The Good Doctor (2017) s04e03 Episode Script
Newbies
Hello.
I'm Freddie Highmore.
The following episode portrays our hope for the future, a future where no one will have to wear masks or take other steps to stay safe from COVID.
Until then, please protect yourself and others.
I'm Jordan Allen.
My first year in med school, I designed an ankle brace that monitors extent of immobilization via a phone app.
When I licensed it to Bioventus, I was able to pay off over half my student loans.
John Lundberg.
I've worked every summer since I was 16 at Camp Hope Heartland, a summer program for kids with cancer in Des Moines, where I grew up.
Asher Wolke.
Uh, when I was 18, I left the Hasidic community that I was raised in.
I realized if there really was a God, it had to be a cruel being that I felt nothing but contempt for.
That's also when I decided to go to med school, and start dating men.
I'm Olivia Jackson.
I'm 25.
From Chicago.
(INHALES DEEPLY) I play ragtime piano alone in my apartment.
Is that interesting? Will Hooper.
Technically, I'm a professional athlete.
Although in a sport nobody pays attention to, and the stipend barely covers our training expenses, but I'm on the US National Rowing team.
Men's Eight.
Hey, I'm Enrique.
I spent last summer in Costa Rica, where I learned to surf, which I'm totally obsessed with now.
(CHUCKLES) Uh, I had a pretty interesting encounter with a saltwater crocodile.
I just thought it was a big Why are you wearing a swimsuit? Oh, they're actually hybrid boardshorts.
I like to work hard, and it's easier to do when you're comfortable.
Plus, I think the casual dress puts patients at ease.
(CHUCKLES LIGHTLY) Uh And Dr.
Lim said that the shorts were fine.
Hospital policy requires all residents to He's not a resident.
He's a resident applicant.
One of six finalists for four openings.
Now, they'll be shadowing for two days.
Give them the grand tour, show them the ropes, feel free to turn up the heat a bit.
See how they react under pressure.
You will be responsible for supervising them, so I want your totally honest input before I make any final decisions.
Those shorts Let's call them strike one.
Oh, and in addition to being an Olympian, Will Hooper is a Rhodes and graduated top of his class at Stanford.
He is very handsome.
He's very full of himself.
He's ranked first by every top program, so whatever you can do to recruit him to ours, do it.
I can already give you my input on the sh Don't judge a book by its boardshorts.
- (KNOCK ON DOOR) - (DOOR OPENS) DR.
REZNICK: You wanted to see me? Good morning.
Sorry.
Good morning.
- (DOOR CLOSES) - What'd I do wrong? Just wanted to check in.
See how the new role was coming along.
Honestly? You could start our new supervisor-resident relationship with a lie.
That's always fun.
Internal medicine is boring.
Between smokers and obese diabetics, seems like all I'm doing is protecting people from themselves.
(CHUCKLES) As a surgical resident, you never treated drunk drivers? Or extracted random objects from guys' I get it.
People are stupid.
Not my point, but true.
(SIGHS) Not the same adrenaline rush, but internal medicine can be rewarding.
Given time, if you're patient.
Thanks.
That is not how I thought this meeting was gonna go.
I thought one of the nurses complained about me.
Wasn't just one.
And if it happens again, this meeting will go exactly how you thought it would.
(DOOR CLOSES) Sorry.
I should've just canceled the appointment.
You were right.
Dizziness went away as soon as I stopped drinking coffee and Red Bull all day.
No worries.
Can you lie flat on your back, please? Yeah.
You get that scar in a fire? Sort of.
A homemade Roman candle when I was 12.
(CHUCKLES) You'd be surprised how many of us at the firehouse were pyros as kids.
I made a potato gun for my sixth-grade science fair.
Almost got me kicked out of school.
You'll have to come visit us sometime.
(INHALES SHARPLY) You'd fit right in.
JOSH: You see something? Don't talk.
Just breathe normally.
(MACHINE BEEPS) (MACHINE BEEPS) You have a large tumor on the wall of your heart.
Cancer? I don't know.
But you're definitely gonna need surgery.
As soon as possible.
I appreciate you letting me share your case with the whole class.
MONICA: No problem.
I stopped being shy after the 100th time I had to do this.
I'll be using a version of Lejour's technique I've adapted.
We'll divide the breast into three pedicles, and then redistribute the tissue and insert saline implants to correct the tuberous breast deformity.
Why would you want breast implants? You're beautiful.
And your breasts look fine just the way they are.
No.
No, they don't.
The base is constricted, horizontal development is deficient, and the nipple-areola complex - Murphy.
- It's okay.
He's right.
That's why I'm here.
Thank you.
I know that you're trying to be nice.
My friends and family have been telling me for years, "You're beautiful just the way you are.
" But I don't feel beautiful.
You're 17.
Every girl your age feels like that.
That can't be true.
Tuberous breast deformity is a rare condition.
We're not going to debate a personal decision the patient's already made.
I've been thinking about this since I was 13.
Every time I look in the mirror.
I'm about to start college, and there is no way that I'm gonna begin this new chapter until I'm fixed.
Great.
You thinking median sternotomy or right thoracotomy? I'm thinking I should finish my review of the imaging.
Sure.
No rush.
Actually, there is a bit of a rush.
But you know what I mean.
So, newbies.
What up? Where y'all from? - Like hometowns, or - Med schools.
Why would I care where you grew up? Stanford.
- Uh, NYU.
- Harvard.
Preferred specialties? Ortho.
All the way.
Neuro.
I'm planning a dual specialty in neonatal and pediatric oncology.
Impressive.
Also unlikely.
I know, it's a ton of work, but I'm pretty good at multi-tasking.
In med school, I did a combined MD/PhD - What's your mom do? - My mom? Don't stall.
Just answer.
She teaches high-school French.
Homemaker.
Surgeon.
Ouch.
Dad? Also a surgeon.
Double ouch.
And yours? Hasidic rabbi.
You've left the nest.
Actually, the the whole forest.
And yours obviously works on Wall Street.
But not a trader.
I'm guessing an M&A lawyer? How'd you know? She's read your resume, researched your social media.
She's probably run a credit check, too.
And you're under 50, but wear Brooks Brothers button-downs.
- (MONITOR BEEPS) - Are you done yet? Left thoracotomy with a possible incision into the right atrium and inter-atrial septum as needed.
Left atrial approach through Sondergaard's groove makes more sense.
Not to me.
He's my patient.
But you're not a surgeon.
Which is why there is no reason for you to be grilling them, or picking the approach.
Stop worrying about protecting your turf.
Stop stepping all over it.
You're looking at tests I did for my patient.
How am I stepping all over your turf? I think what Dr.
Browne is trying to say is, given there's no perfect approach, maybe it's best to defer to the surgical department's recommendation.
Did he just mansplain? Not at all.
I I was just trying So you're just gonna do it again? No, I'm just trying BOTH: Shut up.
We're gonna go in through a left thoracotomy.
Not my preference, but it'll work.
DR.
ANDREWS: What were you thinking? You thought you'd impress me by undermining the patient's confidence in my judgment? I'm sorry.
That wasn't my intent.
And you're supposed to be a mentor now, modeling professional behavior, not making it worse, Murphy.
She questioned your surgical plan.
I defended it.
How can we both be wrong? I don't need you to defend me.
And I never wanna have a surgical debate in front of a patient.
We're not in front of the patient now.
The patient's breasts are small and a bit asymmetrical, but no woman's breasts are perfectly shaped.
You're wearing Prada shoes and a Dolce & Gabbana blouse, which cost more than most med students' rent, so, clearly, you understand your appearance has a tremendous impact on how people treat you.
There's a difference between nice clothes and a major surgery.
And I also understand the cosmetic surgery industry is dominated by male physicians with a sexist bias.
