The Good Doctor (2017) s05e09 Episode Script

You have a couch, right? Mm-hmm.
- Thank you.
- Mm-hmm.
Hey, good morning.
Salen didn't tell you? She made me Chief of Surgery.
Dr.
Park, this is Joe.
He was helping his son, Cody, into his wheelchair when they had a spill.
I'm too big for Dad.
No, you're not, buddy.
Cody has Kabuki Syndrome.
You got banged up, too, huh? I-I'm okay.
Just help Dad.
You know about Kabuki? Genetic disorder characterized by low muscle tone, heart defects, intellectual impairment And in Cody's case, chronic hypoglycemia.
And Joe has a group three clavicle fracture and shoulder dislocation.
Ah, it looks worse than it feels.
You're not in pain? Is that a bad thing? Might be a sign of nerve damage.
We'll use some plate and screws to stabilize your collarbone.
While we're in there, we'll figure out why you're not hurting.
Are you gonna be okay? Yeah.
I'll be right back, Code.
Last few years, it's just been the two of us.
But we're a team.
Best team ever.
Bye, Dad.
See you in a bit, buddy.
Sorry if I'm a bit nervous.
I'm a huge fan.
So I still have one? I was 16 when I first saw the Dunn Sisters live, and I saw your sister's tour last year at the Rose Bowl.
Then you've seen her more than I have.
She's made it even without my accompaniment.
Hey.
Your bloodwork confirms good compatibility with the donor tissue, so, Nelly, if you're up for it I have been for five years.
All right.
Let's begin prep on all asp Oh.
There's a thrill in her left carotid.
Could be arterial obstruction.
Without an adequate blood supply to the donor trachea, we can't do the surgery.
It's a concern, but not sure it's a problem.
Let's do a CTA.
You'll be fine.
Uh, don't, uh Don't bother.
I'm fired? No.
But I expect you'll be moving on.
Dr.
Novick at San Jose General is looking for a new Head of Trauma.
It'll be more money and a chance for a fresh start.
He's expecting your call.
That's one way to deal with dissent.
And by dissent, I mean attempting to hold you accountable for your negligence.
I'm sorry you couldn't get on board with my approach.
We could have crushed it.
I'll text you his number.
Giants fan? Churros.
Most people call 'em the San Jose Giants, but fans call them the Churros.
How many stitches am I gonna get? Looks like six.
You've had them before, though, right? Yep, when I was a baby and they fixed my heart.
How many is my dad gonna need? A few more than six.
But we've got our two best doctors working on him.
You know, besides me.
How long is Dad's surgery gonna take? He should be out in about two hours.
He was a high school principal in charge of 844 kids.
Mm, very cool.
But he had to quit to look after me.
Will he still be able to lift me? Once his arm's all better? Absolutely.
You two will be out there catching foul balls before you know it.
You promise? Mm-hmm.
All done.
What does Lea like for breakfast? Huevos Rancheros con salsa verde.
Muy bien, but I'm asking because she's sleeping on my couch.
Nelly's internal carotids look good.
Hmm, yes.
They do look better than they felt.
Check the external carotids.
So you're not getting married? Yes.
Because of something she said over two years ago? Shaun, stop being a relationship archeologist.
You're digging up stuff that isn't relevant.
Archeologists dig up stuff that is very relevant.
And Lea still believes it.
She changed my client satisfa She apologized, Shaun.
You're attributing an expired motive to her current actions.
How do I know it's expired? Because you trust her, and you love her for who she is, a flawed, messy, and totally wonderful human being.
Hmm, the left external carotid is stenotic.
I was right.
We can't do the surgery.
You have to do the surgery.
Poor flow from the carotid could lead to graft necrosis, sepsis, and possible death.
It's been a minute.
You look awful.
You look fake.
Because of the blood flow issues, the transplant will be riskier than we thought, but I don't believe prohibitively so.
It's still a viable option if you feel it's worth the risks.
It isn't, okay? Your electrolarynx works fine, and a normal voice is not worth dying for.
You don't sing, do you? N-No, but even if the transplant is successful, your new voice may be very different from your original singing voice.
I know.
I just want a voice.
People don't listen to robots.
Nelly, we're talking about your life.
See? You didn't hear me.
I want the surgery.
Okay.
Nerve signaling is disrupted.
That's why Joe wasn't feeling any pain.
Evaluating the brachial plexus.
Just a heads-up, you may be getting a call for a reference.
You're leaving St.
Bon's? More like fleeing Salen Morrison.
Demoting you is an insult to all of us.
I found the culprit.
Bone splinter compressing the plexus.
Well, thanks for that.
I'm sure Andrews will do a fine job.
If he's not Salen's puppet.
