The Good Doctor (2017) s04e11 Episode Script

1 You should be getting a raise.
You don't get a raise every time you do something well.
You did something very well and saved $1.
75 million.
- I'll talk to Dr.
Glassman about it.
- No, you won't.
If any talking or anything else needs to be done, I'm fully capable of handling that my Hey! No, no, no, no, no, no, no, no, no.
Hey.
Hey.
That's my car.
You can pick it up at Tricky's Towing.
I'm picking it up right now because this is my car, I'm allowed to park here, and you're a trespasser.
Any time after 1:00.
Shaun, tell him.
Mm, this is not your spot.
Oops.
Someone told a lie.
I just got a spot last week, so it's kind of new to everyone.
So, yes, it is not my spot, but that doesn't make it the wrong spot.
It'll be $250, cash or credit.
I'm not paying $250.
I don't have $250 to waste on th If you get that raise Shaun.
Would you just stop for a minute? - Not once I start.
- That's not a law.
That's just some bull you bastards made up so you can do this.
$350.
Hostile work environment fee.
Jeffrey Williams.
21 years old years old.
When he was 5, he fell in love with baseball, dreamt of playing with the Tigers.
By the time he was 8, he was the best hitter in Little League.
Right, Jeff? At 9, he led his team all the way to the Divisionals.
Pura vida, Dannie.
Retropulsion.
What? Her thumb moved.
- What does that mean? - Nothing.
If it happened, it's a normal response in dying muscles.
Or it could just be the result of hypoxia or an electrolyte imbalance.
Or brain activity.
The E.
E.
G.
showed no purposeful brain activity.
Hook her back up.
Elias, over the last 10 years, Dannie's had thousands of tests.
- If there was any chance - Dr.
Reznick, please.
Now.
Ankylosing spondylitis.
Nasty little disease.
When Jeff was 10, the inflammation was so bad the bones in his back started to fuse together into one big, gnarly bone.
If you can't extend your back, you can't use your legs.
If you can't unwind your back, you can't use your arms.
Useless legs, useless arms.
Can't even fit into a standard wheelchair.
I've had breakfast in bed since I was 10.
And lunch.
And dinner.
Are you in a lot of pain? Not compared to what it was.
I wish I'd met that rheumatologist at the Baltimore Spine Clinic seven years earlier.
They didn't offer you surgery? Well, I've I've been to nine neurosurgeons, and they all said that they couldn't fix me, so But thanks to Dr.
Glassman, my post-pretzel future's looking bright.
I wanna move out of long-term care, study engineering, go to Europe, hell, go to a ballpark and see the game, maybe with a girl.
I'd just love to be able to hug someone again.
I'm gonna need two residents to assist me with With the surgery.
What were you doing 10 years ago? That's how long it's been since the aneurysm in her brain ruptured and how long Elias has been visiting, bringing her Peppermint Patties and hoping for that special day she opens her eyes and says, "Hi, honey.
Did I sleep in?" And I had finally gotten him to give that up.
Give up hope? Give up an impossible fantasy that has paralyzed his life.
He used to have a career, goals, a wife, things he can have again if we let him move on.
And by "we", I mean you.
So you are gonna tell him that the twitch meant nothing.
But she has elevated levels of dopamine.
Which is a stress hormone, likely produced by the adrenal when it was temporarily shut down.
But it's also a neurotransmitter in the brain and may be associated with increased brain activity.
We need to do a SPECT C.
T.
of her brain and full body with radiotracers to find the source of the dopamine.
You know about Elias, right? The patient's husband who can't move on and it's making everything worse? Do you see an analogy here? No.
No more tests, Shaun.
I'll ask Dr.
Lim.
- I'm calling your bluff.
- I don't know how to bluff.
Joint cuts are nearly perfect.
Nearly perfect leaves him with no feeling in his legs.
I kind of cracked the vertebral body.
But I got the rest right.
That is perfect.
