The Good Doctor (2017) s06e11 Episode Script

Mm, I love this so much.
The lake, the fir trees,
the fresh air
Good. You have 14 minutes to enjoy it.
We are 4 hours and 10 minutes
away from the resort,
and your Prenatal Massage and
Aura Cleansing begins at 5:45,
given six rest stops
at eight minutes apiece.
Wait, you've timed my pee breaks?
Generously.
Shaun, we're supposed to be relaxing.
Schedules are not relaxing.
I find them very soothing.
Okay.
- 14 minutes it is.
- 13.
14 is fine.
Oh, that poor dog.
47-year-old male,
multi-impalement, disoriented,
significant blood loss.
Ultrasound and surgical tape.
These spikes
Wood and metal?
We We were trimming trees and
and a shovel got sucked
into the wood chipper.
- You work with him?
- Sometimes. I'm I'm his son.
I count 20 pieces. Airway's patent,
and he's got good pulses.
Lalo? He's one of my patients.
No significant free fluid
in the abdomen.
No bronchospasms or wheezing.
No. Fluid's accumulating
in the pericardium.
You jostle that spike,
he could bleed out.
We'll have to do it in the O.R.
Dad? Dad, can you hear me?
- Aah!
- No.
- No, no, no, Dad!
- Oh!
- No!
- Aah!
Let's get him to the O.R.!
He couldn't have gotten far.
We don't know that,
and that ground is very uneven,
and we know from experience,
- the woods can be dangerous.
- Shh.
Hey, there, buddy.
We're here to help.
It is having trouble breathing.
Leg and multiple rib fractures.
Poor little guy.
I need to reduce the rib fractures.
- Hold it steady.
- Uh, okay.
Hang on, buddy. It'll be okay.
We need to get it
to a veterinary hospital.
Vince?
I gotta get you to St. Bon's.
I need you to do it here.
I'm a first-year resident.
That's unsupervised surgery.
I can't go to the hospital.
There was a gang member at that party.
Me being there was a patrol violation.
Cops get that bullet,
I'm going back to prison.
Just go to your P.O. Tell him the truth.
'Cause the criminal justice
system is always fair,
especially to guys who look like me.
I finally got my life back on track.
I have a good job.
I'm trying to work things out with Viva.
I'm watching my baby twice a week.
I go back inside,
I could lose everything.
Danni please.
All right, the bullet's
close to the surface.
It's more of a procedure than a surgery.
Thank you.
All right, I gotta get some stuff first.
What's the strategy?
We should start
with the most life-threatening spikes
these two in the chest,
maybe the abdomen
We can't risk
a major hemorrhage so soon.
Do the easier ones,
buy time for the transfusions to work.
Oh.
Dr. Reznick's right.
We start with the distal extremities.
I'll take his leg.
You get the pieces in his right arm.
I'll take his left.
Now that there's an adult in the room
Always a pleasure.
You leaving, I mean.
Hey.
So, after basketball on Wednesday,
I'm introducing Clay
to the wonders of Su Cai Bao.
You in?
Assuming that's food, sure.
Great. It's a date. 8:00 p.m. my place.
Didn't you just finish a night shift?
Too much caffeine.
I'm building a trauma simulator
to practice removing foreign bodies.
You're weird.
You'll probably be my boss someday.
First grade, I begged
my parents for a puppy.
Tessa chocolate Lab,
sweetest little face.
Next morning, Tessa peed
on my dad's briefcase.
He returned her that night.
That doesn't sound like good parenting.
It wasn't.
The dog's got a damaged spleen,
broken ribs,
and a fractured radius,
and skin lacerations.
- He'll need
- An ex-lap and thoracotomy.
I'm a surgeon at San Jose
St. Bonaventure Hospital.
We should go.
When are you planning to do it?
I'm not.
I don't work without up-front payment,
and since we don't know
the dog's owners
Well, we'll pay.
That could be expensive.
Quite.
I could slot him in tomorrow morning.
Well, I guess we could stay in a motel?
I mean, we should really
be here for Buddy.
I've named him Buddy.
Whatever its real name is,
it is a dog and not our dog.
And we are going to miss
your Prenatal Massage.
Buddy needs us more than I need
my aura cleansed, Shaun.
Okay.
It is your babymoon.
Ready?
It's just a fragment.
The bullet must have shattered.
- It's still in me?
- Yeah.