Good news is, no nerve laceration.
I have an interview to run trauma over at SJ General.
That was fast.
They need any surgical residents? Or anesthesiologists? Nerve signaling isn't improving.
It's an ossified ligament compressing the cervical cord.
His arm's permanently paralyzed.
The ossified ligament has probably developed over years.
It's why you weren't feeling any pain.
Your fall drove it into your cervical cord.
Can't you remove it? It's adhered to the dura encasing your spinal cord.
The surgery to remove it could leave you paralyzed in multiple limbs.
I can't take care of Cody with one arm.
You know, if I don't have this surgery, there's a 100% chance that my son will be institutionalized.
I'm sorry.
But I strongly recommend against it.
I agree with Dr.
Park.
But only you know what's best for your family.
I need to do this.
We're starting you on immunosuppressive therapy.
You may feel some headaches or nausea.
Dr.
Allen is a bit of a fangirl.
Hey, backstage passes if you can talk some sense into my sister.
Dr.
Andrews is the best.
If he says he can make it work, it'll work.
Dr.
Murphy doesn't think so.
Dr.
Andrews is the Chief of Surgery.
I'm your big sister.
If I had listened to you, I would have ended my career in fishnets.
If you'd listened to me, you'd still have a career.
Yes.
I should have been wearing my seatbelt, especially with you driving.
I demonstrated lousy judgment.
It's kind of like this whole transplant thing.
Ooh, clever new spin.
If only your songs were that smart.
Okay.
You've been at St.
Bonaventure for 17 years, went from resident to Chief.
Makes for a pretty boring resume.
It shows dedication and a loyal following.
But it does beg the question, why now? Um St.
Bon's has changed a lot.
Well, Salen and Ethicure will do that.
But still, man, it's tough to leave home.
Yeah.
St.
Bon's made me the doctor I am, but I don't know if it's home anymore.
Hmm.
Well, it's their loss.
You'd be overseeing the busiest Level 1 trauma center in the Bay Area.
The wall is too stiff.
Too stiff.
I can't maintain lumen patency.
And that's why we're practicing.
You practice because something is difficult, not because it's impossible.
Ugh, okay, obstruct it again for the eighth time.
We should not attempt this.
This is an innovative surgery, Shaun.
The exact kind of case that usually makes you very excited.
Instead, it's made you very contrary.
That might be because there's a certain someone crashing on my couch.
Hmm.
Oh, she means Lea.
Oh, I know.
This is not about Lea, okay? This is about a bad surgery.
It's a risky surgery, Shaun, but one that can drastically improve the quality of this young woman's life, and not just physically, but emotionally and psychologically.
We need to be aware of how our own personal dynamics might impact our decisions.
Oh, you're talking about me and Lea.
Again.
Yes, I am.
You and Salen are dating.
Is that dynamic impacting your decision to Why did you just kick me? I'm very aware of my "dynamic," and, no, it's not affecting my medical decisions.
Ninth time's the charm.
It's perfusing.
This is possible, and it's going to work.
Looking good.
What's his name? - Sebastian.
- Ooh.
First time I swiped right in Three months.
Mm.
Looks like you got your night planned.
Yeah, I thought We could talk.
Tomorrow.
My problems are not going anywhere.
Give me a beer.
No.
Go.
I-I'll be fine.
Mm-mmm, I already broke Sebastian's heart.
Beer.
Mm-hmm.
I never did like the big office.
Always made me feel guilty for not reading enough books.
A Dr.
Novick called me from San Jose General asking me if he could poach you.
Six months ago, I would have been pissed.
Six months ago, this was a great place to work.
Yeah, well, we had a good run.
Must be hard not to say "I told you so.
" Excruciating.
You did what you had to do.
Now you gotta go.
Should I? Get out while you can.
And let Salen ruin this place? This is my home.
I'm gonna fight for it.
Hey.
Lexi? You want to see your sister? Yes.
I don't know.
You You should see her.
It may be your last chance.
I thought I'd lost her in the car accident.
Prayed to just keep her alive, but I really did lose her that night.
She was pissed that I'd go on without her, but I-I had to.
It was my life.
I'm glad you did.
Without her music, it's not the same.
She's the genius, and without her You miss her.
What really hurts is that she thinks this is what I've always wanted, to be the star.
Did she tell you that? She doesn't have to.
You should tell her how you feel and trust her to tell you the truth about how she feels.
Nelly's crashing.
We need epi and a central line, STAT.
She's having a reaction to the immunosuppressive therapy.
We have to call off the transplant.
No, we don't.
We find a fix to this problem, and if she still wants the surgery, we'll do it.
Dr.