I've invited you to observe as a learning opportunity.
So I'd suggest less lecturing and more listening.
We'll access the tumor via an incision in the chest wall between your ribs.
It'll be an easier recovery than if we opened your sternum.
Are you sure you don't want us to call your family before we put you under? Why? So they can freak out and worry? I'd rather just give them the good news when it's over.
It is going to be good news, right? With a bit of cardiac rehab and a positive attitude, which I know you have, you'll be back sliding down the fire pole in no time.
Our firehouse has stairs.
Hmm.
Bummer.
LEA: It's a social media group where we all pretend to be ants.
SHAUN: Why? Because ants don't care about politics, sports teams, or anything else people get so savage about.
Male ants develop from unfertilized eggs, which means they don't have a father and can't have sons.
But they do have grandfathers and can have grandsons.
Interesting.
And confusing.
Is it just me, or are those doctors watching us? They're the new resident applicants.
They're here so Park, Claire, and I can evaluate them for Dr.
Lim.
So, why are they standing over there? Park had a video chat with Kellan, and I had a real lunch with you.
Shaun, you can't just have them stand there while you eat.
Part of being a good boss is being a good host.
You need to introduce them to people.
Like me.
Right now.
Come here, please.
Dr.
Allen, Dr.
Lundberg, Dr.
Guerin, this is my girlfriend, Lea.
She runs the IT department now.
Okay.
Nice to meet you all.
Please join us.
Shaun's been telling me all about you.
Mmm.
N No.
I haven't.
So, I hope Shaun's not being too hard on you.
No, he's been great.
And the case we're observing is really interesting.
We're correcting a 17-year-old girl's tuberous breasts with saline implants.
Dr.
Allen told Dr.
Andrews it was unethical.
He got mad.
I didn't say it was unethical.
I just I suppose I shouldn't have interfered.
Well, I don't know what a tuberous breast is, but I think implants are way overrated.
That's because your breasts are excellent.
Thank you.
That's exactly my point.
Mine aren't huge, but every guy who's ever seen them up close and personal has been thrilled.
I definitely was.
I am thrilled by every part of your body.
Sorry.
My bad.
Total TMI.
I'm not even bothered by your adenoidal voice.
Except when you talk to your mom on the phone.
But I just put on headphones.
At least you'll know he'll be a totally honest boss.
(MONITOR BEEPING) DR.
REZNICK ON SPEAKER: The incision's extended superiorly to meet the atriotomy, and then the inter-atrial septum is opened up.
Retractor.
A Carpentier retractor is used to visualize the mitral valve.
That will allow a clear view of the tumor.
Can we turn the channel? Color commentary's getting a bit annoying.
DR.
REZNICK: With the right atrium opened obliq (SIGHS) How's Team Browne? Any early standouts? Jackson's a bit timid, but smart.
Wolke is definitely enthusiastic.
And your star recruit is (INHALES DEEPLY) Pretty full of himself.
I'm looking for surgeons, and according to his recs, he can dissect and suture like a pro.
I thought you were also looking for our input.
He's ranked first by every top program.
You really think they're all wrong and you're right? So, what brings you all to the biz? Had my ACL reconstructed in high school, both my rotators in college.
I love the idea of fixing people, helping them be the best they can be.
Surgeons are the ones with the God complex, right? I have that.
I spent my life speaking Yiddish and studying the Talmud, and not shaving the sides of my hair, because someone up there supposedly cares.
Uh, but then I realized no one's up there.
No one cares.
No benevolent higher power is going to save us, so (INHALES DEEPLY) We have to save each other.
Can you top that? - Definitely not.
- Try anyway.
You're obviously smart.
You've got two degrees from Harvard.
My parents are Harvard alums, so I'm sure that helped me get in.
You're not gonna get hired by undermining your own Something went wrong.
OLIVIA: Looks like they nicked a pulmonary artery.
No.
If they had, Browne would be suctioning instead of Lim reaching in with her hands.
ASHER: What are they doing now? Nothing.
We can't access the tumor without compromising his entire cardiac outflow tract.
What about going in the way I suggested? The median sternotomy.
The tumor's too far back.
We need to close him up.
Proton beam radiation would be too toxic to the heart.
DR.
LIM: So is immunotherapy.
We can't access the entire tumor surgically, and we can't kill it without killing his heart along with it.
What if we cut out the parts we can access and try our luck with chemo on what's left? IV doxorubicin and ifosfamide might slow the growth, give him a few more months.
No, I'm not sending my patient home with just a few extra months.
It's better than nothing.
What about a transplant? Not an option.
Heart tumors are a contraindication.
What if we transplant his own heart? If we take it totally out of his chest, we'd have access to the posterior heart.
We could excise the tumor, fix the defect it left behind, - and then put it back in.
- Cool.
CLAIRE: Mmm.
Not cool.
At least with a normal heart transplant, you'd be getting a healthy heart.
Her idea keeps the risk of removing the heart, and adds the risk that the heart we'd be putting back in has just been severely compromised having had a tumor cut out of it.
He's young, and the part of his heart not infiltrated with tumor is strong.
Do a cardiac MRA and see if the tumor's infiltrated the coronary arteries.
If it hasn't, Morgan's idea could work.
I'll schedule it.
DR.
ANDREWS: Dr.
Murphy is dividing the breast parenchyma into three pedicles.
Anyone know where this technique is derived from? Breast reduction surgery.
That's right.
And why would I use a breast reduction technique to make the patient's breasts larger? The technique frees up the tissue.
You can bring the pedicles together to make the breasts smaller or spread them out over an implant to make them larger.
DR.
ANDREWS: Very good.
And now I'm going to turn the sound off.
Don't worry.
Nothing's wrong.
I just wanna talk about you behind your backs for a little bit.
So, first impressions.
Murphy? I like Dr.
John Lundberg.
DR.
ANDREWS: I haven't even heard him speak yet.
He has the highest U.
S.
M.
L.
E.
scores.
And that's important to you? (SOFTLY) Yes.
It shows he has a broad knowledge of medicine.
What is important to you? Well, I'm more interested in what they can do with their knowledge, which is why, so far, I'm most impressed with Jordan Allen.
No.
No, you said she undermined you.
Which takes courage and an assertiveness that will serve her well.
Then why did you tell her to stop lecturing you? It's easier to teach an aggressive resident restraint than a passive one to assert themselves.
Oh.
What about you, Park? What's important to you? I wanna know who I can stand to be around for 80 hours a week.
One thing I learned as a cop, you don't really know a person until you've had a few drinks with them.
(MACHINE WHIRRING) DR.
REZNICK: LAD and circumflex look clean.
CLAIRE: What's with the right coronary? It looks narrowed at the origin.
It's a bit narrow, but looks like a normal variant.
Yeah, but it seems hazy, like there could be some tumor infiltration.
What do you guys think? - Us? - Yeah.
Come take a look.
I guess - It's angiogenesis of the left - Stop.
Interrupting a female coworker is almost as annoying as mansplaining.
This isn't a rowing race.
You don't always have to speak first.
I do not love the interruption.
But I like the enthusiasm.
What were you gonna say? First, um, I'm not sexist.
Of course not.
He's shifting from right to left dominant circulation to feed blood to the tumor.
- Angiogenesis.
- I doubt it.
Surgery already showed his tumor extending to the right side, as well.
What were you gonna say? The pulmonary artery is right behind that vessel.
It's causing radiographic scatter in this area.
The haze is just an artifact.
His arteries are clean.
I think she's right.
Hmm.
Your idea might just work.
DR.
ANDREWS: If you invert the sutures and bury them under the skin, the scar will be invisible.
No one will ever know we were here.
Nice work, both of you.
