The Good Doctor (2017) s06e08 Episode Script

[BEEPING STOPS]
[SIGHS]
Time to get up already?
Mm, for me. Early department meeting.
You should stay in bed a while longer.
So should you.
Mm.
How about I put a call in to Rosalia's,
- breakfast burrito, latte for pickup.
- [GROANS]
20 minutes saved.
If I get back in that bed,
it's gonna be for more than 20 minutes.
Oh.
I can be late.
[PEREZ] I told you to put on a jacket.
And I told you I'd be fine.
Are you fine?
No. I'm freezing.
[CHUCKLES] It's San Jose.
"Winter" is a relative term.
Eh.
- Thanks.
- Mm-hmm.
Weren't you wearing that yesterday?
I crashed at her place.
We were working on a research
project and finished late,
and he slept on the couch.
Didn't you have a date?
I rescheduled it.
I gotta get inside and shower
or I'll be late for my call.
See you.
- All right.
- See ya.
- He's bread crumbing you.
- Excuse me?
He's flirtatious, non-committal.
He's giving you just enough
attention to keep you on the hook.
He's dropping crumbs.
You'll never get the full slice.
We're just friends.
- I'm fine with that.
- [CELLPHONE DINGS]
Hm. Or maybe you're settling
for whatever he'll give you.
When did the stomach pain begin?
A couple weeks ago.
I'm on my tenth day of Lupron,
so it could be the side effects.
We're hoping for an embryo
transfer at the end of the month.
Gotta take care of this mama.
Other than the pain, any other
Emesis, fever, sweats.
[GROANS, INHALES SHARPLY]
Some tenderness and distension.
A scar on the right lower quadrant.
That's a first date souvenir.
Unofficial first date.
[SHAUN] A McBurney's incision.
You had an open appendectomy.
She had a ruptured appendix.
I'm an RN.
Oh, it was a medical meet-cute.
[GASPING] I'm okay.
[SHAUN] You are not.
There is an irregularly shaped mass
in the right-side pelvic region.
You need a CT, stat.
[MORGAN'S VOICE ECHOING] Can I help you?
Are you okay?
Um, I fell and hit my head.
Come here.
[GROANS]
Possible head trauma.
Can you give me your name
and date of birth?
Um, Toni Rhodes,
Aug August 7, 1995.
Slowly reactive pupils.
Any drugs or alcohol use?
No. No.
Uh, yes.
I I had a couple drinks last night.
How did I get here?
[GROANS]
And we need a head CT to check
for brain bleed or skull fractures.
Oh, my stomach is
How did you get this?
Okay, her abdomen is rigid
and distended.
Significant intraperitoneal hemorrhage
at left upper quadrant.
You're bleeding from your spleen.
We need to get you into surgery.
[THEME MUSIC PLAYING]
I reviewed your patient's ultrasound.
The appearance of that
mixed-echogenic mass is unusual.
Yes.
- We
- Keep me posted.
Ooh, you went to Rosalia's?
The breakfast burrito
with the spicy chorizo
Try molten chorizo.
Totally worth the ulcer
I'm probably getting.
- Hard Stan.
- [CHUCKLES]
I have never been to Rosalia's.
I recommend it.
Your images are ready, Dr. Murphy.
There is the mass.
There's a ton of free fluid
surrounding the lesion.
Possible active bleeding and
invasion into adjacent organs.
She needs surgery immediately
for resection of the lesion.
How long have you had these?
My monster horns?
A few years.
But now they're making it hard
for my glasses to stay on.
[CHUCKLES]
I keep them hidden with my hair.
You are beautiful,
and you have nothing to hide.
But those glasses do need to stay put,
so I think we should
remove these growths.
Without shaving my hair
or leaving big scars?
Those are the only options
other doctors have given me.
Those doctors don't know my technique.
I'll make a tiny incision here.
It minimizes scars, and it'll
leave your hair intact.
- Okay. [CHUCKLES]
- Okay?
