The Good Doctor (2017) s04e14 Episode Script

1 (BOTH BREATHING HEAVILY) Bet that burned some calories.
Almost as good as a session of hot yoga.
With considerably fewer wind chimes.
You forgot your phone charger.
Leave it here for next time.
Since when did you start counting on a next time? Since the last time we went three rounds.
But if you want to stop I didn't say that.
I recall you saying quite the opposite.
I want you not to depend on this being here for you, thinking you can plug in any time you want.
I'm aware that I need the charger's consent.
You need to see other women.
- Why? I don't really want to - No excuses.
If we're gonna keep hooking up, you should start sleeping with other people.
You're a very strange woman.
Have you seen my phone? Oh.
And remember, we have to leave the hospital by six tonight for birthing class.
The birthing class that I don't need on account of my O.
B.
rotation in medical school.
But where I will learn how to give you the support you need while giving birth to our child.
That is my guy.
I got the results of the fetal DNA test.
Okay.
This will tell us the sex of the baby.
I know.
On account of my O.
B.
rotation in medical school.
Aren't you excited? Not by that.
There are only two outcomes that can be detected on this test, and I am fine with either.
So am I.
I'm excited to find this out.
Please come here so we can look together.
It's a girl.
We're having a girl.
Would you like to paint the nursery pink? No.
This isn't the '50s.
(CHUCKLES) Oh! (GIGGLES) Okay.
(LAUGHS) - Okay.
- Okay.
- I will see you in class.
- Okay.
Okay.
(LAUGHS) (DOOR CLOSES) I've got Bay 3.
- The chest contusion? - Uh-huh.
Why are you all bright-eyed and bushy-tailed over a bruise? This is Dr.
Wolke.
I'm Dr.
Reznick.
Tell me how you got that contusion, Mister Bradley "The Body" Vargas, currently top-ranked in his MMA weight class.
I've seen all of your fights.
You're amazing.
So much for slipping in and out of here without being recognized.
Mm, sparring, roundhouse right to the chest.
Mm, that was some kick.
This is a pretty large hematoma.
We need to drain it.
Uh, you're already training for Vazquez? That fight's not for a couple months.
A real fan.
Drain it? Like with a needle? We can numb you if you like.
Get that away from me.
Not here.
CLAIRE: Your pre-op tests came back normal, so we can go ahead with the hip replacement.
My physical therapist says I should be walking four hours after surgery and good to go in ten to 12 weeks, but I'm aiming for nine.
Can you please tell my mom that that's not a good idea? (CHUCKLES) You should not rush your recovery.
Does it matter to you whether you are having a boy or a girl? I'm having a boy.
We're gonna name him Ray, after my dad.
My girlfriend and I are going to have a daughter.
That's great news, Shaun.
Why? The procedure will take a couple of hours, so we should be able to get you home in a day or two.
Oh, I am looking forward to getting back in the air, pain free.
No more pills or cortisone shots or (CHUCKLES) my internist telling me my hips are too wide for the cockpit.
Sounds more like a Navy problem, than a you problem.
Clearly the cockpit needs a redesign - (CELL PHONE CHIMES) - [SCOFFS.]
as well as a renaming.
(CHUCKLES) O.
R.
two is ready.
It's time.
Both implants seem to be intact.
Thanks.
Sorry I freaked out.
Too many people back there.
If my fans found out I had pec implants, my career'd be over.
I saw you make McEwan tap in one round.
Implants had nothing to do with that.
My body's a big part of the brand.
Everything else is real, 100% U.
S.
prime Bradley.
You do not need to explain anything.
It's just, how many guys, let alone fighters, get plastic surgery? I'm sure more than you think.
When I was a kid, well, I was a big boy.
I got picked on all the time.
My mom wanted me to be able to protect myself, so she put me in jiujitsu.
I loved it.
I started training every day.
It seems to have worked.
Yeah.
After the fat was gone, well, man boobs don't look good on anyone.
They did very nice work.
I would never know.
We still need to drain it.
I'll get the procedure room set up.