- (MONITOR BEEPING) - Her BP's dropping.
Push fluids, start IV pressors.
Check for bleeding.
- (RAPID BEEPING) - She's in V-tach.
Move in the crash cart.
No bleeding.
No hematomas.
- SHAUN: Charging.
- (DEFIBRILLATOR POWERS UP) SHAUN: Clear.
(DEFIBRILLATOR THUMPS) (RAPID BEEPING CONTINUES) (BEEPING SLOWS) Sinus rhythm.
Her BP is stabilizing.
(MONITOR BEEPING REGULARLY) Get her to the ICU.
I want post-op labs, CTA chest, and full 24-hour cardiac telemetry.
We need to figure out what just happened.
(MONITOR BEEPING) She's stable, but diffuse delta wave slowing.
Minimal brain activity.
An undiagnosed metabolic disorder could've caused an adverse reaction to the anesthesia.
Yeah, but her pre-op labs were all normal.
It's gotta be some sort of hidden heart condition.
You're big on opinions.
How are you with ideas? What would you do next? I'd check train of fours and reverse the paralytics with neostigmine.
If Dr.
Murphy's right, she should wake up.
Smart.
But risky.
The meds will stress her heart.
If Park's right, she could arrest again.
I saw a similar case last year.
In Borneo.
You interned at a hospital in Borneo? Uh, no.
I, uh, volunteered at an orangutan rescue foundation.
Our guide, a local villager, fell out of a tree.
He was, like, 80 feet up.
How is falling out of a tree similar to a patient arresting during breast reconstruction surgery? Well, he broke his back, uh, but when we got him to the hospital, I found he also had heart damage from rheumatic fever and metabolic abnormality from iodine deficiency.
It's rare here, but it's common there.
We only realized it when we ran a nuclear profusion scan of his entire body.
Good catch.
But a scan that extensive requires multiple radioactive tracers.
You think her heart could handle that? Not tonight.
I'll get consent from the mom.
We'll do it first thing in the morning.
Once we confirm atrial closure, we'll put the heart back in.
Dr.
Lim will reconnect the aorta and the superior venous connections, while I connect the inferior.
During my sub-internship, I assisted on multiple heart transplants.
Even sutured the atrial cuff in one.
I got to scrub in on a liver transplant once.
The The patient died.
What'd you learn? That bile duct leaks are a lot harder to detect than bleeds.
Good.
Next time, I'd lead with that instead of the patient's death.
Are you all done yet? Why? Dr.
Park wants everyone to join him in the break room.
(UPBEAT MUSIC PLAYING ON STEREO) I'm Alex Park.
I'm a former amateur martial arts competitor who once thought it'd be fun to spar with a pro boxer visiting my dad's gym.
And that guy was, uh, Mike Tyson.
Who's Mike Tyson? He's a guy from The Hangover.
With the tiger and the tattoo on his face.
Nice.
You've just revealed you're crazy and old.
I've seen the musical Wicked over 50 times.
The San Francisco tryout, Broadway, Chicago.
I've even seen a friend's boyfriend's niece play Glinda at Stagedoor summer camp.
Nerd.
Next.
(CLEARS THROAT) I'm Claire Browne.
Um, I love music, but I hate musicals, and, um, I don't I don't really like to talk about myself, so it's Shaun's turn.
My name is Dr.
Shaun Murphy.
I used to not like music, but my girlfriend, Lea, she changed my mind.
I also like to watch The Weather Channel on TV.
And (SHUDDERS) I think pickles are disgusting.
(LAUGHTER) Cops know how to manage up.
Managing down's another story.
Well, he's mature, thoughtful, doesn't have an ego.
Neither does Murphy, but do you think that qualifies him to supervise First Years? Well, Murphy's smart, brutally honest, has no regard for social convention.
(CHUCKLES) Mmm.
It works for Bill Belichick.
The Patriots are the most corrupt, dishonest organization in the history of the NFL.
Well, the Seahawks suck.
So, how's your experience been here? It's been good.
Did you consider any other programs or was this your first choice? This was my only choice.
Why do you hate God? Oh.
Uh, actually, I don't believe there is a God.
I thought maybe it was because you believed he hated homosexuals.
(CHUCKLES) I I don't think this is something that we should be discussing at work.
Why not? Well, because it's personal.
Do you have a boyfriend? I I'm sorry, but you can't ask that question in a workplace.
Dr.
Park, he wants us to get to know you.
How can I do that without asking personal questions? I have a girlfriend, and she is very important to me.
It affects my life in every way.
Probably should've thought of that before you told her how much her voice annoyed you.
I said it didn't bother me.
It It was a compliment.
What I heard is you criticizing her voice, and you bringing her mother into it.
You're in trouble.
What about Browne? She may have as much problem being a leader as Murphy, and without his gifts.
She has her own gifts.
Yeah, dealing with patients and their families.
But with her colleagues, she can be insecure.
Her assertiveness has always been a question mark for me.
They've all got areas that need improving, but I've gotten to know Browne a bit better these past few months.
She's stronger than she looks.
When's the last time you saw anyone digging a ditch in a suit and tie? Surgeons don't dig ditches.
They help people at the most vulnerable time in their life.
And you shouldn't take the responsibility on if you're not fully committed to it.
You're entering a new phase in your career, position of authority.
Maybe my clothes are making you feel disrespected.
No.
The truth is, I just hate wearing anything that makes me feel like a suit.
DR.
REZNICK: Great news.
I was able to get Sowinski on anesthesia for tomorrow.
Uh, why? What happened to Foley? Nothing, I just think Sowinski's better.
And we definitely need the A-team on this.
Yeah, I I agree.
Which is why I went out of my way to get Foley.
But Foley doesn't do well under pressure.
- Remember that time - Morgan.
You need to butt out.
You're not a surgeon.
This is not your job.
My job is to help my patient through the entire treatment process.
The best anesthesiologist for transplant surgery is Sowinski.
And I've already cleared it with Lim, so that's who it's gonna be.
Deal with it.
(DOOR OPENS, CLOSES) Are you mad at me? I said your voice doesn't bother me.
It was a compliment.
Actually, what you said is that you love my breasts so much that with the help of noise-canceling headphones, you're willing to put up with my annoying voice.
Yes.
Not a compliment.
Oh.
So you are mad at me? I'm not mad, Shaun.
I'm just busy, trying to keep, like, a billion bots and hackers out of our network.
(MOUSE CLICKING) Actually, no.
I'm not doing that.
Gonna go home.
You want to have some tequila, stat? We also have some pizza left.
No, I don't want tequila or pizza.
- (LAPTOP SLAMS SHUT) - That must mean you're mad.
I'm just upset.
And confused.
And I really don't think there is anything you can do about it, so you just need to stop trying and leave me alone.
SHAUN: She's not mad at me.
JORDAN: She's definitely mad at you.
She doesn't usually hide what she thinks.
ENRIQUE: She's not mad at him.
She knows how he is, how he talks.
She's mad at herself.
And scared.
We all have stuff that we're insecure about.
That's why it's so risky falling in love.
We all hope that when we let our guard down, it's for the one person that doesn't see our flaws.
So, what do I do? You were being honest.
You can't apologize that away.
You gotta figure out what she needs to feel secure in the relationship again.
Don't look at me.
I'm single.
It's not my place to comment on your personal life.
You have an opinion.
Let's hear it.
Fine.
Can you zoom in on her skull base? DR.
PARK: I can, but why? We're worried about her heart and metabolic abnormalities.
We shouldn't be.
Not anymore.
You and Dr.
Murphy were both wrong.
She doesn't have a cardiac or metabolic issue.
She has poor blood flow in the artery supplying blood to the area of her brain that controls consciousness.
A small clot in her artery of Percheron.