Put Gwendolyn on my schedule
in the morning.
Thank you, Dr. Andrews.
Yes.
Toni's CT came back clean.
No fractures or intracranial bleeding,
so she's clear for surgery.
Hm.
We need to finish our research
for tomorrow?
I'll spring for pizza.
Have you ever heard of bread crumbing?
Does it involve pigeons?
- No.
- [CHUCKLES]
It's when two people hang out a lot.
One wants to be more than friends,
and the other isn't clear.
Question is, what should
the first person do
be patient or move on?
Asking for a friend.
I'd say real personal connection
can be rare, invaluable,
whether the context
is romantic or platonic.
I'll see you inside.
[ASHER] There are tentacles
of scar tissue
reaching into every organ.
Multiple abscesses and infection burden.
We will need several drains.
100 cc already. This infection is crazy.
So, things with you and Lim
are still sorta awkward?
Dr. Lim and I have
a professional relationship
centered on medicine.
The mass is adherent to the pelvic wall,
colon, bladder, uterus.
But you guys used to be closer.
Do you miss that?
Cutting through more tissue.
Dr. Lim is Chief of Surgery,
I am an attending.
A medical focus is logical
and productive.
We've reached the mass.
Cutting into the capsule.
Wait.
Oh, my God, is that
A surgical towel.
Have my special ex lap tray ready.
Transfuse two units and stay two ahead.
Place a Foley catheter now.
Her hematocrit's in the toilet.
A fall shouldn't have caused
this much damage.
[PEREZ] She was high when she came in.
No telling what could've happened.
How about we hold that judgment
till her tox results come back?
Placing arterial line now.
Sluggish pupils, memory loss,
confusion she's using.
Not judgment, just recognize
certain behavior when I see it.
She's hemodynamically unstable.
Debate later.
Right now, we need to stop this bleed.
Dr. Allen, why aren't you
placing the catheter?
There's severe bruising
and signs of major trauma
in her pelvic region.
I think she was raped.
We were able to save your spleen,
but you bled a lot during the surgery
for reasons we don't understand yet.
We need to run more tests.
When we were placing your catheter,
we discovered some bruising
and signs of trauma
in your pelvic region.
We're worried you may have been
sexually assaulted.
[EXHALES SHARPLY]
No, that's just not possible.
Your urine testing also came
back positive for Rohypnol.
It's often associated with date rape.
No, I-I
I went out for drinks with my friend.
We were celebrating his new job.
I watched the bartender mix my drinks.
I was tipsy, but I wasn't drunk.
The bruises must be from when I tripped.
I would remember if
what you're saying happened.
Rohypnol can cause short-term amnesia.
I'm sure this information is a shock.
We're here to support you.
The best way to gather evidence
as to what happened is to do a rape kit.
No, I I don't need that.
I was with my friend.
He wouldn't let anything happen to me.
You don't have to decide right now.
Get some rest.
We'll let you know when
your latest labs come back.
[SIGHS]
A retained surgical item?
It's a towel that was left
in you after a procedure.
It is adherent to several vital organs.
We could not remove it
without irreversibly damaging
Left behind by who? My doctor?
Let's focus on getting it out
first, and then we can
Who performed my appendectomy?
Broder, I think. But
The count of sponges and other items
inside the surgical cavity is
done by the lead scrub nurse.
But you may discuss this later.
Okay. So who was the lead scrub nurse?
Gomez, maybe, or Kraus.
I really don't remember.
But you were definitely there.
Are you blaming this on me?
You were one of the nurses.
I mean, shouldn't you have noticed?
I was circulating, not scrub.
No way I was the one who did this.
A minute ago you can't remember,
but now you're sure you didn't do it.
- Maybe we should move on to
- Why are you attacking me?
I just found out I have
an infected towel in my gut
that will require major surgery,
and you're making this about you.
You're acting like this was my fault.
It doesn't matter whose fault it was.
