The Good Doctor (2017) s06e10 Episode Script

Previously on "The Good Doctor"
Glassman found movement
in my psoas and glutes.
He and Murphy found
an endoscopic solution.
- How about I make you dinner?
- Sounds good.
It's a date then.
A date.
Audrey Will you marry me?
Shaun. I'm pregnant.
My OB told us it isn't safe
for me or the baby.
Danny!
No, no, no. Danny.
Danny.
- Good morning.
- Morning.
I'll get the coffee.
This is my third stay in a week.
I no longer require guest-level service.
I want the practice.
Two cups, no cane,
no guarantee how long it'll take.
Well, when it comes to you,
my patience is boundless.
One of the many things
I adore about you.
It's been three months.
The man's a saint.
I have been recovering
from a major surgery
and re-learning to walk.
Your recovery's remarkable.
So is your procrastination.
I am taking the time to consider
the biggest decision of my life.
Clay's fine.
No man no person
is fine waiting this long
for an answer to that question.
Ever done one
of whatever this is before?
No. You?
Mm-mm.
I've been clean for 92 days.
I went to rehab for two months,
and I go to meetings every single day.
I don't know if you two
can ever trust me again,
but I am willing to do whatever it takes
to earn back my place here.
And we'll do everything we can
to support you in your recovery.
But our number-one obligation
is to our patients.
For their safety and yours,
we need to put some guardrails in place.
You'll be on probation for six months.
You cannot prescribe or administer
any controlled substances.
You will be given random drug tests,
and every step of your patient care
will be supervised by the
Senior Resident on your case.
Today that is Dr. Allen.
You okay with those terms, Dr. Perez?
Absolutely.
I'm just happy to be here.
How are you?
Better.
A lot better.
I hadn't heard from you.
Which is totally understandable.
I just wasn't sure
I didn't know what to say.
You're not the reason that
that happened.
As your supervisor on the case,
I will oversee your charting,
your patient interactions,
double-check your med orders.
And this.
Fetal movement is good.
Heart rate is normal at 150.
I've been monitoring
the heart rate daily.
It ranges from 146 to 163 BPM.
Her last emesis was three weeks ago.
So the nausea's getting better.
- Great.
- And the fatigue.
Less improvement on
the constant state of terror.
You made it through the first trimester.
- You're doing great.
- Mm.
You two want to know
the sex of the baby?
- Yes.
- No. Don't look.
It'll be a fun surprise.
Oh.
It is fun to be prepared.
Oh.
What's going on?
There is a small, thinning area
on your uterine wall.
It is slightly hypoechoic,
likely a result of the scar
tissue from your prior surgery
and Asherman's syndrome.
Is that bad? It sounds bad.
Mm.
If it progresses,
your uterus could rupture
and we would lose the baby.
But it's very possible
the lining will remain stable
and your pregnancy
will progress normally.
What happens now?
We'll put you on bed rest
and monitor you closely.
You're wrong.
There may be a surgery
that can fix this.
I need to talk to Dr. Lim
and Dr. Glassman.
Hello. I have admitted Lea
for close monitoring
and a follow-up MRI,
which detected a small amount
of free fluid in the abdomen.
This, plus a slight decline
in the hematocrit,
increases the likelihood
of rupture by 3% to 5%.
Shaun, I'm so sorry.
How are you and Lea holding up?
Oh. Fine.
I found a surgery to fix it.
I have spent the last three months
researching every complication
of Asherman's syndrome.
I discovered an experimental procedure
to reinforce the uterine lining
with collagen fleece
that will expand as the uterus grows.
I have studied the technique,
and I will teach you how to do it.
How many times has
this procedure been done?
Five. Three had good outcomes
and the babies were carried
to full term,
and the odds are better for Lea
because you are above-average surgeons.
Shaun, I don't need to remind you,
but this procedure can induce labor
and can cause major bleeding.
You could lose the baby.
If we wait and the uterus ruptures,
we will definitely lose the baby
and Lea could suffer
a catastrophic hemorrhage.
Due to the size of the uterine window,
there's a good chance it won't.
No, with Lea's prior surgery
and the significant scar tissue,
I put the likelihood of rupture
at close to 65%.
Those chances
not good.