PARK: Is that why you want me to sleep with other people? So you can shamelessly flirt with patients? I feel no shame.
And I'm not stopping you.
So why do I need to see other women? This is embarrassing.
For you.
What man asks that question? You are soft and prone to attachment.
I promise you I will not get attached.
Empty words.
You have a Bumble profile.
Use it.
No need.
What's gonna keep me from getting attached to you isn't the charms of other women.
It's your utter lack of any.
(MONITOR BEEPING) LIM: Nice osteotomy of the femoral head.
CLAIRE: It's bone on bone in here.
I don't know how Jean pushed through the pain.
A female fighter pilot in the "Top Gun" era? She's pushed through worse.
SHAUN: Things are much better for women today.
In this surgery, I am the only man.
But until they find a way to put uteruses in men, biology will always force us to make sacrifices our male colleagues don't.
Is that why you don't have children? Shaun, that is not something you should ever ask a woman.
Well, I brought it up.
I never consciously made that decision.
But along the way, I made a bunch of small ones that put my job in front of having a family, and I don't regret it.
But it does piss me off that most men don't have to choose.
Mobilize the proximal femur, then ream and rasp.
(ALARM BLARING) Jean's pressure just tanked 64 over 38.
Push fluids, start pressors.
Heart rate's low at 42, sinus bradycardia.
Her pre-op tests were all normal.
She has no cardiac history.
If she threw a clot, she'd be tachy.
Check for any occult bleeding.
I'll get the transesophageal echo.
There is no bleeding.
Check a twelve-lead, start troponins.
Her B.
P.
is stabilizing.
(ALARM STOPS, BEEPING RESUMES) Remove osteophytes, place cup, direct screws posterolaterally.
Her pressure should not have dropped.
And we don't know why it came back up.
Was it the fluids and pressors or spontaneous reversal or We need to finish her hip arthoplasty before she bottoms out again, and then yes, we need to figure out why it happened in the first place.
Okay.
(MONITOR BEEPING) Go ahead and advance the needle.
(MONITOR BEEPING) Are you seeing anybody? Oh, no.
Is this about to get weird? No, I No.
(CHUCKLES) I'm taking a flouro shot.
Do you usually date one person exclusively, or are you seeing a few people at once? Be careful not to breach the pleural space.
Define your terms.
Does "date" mean "have dinner with" or "meet up for sex"? I'm not entirely sure.
Mm, by the time there's food involved, I prefer to be exclusive.
In the hematoma now.
(MONITOR BEEPING) Mm, I'm not able to aspirate anything.
That's not just clotted blood.
It's a mass.
It's about five centimeters across, firm, non-mobile.
It's very dense.
Get a biopsy, but that looks like breast cancer.
(BEEPING) If there might be a problem with her heart, should she be putting strain on it? If I'm gonna have a heart attack, this is the best place for it.
That is exactly right.
(BEEPING CONTINUES) It's very likely your mom is fine, that the blood pressure drop was just a reaction to the anesthesia.
You're a very successful pilot.
Was that harder because you are a woman? For me, standing out was a plus.
It got me noticed.
Mm, that's not always a good thing.
It's the Navy.
(LAUGHS) Was the bar higher for me than the guys? Yeah.
But pressure's just an opportunity to get better.
Your mother is very inspiring.
Yes she is.
I can go harder if you need me to.
Yes, please.
I don't have breasts.
How can I have breast cancer? You have breast tissue, and while it's rare in men, it does happen.
The biopsy has identified a particularly aggressive tumor.
But the good news is we caught it early.
(BREATHES DEEPLY) W-What's next? (CELLPHONE CHIMES) Sorry.
We're recommending surgery to remove the mass.
Followed by chemotherapy.
We don't believe there'll be any long-term - loss of strength or - Can I keep my implants? Like, will they be able to work around them? - It's possible.
- But highly unlikely.
At the end of this, the Body gotta look like the Body.
Otherwise, I'll lose my sponsors, my career.
A lumpectomy makes sense considering If we want to let the patient prioritize his appearance over his health.
He needs a mastectomy.