There's damage deeper in your leg.
I can't locate the rest of the bullet
unless I cut further in your muscle.
So cut.
I need a second opinion.
Hey.
Question if a bullet's stuck
behind the vastus medialis
This for your simulator?
Yeah, it's a scenario I'm practicing.
Um, how do you decide
if you leave it in?
Well, it depends on the imaging.
What if you're going in blind?
Well, it depends on the angle of entry,
caliber of the bullet, exact location.
Okay. I'll figure it out.
Danni
how about you tell me
what's actually going on?
Removing the left
lateral mid-thigh spike.
Irrigating the spike near the sternum.
No signs of pneumothorax.
Starting on the shoulder.
Lost the pulse. He's in V-tach.
- Get the internal paddles.
- Setting up the internal paddles.
He's coding. Where are those paddles?
Almost ready.
There's no time.
Starting cardiac massage.
Push 1 milligram epi.
We've got sinus rhythm.
Blood pressure's normalizing.
Good job, Dr. Park.
I'll do more sharp dissection.
His body can't take any more.
We'll get a panscan CT, CTA,
transfuse him,
and resume in the morning.
Nine spikes down, 11 to go.
Definitely landed
in the medial compartment.
Blood flow?
Good pulses.
Intact nerve function in the leg.
If he was in the O.R.,
we'd leave the bullet in.
Got it. Thank you.
I'll pack the wound and send him home.
Hold on. Can you take me off video?
Yeah, I'm not a big fan
of being lied to.
It won't happen again.
Thanks, Asher.
There's a stain on the floor.
Mmm.
Now there's a pillow on the floor.
Yeah, they should really
clean that carpet.
Let me call the front desk.
Ugh, it's sticky!
Okay, maybe maybe I overreacted.
You did.
I I thought you loved animals.
I love rabbits and fish.
They don't slobber or jump
on you or make messes.
Well, you know, Shaun,
someone's about to come into our life
who's going to slobber
and jump on us and make messes.
If you are talking about our son
Yes, of course,
I'm talking about our son.
Sorry.
Clearly, we are both stressed.
I don't think I'm stressed.
Fine.
Only I am.
And tired.
And I'm gonna get ready for bed.
Ew!
Something's wrong.
That's infected.
If I don't get the rest of the
bullet out, you're gonna go septic.
So you can do it here, right?
I shouldn't.
You got me this far.
Please.
Okay. I'm gonna need some help.
During the surgery, we discovered
sacral and lumbar fractures.
What does that mean?
The dog will have trouble walking
and will be incontinent.
So
a second surgery?
Unlikely to be effective.
The dog would still be at risk
for infections, UTIs,
and will require constant care.
Euthanasia would be more humane.
We brought this dog here to save him,
not have him put down.
I'm gonna find his family.
And if I can't,
I will find him a new family.
And you're gonna find a surgery
to fix his incontinence.
Dr. Sinclair is the expert
in veterinary medicine.
If he cannot think of
an effective surgery
for incontinence,
there probably isn't one.
In which case, it's very unlikely
the dog will be adopted.
Then we'll adopt him.
I will find a surgery.
Hey. Where are the supplies?
I didn't bring them.
Danni, you shouldn't be doing this.
This is straight-up surgery.
Go home.
Let me help you take him
back to the hospital.
- That's not happening.
- Why not?
If you weren't gonna do this,
why'd you even come?
Because I I didn't want
to desert you.
So don't.
I'll go get the supplies myself.
I just need you to talk me through it.
You won't even have to touch him.
If this ever gets out,
I'll take the fall.
This is why he went into V-tach.
The spike in his shoulder damaged
every critical structure in the area.
We need to do a carotid to
subclavian bypass before we pull it out.
Risks sending him into V-tach again.
Well, we need to remove the spike.
Unless we remove his arm.
In his current condition,
it's a less risky surgery.
Comes down to what Lalo's
willing to risk.
And we can't ask him
because he's too unstable
to take him off the ventilator.
We could ask his son.
He's 16.
He's not authorized
to make medical decisions.
Sure, but he'd have
a better idea than us
what his father would want.
Talk to him.
Oh, Buddy.
It's okay.
We're gonna find your humans.
Are you okay?
Yep. All good.
Were you trying to pet the dog?
No. Mmm-mmm.
You should never touch an
injured animal near its wound.
I know.
I'm gonna start putting up
lost dog fliers.