Lea's body, her call.
Drew Dewitt.
Has recurrent desmoid tumors
caused by Gardner's syndrome.
The one on his liver is benign,
but it hasn't responded to chemo.
It's encroaching on the stomach
and spleen. It has to come out.
Thus, the surgical consult.
He has almost no small intestine.
He needed a major resection a year ago.
He's been living off
IV nutrition ever since.
I've treated him for post-op infections
and pain management over the last year.
I've never seen this much
scar tissue in a patient.
How many surgeries has he had?
20. Plus 16 rounds chemo
and 34 hospital stays.
Unfortunately, we have to add
one more surgery to that list.
Will this surgery affect his
place on the transplant list?
We've been waiting over a year
for a small bowel.
Apparently, I'm "too healthy"
to move to the top.
It shouldn't, barring long-term
infection or other organ damage.
When you're ready,
we can take you to pre-op.
- You got this, D.
- You know it.
I have no idea.
Would you like us to go over
the risks and benefits again?
No, I know everything
that could go wrong.
All I can see is what can go wrong.
You don't have to decide right now.
We can continue to monitor.
If we wait, the uterine window
could expand
and make the surgery more risky.
Now is the safest time.
Don't pressure her, Shaun.
Okay. Okay, I know I trust you.
So if you think surgery is the
right decision, then we should do it.
On one condition.
I want you in the OR.
Not for me, but if something
were to go wrong
and we lose our baby,
I need you to be with her.
Or him.
With my guidance, I think
there is a very good chance
our baby will be fine.
Mm.
Forceps and Metz.
How's it feel to be in the OR again?
Very good, sir.
We're all very glad to have you back.
We've exposed the surface of the liver.
Tumor's invaded the liver
capsule and parenchyma.
That's twice the size
it appeared on imaging.
If we take out all of the tumor,
he'll only have half a liver left.
We don't have a choice.
Ultrasonic dissector for resection.
Make sure to approximate the edges
so it overlaps with the uterine window.
I internalized that the first
three times you told me, Shaun.
I'm sorry you and Lea
are going through this.
Mm. Dr. Lim was able
to place the fleece patch
seven seconds faster.
But your laparoscopic
suturing technique is superior.
You will be in charge of that.
Practice it now. Please.
Shaun, I've done it a million times.
You have never done them on my wife.
Fair point.
Because we had to
take more of your liver
than we'd hoped, your
liver function is declining.
Getting your nutrition through
an IV is tough on your body.
The TPN that's keeping me
alive's also killing me?
That's gnarly.
So, what's the alternative to TPN?
How do we get him nutrients?
We're looking into it.
For now, we're gonna
manage your symptoms
and keep you stable until a
small bowel becomes available.
There's no way those organ cops
can say I'm too healthy now.
I'll order cholestyramine
for the itching
and liver function testing
every few hours.
I'll call UNOS
and do whatever I have to
to get him moved up the list.
Where you sneaking off to?
I'm walking down the hall,
in plain sight.
The alarms, the pills,
the classic Morgan evasion techniques.
You're getting your embryos
implanted, aren't you?
Congrats on cracking
that already wide-open case.
I have to give myself
a time-sensitive injection now,
then yell at some
nice transplant people.
Why didn't you tell me? I could help.
I'll refer you to the minutes
of our previous meeting
"We need boundaries."
I remember you put on my
hospital socks for me last time, too.
I hate that we have a routine.
This time is different.
- Hi.
- I love you.
How are you? Do you need anything?
There's Funfetti cake in Pedes
for Nurse Hawks' birthday.
Do you want me to get you a piece?
Just this is great.
Please leave.
Having visitors increases the risk
of perioperative infection,
and stimulation
can raise blood pressure,
which increases the risk of
intraoperative complications.
I need to do your pre-op exam.
He just doubled over.
My gut is trying to kill me.
Please, can you give him something?
I'll up his morphine.
Check the site for infection.
Hang on. You're gonna be okay.
Dr. Allen, his wound dehisced.
What does that mean?
His muscles couldn't hold the stitches.
It tore open.
Move the patch three
millimeters to your right.
It should overlap with the wound margin.
- Got it.
- Yes, there.
That is good.
Dr. Wolke,
take the scope, please. Sutures.