If we don't remove it fast, she's never going to wake up.
(MONITOR BEEPING) (SOFTLY) That's amazing.
No, it's not.
The heart's totally outside of the body and still beating.
It's like it has a mind of its own.
She should've started the reimplantation by now.
Is everything okay, Dr.
Lim? DR.
LIM: The tumor had tendrils invading the right atrial wall.
We took so much tissue to get a clear margin, there's not enough left to reconstruct his heart's inflow chambers.
How about expanded PTFE graft? There's not enough atrial remnant to attach the graft.
You could use the septal wall.
He's got dense conduction fibers there.
- It could cause heart arrhythmias.
- Not if you use - (MONITOR BEEPS RAPIDLY) - He's got low arterial pressure.
He's springing leaks at the cannulation sites.
It's a bleeding disorder caused by prolonged bypass.
You need to get his heart back in ASAP.
Morgan, we can't put the heart back in with two missing chambers.
DR.
ANDREWS: (DISTORTED) It's a rare complication, but a blood clot is a risk in any surgery.
DR.
PARK: It's too deep in the brain for open surgery.
If we go rooting around in there, we'd definitely damage the PCA and kill her.
We could inject a dissolving agent into the clot.
There's a 50% probability it won't fully dissolve, which could leave her with permanent weakness and cognitive difficulties.
JORDAN: Assuming she wakes up at all.
We need to remove the clot with a stent retriever.
If we rupture the posterior cerebral artery, she'll die on the table.
Or total recovery.
That's how she came into this hospital.
That's how she's leaving.
Prep her for stent retrieval.
(MONITOR BEEPING) I'm hanging platelets and fresh frozen plasma.
His pressure is still in the toilet, but the bleeding is slowing down.
Not for long.
Small intestine submucosa has the right compliance to shape the chamber walls, but There isn't enough to cover that much area.
Use too little and he'll have heart failure in a month.
I know.
That's the "but.
" How thick is his deep fascia? If it's over 2 millimeters DR.
LIM: Morgan.
Get out.
I'm sorry.
I'll I'll be quiet.
No, you won't.
You can't.
So leave the OR gallery.
Now.
We need 2.
6-millimeter-thick tissue with perfect compliance for arterial filling and contractile pressures.
If it was just the valve, we'd use a bovine pericardial graft.
But cow heart tissue is not durable enough to do an entire chamber.
But pig bladder tissue is just right.
I've used it for bladder reconstructive surgeries, but never hearts.
Let's rebuild the entire atrial walls with it.
Get down to the tissue procurement lab and get 200 centimeters of porcine bladder tissue.
(MONITOR BEEPING) Her EEG delta waves are slowing further.
DR.
ANDREWS: She only has one vessel feeding her thalamus.
That's why the clot landed where it did.
I'm approaching the artery of Percheron.
I'm one millimeter from the clot.
Stop right there.
If we disrupt this clot, we could cause a shower of emboli into her brain.
Deploying the retriever.
(MONITOR BEEPING RAPIDLY) EEG just went flatline.
Calm down.
I'm almost Got it.
Blood's flowing through the artery.
Her brain tracing's looking better.
(MONITOR BEEPING REGULARLY) This should fill the gap between the inferior and superior vena cava when the new chambers get sewn in.
Where's that graft? I need more sponges.
The bleeding is getting worse.
- (MONITOR BEEPING RAPIDLY) - Oh, he's tanking.
Can you push epi? I already did.
He's maxing out.
I'm running out of ways to keep his pressure up.
I got it.
They had 205 centimeters of it.
Thank you.
If you want to gown up, you can watch from down here.
Definitely.
Thanks.
I thought telling her how much I love her in front of other people would make her feel good.
But Dr.
Guerin said I made her feel insecure, and scared.
Women are sensitive.
When commenting on their flaws, total honesty is a high-risk procedure.
That sounds sexist.
Aren't men also insecure about their flaws? Men are much, much worse.
And also, we're really stupid.
Okay.
What can I do now? I've already said my stupid stuff.
I don't want her to be upset with me.
I have a thought.
I think this run of sutures will hold it to the annulus, but I'm worried about leaks.
We can put a second row of pledgeted sutures to make sure it's hemostatic.
That is unreal.
It's a work of art.
Now let's get it back in while we can still get him off bypass alive.
(FLATLINE) CLAIRE: Re-perfusing the heart.
- (EKG BEEPING) - DR.
LIM: We've got a rhythm.
(MONITOR BEEPING REGULARLY) (MONITOR BEEPING) (BREATHES DEEPLY) Hey.
There was a complication during the reconstruction surgery.
A clot, which caused you to lapse into a coma.
We performed a second surgery on your brain, which was successful.
Um You're gonna be fine.
But my breasts The clot occurred after we finished inserting the implants.
I think you're gonna be very pleased with the results.
Thank you.
Yep.
I think I'm sorry.
Dr.
Guerin said I should never say anything that might sound negative to a girlfriend.
And Dr.
Glassman said total honesty is a high-risk procedure with a girlfriend.
It's better to show my love than try to explain it.
But I want to be totally honest with you.
(SIGHS SOFTLY) I don't like your body because it's excellent.
I like it because it's yours.
And I love hearing you talk.
When I hear your voice, especially when I've had a difficult day, I find it comforting.
Now I want to hug you.
Can I? I'd like that.
I love you.
Thank you.
For your total honesty.
(SIGHS) (MONITOR BEEPING) DR.
REZNICK: Your surgery went well.
With some time in rehab, you should be back to work in a month.
Thank you.
Don't thank me.
Thank your surgeon.
She did all the important stuff.
Lim's golden boy is in.
Nothing we can do about that.
So that leaves three openings.
The thought of working with Will Hooper for the next two years If Dr.
Lim thinks he'll be a good resident, I'm sure she has good reasons.
She probably thinks arrogance is helpful to a surgeon.
Well, we could try to change her mind.
Eh, she asked us to evaluate the applicants, not her.
She asked us to be totally honest.
Eh, "totally honest" is a relative term when you're telling your boss she's totally wrong.
So, Hooper's in.
Who else? Dr.
Andrews likes Dr.
Jordan Allen.
Oh, I do, too.
She's confident, driven.
She won't take a lot of hand-holding, and keeping Andrews happy keeps us happy.
That leaves two more.
Who's next? Asher Wolke is very up-front about who he is.
- I like that.
- He's definitely eager.
And he couldn't be more open to learning.
Agree.
That leaves one more.
BOTH: John Lundberg.
Smart, professional, mature.
He's a no-brainer.
Lundberg's in.
Lundberg's out.
He stopped by my office before he left.
Said he's no longer interested.
He said you all were unprofessional.
Drinking at work.
Asking inappropriate questions.
Dating drama.
Mmm-hmm.
So, who's your alt? Olivia Jackson or Boardshorts? Olivia knows her stuff, but she's a bit insecure.
Her answers sound like questions.
I like Boardshorts.
He's sensitive.
Like a woman.
I vote for both of them.
That's not an option.
We don't have the budget.
(SIGHS) Hooper is the worst.
The person I said was the best? He is arrogant and obnoxious.
If he works here, we'll hate him, the work will suffer, and we'll either kill patients or we'll kill him.
And there is no way that you don't see that, which makes me think You do.
This was a test.
You just wanted to see if we'd be totally honest.
- Well done.
- (CHUCKLES) Hooper is definitely the worst.
I only let him shadow as a favor to a board member.
I figured I'd give him a second chance after his obnoxious interview.
And also do a little experiment.
(LAUGHS) So It's Jordan, Asher, Olivia, and Enrique.
To the next phase of your surgical training.
You helped pick them.
As senior residents, it's now your job to help train them.