Welcome to my team.
Textbook.
You followed the video demonstration exactly.
You didn't.
The third bone is the problem, and you messed around with the first one.
Why? My model was a bit more severe than the one in the demo, so I thought a three-column reconstruction might be better.
Nice.
Nice improv.
You're on my team.
I mapped out every screw placement, osteotomy cut, rod contouring.
You know, I've been trying to figure out why you're doing this.
I don't know.
Change a kid's life? Something like that.
I'm thinking you must be afraid.
- What? - Come on.
You've been impulsive ever since you recovered from cancer.
You quit surgery to start a clinic, married my favorite barista after a few dates, and I'm guessing none of it made you happy.
I'm sorry.
We barely talk to each other outside of the board meetings, and now, all of a sudden, you can see into my soul? I love my wife.
I love my work.
Great.
And you still feel empty, don't you? I'm thinking you're scared something's missing from your life, so you keep reaching.
You take on a case no other surgeon will touch.
As fascinating as all this is, I don't think Jeffrey really cares all that much - why we're doing the surgery.
- He should.
Because your motives are affecting your ability to properly assess whether that surgery is worth the risk.
Thank you for the input.
You were supposed to meet me for lunch at 12:15.
It's 12:23.
I'm not the first person Tricky has shafted.
He's earned his name.
I'm gathering every complaint I can find, which I wouldn't be doing if you'd backed me up.
So no lunch.
Mm, are you mad at me? When you're mad at me, you don't look at me.
Although, you are now, so maybe you're not.
I turned to my boyfriend for support, and he hung me out to dry, so let's just say I am disappointed.
I told the truth.
This isn't about honesty.
This is about having my back.
We're a team now, Shaun, working together for a common goal.
And right now, our goal is to get my car back.
Then you need to pay $350.
I'm paying nothing.
He is a pirate, and I'm going to expose him to the world.
No increased dopamine-specific uptake.
It's not coming from the brain.
Which means it must've come from the adrenal glands when we shut down their oxygen supply.
Move down to adrenals.
Impressive To mourn his wife for 10 years.
He's not mourning her.
He can't as long as she's alive.
Dannie is stuck in limbo, somewhere between life and death.
So is he.
If there are time limits to being a good partner, are there also ethical limits? Should you support them even if they've done something wrong? You think maybe the coma patient robbed a bank? Good alibi.
What did Lea do? Doesn't matter.
Support her.
Whether you agree with them or not, the job of a good partner is to be supportive.
As opposed to, say, resolving disputes by running to the Chief of Surgery.
It's not coming from the adrenals either.
There it is, but it's not coming from an organ.
It's coming from a tumor.
Dannie has cancer.
You could say we're doing a kind of Humpty Dumpty, only this time, we're actually going to put you back together again.
Don't get too excited, though.
Dr.
Andrews wants to give us a little reality check.
If all goes well, you'll have a restricted range of motion and be dependent on a walker.
If all doesn't go well, there is a risk of paralysis and, given the potential for massive blood loss, there's a small chance you might not survive the surgery.
But you have a great team and one of the top neurosurgeons in the world.
So, what do you say? This is really happening.
Yes, sir.
Tomorrow morning.
First thing.
I'm sorry, Dr.
Glassman.
I can't I can't do it.
She has a paraganglioma abutting her vertebrae.
Her twitch wasn't a sign of increased brain activity.
It was just a reaction to the tumor irritating her nerves.
We can take her off life support.
What about this cancer? Is it treatable? The only treatment would be surgery, and it's in a difficult location.
Well, what happens if you don't remove it? It's malignant.
Dannie would die within a couple of months.
Then you have to operate.
She could die in the O.
R.
rather than here with you holding her hand.
We rechecked her E.
E.
G.
There's no change.
There was a change.
Uh, the thumb movement was a change.
And the cancer and the dopamine were changes.
Something else could change, and maybe that's the change that'll wake her up.