Would you be that dismissive if our patient was a woman choosing to preserve her - (CELLPHONE BUZZES) - Someone's popular today.
They're all dating app alerts.
It's amazing what upgrading a profile pic can do.
You should vary your password more.
Where'd you get this photo? I took it for personal use.
But I'm happy to let it be your introduction to the world of e-dating.
Fly, muscular sparrow.
Fly.
- This photo's such a - The words you're looking for are "thirst trap," and you're welcome.
(CHUCKLES) MELODY: Relax.
Relax.
While you are under the soothing touch of your partner, let's discuss birthing plans.
Okay, maybe just a little less pressure.
Like this? Uh, not really.
Remember, you are in charge of your birthing experience.
Every aspect of your labor is your decision, starting with when you head to the hospital.
Okay, maybe just stop.
It's okay.
It's okay.
I recommend what doulas call the 4-1-1 rule.
You wait until contractions are four minutes apart and last for one minute for at least Five minute intervals is safer.
That's one opinion, Dr.
Murphy, for mothers who enjoy waiting at the hospital.
Once you arrive, clearly instruct your partner and your doctor of what you want.
No.
The doctor needs to be in charge.
What if there is a complication? Mm.
Maybe just let her talk.
(QUIETLY) Sorry.
After your water breaks, fortify yourself for the work ahead.
Be that with meditation or a pre-selected song that you find soothing or perhaps a light snack.
That is a very bad idea.
Dr.
Murphy, please hold your comments until the You shouldn't eat after your water breaks.
Many women experience bowel incontinence during labor.
WOMAN: Is that true? - We might poop ourselves.
- Okay.
No one mentioned involuntary pooping.
(EXHALES SHARPLY) - How was the class? - Very informative.
- When's the next one? - There won't be a next one.
We were thrown out.
None of our tests showed any issues with your heart.
You are in great shape.
Then what caused the blood pressure drop? Mm, Dr.
Browne must have been right.
It was a reaction to the anesthesia.
So, when can I get out of here? When we know you can get around safely on your new hip.
Oh.
Let's do this.
(EXHALES SHARPLY) (EXHALES SHARPLY) Careful, Mom.
It's not a race.
Everything's a race, dear.
(ECHOING) Mom! (DRAMATIC MUSIC PLAYS) Jean's hip is intact, which means it didn't cause her fall.
No, her blood pressure did.
Jean was still being monitored when she collapsed.
Her blood pressure fell precipitously, just like in surgery.
Sudden hypotensive crisis could be a high spinal cord tumor.
Or carotid stenosis, or carotid sinus hypersensitivity.
Endocrine deficiency? Make a list.
Start ruling things out.
Uh.
Make a list somewhere else.
Mm.
Shaun! Come meet Theresa.
She's a doula, and we're talking about her helping me during my labor.
Hello.
Lea does not need a doula.
I will be helping her.
But thank you.
Let me know what you decide.
Of course.
Thank you.
Shaun, I am so excited about our baby.
And I am so scared about delivering her.
It's gonna hurt.
It could go on for hours.
Possibly over a day.
And I need to know that I can have whatever I need, a massage at exactly the right pressure - Mm.
- a hand to squeeze really hard, a cool, wet washcloth.
Oh.
Or a warm, wet washcloth.
Oh.
Can you do that? I can get better at massages.
I'm sure you can, but those aren't really your strengths, are they? It's just a set-up for failure, and I know neither of us wants that.
No.
We don't.
Yeah.
HEATHER: Dr.
Park.
Dr.
Boyd.
I definitely do not know this because it's completely confidential, but hypothetically, if you were treating MMA rockstar Bradley Vargas, and if I had a ten-year-old patient who would go bananas for a signed photo I'll see what I can do.
Thanks in advance for the autograph.
It'll make a ten-year-old's day.
- No.
- What? She's all wrong.
She's a Pedes resident.
They're all kind and nurturing and they care about things, and she obviously wants you to keep all your chargers at her house.
That's not what you need.
You need fun.
Text the redhead.
- What redhead? - Candace309.
(KEYBOARD CLACKING) Change your password to something I can't guess.