And don't take this responsibility lightly, because if you don't train them well, people will die.
I'm Freddie Highmore.
The following episode portrays our hope for the future, a future where no one will have to wear masks or take other steps to stay safe from COVID.
Until then, please protect yourself and others.
I'm Jordan Allen.
My first year in med school, I designed an ankle brace that monitors extent of immobilization via a phone app.
When I licensed it to Bioventus, I was able to pay off over half my student loans.
John Lundberg.
I've worked every summer since I was 16 at Camp Hope Heartland, a summer program for kids with cancer in Des Moines, where I grew up.
Asher Wolke.
Uh, when I was 18, I left the Hasidic community that I was raised in.
I realized if there really was a God, it had to be a cruel being that I felt nothing but contempt for.
That's also when I decided to go to med school, and start dating men.
I'm Olivia Jackson.
I'm 25.
From Chicago.
(INHALES DEEPLY) I play ragtime piano alone in my apartment.
Is that interesting? Will Hooper.
Technically, I'm a professional athlete.
Although in a sport nobody pays attention to, and the stipend barely covers our training expenses, but I'm on the US National Rowing team.
Men's Eight.
Hey, I'm Enrique.
I spent last summer in Costa Rica, where I learned to surf, which I'm totally obsessed with now.
(CHUCKLES) Uh, I had a pretty interesting encounter with a saltwater crocodile.
I just thought it was a big Why are you wearing a swimsuit? Oh, they're actually hybrid boardshorts.
I like to work hard, and it's easier to do when you're comfortable.
Plus, I think the casual dress puts patients at ease.
(CHUCKLES LIGHTLY) Uh And Dr.
Lim said that the shorts were fine.
Hospital policy requires all residents to He's not a resident.
He's a resident applicant.
One of six finalists for four openings.
Now, they'll be shadowing for two days.
Give them the grand tour, show them the ropes, feel free to turn up the heat a bit.
See how they react under pressure.
You will be responsible for supervising them, so I want your totally honest input before I make any final decisions.
Those shorts Let's call them strike one.
Oh, and in addition to being an Olympian, Will Hooper is a Rhodes and graduated top of his class at Stanford.
He is very handsome.
He's very full of himself.
He's ranked first by every top program, so whatever you can do to recruit him to ours, do it.
I can already give you my input on the sh Don't judge a book by its boardshorts.
- (KNOCK ON DOOR) - (DOOR OPENS) DR.
REZNICK: You wanted to see me? Good morning.
Sorry.
Good morning.
- (DOOR CLOSES) - What'd I do wrong? Just wanted to check in.
See how the new role was coming along.
Honestly? You could start our new supervisor-resident relationship with a lie.
That's always fun.
Internal medicine is boring.
Between smokers and obese diabetics, seems like all I'm doing is protecting people from themselves.
(CHUCKLES) As a surgical resident, you never treated drunk drivers? Or extracted random objects from guys' I get it.
People are stupid.
Not my point, but true.
(SIGHS) Not the same adrenaline rush, but internal medicine can be rewarding.
Given time, if you're patient.
Thanks.
That is not how I thought this meeting was gonna go.
I thought one of the nurses complained about me.
Wasn't just one.
And if it happens again, this meeting will go exactly how you thought it would.
(DOOR CLOSES) Sorry.
I should've just canceled the appointment.
You were right.
Dizziness went away as soon as I stopped drinking coffee and Red Bull all day.
No worries.
Can you lie flat on your back, please? Yeah.
You get that scar in a fire? Sort of.
A homemade Roman candle when I was 12.
(CHUCKLES) You'd be surprised how many of us at the firehouse were pyros as kids.
I made a potato gun for my sixth-grade science fair.
Almost got me kicked out of school.
You'll have to come visit us sometime.
(INHALES SHARPLY) You'd fit right in.
JOSH: You see something? Don't talk.
Just breathe normally.
(MACHINE BEEPS) (MACHINE BEEPS) You have a large tumor on the wall of your heart.
Cancer? I don't know.
But you're definitely gonna need surgery.
As soon as possible.
I appreciate you letting me share your case with the whole class.
MONICA: No problem.
I stopped being shy after the 100th time I had to do this.
I'll be using a version of Lejour's technique I've adapted.
We'll divide the breast into three pedicles, and then redistribute the tissue and insert saline implants to correct the tuberous breast deformity.
Why would you want breast implants? You're beautiful.
And your breasts look fine just the way they are.
No.
No, they don't.
The base is constricted, horizontal development is deficient, and the nipple-areola complex - Murphy.
- It's okay.
He's right.
That's why I'm here.
Thank you.
I know that you're trying to be nice.
My friends and family have been telling me for years, "You're beautiful just the way you are.
" But I don't feel beautiful.
You're 17.
Every girl your age feels like that.
That can't be true.
Tuberous breast deformity is a rare condition.
We're not going to debate a personal decision the patient's already made.
I've been thinking about this since I was 13.
Every time I look in the mirror.
I'm about to start college, and there is no way that I'm gonna begin this new chapter until I'm fixed.
Great.
You thinking median sternotomy or right thoracotomy? I'm thinking I should finish my review of the imaging.
Sure.
No rush.
Actually, there is a bit of a rush.
But you know what I mean.
So, newbies.
What up? Where y'all from? - Like hometowns, or - Med schools.
Why would I care where you grew up? Stanford.
- Uh, NYU.
- Harvard.
Preferred specialties? Ortho.
All the way.
Neuro.
I'm planning a dual specialty in neonatal and pediatric oncology.
Impressive.
Also unlikely.
I know, it's a ton of work, but I'm pretty good at multi-tasking.
In med school, I did a combined MD/PhD - What's your mom do? - My mom? Don't stall.
Just answer.
She teaches high-school French.
Homemaker.
Surgeon.
Ouch.
Dad? Also a surgeon.
Double ouch.
And yours? Hasidic rabbi.
You've left the nest.
Actually, the the whole forest.
And yours obviously works on Wall Street.
But not a trader.
I'm guessing an M&A lawyer? How'd you know? She's read your resume, researched your social media.
She's probably run a credit check, too.
And you're under 50, but wear Brooks Brothers button-downs.
- (MONITOR BEEPS) - Are you done yet? Left thoracotomy with a possible incision into the right atrium and inter-atrial septum as needed.
Left atrial approach through Sondergaard's groove makes more sense.
Not to me.
He's my patient.
But you're not a surgeon.
Which is why there is no reason for you to be grilling them, or picking the approach.
Stop worrying about protecting your turf.
Stop stepping all over it.
You're looking at tests I did for my patient.
How am I stepping all over your turf? I think what Dr.
Browne is trying to say is, given there's no perfect approach, maybe it's best to defer to the surgical department's recommendation.
Did he just mansplain? Not at all.
I I was just trying So you're just gonna do it again? No, I'm just trying BOTH: Shut up.
We're gonna go in through a left thoracotomy.
Not my preference, but it'll work.
DR.
ANDREWS: What were you thinking? You thought you'd impress me by undermining the patient's confidence in my judgment? I'm sorry.
That wasn't my intent.
And you're supposed to be a mentor now, modeling professional behavior, not making it worse, Murphy.
She questioned your surgical plan.
I defended it.
How can we both be wrong? I don't need you to defend me.
And I never wanna have a surgical debate in front of a patient.
We're not in front of the patient now.
The patient's breasts are small and a bit asymmetrical, but no woman's breasts are perfectly shaped.
You're wearing Prada shoes and a Dolce & Gabbana blouse, which cost more than most med students' rent, so, clearly, you understand your appearance has a tremendous impact on how people treat you.
There's a difference between nice clothes and a major surgery.
And I also understand the cosmetic surgery industry is dominated by male physicians with a sexist bias.