5-0 Prolene sutures
in the myometrium defect
need to be placed
exactly one millimeter apart.
Dr. Murphy, take one more step,
I'm gonna have to ask you to leave.
Applying the glue.
No, no. That's too far.
- The view is obscured.
- Shaun. A little to your left.
She's bleeding.
No signs of rupture.
You may have placed the sutures too deep
because you didn't have a clear view.
The sutures are fine.
I should take over.
Shaun.
There,
a small bleed underneath the patch.
Must've nicked a vessel.
I'll clip it.
Suction.
Okay, we can continue to close.
Yes. Lea and the baby are fine.
In spite of the avoidable errors.
His abdominal wall
is too weak and damaged
from prior surgeries
to hold the sutures.
We covered the wound with plastic,
but we need to take him back to the OR
and close him up
before it gets infected.
The tissue will just tear open again.
His skin and muscles need time
and nutrition to heal.
I have a small bowel for Drew.
Drew's wound dehisced.
We can't take that organ.
I'm not turning it down.
This is Drew's only chance.
Tell UNOS we need to
run some more tests.
Buy us a few hours.
That's how long we have to figure out
how to stitch this kid back together.
What about component separation?
That could weaken the tissue even more.
Right.
Maybe a four-step Fabian procedure.
Except Drew doesn't
have time for four steps.
Hi.
Here to check Lea's post-op vitals.
I also brought supplements.
Mm.
Thank you.
All right, your post-op
ultrasound looks good.
Oh.
Fetal movement and heart tones
are great.
Oh, thank God.
When can I go home?
You need to be here for monitoring
for several more days.
I can't go days like this, Shaun.
I hate it here.
You are here for work every day.
Not in this room, in this bed,
thinking about everything.
Jerome and I can visit
on our lunch break.
Oh, we could take the "What
Yankee Candle Are You?" quiz
that's on page 17.
Rest will help you recover faster
so you don't have to be here anymore.
Her ultrasound does look good.
Thank you. You can go.
Thank you.
UNOS called again.
I told them we have to re-run
Drew's liver function test
and get a CT scan.
I bought us an hour at most.
What about a Sure-Closure device?
Too high a risk for ventral hernia,
which could lead to us needing
to resect his large intestine,
leaving him even worse off.
I already played it out.
For your embryo thing,
you know, whenever that is,
I can give you a ride, if you need one.
I'll get an Uber.
You really want to go to
the most important appointment
of your life with a stranger in a Camry?
I've chosen to do this alone,
and I'm fine with it.
And I'm I'm trying very hard
not to care about what
anyone else thinks about that.
So having you imply how sad it is
that I have to take a cab
to a doctor's office
is not helpful.
He threw up, and his pain
is getting worse.
He's already maxed out on morphine.
I'm overriding.
There's increased
redness and swelling on the edges.
Early signs of infection.
I love you, Mom.
- You're gonna be fine.
- It's okay.
We knew we'd get here someday.
I'm ready.
No.
I am not giving up on you.
Don't give up on me, D.
Please.
Oh. I-I will take those.
They're from all the nurses.
We just want you both to know
that we're thinking about you.
I will pass that along.
But not these.
Baby's breath has
a strikingly unpleasant odor.
Is there anything you need?
We're fine.
Uh, 502's family is on their way in.
Heads up they are a loud bunch.
They're very excited
to be taking Meemaw home.
I don't think Lea's fine.
She's lonely and bored,
and being back in that room
is bringing up
a lot of painful memories.
And I know you're just
you're trying to protect her,
but
but it's making you
kind of a pain in the ass.
Your wife, who's carrying
the tiny human,
she needs her loud bunch.
People asking how she is doing
and being worried
will only make Lea worry more,
and that is not helpful.
Not for you,
but I think Lea needs more
than just you right now.
She needs lots of people
showing concern and love.
And maybe you do, too.
More than you think.
Question for you.
Does it bother you that this
has been sitting here
for three months?
No.
- Does it bother you?
- No.
I'm feeling a little pressured.
I've barely brought it up.
And I appreciate that.
But it sitting here is kind of pressure.
It was meant to be a cute gesture.