(KEYBOARD CLACKING) No tumors in the frontal or parietal lobes.
Next we should check for a glial-based tumor in the brain stem.
Squeeze my hand as hard as you can.
Lea said she may need to do that during labor.
I want to be prepared.
Okay.
Okay, that's enough.
We need a better look in the high cervical cord.
Is Lea feeling nervous about labor? She thinks she needs a doula to support her, but she doesn't.
You squeezed my hand very hard.
I can take it.
Mm, I think there's probably gonna be more to it than that, Shaun.
I've also looked into antimicrobial options for washcloths, to wipe her forehead.
What else? I don't know.
Neither do you, or Lea, or the doctor, or the doula That's what's terrifying about it.
It's the biggest day of your life, and the only thing you know for sure is that another human is gonna force its way out of you.
High cervical cord is clear.
Breathe.
(EXHALES SLOWLY) (BREATHING SHAKILY) Good.
You're almost there.
The lighting in this room is very harsh.
We didn't call for a surgical consult, Dr.
Murphy.
I know.
I'm here for research.
Well, this is a bad time.
Next contraction, I need you to push.
Okay.
I am very interested in anything you can share about your experience.
- (EXHALES SHARPLY) - What are you feeling right now? Like oh, like he's trying to Oh, rip out everything! Do you wish you had gotten an epidural? Yes! It's too late now.
(GROANS) Please page Dr.
Glassman.
(BREATHING SHAKILY) Lea wants to have a doula.
Okay, and, uh, you don't? Research shows that doula-assisted births have fewer complications, decreased length of labor, and increased breastfeeding rates.
So, you do want a doula? N-No.
I can precisely measure the time between contractions and get the right washcloths and I've mapped out the fastest route from the OB floor to the cafeteria for ice chips.
I don't want Lea to have a doula.
But they are good.
I am very bad at massages.
So, you you want Lea to have everything that she wants, but you don't want her to want a doula? Yes.
How do I do that? I don't know.
I just (CHUCKLES) It can't be done.
It's like you you want a red shirt really badly, but it has to be green.
Why can't you just give her what she needs? Hm.
Okay.
Good.
(MONITOR BEEPING) ANDREWS: We need to expose the underlying pec major.
Dr.
Park, gently cut with microdissection needle.
Mm.
I really need to join a gym.
I mean, I know I'm never gonna look like "The Body," but I could try to look like I have a body.
(CHUCKLES) Raise the flap and be careful not to thin it too much.
Bradley's transformation is impressive, but it's not real.
Strength, determination, hard work those things are real, and worth striving for.
Not to the exclusion of all else.
The day I lost my job as Chief, I went home and drank myself to sleep every night for a week.
Better to drown my sorrows than to let my wife see me cry.
When your marriage fell apart, did you tell a good friend that you were heartbroken, or did you just hit something really hard for a long time? Both are fine, but men don't do both.
I'm guessing no one told you you were a "real man" when you came out, but that took a lot more courage than getting pummeled inside of an octagon.
I can't see any clear tumor margins.
The tumor extends beyond what was visible on imaging.
It was obscured by the pec implant.
Close him up.
We need to wake him and get his consent for a total mastectomy.
I can't go home yet.
I still don't know what's wrong with my patient.
Then why did you ask me to wait? This is for you.
Oh.
Okay.
This will massage your shoulders whenever you want at exactly the right pressure.
There are three settings and a pulsing option, which I think would be irritating, but it is up to you.
When I wear this, you can squeeze as hard as you want.
Also, I have been building up my washcloth tolerance.
I am up to 15 seconds.
That's great, Shaun.
But I decided I want Theresa there for the birth.
It'll make me feel safer and more comfortable.
I can make you feel safe and comfortable.
I am the father.
I am going to be a good father.
I know that, and I believe that.
You don't need her.
Maybe not, but I want her there.
It's my body and my birth experience, and I want to have a doula there with me, so we're gonna have one.
I love you.
I'll see you at home.
WOMAN ON TELEVISION: less than two weeks away, so don't get too comfortable.
The brain and spinal MRI scans were clear.