I've invited you to observe as a learning opportunity.
So I'd suggest less lecturing and more listening.
We'll access the tumor via an incision in the chest wall between your ribs.
It'll be an easier recovery than if we opened your sternum.
Are you sure you don't want us to call your family before we put you under? Why? So they can freak out and worry? I'd rather just give them the good news when it's over.
It is going to be good news, right? With a bit of cardiac rehab and a positive attitude, which I know you have, you'll be back sliding down the fire pole in no time.
Our firehouse has stairs.
Hmm.
Bummer.
LEA: It's a social media group where we all pretend to be ants.
SHAUN: Why? Because ants don't care about politics, sports teams, or anything else people get so savage about.
Male ants develop from unfertilized eggs, which means they don't have a father and can't have sons.
But they do have grandfathers and can have grandsons.
Interesting.
And confusing.
Is it just me, or are those doctors watching us? They're the new resident applicants.
They're here so Park, Claire, and I can evaluate them for Dr.
Lim.
So, why are they standing over there? Park had a video chat with Kellan, and I had a real lunch with you.
Shaun, you can't just have them stand there while you eat.
Part of being a good boss is being a good host.
You need to introduce them to people.
Like me.
Right now.
Come here, please.
Dr.
Allen, Dr.
Lundberg, Dr.
Guerin, this is my girlfriend, Lea.
She runs the IT department now.
Okay.
Nice to meet you all.
Please join us.
Shaun's been telling me all about you.
Mmm.
N No.
I haven't.
So, I hope Shaun's not being too hard on you.
No, he's been great.
And the case we're observing is really interesting.
We're correcting a 17-year-old girl's tuberous breasts with saline implants.
Dr.
Allen told Dr.
Andrews it was unethical.
He got mad.
I didn't say it was unethical.
I just I suppose I shouldn't have interfered.
Well, I don't know what a tuberous breast is, but I think implants are way overrated.
That's because your breasts are excellent.
Thank you.
That's exactly my point.
Mine aren't huge, but every guy who's ever seen them up close and personal has been thrilled.
I definitely was.
I am thrilled by every part of your body.
Sorry.
My bad.
Total TMI.
I'm not even bothered by your adenoidal voice.
Except when you talk to your mom on the phone.
But I just put on headphones.
At least you'll know he'll be a totally honest boss.
(MONITOR BEEPING) DR.
REZNICK ON SPEAKER: The incision's extended superiorly to meet the atriotomy, and then the inter-atrial septum is opened up.
Retractor.
A Carpentier retractor is used to visualize the mitral valve.
That will allow a clear view of the tumor.
Can we turn the channel? Color commentary's getting a bit annoying.
DR.
REZNICK: With the right atrium opened obliq (SIGHS) How's Team Browne? Any early standouts? Jackson's a bit timid, but smart.
Wolke is definitely enthusiastic.
And your star recruit is (INHALES DEEPLY) Pretty full of himself.
I'm looking for surgeons, and according to his recs, he can dissect and suture like a pro.
I thought you were also looking for our input.
He's ranked first by every top program.
You really think they're all wrong and you're right? So, what brings you all to the biz? Had my ACL reconstructed in high school, both my rotators in college.
I love the idea of fixing people, helping them be the best they can be.
Surgeons are the ones with the God complex, right? I have that.
I spent my life speaking Yiddish and studying the Talmud, and not shaving the sides of my hair, because someone up there supposedly cares.
Uh, but then I realized no one's up there.
No one cares.
No benevolent higher power is going to save us, so (INHALES DEEPLY) We have to save each other.
Can you top that? - Definitely not.
- Try anyway.
You're obviously smart.
You've got two degrees from Harvard.
My parents are Harvard alums, so I'm sure that helped me get in.
You're not gonna get hired by undermining your own Something went wrong.
OLIVIA: Looks like they nicked a pulmonary artery.
No.
If they had, Browne would be suctioning instead of Lim reaching in with her hands.
ASHER: What are they doing now? Nothing.
We can't access the tumor without compromising his entire cardiac outflow tract.
What about going in the way I suggested? The median sternotomy.
The tumor's too far back.
We need to close him up.
Proton beam radiation would be too toxic to the heart.
DR.
LIM: So is immunotherapy.
We can't access the entire tumor surgically, and we can't kill it without killing his heart along with it.
What if we cut out the parts we can access and try our luck with chemo on what's left? IV doxorubicin and ifosfamide might slow the growth, give him a few more months.
No, I'm not sending my patient home with just a few extra months.
It's better than nothing.
What about a transplant? Not an option.
Heart tumors are a contraindication.
What if we transplant his own heart? If we take it totally out of his chest, we'd have access to the posterior heart.
We could excise the tumor, fix the defect it left behind, - and then put it back in.
- Cool.
CLAIRE: Mmm.
Not cool.
At least with a normal heart transplant, you'd be getting a healthy heart.
Her idea keeps the risk of removing the heart, and adds the risk that the heart we'd be putting back in has just been severely compromised having had a tumor cut out of it.
He's young, and the part of his heart not infiltrated with tumor is strong.
Do a cardiac MRA and see if the tumor's infiltrated the coronary arteries.
If it hasn't, Morgan's idea could work.
I'll schedule it.
DR.
ANDREWS: Dr.
Murphy is dividing the breast parenchyma into three pedicles.
Anyone know where this technique is derived from? Breast reduction surgery.
That's right.
And why would I use a breast reduction technique to make the patient's breasts larger? The technique frees up the tissue.
You can bring the pedicles together to make the breasts smaller or spread them out over an implant to make them larger.
DR.
ANDREWS: Very good.
And now I'm going to turn the sound off.
Don't worry.
Nothing's wrong.
I just wanna talk about you behind your backs for a little bit.
So, first impressions.
Murphy? I like Dr.
John Lundberg.
DR.
ANDREWS: I haven't even heard him speak yet.
He has the highest U.
S.
M.
L.
E.
scores.
And that's important to you? (SOFTLY) Yes.
It shows he has a broad knowledge of medicine.
What is important to you? Well, I'm more interested in what they can do with their knowledge, which is why, so far, I'm most impressed with Jordan Allen.
No.
No, you said she undermined you.
Which takes courage and an assertiveness that will serve her well.
Then why did you tell her to stop lecturing you? It's easier to teach an aggressive resident restraint than a passive one to assert themselves.
Oh.
What about you, Park? What's important to you? I wanna know who I can stand to be around for 80 hours a week.
One thing I learned as a cop, you don't really know a person until you've had a few drinks with them.
(MACHINE WHIRRING) DR.
REZNICK: LAD and circumflex look clean.
CLAIRE: What's with the right coronary? It looks narrowed at the origin.
It's a bit narrow, but looks like a normal variant.
Yeah, but it seems hazy, like there could be some tumor infiltration.
What do you guys think? - Us? - Yeah.
Come take a look.
I guess - It's angiogenesis of the left - Stop.
Interrupting a female coworker is almost as annoying as mansplaining.
This isn't a rowing race.
You don't always have to speak first.
I do not love the interruption.
But I like the enthusiasm.
What were you gonna say? First, um, I'm not sexist.
Of course not.
He's shifting from right to left dominant circulation to feed blood to the tumor.
- Angiogenesis.
- I doubt it.
Surgery already showed his tumor extending to the right side, as well.
What were you gonna say? The pulmonary artery is right behind that vessel.
It's causing radiographic scatter in this area.
The haze is just an artifact.
His arteries are clean.
I think she's right.
Hmm.
Your idea might just work.
DR.
ANDREWS: If you invert the sutures and bury them under the skin, the scar will be invisible.
No one will ever know we were here.
Nice work, both of you.
- (MONITOR BEEPING) - Her BP's dropping.