We will approach the towel
like a sarcoma
perform an en bloc resection,
bypass any intertwined
vital arterial structures,
and finish with a thorough debridement.
I think that's a reasonable option.
Well, right now, your opinion
doesn't mean a lot.
I just need a minute.
I'll be out in the hall.
[MONITOR BEEPING]
She's not conscious.
She's syncopal.
- She fainted?
- [MONITOR ALARM]
- Naveen.
- BP spiking.
- Oh, my God.
- Heart rate's up.
Possible bleed or septic shock.
Crash airway tray!
An additional abscess cavity
in the towel may have ruptured.
We need to get her back to the O.R.
- You wanted to see me?
- Hey.
Yeah, I'm double booked tomorrow.
You'll be scrubbing in with
Dr. Annanian for Gwendolyn's surgery.
But she was so impressed with you.
She's really excited
to have you as her surgeon.
Well, it's a meeting I can't miss.
But Dr. Annanian has my surgical plan.
I'll check in afterwards.
The rupture caused
widespread peritonitis.
This infection is way worse than before.
Aggressively irrigate,
debride, and suction.
We need to control the infection.
Send tissue and fluid to the micro lab
so we can focus her antibiotics.
[ALARM BEEPING RAPIDLY]
Big drop in BP.
Heart rate spiking.
She isn't tolerating surgery.
We need to close her again. Sutures.
Wait, what about the towel?
We can't operate until her BP
and O2 sats are under control.
She'll need to remain sedated
and intubated until she stabilizes.
And we need to find a new
approach to removing the towel.
Once she's closed,
I can dive into research.
I will consult with Dr. Lim.
[DOOR OPENS]
I would like a surgical consult.
The Mukherjee case?
The mass on the CT was
a retained surgical towel.
And is acutely infected
and adherent to vital organs.
The patient blames her wife,
who was a surgical nurse
during the appendectomy
circulating, not scrub.
If we could stick to the medical
The patient didn't understand
the count was not
her wife's responsibility.
They argued quite a
The most pressing issue is the
towel poisoning her from the inside.
What is your plan to remove it?
That
is what I am here to discuss.
You are an attending, Dr. Murphy.
And your patient has a few hours
before she's stable enough
for any procedure.
Research RSIs and brainstorm
possible solutions with your team.
Then, if you still need
a consult, my door is open.
How's Toni's platelet count?
Still dropping.
Did you do an anti-platelet antibody?
Waiting on results.
Order another PRBC transfusion
to get her hematocrit up.
Any progress on the rape kit?
She doesn't want to talk about it.
I can't blame her.
It's an invasive process
that only serves to prove
something horrible happened
that she doesn't remember.
Her brain may not be able
to remember, but her body does.
And chances are, eventually,
it will all come back.
Shouldn't we respect her wishes?
I mean, we don't want her to feel like
she's being assaulted all over again.
Denying what happened doesn't
change the fact that it happened.
[CELLPHONES DING]
It's Toni Code Gray.
[TONI CRYING] No, please, please, stop!
She woke up screaming,
and she pulled out her IV.
Just stay away from me!
We just want to help you.
Toni, you're okay.
We're here with you.
It's not real.
Can you breathe with me?
[BREATHES DEEPLY, SHAKILY]
[MONITOR ALARM]
You're okay.
You're not in danger anymore.
I
had a nightmare.
Her gown.
I need to take a look at that.
Okay?
The spleen repair didn't work.
[ELEVATOR BELL DINGS]
[SHAUN] Over the course
of your long career,
you have removed five retained sponges.
That is statistically higher
than any surgeon in the region.
Special skill on my resume
right under juggling.
My patient has a retained towel
that has caused sepsis
with multi-organ involvement.
I would like a surgical consult.
Perfect request
for your department head.
Dr. Lim said I should tackle
the problem on my own.
Well, that's interesting.
She is right. I am an attending.
But your RSI experience would
be very helpful on this case.
All right, I'll take a look.
Thank you.