You don't have a tumor.
(SIGHS) One less thing to worry about.
What's left? There is still a very long list.
I need to perform a carotid sinus massage to test for hypersensitivity.
I have been working on my massage technique, but you may pass out.
That's how we know if the test worked.
Elongate your neck and turn your head ten degrees away from me.
Did you have a doula when you gave birth? (CHUCKLES) No one I know had a doula back then.
Or fancy birthing suites or hypno-breathing or the luxury of three months off to recover.
It's not a luxury, Mom.
It's important for the mom and the baby.
If women wanna compete, then compete.
(CHUCKLES) We can't ask for special treatment and then complain that the playing field isn't level.
I got a long weekend, and then back in the plane.
I didn't have a choice.
You had a choice.
Stop breathing, please.
You always loved to fly.
Maybe more than being stuck on the ground with me and Dad.
No.
Okay.
(EXHALES SHARPLY) I didn't like leaving either one of you.
I just wanted you to see me be strong so you knew you could be strong, too.
I did.
Being scared and weak, I wasn't always sure if that was okay.
- (ALARM BEEPING) - Oh, my God.
Wait, is this what was supposed to happen? No.
This is not supposed to happen.
(BEEPING CONTINUES) (EXHALES SHARPLY) You need a total mastectomy, including the removal of your pec implant.
But with training, your strength should fully I can't get back in the octagon with half my chest caved in.
- I'll lose my sponsors.
- Then find new ones.
Once people know what you've been through You honestly think I'm gonna let anyone know I had breast cancer? What about non-surgical options? What about chemo? Chemo alone isn't the best way to treat this.
It doesn't have to be the best.
It just has to work.
There's no guarantee it will, and given the tumor's invasiveness, they'll have to use toxic I can take whatever you throw at me.
But I'm not having surgery.
EEG results are normal.
You've never had a seizure before, but it's possible one was missed.
There are many different types.
Does Jean ever stare off, become non-responsive? No.
No.
But there was that one "bathroom episode"? When I came to stay with you, after Dad died.
Oh, that was nothing.
It was late and she fell asleep watching TV.
She got up to use the bathroom and got light-headed and then almost fainted.
I think I was just exhausted.
Did it happen again? Uh, hardly ever.
A couple times, over the last few years.
There is no mention of this in your medical record.
I told my internist.
He said it happens to some women during menopause.
Have you experienced other symptoms that were attributed to menopause? Of course.
Tell me what they are and when they started.
Um, I think I had some constipation and sleep issues.
- When? How long? - I-I-I don't know.
I don't remember.
I-I told my doctor, and he told me not to worry about it.
He told me to forget about it, so I did.
(TELEPHONE RINGING) Mrs.
Williams.
I have an urgent problem I have to talk to you about.
You'll need to wait your turn, Mr.
, uh I am Dr.
Shaun Murphy.
I need answers about Jean Starzak.
She was your patient.
Now she is my patient.
Dr.
Murphy, if you can wait, we can talk in private.
Okay.
Yes.
You failed to chart many of Jean's symptoms, constipation, sleep disturbances, hot flashes, reduced libido.
She's not sure she remembers all of her symptoms or when they began, so we cannot figure out what is wrong with her.
Sounds to me like she's in menopause.
You're a talented diagnostician, Mrs.
Williams.
No.
She's not.
Menopause doesn't explain her recent blood pressure issues.
Mrs.
Starzak's chart, please.
It's not in there.
And she mentioned several episodes of nighttime dizziness, which I believe were seizures.
What is in here is enough to remind me that the dizziness was menopause.
Micturition syncope, not seizures.
And the blood pressure issue isn't new.
But also isn't a symptom of anything besides her anxiety about forced retirement.
It wasn't I know it happened during surgery.
She wasn't anxious.
She was unconscious.
My daughter is never coming to see you.
According to this piece in "Clinical Endocrinology", Jean's symptoms match pretty well with Addison's disease.
She doesn't have hyperpigmentation, or weight loss.
- Not all cases presented with - Cortisol levels are normal.