Andrews still wants to do the trachea transplant, but I think that's a very bad idea, so I'd rather not help him figure out how to do it.
Dr.
Andrews thinks I only feel that way because I am upset about Lea.
Well, you are upset.
Emotions have a way of leaking everywhere sometimes.
Okay, how do I know if that's happening? I don't know, Shaun.
You just have to focus on, you know, work, I guess.
Look, Dr.
Andrews is smart, he's experienced, the Chief of the Department.
He also happens to be your boss.
You're just a resident, so guess what.
Tell him what you think and, bang, boss wins.
Okay.
Okay, I will help him.
But our patient will probably die.
Pedicle screws.
I'm guessing you aced the interview? Yes.
And turned the job down.
Cervicothoracic rod.
Remember The Magnificent Seven? Which version? The metaphor works for either one, or Seven Samurai.
Our village is under siege, and I've decided to recruit a ragtag group of freedom fighters willing to stand up to the bad guy.
I'm in.
If she finds out, she will slaughter us.
I'm in.
I have four months left of my residency.
- I get it.
- I've been keeping my head down.
That's smart.
That's what I told myself.
Then she killed a baby.
I'm in.
Yippee-ki-yay.
Ossified ligament is isolated.
Elevating.
It's eroded through the dura.
Evoked potentials are dropping.
Yeah, it's fused to the spinal cord itself.
Dad? Dad? Cody, what's up? Dad shoulda been done with his surgery by now.
I said his doctors are good, not fast.
They're major slowpokes.
I need to see Dad.
Hey, Cody, everything is okay.
I'm a doctor.
I know all about this stuff.
- That's what they said! - Who? The doctors! When Mom died! You have to keep calm, Cody.
Just nice, gentle breaths.
Now? Please? Now! Please! I need oxygen and a crash cart! I can't feel my legs.
The ligament was adhered to your spinal cord.
There was no way to decompress it without damage.
Am I a paraplegic? Yes.
There's nothing else? Not at this time, Joe.
Where's Cody? In the ICU.
He had a panic attack that led to a ruptured aortic aneurysm at the site of his childhood heart surgery.
He's recovering now.
You took a big, brave risk for your family.
Can I see my son now? Monoclonal antibodies could block cytokine signals.
Nelly's reaction to the immunosuppressants suggests she'll have an even worse reaction to the antibodies.
What if we tried a different grafting technique like No, no, there is too much scar tissue from the I Oh, relax.
I'm just an attending now.
With a favor to ask.
Park already asked me.
I really respect you, but I worked my ass off to get into this residency program.
I can't risk it.
I know you think things were better before Salen took over.
- Definitely.
- So, you're in? Definitely not.
I have too many emotions, and they may already be leaking.
I can't even tell.
Oh.
Oh.
Bone marrow.
Oh, that was odd.
I'm pretty sure she just had an idea.
Hmm.
You may want to go with her.
I have to go.
By infusing the donor's bone marrow stem cells into Nelly, we trick her body into thinking the donor trachea is hers.
Nice.
Although, it does increase the risk of infection, which I assume you're about to point out.
No, not now that you've said it.
I may be cranky about Lea, but you are definitely my boss, and the boss wins.
Run it past Nelly.
Hey, Codeman.
Dad.
What Why are you in a wheelchair? When they tried to fix my arm, it kind of messed up my legs.
Now I get to ride around in this hotrod all day.
How you feeling? Tired.
When can we go home? Real soon, buddy.
But you're gonna have a new home.
What? Where are we going? I I can't come with you.
Y-You'd live somewhere else? With both of us in the chairs, it's just I don't know how we'd manage.
There's a great place in San Francisco.
Dad, no No, you'll be way closer to the Giants.
And I'll come see you and take you to a game.
But we're a team.
Always will be, buddy.
Cody? Are you seeing double? It happens sometimes.
We need to get him an MRI.
This could actually be a good thing.
Trick my body any way you want.
You forget something? I remembered something.
Christmas, 1999.
We had two Big presents under the tree.
You opened yours first.
I never wanna cause you harm A Baby Taylor acoustic guitar.
I was hoping for a keyboard.
But you got a makeup set because you were the pretty one.
Because I was the talentless one.
I still f-feel like that.
You sell out arenas.
You write like Joni Mitchell.
It would be nice to do it together.
She misses her, too.
In fourth grade, I always got picked on and beat up in the locker room before gym class.
My gym teacher, Mr.
Carl, tried to get the other kids to stop.
That just made it worse.
So he told me if I stopped coming to gym class, he'd give me a B anyway.
So I stopped.
Okay I still got bullied, just not in the locker room.
All Mr.
Carl did was make me feel weak and useless.
The same way you felt when I changed your scores.