A subtle
Not so subtle reminder
that the offer is still "on the table,"
which has clearly
overstayed its welcome,
and the last thing I want
is for it to come between us.
Are you un-proposing?
No, I'm un-pressuring.
I love you, and I'm not going anywhere.
When you're ready,
we'll put it back on the table.
What about a Velcro biocompatible patch?
It would facilitate
his granulation tissue growth.
How do we keep it from adhering
to other organs?
Yeah.
This should be turmeric chicken
with asparagus.
That's what I was gonna
make you for our date.
And after work, all I had to do was
go to the store and get some chicken.
But instead, I-I texted my dealer.
For a thousand reasons,
none of which excuse
nor explain anything.
You don't owe me an explanation.
I do.
And I wish I could give you one.
Every day for the past 92 days,
I've asked myself,
"Why didn't I just go get the chicken?"
I mean, we would have had
a great dinner.
I mean, you would have been
funny and beautiful.
And I would have tried
way too hard to be charming.
And then
who knows?
I'd give anything to go back,
start over.
Give us a clean slate.
Me too.
What if we did that for Drew?
What if, along with a new bowel,
we gave him a whole new abdominal wall?
Clean slate.
Has it ever been done before?
Not exactly.
I'm gonna look down and see
someone else's abs?
Replacing it is the only way to
get you a new small bowel.
You'll be able to eat again.
You'll get stronger.
What are the chances it'll work?
It's never been done in tandem
with another transplant.
There are increased risks
of rejection or infection.
But both organs are in great
shape and a good match.
It's our best shot to save your liver
and give your body time to heal.
Thank you so much.
Okay.
Well, let's do this.
If we don't keep quiet,
Shaun is gonna come down on us
with the hammer of Thor, okay?
It's so nice to laugh.
Enter Shaun with a chest plate
and a red cape with the Mjolnir.
I don't want to get kicked out
before I know
boy or girl?
I have to start scoping out
the latest baby fashions.
I don't know.
I don't want to know.
Last time, when we found out
we were having a girl,
Shaun and I were choosing her name.
I liked Sage and Skylar and Sofia.
Something with an "S,"
after my grandma, Susie.
And then she was gone.
And I can't do that again.
Maybe you should tell Shaun about this.
He's already so worried,
no matter what he says.
And what if talking about it just
I have something for you.
Mm?
My faith.
Not just in God.
I have faith in the surgery you had.
I have faith in you and Shaun,
and that your baby,
whatever it is,
is going to be okay.
Your 10-minute visit has run over.
I have to scrub in anyways.
Pencil me in for the next
10-minute opening, Thor.
Thank you. I-I needed that.
Mmph. Pfft.
But not that.
I kind of feel nauseous.
We should do another ultrasound.
Mm.
This surgery could buy you
a year, maybe more,
give you back some quality of life.
But
it should be what you want.
You're 17 and you've suffered more
than some people their whole lives.
No one would fault you
for deciding you're done.
I can't.
Your mom has given you
all the support in the world,
but this is your fight.
Do you want to keep going?
The worst part about
all of this is knowing
one day, it'll end,
and my mom will be alone.
She's been with me through all
the hardest parts of my life,
and I won't be around when she has
to go through
the hardest part of hers.
If I can put that off,
if even for a little bit,
then I'm gonna do that.
And hope that makes
the days she'll face alone
a little easier.
You're all set.
We'll take you to surgery soon.
I love you.
And whatever happens
you don't need to worry about me.
I'll be okay.
I love you, too, Mom.
She was feeling nauseous,
so I did an ultrasound,
which detected increased
fluid in the abdomen,
but then she lost consciousness.
It is almost certainly
internal bleeding.
I'll scrub in, right away.
No, no, no. You can't come in.
This is likely a complication
- from the first surgery.
- Shaun
It is my fault, and I need to fix it.
Shaun, if we can't stop the bleeding,
we may have to take Lea's
uterus in order to save her life.
If we get there, we're gonna
make the decision quickly
and with medical factors only,
no emotion.
Lea would want me in there
in case we lose the baby.
If that happens
if that happens,
I will come back and get you, I promise.
Surgical site looks good.
Patch is intact.
No signs of acute placental abruption.
Bladder's clean.
No blood coming from the
ovaries or the fallopian tubes.