There have been several recent case studies correlating hypothyroidism with low post-op BP.
Jean's TSH is borderline high.
But her thyroid hormone is in the normal range.
What about sleep apnea? I read about a case involving BP crashes.
That's interesting.
Mm, Jean's body type isn't typical with apnea, but we could ask about snoring.
I would like to see that case literature.
It's not a conventional case write-up.
I saw a post on Reddit.
Mm.
What subgroup? The women's health community.
Mm.
It's not scientific.
At all.
It's not helpful.
But neither is this.
There is nothing here.
The medical establishment isn't looking into this stuff.
It's ignored women like Jean, as demonstrated by her own doctor not charting her symptoms.
That is true, but it is still a bad idea to rely on anecdotal evidence.
I agree with you.
If you have a better idea, I am happy to go with it.
Keep checking Reddit.
Claire, can you look at social media postings? I'll check out the blogs.
You changed your profile picture.
- It sucks.
- It looks like me.
It's not like I photoshopped your head on someone else's body.
If I'm gonna sell myself, I at least want to sell who I actually am.
The women who answer your posts don't care who you actually are.
And based on this photo, I don't think you know who you are.
You're reading Proust? BRADLEY: (VOMITING) Once the ondansetron kicks in, you should start feeling better.
Just in time for your next chemo session.
(CLEARS THROAT, SNIFFLES) I'll get through it.
I know you will.
Doesn't mean you should.
It's dumb.
You're acting like an idiot because you're less afraid of months of pain and nausea than being exposed.
You've constructed a perfect facade, and you're gonna kill yourself trying to preserve it.
But being strong has nothing to do with being "The Body.
" Tell that to my fans.
My sponsors.
I think you should.
Tell them none of this makes you a man.
You were just as brave and strong back when you were a fat, bullied little kid that decided to make a change.
That kid didn't let other people tell him who he could be or what he was capable of.
Don't let him down now.
Schedule the surgery.
This woman says she had chronic low blood pressure and her doctors blamed it on her "weight loss obsession".
Turned out she had congestive heart failure.
This woman's seizures were attributed to her pregnancy.
She was on her fourth doctor before they correctly diagnosed her epilepsy.
CLAIRE: I got something.
This woman spent years with the same symptoms as Jean, before she was diagnosed.
Parkinson's Disease.
It healing well.
Pathology results show clean margins.
You should regain full strength and be back in the octagon in a few months.
Thank you.
There's something I wanna show you.
"My Next Fight is Breast Cancer.
" Over a million views, with some very encouraging comments.
A few you will want to mute.
(CHUCKLES) And a bunch of women who are really into scars.
The test confirms you have Parkinson's Disease.
CLAIRE: We believe it's been progressing for a few years.
Your hip pain may well have been the first indicator.
Can I still fly? I'm afraid not.
How do we treat it? Unfortunately, the delay in diagnosis has allowed the symptoms to intensify, and there is nothing we can do to reverse that.
You should still have several more years of decent mobility, and we can help manage the symptoms with medication.
We'll let you two have some time alone.
I'd like to go home.
Can you, uh Can you see about getting me discharged? Tory, please go.
No, Mom.
It's okay.
(SOBBING) How's your phone battery? 'Cause there's a charger at my place.
It's time to retire that metaphor.
I'm busy.
You were right.
I'm attachment-prone, and there's nothing wrong with that.
As long as I'm with someone who feels the same way.
HEATHER: I found the place.
Flannigans.
Oysters.
Overpriced IPAs.
The game on three big screens.
- (ELEVATOR BELL DINGS) - Perfect.
See you tomorrow.
I want our daughter to have the chance to have everything she wants, and I want you to have the chance to have everything you want.
But I can't.
Not by myself.
It's okay that I am bad at massages.
She will handle them.
Thank you.
How do you two feel about frankincense oil? Um (EXHALES SHARPLY) No thanks.
(CHUCKLES) Lea, the world is harder for women.
I want to change that, but I don't know how.
By being an amazing dad to our daughter.
By letting her know that she's loved and supported.
We'll raise her to be strong.
Like you.