Push fluids, start IV pressors.
Check for bleeding.
- (RAPID BEEPING) - She's in V-tach.
Move in the crash cart.
No bleeding.
No hematomas.
- SHAUN: Charging.
- (DEFIBRILLATOR POWERS UP) SHAUN: Clear.
(DEFIBRILLATOR THUMPS) (RAPID BEEPING CONTINUES) (BEEPING SLOWS) Sinus rhythm.
Her BP is stabilizing.
(MONITOR BEEPING REGULARLY) Get her to the ICU.
I want post-op labs, CTA chest, and full 24-hour cardiac telemetry.
We need to figure out what just happened.
(MONITOR BEEPING) She's stable, but diffuse delta wave slowing.
Minimal brain activity.
An undiagnosed metabolic disorder could've caused an adverse reaction to the anesthesia.
Yeah, but her pre-op labs were all normal.
It's gotta be some sort of hidden heart condition.
You're big on opinions.
How are you with ideas? What would you do next? I'd check train of fours and reverse the paralytics with neostigmine.
If Dr.
Murphy's right, she should wake up.
Smart.
But risky.
The meds will stress her heart.
If Park's right, she could arrest again.
I saw a similar case last year.
In Borneo.
You interned at a hospital in Borneo? Uh, no.
I, uh, volunteered at an orangutan rescue foundation.
Our guide, a local villager, fell out of a tree.
He was, like, 80 feet up.
How is falling out of a tree similar to a patient arresting during breast reconstruction surgery? Well, he broke his back, uh, but when we got him to the hospital, I found he also had heart damage from rheumatic fever and metabolic abnormality from iodine deficiency.
It's rare here, but it's common there.
We only realized it when we ran a nuclear profusion scan of his entire body.
Good catch.
But a scan that extensive requires multiple radioactive tracers.
You think her heart could handle that? Not tonight.
I'll get consent from the mom.
We'll do it first thing in the morning.
Once we confirm atrial closure, we'll put the heart back in.
Dr.
Lim will reconnect the aorta and the superior venous connections, while I connect the inferior.
During my sub-internship, I assisted on multiple heart transplants.
Even sutured the atrial cuff in one.
I got to scrub in on a liver transplant once.
The The patient died.
What'd you learn? That bile duct leaks are a lot harder to detect than bleeds.
Good.
Next time, I'd lead with that instead of the patient's death.
Are you all done yet? Why? Dr.
Park wants everyone to join him in the break room.
(UPBEAT MUSIC PLAYING ON STEREO) I'm Alex Park.
I'm a former amateur martial arts competitor who once thought it'd be fun to spar with a pro boxer visiting my dad's gym.
And that guy was, uh, Mike Tyson.
Who's Mike Tyson? He's a guy from The Hangover.
With the tiger and the tattoo on his face.
Nice.
You've just revealed you're crazy and old.
I've seen the musical Wicked over 50 times.
The San Francisco tryout, Broadway, Chicago.
I've even seen a friend's boyfriend's niece play Glinda at Stagedoor summer camp.
Nerd.
Next.
(CLEARS THROAT) I'm Claire Browne.
Um, I love music, but I hate musicals, and, um, I don't I don't really like to talk about myself, so it's Shaun's turn.
My name is Dr.
Shaun Murphy.
I used to not like music, but my girlfriend, Lea, she changed my mind.
I also like to watch The Weather Channel on TV.
And (SHUDDERS) I think pickles are disgusting.
(LAUGHTER) Cops know how to manage up.
Managing down's another story.
Well, he's mature, thoughtful, doesn't have an ego.
Neither does Murphy, but do you think that qualifies him to supervise First Years? Well, Murphy's smart, brutally honest, has no regard for social convention.
(CHUCKLES) Mmm.
It works for Bill Belichick.
The Patriots are the most corrupt, dishonest organization in the history of the NFL.
Well, the Seahawks suck.
So, how's your experience been here? It's been good.
Did you consider any other programs or was this your first choice? This was my only choice.
Why do you hate God? Oh.
Uh, actually, I don't believe there is a God.
I thought maybe it was because you believed he hated homosexuals.
(CHUCKLES) I I don't think this is something that we should be discussing at work.
Why not? Well, because it's personal.
Do you have a boyfriend? I I'm sorry, but you can't ask that question in a workplace.
Dr.
Park, he wants us to get to know you.
How can I do that without asking personal questions? I have a girlfriend, and she is very important to me.
It affects my life in every way.
Probably should've thought of that before you told her how much her voice annoyed you.
I said it didn't bother me.
It It was a compliment.
What I heard is you criticizing her voice, and you bringing her mother into it.
You're in trouble.
What about Browne? She may have as much problem being a leader as Murphy, and without his gifts.
She has her own gifts.
Yeah, dealing with patients and their families.
But with her colleagues, she can be insecure.
Her assertiveness has always been a question mark for me.
They've all got areas that need improving, but I've gotten to know Browne a bit better these past few months.
She's stronger than she looks.
When's the last time you saw anyone digging a ditch in a suit and tie? Surgeons don't dig ditches.
They help people at the most vulnerable time in their life.
And you shouldn't take the responsibility on if you're not fully committed to it.
You're entering a new phase in your career, position of authority.
Maybe my clothes are making you feel disrespected.
No.
The truth is, I just hate wearing anything that makes me feel like a suit.
DR.
REZNICK: Great news.
I was able to get Sowinski on anesthesia for tomorrow.
Uh, why? What happened to Foley? Nothing, I just think Sowinski's better.
And we definitely need the A-team on this.
Yeah, I I agree.
Which is why I went out of my way to get Foley.
But Foley doesn't do well under pressure.
- Remember that time - Morgan.
You need to butt out.
You're not a surgeon.
This is not your job.
My job is to help my patient through the entire treatment process.
The best anesthesiologist for transplant surgery is Sowinski.
And I've already cleared it with Lim, so that's who it's gonna be.
Deal with it.
(DOOR OPENS, CLOSES) Are you mad at me? I said your voice doesn't bother me.
It was a compliment.
Actually, what you said is that you love my breasts so much that with the help of noise-canceling headphones, you're willing to put up with my annoying voice.
Yes.
Not a compliment.
Oh.
So you are mad at me? I'm not mad, Shaun.
I'm just busy, trying to keep, like, a billion bots and hackers out of our network.
(MOUSE CLICKING) Actually, no.
I'm not doing that.
Gonna go home.
You want to have some tequila, stat? We also have some pizza left.
No, I don't want tequila or pizza.
- (LAPTOP SLAMS SHUT) - That must mean you're mad.
I'm just upset.
And confused.
And I really don't think there is anything you can do about it, so you just need to stop trying and leave me alone.
SHAUN: She's not mad at me.
JORDAN: She's definitely mad at you.
She doesn't usually hide what she thinks.
ENRIQUE: She's not mad at him.
She knows how he is, how he talks.
She's mad at herself.
And scared.
We all have stuff that we're insecure about.
That's why it's so risky falling in love.
We all hope that when we let our guard down, it's for the one person that doesn't see our flaws.
So, what do I do? You were being honest.
You can't apologize that away.
You gotta figure out what she needs to feel secure in the relationship again.
Don't look at me.
I'm single.
It's not my place to comment on your personal life.
You have an opinion.
Let's hear it.
Fine.
Can you zoom in on her skull base? DR.
PARK: I can, but why? We're worried about her heart and metabolic abnormalities.
We shouldn't be.
Not anymore.
You and Dr.
Murphy were both wrong.
She doesn't have a cardiac or metabolic issue.
She has poor blood flow in the artery supplying blood to the area of her brain that controls consciousness.
A small clot in her artery of Percheron.
If we don't remove it fast, she's never going to wake up.