Nurse Villanueva,
why is Gwen's surgery
still on my schedule?
She panicked when I told her
it'd be another surgeon.
- She really wants you.
- Assure the patient
she's in great hands with Dr. Annanian,
and take her off my rotation.
No.
You told her you'd do the surgery.
You can tell her that
you're not going to do it.
What about a minimally
invasive surgery
cutting up the towel, removing it
piece by piece through a single port?
That won't work.
Where it's stitched to the organs,
the infected tissue
puts her at high risk.
An aggressive gross total
resection of all organs invaded
by the towel plus all infected
and necrotic tissue
is the best option
for long-term survival.
That procedure risks major bleeds,
and we'd have to remove her uterus.
They're planning a family, and
Naveen is supposed to carry the baby.
That will also be impossible
if she is dead.
That's elegantly put.
The wife of the patient is here, right?
Explain the options to her,
and see how she wants us to proceed.
They had an argument
before her last surgery.
She will not be pleased with
her wife making that decision.
Just go talk to her.
We figured out why you've been bleeding.
You have a condition known as ITP.
Your immune system
is destroying your platelets.
Can you fix it?
There is medication that can help.
And we need to remove your spleen.
Why didn't you just do that
during my earlier surgery?
We weren't aware of your ITP.
It's a condition that
can be triggered by trauma.
The ITP complicates our approach.
Usually, we'd remove your
spleen through your abdomen,
but that risks a catastrophic bleed.
We can remove your spleen
vaginally with minimal incisions.
There's less risk of bleeding.
[SIGHS]
Okay, let's do it.
I'm hoping you'll let us do a
rape kit before the procedure.
I already told you, no.
[SCREAMING]
The transvaginal approach will destroy
all evidence of the sexual assault.
No.
I don't care.
Without the kit, you'll have no proof.
[GLASS SHATTERS]
You're right.
I believe that something
terrible happened to me.
But that is true whether or not
I go chase down the boogeyman.
But it could help.
Nothing will help.
Don't let whoever did this
to you get away with it.
He already has.
Doing a rape kit
is not going to unrape me.
Go ahead with the surgery.
We need your decision.
Is there any way to do
the total resection
without removing Naveen's uterus?
No.
She's dreamed of being pregnant
her whole life.
I can't choose this for her.
You can.
We understand how difficult this is.
- She'll never forgive me.
- She will.
I mean, it's obvious Naveen loves you.
She already blames me
for what's happening.
If I'm the one that takes away
her chance to carry a child
You are right.
If you choose the gross resection
and your wife loses her uterus,
it is likely she will never forgive you.
But that is irrelevant.
This is your decision.
You have to make it.
Whatever happens next.
Do the total resection.
I haven't seen you around here
for a while, huh?
Forgot how relationships
can eat into discretionary time.
Doesn't exactly sound like a complaint.
It's not.
Shaun came to me
with a surgical consult.
Your RSI record. Smart.
He did it because you sent him away.
Well, part of the Chief's job
is to empower their attendings
to find their own solutions.
Sounds like Shaun did.
A lot of ways to empower an attending.
And I chose one.
Because you're still angry with Shaun?
- Okay.
- How long are you gonna keep that up?
How about as long as I want?
Okay, you be as mad at Shaun
for as long as you need to be.
Thanks for the permission.
Just so you know, it's toxic.
And not just for Shaun.
Spare me.
You're not concerned for anyone
other than Shaun.
I have to get back to work.
Dr. Andrews.
I rescheduled my finance meeting.
But in the future,
I'm requesting a scrub nurse
who respects my role
as surgeon and hospital president.
When I was in the hospital,
you sat at my bedside.
You helped me recover
when I wasn't sure I wanted to.
That meant a lot.
Personal attention
with patients is important
even when you're president.
The laparoscopic splenectomy
is a great alternative
to the transvaginal
Toni's surgery is already
scheduled for this evening.
And she asked that you be
removed from her case.
She may regret not taking
action on this for the rest of her life.
