could the hospital allow that? What is wrong with them? After how hard you've worked, I just It's okay, Mom.
They kind of had to.
That must be a big disappointment It is.
Anything else, Claire? I'm upset, humiliated, so, so mad at my patient's mother for not taking care of her daughter.
And I I'm relieved.
I'm so, so relieved to have that weight off of me, and that makes me feel like a fraud.
Don't you say that.
How can I be so scared to do something I've wanted for so long? Because things that matter are scary.
That's how I feel about coming here, talking about my life and our relationship.
What if I can't fix it? What if I can't make up for all the times I've let you down? And then I think "Just be like Claire.
" Because nothing stops you ever.
You see what you want, and you go after it with everything you've got.
You are an inspiration.
You're my inspiration.
Carly? Hi.
Do you have a second? OR 2 is waiting to learn the patient's mass wasn't cancerous so they can close.
I can come back after.
I'll be at the cafe? - Mm-hmm.
- Okay.
Anesthesiology, line 271.
Anesthesiology, call line 271.
Cancer.
The marlin guy has cancer.
CT chest, abdomen, and pelvis showed no masses.
It's in his leg.
It explains progressive ulcerations despite good arterial flow.
And why the antibiotics aren't working.
We'll send a tissue sample from the ulcerated area.
And when I'm Chief Resident, I'll remember this.
There's a problem with Michelle.
I'm not doing it! You need to calm down.
You don't get to tell me what to do! I want Dr.
Browne! Michelle? What's going on? I want you to do my surgery.
I want her, Mama, not somebody else.
Dr.
Melendez is gonna do your surgery.
He is a great doctor.
He's not you.
Y-You care about me.
Everybody here cares about you, Michelle.
Now, please sit down.
You could rupture your gallbladder.
I-I-I don't want to get better.
- Don't say that.
- It's the truth! Michelle, you need this surgery.
That is all that matters not whether I do it.
I'm gonna be there.
I will be watching from the gallery the whole time.
You just You need You need to sit down.
The kid okay? I had to pull you off.
If you made even the tiniest misstep during surgery, that mom would go from threat to lawsuit.
Is Patricia okay with me watching from the gallery? No.
You can't remove her gallbladder from the gallery.
What? You're doing Michelle's surgery.
How'd you get the mom to change her mind? I explained that, given Dr.
Browne's commitment to her daughter, she's the perfect choice to lead the surgery.
Especially with me over her shoulder the whole time.
Thank you for fighting for me.
That's what bosses do.
Let's go.
- You stood me up.
- Sorry about that.
What's up? Shaun's a little worried he may have freaked you out with his questionnaire the other night.
Oh, I thought it was cool.
Small talk bores the hell out of me.
Well, then, great.
I'll tell him.
Shaun got worried about that all on his own? That doesn't seem like him.
I may have mentioned that people don't usually ask deeply personal questions on an early date.
Claire, I like you, but we don't really know each other.
And yet you decided how I was going to react to Shaun's questions, which isn't your business.
And you were wrong Totally, totally wrong.
Shaun and I don't need you or anyone else to run interference on our relationship.
Butt out.
Is everybody ready for a Time Out? Dr.
Claire Browne, lead surgeon.
Dr.
Neil Melendez, attending surgeon.
Dr.
Shaun Murphy, assisting.
Dr.
Jan Lancaster, anesthesia.
Donna Petringa, scrub nurse.
Shani Walden, circulating nurse.
Patient is Michelle Reynolds.
We will be performing an open cholecystectomy.
All tools I need are confirmed to be present.
Estimated blood loss, 100 cc.
Patient will go to the ICU after surgery.
Is everybody in agreement? Dr.
Murphy, have you ChloraPrepped the site? I have.
10 blade.
Sponge.
Top layer of abdominal muscle is exposed.
I'll need a Bovie to cut through.
Nice work, Dr.
Browne.
Bookwalter Retractor.
I see the liver, and I need to better expose the inferior surface.
Retract the duodenum inferiorly, please.
Gallbladder exposed.
Dr.
Browne? There is more scarring than the imaging suggested.
True.
Talk through your approach.
I grasp the gallbladder fundus forward and use a right-angle clamp in my suction to develop a plane around the gallbladder.
Kelly clamp, a right-angle clamp, and suction.
That was elegant use of the Kelly clamp.
I see the cystic duct and, behind it, the cystic artery.
I need my first assist to confirm that I have identified the common bile duct and it is out of the way.
Yes.
Cutting the duct would be Very, very bad.
Move the gallbladder cranially a little bit.
Titanium clip applier.
You sure you have a clear view? Making the cut.
She's hemorrhaging.
I can't see the source of the bleeding.
MAP is 45 and dropping.
What do you think is happening? Most likely, my scissors' tip nicked the right hepatic artery.
It happens.
It's happened to me.
I need to clamp the common hepatic artery, repair the arterial wall with running 6-0 Prolene sutures.
That's what I would do.
Hey, hey, hey.
Slow down.
Slow down.
No running.
No running.
Dr.
Browne, how's my daughter? The surgery was a success, and we expect a full recovery.
I wanna see her! Is that okay? - Yay! - Okay.
Michelle says she wants to be a doctor.
She would be a great one.
Uh, that therapist Michelle talked to could I get her card? - Hi, baby.
- Hey.
Okay.
Three, two, one.
You were right.
He had angiosarcoma of the leg.
Had to amputate, but the margins were clean.
- Hmm.
- What happened to the Franklin! Oh! Franklin, you amazing fish! You saved my life.
Come on, bring him bring him here.
Bring him Bring him in.
Oh.
Thank you, guys.
Group hug.
Do you prefer to work in a team or do you prefer to lead or follow command? Team and to lead.
What machine or appliance in your house aggravates you the most? The dishwasher.
Hey, I'm just leaving.
Who is this? From the greatest height Slow motion life You know I'd pay to leave these tears behind But it's fine I know we're all the same Slow motion pain Now it's all blood in the open But we're not scared Message received at 5:30 p.
m.
from Mom.
Hey, baby, I got your text.
See, I knew it was just a temporary setback.
We're gonna celebrate.
I made dinner.
And I'm gonna go get some dessert.
I'll see you soon.
I'm so proud of you, baby.
Slow motion life Slow motion life