Elias, her body is dying.
Only if we let it.
I gave up on her once.
I'm not doing that again.
I've got your discharge paperwork.
I'm sorry I wasted your time.
Mm.
I thought I was ready for this, and I knew it was dangerous.
Hey, look, my life isn't perfect, but it's not so bad that I want to risk throwing it all away.
You ever hear of Gates Brown? Left field for the '68 Tigers? Yes.
My dad had his baseball card.
Your dad ever tell you about his story? First person to recognize his talent was a prison guard.
He helped him get out of prison a year early on parole so he could play professional baseball.
I think about Gates Brown a lot.
Whenever I have to make a-a tough, really tough decision, I think about how scared he must've been.
Playing for the Tigers? It's a dream come true.
Real scary.
Getting out of jail early, facing a world he hadn't been in in a while.
What if he didn't live up to expectations? What if he wasn't good enough for the bigs? But he kept fighting.
He kept pushing.
You wanted to have this surgery, and you kept fighting and you kept pushing and doctor after doctor said no, then finally you found a doctor who said yes, and now you stop? That doesn't make any sense.
I don't think that you are afraid that this surgery is gonna fail.
I think you're afraid it's gonna succeed.
For the last several years, you could've taken classes online, worked toward your degree.
You could've gone traveling.
You don't think I've tried? Oh, you tried, okay, and you failed, but, man, did you have a good excuse.
And now you have the surgery and it's successful, but you still fail? That's scary.
Because now you got to look at yourself in the mirror and you have to ask, "Was it my condition, or was it me?" You know where I celebrated my 10th birthday? Children's Hospital, getting 13 steroid shots into my spine.
By the time I was 11, my entire social network was R.
N.
s and M.
D.
s.
I've never had a job.
I've never danced with a girl.
I've never even had a best friend.
I have no idea how to live like a regular person.
So what? So you'll suck at it.
Join the club.
Say no to the surgery if that's the right decision.
But do yourself a favor.
Don't say no because you're afraid to live your life.
I'm going to support you.
Thank you.
I'm looking right at ya.
See? I noticed.
Let me have your phone.
W-Why? I've created a couple hundred Yelp accounts to trash Tricky and maxed out on my I.
P.
address, so I need another one.
You're not allowed to do that.
He's not allowed to extort people, so I'm just extorting him back.
Hm.
Once I threaten to unleash my arsenal, he'll hand over my car.
He might even detail it for me.
I won't have to actually post anything.
Thank you.
This last segment of tumor is holding on to her spinal dura for dear life.
Fine dissecting scissors.
I may be participating in fraud.
But I want to support my partner.
If your partner wants you to do something that makes you feel uncomfortable, shut it down.
Do not enable crazy.
Lea isn't crazy.
We're all crazy sometimes.
Just takes the right motivation.
There is an obvious middle ground.
If you think your partner's doing something wrong, help them see what's right.
Damn it.
The capsule ruptured, and it tore the dura.
We have a C.
S.
F.
leak.
We should try a graft.
Harvest some fascia to reinforce the dura.
Dr.
Lim? Mmm.
Tastes like my birthday.
Lab confirms the tumor wasn't metastatic.
You're cancer-free.
And brain function is apparently fine.
All in all, it's been a pretty good day.
10 years.
I miss anything good? No.
So why'd I wake up? We're running tests.
There have been cases of anesthesia rebooting the dormant brain.
Yours was light, but it still might have Let's just call it a miracle.
Okay, last bone wedge.
Alright, let's start straightening him out.
You know, if you can talk this kid into risking his life, I'm thinking maybe you can talk anyone out of any fear.
I've been trying to talk you out of those caps for years.
These caps save lives.
No fear in that.
I'm afraid to eat a cheeseburger.
Hm? My mother, she was very proud of her cooking.
She told us we didn't need to sacrifice taste to keep Kosher.
At least not with her in the kitchen.