That's her decision, not yours.
I got your message, Shaun.
What's so urgent?
I have added you
to Naveen's surgical team.
Please get ready to scrub in
in 30 minutes.
You have a surgical plan
in place, Shaun.
You're perfectly capable of
executing that plan.
It is my responsibility as attending
to create the conditions most likely to
result
- in a positive outcome.
- Which you've done.
Which include the presence of
a surgeon with RSI experience.
Shaun, you're you've always
been confident in in the O.R.
[SCOFFS] What is this about?
Having a surgeon with
relevant experience present
in case I need advice.
- Well, what if I'm busy?
- You're not.
What exactly about this case
is so concerning
You have more RSI experience
than any surgeon in this hospital.
That is why I would like you
in this surgery.
Please?
All right, fine. I'll be there.
Please get changed.
[MONITOR BEEPING]
I can't reach the highest point
from here.
Best way to hide the scars
is to go in above her hair line.
We'll need to shave some of her hair.
Maybe not.
Someone get me a comb.
Moving on to the hysterectomy.
Please clamp the uterine horns.
Grasping round ligament, midway
to the inter internal inguinal
Infection of the muscular layer
of the uterine wall has reduced.
Maybe we can save her uterus.
Shaun?
Come on.
Shaun.
Stick to the plan.
You cannot save the uterus.
[BREATHES SHAKILY]
Okay.
You are right.
Necrosis is too advanced.
Transfixion sutures and hemoclip.
Hey.
I wanted to see how you're doing.
Naveen is recovering well.
The surgery turned out as expected.
You hesitated in the O.R.
What was that about?
I wanted to save her uterus.
Why'd you get stuck on
not doing the hysterectomy?
The patient wants to carry a child.
Well, that's very empathetic.
I guess you you developed
a personal connection?
Luna made the right decision
even if her wife will never forgive her.
Are you worried that
this will hurt their marriage?
It doesn't matter, okay?
It doesn't matter.
What matters is that she is alive.
We saved her life.
Well, that is one thing that matters.
So is losing a personal connection
No, the medicine is
Shaun, is this about Lim?
What What about her?
I don't know. I just It's
Lim is still up upset with you.
She's still mad at you.
D-Does that bother you?
Dr. Lim and I have
a professional relationship
No. No, you don't.
And you need to fix that.
The two of you need to sort that out.
I don't know what you want me to do.
I want you and Lim
to talk to each other.
She does not want to talk to me.
That depends on what you have to say.
I have nothing to say.
Shaun, Lim is hurting, okay?
You are hurting.
Tell her that.
I mean, maybe
maybe she'll forgive you.
Maybe Maybe she won't.
I don't know.
But the two of you have to resolve this
for both of your sakes and mine.
Dr. Lim and I have
a professional relationship.
I do not need to talk to her.
I have to finish my op note now.
I've never done a splenectomy
that way either.
Cool surgery,
not the coolest circumstances.
Our patient went through
something terrible
and my initial reaction
was to judge her
same way people judge me.
Don't beat yourself up. You didn't know.
You're a good friend.
I know.
[CHUCKLES]
But
I've been waiting to be more than that,
and I don't think
I should do that anymore.
I'm gonna take a rain check on research
and reschedule my date.
I think that's good.
You deserve to be happy.
[CELLPHONE DINGS]
I have to go prep Toni.
[MONITOR BEEPING]
I owe you an apology for pressuring you.
I didn't do a rape kit.
And I've always regretted it.
And I didn't want you to feel the same.
[SIGHS]
I was in medical school.
He was a friend of a friend.
Somewhere along the way,
he became a stalker.
One night he showed up
at a bar I was at.
He followed me home.
I hated the idea of being seen
as a victim
so I never told anyone.
I let that creep go.
And now I'll never know
how many other women he hurt.
But that's my regret.
And it's not fair to put that on you.
[BREATHING HEAVILY]
[SNIFFLES]
[CRYING]
I knew he liked me.