And the bowel is intact.
It's gotta be coming from the uterus.
If we clamp the uterine vessels,
we may slow down the bleeding.
But we put the baby at risk.
If we don't stop it soon,
we're gonna put Lea at risk.
I'll clamp the internal iliac
on the side of the bleed.
Buys us some time.
Give two more units of blood
and stay four ahead.
Retractor.
If the site is hemostatic,
they will look for placental abruption.
Next, they will check
the bladder, ovaries,
and fallopian tubes.
Shaun.
They can't clamp the uterine vessels
without hurting the baby,
but they can place
an atraumatic vascular clamp
on the internal iliacs,
which will slow down the bleed
while they try to locate it.
Once they stop the bleed,
they should be able to repair it
and be done by
5:26.
The surgery went really well.
You should be able to start
eating real food again in a few days.
Better make sure my new
six-pack is looking good.
The abdominal wall is holding together.
No signs of infection.
We'll see how long that lasts.
One step at a time, D.
We'll let you get some rest.
No alcohol in that new gut of yours.
Not for four more years.
One step at a time, Mom.
Hey, I don't want to help
because I feel bad for you.
I feel bad for me.
You're gonna be an amazing mom
because you're amazing at
whatever you put your mind to,
and I'm a little conflicted, I guess,
because I won't be a part of it.
Making my single-mother
IVF journey about you
is uncharacteristically self-absorbed.
I'm impressed.
You changed me.
And doing things alone isn't sad.
Still doesn't mean
you have to do them that way.
From here on, I'm gonna request
not to be supervised by you.
Why?
I didn't OD because of you, or us.
But I knew I couldn't be with you
if I wasn't okay.
So I convinced myself I was.
Jordan, if I let myself
get close to you,
I will fall for you again, and
and I will want so badly to be okay,
to be ready for us.
I can't risk that.
I wouldn't want you to.
Mm.
I can't believe how much
I'm gonna miss somebody
I'll still see every day.
Lea's in emergency surgery.
Two more units, right away.
Removing the packing over the uterus.
Suctioning.
Fetal heart rate 101.
Intermittent decels.
No injury to the vena cava.
Where is all this coming from?
Art line BP is 75 over 43
and falling.
Lea's BP is 67 over 35.
She's bleeding out.
Hysterectomy tray.
Clamp.
After you ligate the uterine vessels,
I'm gonna go get Shaun.
I told him I would.
Clamping the uterine horn.
Ligated the round ligament.
Preparing to transect.
Metz scissors.
Audrey.
Lea and the baby are gonna be just fine.
Lea's left uterine artery was
tethered to some scar tissue.
As the uterus grew, it ruptured.
That was inevitable.
Had nothing to do
with your first surgery.
Okay.
Had Lea not been in the
hospital when this happened,
she might not have survived.
Shaun, your surgery
saved both their lives.
Okay.
Oh!
Thank you, Dr. Glassman.
I got you.
Okay.
Okay.
Good morning.
Can I get that to go?
I gotta stop at my place
and grab a shirt for work.
I'm sure you have a minute. Stay.
Am I about to be punished for something?
No.
- I was just thinking.
- Mm-hmm.
I love you.
I love you, too.
And I love us.
Same. Always good to hear.
And I've decided I want us
to move forward.
At my own, learning-to-walk
kind of pace.
Clay Porter
will you move in with me?
I would kneel, but I'm not sure
I could gracefully get back up again.
It's so sparkly.
Love it.
Mm.
Audrey Lim
you've made me
the happiest man alive.
This is a one-time thing.
Don't expect me to drive you
to your next colonoscopy.
And here I was looking forward to that.
Take McLaughlin to William Street.
The freeway's backed up
this time of day.
Alright, just don't forget the tip.
The fleece patch is holding well
and expanding with the uterus.
Everything looks great.
Your baby is very cute and squirmy.
So, you wanna know what it is?
Y-You already know, don't you?
I have been looking
at your uterus a lot.
Mm.
But But I can keep a secret.
The light blue is very
Heteronormative.
I was going to say pastel.
But, yes, that too.
I think he's gonna like
something in the gray palette.
Calming but warm.
Elegant yet understated.
I think our son
would like that very much.