You are a flawed, messy, and totally wonderful human being.
You're definitely good enough for me.
So are you, Shaun.
I promise.
I trust you.
Thank you.
But at some point, you'll feel worried and insecure, or I'll feel messy, and we will fight agai I don't want to.
Neither do I, Shaun.
Jordan's couch is not comfortable.
But my point is Next time I feel insecure, I'll ring the cowbell.
I think we're gonna need more than the cowbell.
We're gonna need a lot of hard work.
I like hard work.
Me, too.
He was sweaty, pale, had visual issues.
A pituitary tumor may be causing some of the symptoms we thought were due to his Kabuki Syndrome.
This is a fishing expedition.
You feel guilty.
You gave Joe permission to risk it all, and it didn't work.
Now you're desperate to do anything to help this family.
And that's a problem? Getting these people's hopes up for a miracle? His pituitary's clear.
Let's look at his other endocrine organs.
I heard you joined Lim's posse.
I live by the credo, people who kill babies shouldn't run hospitals.
Adrenals are clear.
That's reductive.
There was a mistake, a big one.
No one's denying that.
But systemic changes rarely happen without a hitch, and hopefully, in the long run, this will become a better place.
Pancreas.
Right diagnosis, wrong organ.
Dissecting the distal trachea.
There's extensive lumen scarring.
But we can resect all but the posterior third of the cricoid cartilage to address it.
That's right.
You seem more agreeable.
Lea and I made up.
That's great news.
Tonight's Sebastian's lucky night.
Shall I place the new endotracheal tube? Yes, please, Dr.
Murphy.
Okay.
Let us know when you're ready for O2 flow, Dr.
Murphy.
Have you thought about it? Call Novick back.
Take the job.
Aaron, please, we need you.
This hospital needs you.
It's a small tumor on his pancreas, and it's been causing his low blood sugar, chronic fatigue, and muscle weakness.
He might be able to walk if we remove it.
His doctor said those symptoms were tied to his Kabuki.
Well, sometimes, doctors only see the disability.
Dr.
Reznick saw beyond that.
What if we don't remove it? Nothing new.
It's benign, slow-growing.
No.
I took the big swing.
I can't do that to Cody.
If this works, you could make it together, as a team.
Almost there.
Release the clamps.
Superior aspect looks well-perfused.
Inferior's still pretty dusky.
Bleed.
TCT artery.
No.
Blood pressure's crashing.
Push fluids, pressors.
Give me four units of B-Neg, STAT.
We need a substitute artery.
BP's 70 over 40.
She's bleeding out from our suture sites.
40 over 28.
Epinephrine.
I told you this was a bad surgery.
You didn't listen.
You convinced me I was upset about Lea, but you were wrong.
Sponges.
Innovation doesn't matter.
What Salen wants doesn't matter.
Our patient is dying because of you.
You were wrong.
Where's my B-Neg? Crash cart! Come on.
Come on.
Dr.
Andrews.
Dr.
Andrews.
Bleeding's stopped.
The tracheal perfusion's improved.
BP's 100 over 76.
She's fine.
What just happened? I don't know.
Let's finish this up.
Blood glucose is perfect.
And? The surgery worked.
Can I walk now? Let's give it a shot.
Yeah.
I'll stand right here, just in case.
How do you feel, Codeman? Tall.
Ahh, got it.
The best team ever.
Yeah.
Thank you.
You had a bleed that would have killed most patients.
Turns out, you have incredible clotting factors.
Thank you for that.
I don't think you're gonna be needing that.
Try.
It won't hurt it.
My name is Nelly.
Holy crap.
Thank you.
Our pleasure.
So, you You patched things up with Lea.
And the surgery worked out.
That's That's good.
It was a failure.
Well, the patient survived, and And she's talking now.
That's That's That's a good thing.
She only lived because of her clotting factors.
It had nothing to do with us.
So, you caught a break.
That's okay.
No.
No, it isn't.
I knew it was a bad surgery, but everyone wanted me to think I was wrong.
But you were wrong, and s-so was Dr.
Andrews.
And it is Salen's fault.
She's ruining everything.
Shaun, there is There are some things that are o-out of your control.
This isn't one of them.
I've gotten five press inquiries about Nelly dying.
You saved the voice of the once and future Queen of Pop.
I got lucky.
"Being deeply learned and skilled, "being well-trained and using well-spoken words, "this is good luck.
" Gautama Buddha.
A wise man making a rationalization.
That surgery was bad medicine.
Dr.
Andrews used to be a good doctor, but you made him a bad one.
I need to leave before you make me a bad doctor.
I quit.
Shaun.
I'm in.
Let's run her bandit ass outta town.