I should have made sure
that he knew it wasn't a date.
I shouldn't have had a drink. I
I don't even know
if I told him to stop.
What if I didn't?
It is not your fault.
He took away your choice.
And now you have to do
what's best for you,
whatever that is.
Toni, time for surgery.
Not yet.
There's still a little swelling,
but you'll have minimal scarring.
They're gone.
Now those glasses will stay put.
Nice job with my braids.
Wasn't me.
Always wanted a daughter,
so I learned to braid.
Well, you might've found
a nice side hustle.
[CHUCKLES]
[SIGHS]
Thank you, Dr. Andrews.
You're welcome.
Are you okay to continue?
Yes.
Are you okay to continue?
Yes.
[CAMERA SHUTTER CLICKS, CAMERA WHIRS]
[CAMERA SHUTTER CLICKS, CAMERA WHIRS]
[NURSE'S VOICE ECHOING]
Are you okay to continue?
[CAMERA SHUTTER CLICKS, CAMERA WHIRS]
Are you okay to continue?
Are you okay to continue?
Are you okay to continue?
[CAMERA SHUTTER CLICKS, CAMERA WHIRS]
Naveen, in the process
of removing the towel,
we also had to take your uterus.
We're so sorry.
There was no other way?
[SIGHS]
Yes, but I told them
I told them to do it.
I needed you to survive.
Because you mean everything to me.
And I failed at my most important job
keeping you safe.
I failed you five years ago in the O.R.
and again yesterday.
I was so focused on defending myself,
I wasn't thinking about
what you were going through,
how scared you were.
And I'm so, so sorry.
Whatever you need,
if if you want me here
every step of the way, or
out of the picture completely
You better be here
every step of the way
because I love you
more than anything, too.
I'm sorry.
How's she doing?
Surgery went well.
Her platelet count is turning
in the right direction.
Good.
And beyond the physical?
Too early to tell.
Recovery's a process.
All that time we were together,
why didn't you tell me?
Because I don't need anyone's pity,
yours included.
It's in the past.
What you did for Toni,
that was really brave.
I'm here if you ever need
someone to be brave for you.
Thank you.
I need to talk to you
about your surgery.
I can't change what happened,
and I do not owe you an apology.
Dr. Murphy.
But I am sorry for other things.
In my RSI surgery today,
the medical choice was clear,
but I did not want to proceed
because I knew what
the consequences would be.
In your surgery,
the medical choice was clear,
and I did proceed,
but I did not know
what the consequences would be.
I saved your life,
but my decision also caused you harm.
When I saw you hurt and bleeding
I saw my brother Steve, when he died.
When I thought I might lose you
the way I lost him, I did not like that.
I am sorry
this
has been very hard for you.
A medicine-only relationship
is is not easy.
I
It is not what I want.
I have missed your friendship.
I have missed you.
[BREATHES SHAKILY]
This has been
really hard.
[SNIFFLES]
And my life is in a good place now.
I'm happy.
But
[SNIFFLES]
still angry sometimes.
It may take a while to let that go.
But
I've missed you, too, Shaun.
Hey.
You know, I love being the boss,
but connecting with patients
is the reason I got into
medicine in the first place.
And you made me remember that.
Thank you.
You're welcome.
Could I buy you a drink
as an apology for being a pompous ass?
- [ELEVATOR BELL DINGS]
- No.
Unless you throw in
some wings and fries.
Tough negotiator.
You know it.
Shaun came to see me.
We talked.
Thank you.
You're welcome.
Join me?
I'm sure we can find some cucumber water
around here somewhere.
Late dinner with Clay.
Good night.
- Hey.
- Hey.
Good night.
What was that?
I don't know.
- You're back.
- Yes.
You told me I was isolating
myself in my other office.
Shaun, there's something
you should know.
Lim, when she was in her chair
and adjusted her position,
there was flexion and rotation
in the psoas and in the glutes.
There was movement.
She could walk again.