And it's crazy considering all the other ways I've rejected her faith, but if I do eat one, it feels like I'm cutting my last lifeline to my mother.
My mom taught me how to play a guitar.
We had our problems, a lot of them, but everything seemed to be okay when we were singing.
Since she died, um, I'm afraid to even open the case.
It's the middle of your shift.
You miss me? I had a bad morning.
My patient lived.
That is surprising.
You keep being competent, you'll get used to it.
I need an ice-cream infusion.
The cafeteria has ice cream.
Not Cherry Garcia.
Heard you lost out to a Firsty.
One bright spot in my day.
I did everything perfectly, but it's still not symmetrical.
Hmm.
Nose job.
It's changing as you fix it.
You got to change with it.
Andrews always said the first thing you do with your plan is toss it out.
That's exactly why I didn't do a plastics elective.
Or you're a blue-collar ex-cop who's afraid to color outside the lines.
Your L3 vertebrae is perfect, which means you're not entirely without talent.
But look at the bones you're not supposed to fix.
What are your instincts telling you that this procedure manual isn't? Congratulations.
You're now as good as a Firsty.
I almost feel bad about eating your ice cream.
B.
P.
's 82/50.
Spinal shock? S.
S.
E.
P.
and M.
E.
P.
waves are normal.
Check for buckling.
No cord compression.
Pressure's still dropping.
Did we poke a hole in the canal? Let's back out these screws.
Spine's not the problem.
It's his heart.
It's in failure.
Crash cart! I know why Dannie woke up.
The paraganglioma was filled with dopamine.
And leaking it in trace amounts.
That's how we found it.
But when the capsule ruptured, the tumor released the dopamine in very large amounts.
Her spinal tap showed over 1,200 nanograms per liter.
Which bathed her brain in dopamine, which energized it and woke her up.
It was just a freak event.
A temporary freak event.
The dopamine's gonna wear off, and her brain will shut down again.
Yes.
And the dose she'd need to stay awake would be toxic.
If we don't replicate the surge, she'll relapse into a coma.
And if we do, she'll die.
Your dopamine levels are dropping quickly, and when they return to normal, you'll return to your comatose state.
- What? - No.
Sh Look at her.
She's lucid.
She's talking and laughing.
She's fine.
I'm sorry.
Th-That's it? There's no treatment, no surgery, no medication? - Elias, I wish we - No! H-How long do I have? Less than 24 hours.
Oh.
But she could wake up again, right? I mean, you didn't think she would this time.
You said she shouldn't have.
The series of events that coincided to make this happen was so unlikely, it is safe to say it will never happen again.
I want to see another doctor.
- Elias.
- There There must be some way Elias.
We have to face this.
Why? Because they say so? Listen to me.
You're right here, looking into my eyes and holding my hand.
You're not going anywhere, Dannie.
I promise.
Troponin's normal.
It's not a heart attack.
Yeah, no signs of P.
E.
No clots in the heart either.
Normal valves, no wall motion abnormalities.
But he has S/D wave fusion on RV inflow.
His heart's not filling properly.
His legs are swollen.
His fluid's not returning from his lower body.
His anatomy adapted to his contortions.
Nothing is where it started.
And now, moving to this new position could be trapping his vena cava.
His spine and breastbone are squeezing off blood flow to his heart.
The vein's compressed.
Can we prop it open with a stent? There's too much chest-cavity restriction.
Jeff's body is not letting us straighten him out.
We need to reverse the surgery.
All the king's horses.
About time Elias took a bathroom break.
He never shuts up about you.
I know you love skiing, both water and downhill, and how you actually did both the same day in Tahoe despite a water temperature of 48 degrees.
I know your favorite movie is "Battlefield Earth".
So bad it's good.
I get it.
And your favorite candy, well, that I got all on my own.
I also heard about the puppies, how he couldn't decide between three of them, and so he Brought them all home.
Yeah.