(MONITOR BEEPING) (SOFTLY) That's amazing.
No, it's not.
The heart's totally outside of the body and still beating.
It's like it has a mind of its own.
She should've started the reimplantation by now.
Is everything okay, Dr.
Lim? DR.
LIM: The tumor had tendrils invading the right atrial wall.
We took so much tissue to get a clear margin, there's not enough left to reconstruct his heart's inflow chambers.
How about expanded PTFE graft? There's not enough atrial remnant to attach the graft.
You could use the septal wall.
He's got dense conduction fibers there.
- It could cause heart arrhythmias.
- Not if you use - (MONITOR BEEPS RAPIDLY) - He's got low arterial pressure.
He's springing leaks at the cannulation sites.
It's a bleeding disorder caused by prolonged bypass.
You need to get his heart back in ASAP.
Morgan, we can't put the heart back in with two missing chambers.
DR.
ANDREWS: (DISTORTED) It's a rare complication, but a blood clot is a risk in any surgery.
DR.
PARK: It's too deep in the brain for open surgery.
If we go rooting around in there, we'd definitely damage the PCA and kill her.
We could inject a dissolving agent into the clot.
There's a 50% probability it won't fully dissolve, which could leave her with permanent weakness and cognitive difficulties.
JORDAN: Assuming she wakes up at all.
We need to remove the clot with a stent retriever.
If we rupture the posterior cerebral artery, she'll die on the table.
Or total recovery.
That's how she came into this hospital.
That's how she's leaving.
Prep her for stent retrieval.
(MONITOR BEEPING) I'm hanging platelets and fresh frozen plasma.
His pressure is still in the toilet, but the bleeding is slowing down.
Not for long.
Small intestine submucosa has the right compliance to shape the chamber walls, but There isn't enough to cover that much area.
Use too little and he'll have heart failure in a month.
I know.
That's the "but.
" How thick is his deep fascia? If it's over 2 millimeters DR.
LIM: Morgan.
Get out.
I'm sorry.
I'll I'll be quiet.
No, you won't.
You can't.
So leave the OR gallery.
Now.
We need 2.
6-millimeter-thick tissue with perfect compliance for arterial filling and contractile pressures.
If it was just the valve, we'd use a bovine pericardial graft.
But cow heart tissue is not durable enough to do an entire chamber.
But pig bladder tissue is just right.
I've used it for bladder reconstructive surgeries, but never hearts.
Let's rebuild the entire atrial walls with it.
Get down to the tissue procurement lab and get 200 centimeters of porcine bladder tissue.
(MONITOR BEEPING) Her EEG delta waves are slowing further.
DR.
ANDREWS: She only has one vessel feeding her thalamus.
That's why the clot landed where it did.
I'm approaching the artery of Percheron.
I'm one millimeter from the clot.
Stop right there.
If we disrupt this clot, we could cause a shower of emboli into her brain.
Deploying the retriever.
(MONITOR BEEPING RAPIDLY) EEG just went flatline.
Calm down.
I'm almost Got it.
Blood's flowing through the artery.
Her brain tracing's looking better.
(MONITOR BEEPING REGULARLY) This should fill the gap between the inferior and superior vena cava when the new chambers get sewn in.
Where's that graft? I need more sponges.
The bleeding is getting worse.
- (MONITOR BEEPING RAPIDLY) - Oh, he's tanking.
Can you push epi? I already did.
He's maxing out.
I'm running out of ways to keep his pressure up.
I got it.
They had 205 centimeters of it.
Thank you.
If you want to gown up, you can watch from down here.
Definitely.
Thanks.
I thought telling her how much I love her in front of other people would make her feel good.
But Dr.
Guerin said I made her feel insecure, and scared.
Women are sensitive.
When commenting on their flaws, total honesty is a high-risk procedure.
That sounds sexist.
Aren't men also insecure about their flaws? Men are much, much worse.
And also, we're really stupid.
Okay.
What can I do now? I've already said my stupid stuff.
I don't want her to be upset with me.
I have a thought.
I think this run of sutures will hold it to the annulus, but I'm worried about leaks.
We can put a second row of pledgeted sutures to make sure it's hemostatic.
That is unreal.
It's a work of art.
Now let's get it back in while we can still get him off bypass alive.
(FLATLINE) CLAIRE: Re-perfusing the heart.
- (EKG BEEPING) - DR.
LIM: We've got a rhythm.
(MONITOR BEEPING REGULARLY) (MONITOR BEEPING) (BREATHES DEEPLY) Hey.
There was a complication during the reconstruction surgery.
A clot, which caused you to lapse into a coma.
We performed a second surgery on your brain, which was successful.
Um You're gonna be fine.
But my breasts The clot occurred after we finished inserting the implants.
I think you're gonna be very pleased with the results.
Thank you.
Yep.
I think I'm sorry.
Dr.
Guerin said I should never say anything that might sound negative to a girlfriend.
And Dr.
Glassman said total honesty is a high-risk procedure with a girlfriend.
It's better to show my love than try to explain it.
But I want to be totally honest with you.
(SIGHS SOFTLY) I don't like your body because it's excellent.
I like it because it's yours.
And I love hearing you talk.
When I hear your voice, especially when I've had a difficult day, I find it comforting.
Now I want to hug you.
Can I? I'd like that.
I love you.
Thank you.
For your total honesty.
(SIGHS) (MONITOR BEEPING) DR.
REZNICK: Your surgery went well.
With some time in rehab, you should be back to work in a month.
Thank you.
Don't thank me.
Thank your surgeon.
She did all the important stuff.
Lim's golden boy is in.
Nothing we can do about that.
So that leaves three openings.
The thought of working with Will Hooper for the next two years If Dr.
Lim thinks he'll be a good resident, I'm sure she has good reasons.
She probably thinks arrogance is helpful to a surgeon.
Well, we could try to change her mind.
Eh, she asked us to evaluate the applicants, not her.
She asked us to be totally honest.
Eh, "totally honest" is a relative term when you're telling your boss she's totally wrong.
So, Hooper's in.
Who else? Dr.
Andrews likes Dr.
Jordan Allen.
Oh, I do, too.
She's confident, driven.
She won't take a lot of hand-holding, and keeping Andrews happy keeps us happy.
That leaves two more.
Who's next? Asher Wolke is very up-front about who he is.
- I like that.
- He's definitely eager.
And he couldn't be more open to learning.
Agree.
That leaves one more.
BOTH: John Lundberg.
Smart, professional, mature.
He's a no-brainer.
Lundberg's in.
Lundberg's out.
He stopped by my office before he left.
Said he's no longer interested.
He said you all were unprofessional.
Drinking at work.
Asking inappropriate questions.
Dating drama.
Mmm-hmm.
So, who's your alt? Olivia Jackson or Boardshorts? Olivia knows her stuff, but she's a bit insecure.
Her answers sound like questions.
I like Boardshorts.
He's sensitive.
Like a woman.
I vote for both of them.
That's not an option.
We don't have the budget.
(SIGHS) Hooper is the worst.
The person I said was the best? He is arrogant and obnoxious.
If he works here, we'll hate him, the work will suffer, and we'll either kill patients or we'll kill him.
And there is no way that you don't see that, which makes me think You do.
This was a test.
You just wanted to see if we'd be totally honest.
- Well done.
- (CHUCKLES) Hooper is definitely the worst.
I only let him shadow as a favor to a board member.
I figured I'd give him a second chance after his obnoxious interview.
And also do a little experiment.
(LAUGHS) So It's Jordan, Asher, Olivia, and Enrique.
To the next phase of your surgical training.
You helped pick them.
As senior residents, it's now your job to help train them.
And don't take this responsibility lightly, because if you don't train them well, people will die.