Are you trying to tell me that I'm a lucky girl? It's okay.
I know that I am.
I found my soul mate.
Do people still use that lame word? He's a wonderful man who has trouble making tough decisions, and he's gonna spend the rest of his life sitting at your bedside, listening to a ventilator keeping you alive.
Which puts it all on you.
Screw's stuck.
I'll try a lamina spreader.
If we do a bone graft here, we can re-fuse the T3 vertebrae the way it was before.
It'll never be the way it was before.
We cracked his spine at 15 different levels.
He will be more contorted.
He'll be more in pain.
T-handle.
Pectus excavatum.
Pectus excavatum.
If you never heard of it, don't feel bad it's very rare.
The person is born with a big dent in the middle of his chest.
Sometimes it's so bad that the breastbone presses against the heart, and you got to break away the sternum, you got to crack open the ribs, prop it open with metal bars.
If we can do that for Jeff, then we can create enough space in his chest.
Close him up.
Let's turn him around.
It's, uh, a D.
N.
R.
I don't want to be put back on life support.
That's not life.
You gave her this? But I signed it.
You remember our first Valentine's Day together? You gave me that That silver pendant with the two little hearts.
I told you I was considering that job in Boston.
And you let me go.
- You didn't need my permission.
- I know.
I know.
But you knew that it was something that I needed to do.
And you also knew that I was scared.
Dannie, this isn't Boston.
I can't.
I can't let you go.
I know.
I think that's why I woke up.
Mm-hmm.
- Hey.
- Hey.
Something that I have always felt guilty about.
Costa Rica.
That was your dream trip.
Your mother was sick.
Mm.
Not very.
But you never complained.
Canceled everything.
Did you ever go? How could I go without you? Because you have to.
For both of us.
Let me have that thought.
Pura vida.
Dannie? Pura vida.
Wanna try and stand up? You got this.
No, no.
Okay, I'm afraid I'm gonna fall.
That's why you got to try.
Dr.
Glassman.
It's after 6:00.
You're open 24 hours.
I'm not saying I'm closed.
I'm saying it's after regular business hours.
There's a $50 fee for that.
Hm.
I've created 336 of the most scathing critiques of you and your sleazy operation.
So give me my car back, or I'll post them and shut your ass down.
I'm not buying it, Cupcake.
You're no outlaw, and I'm gonna have to add a $200 "unfair business practice" fee.
I push this button, and you can kiss Tricky's Towing goodbye.
Cash or credit? This time, I'm not lying.
Shaun, tell him.
Cash.
This way.
Drive away! Drive away! Get back here! - Whoo! - O-Okay, drive fast.
Oh, my God, Shaun.
Kick its butt.
So? It's really really good.
That was tight.
Everyone give it up for Travers! Next up is Claire.
Hey, you got this.
Okay.
Um, this is a song my My mother taught me.
So if you don't like it, shame on you.
You can hold my hand If you need to let go I can be your mountain When you're feeling valley-low I want a house with a crowded table And a place by the fire for everyone Let us take on the world like we're young and able So bring us all together when the day is done If you want a garden I got Jeff's post-op images.
Everything looks great.
Yeah.
What you did was phenomenal.
It's got to feel pretty good.
Feels great.
Three patients I turned down.
This world needs more people screwed up just enough to think they can do the impossible.
You owe me seven bucks.
This costs $6.
Delivery charge.
I just increased your rent by $20.
His face was awesome.
Mostly blind rage with a sprinkle of bewilderment.
And how about you leaping into the car like the Man of Steel? I hurt my knee.
Making what you did even more spectacular.
I can't believe you stiffed the guy like that.
I didn't.
I paid him $250, which is what he was entitled to, leaving him with no reason to retaliate.
That is fair.
Lea you have been a bit crazy the last two days, and I needed to help you see what was right.
I have been a bit crazy.
But it wasn't really about the car.
Two days ago, I found out Shaun I'm pregnant.