Making the incision.
Dissecting at the muscle
to free up the purulence.
What's her name?
Lila.
What's she like?
The first time she saw snow,
she ran outside
no gloves, no hat.
I-I had to drag her back in
before she
before she turned blue.
She's like me
never listens to anyone.
Mmm.
Sounds like Powell, actually.
I know I can be a bit much.
My parents were really tough.
I learned at a young age
that if I didn't push back,
hard, that I'd be pushed around.
So it helped me,
especially after I lost my leg.
My med school advisor told me
that I shouldn't be a surgeon
because I wouldn't be able to
stand for hours in the O.R.
But I can.
And I am.
Danni, are you okay?
It's Audrey.
I called out of my shift this morning.
I just told her it was
a family emergency.
Oh, she's been calling and texting.
This is not good. This is not good.
I know.
Wait, wait, wait! Where are you
Just, shh. Just
- Hey.
- Hey, is everything okay?
Yeah, yeah, a good friend's
having some issues.
We're still in the middle of it.
Oh.
After what happened with Perez,
I was worried.
Just wanted to check on you.
Thanks. I totally get it.
- You'll be in tomorrow?
- Yeah.
What was that?
Hey.
If we remove the spike
from your dad's shoulder,
it could cause complications
that would kill him.
How likely?
Maybe a 5% to 10% chance.
The safer option would be
to amputate the arm.
So you're asking me to decide
whether to cut off my dad's arm?
No, we're not.
We just want to figure out
what your dad would want
if he was awake.
Do you have any other support system?
Family, friends who help out?
Not really.
Mom died, and the rest
of the family's in El Salvador.
Has he ever worked with other gardeners?
I mean, me.
I help out most mornings before school.
Um, he fell off a roof last winter.
Got a concussion.
I picked up some slack, and it was fine.
I-I know this is different,
but he always says, "We stick
together, we'll find a way."
If cutting off his arm
means he'll live
then do it.
That's what he'd want.
Why are you talking to me
about operating on a dog?
Lea asked me to.
She is very stressed,
and I don't know why.
Well, considering what
she's been through, you know?
But she knows her pregnancy is safe now.
Well, you don't get over
something like that in in a week.
Okay, s-so how much time will she need?
I don't know, Shaun.
Maybe this isn't even
the main issue, you know?
Mmm.
Maybe Lea is worried about being a mom?
Well, she wouldn't be the first.
Aren't you a little bit worried
about being a dad?
A little.
Crying babies can be very loud,
and their bowel movements and spit-up
can be very disgusting and smelly.
But I have noise-reducing earplugs
and peppermint oil for under my nose.
And I will keep a supply
of surgical smocks at home.
You've certainly gamed that out, huh?
Yes. How do I help Lea be less worried?
I don't know, Shaun.
You don't know what the issue is, right?
So I would talk to her
and tell her that you've noticed
she's been a little bit stressed lately,
and ask her what's going on.
And send me the doggy imaging.
He's stable, for now.
- I'm so sorry.
- You should be.
If you're gonna blame anybody, blame me.
Oh, I do. This was unethical, stupid,
and if he dies, possibly criminal.
Vince would've died of sepsis.
- So call an ambulance.
- Then what?
EMTs can't force him
to go to the hospital.
They can if he's unconscious.
But he could be dead by then.
The only way to make sure that he lives
is to operate here.
You're a trauma surgeon.
It would be simple and ethical.
- Who is this guy?
- I told you.
He's a friend of mine from the Navy.
Who's on parole for what?
- That doesn't matter.
- Does to me.
Vince was the first one to the accident.
He tourniqueted my leg.
He held my hand. He comforted me.
He was the only person that day
that looked me straight in the eyes.
Everybody else was just too scared,
too freaked out too disgusted.
I'm sorry.
Will you give us a second?
If I hadn't warned you
off of that surgery
four months ago,
you could've ended up worse off
or dead on the table.
And whether you knew it or not,
you needed me.
Right now, Audrey, I need you.
I will help you with your friend.
And then we'll deal with what you did.
I put up tons of fliers,
called around to all the shelters
and vet hospitals and
- Did Glassman have ideas at least?
- Yes.
That I should talk to you.
I've noticed you are stressed,
and I don't know exactly why,
but maybe it is because you are
worried about motherhood.
I meant about the surgery for the dog.
But I am worried, yeah.
You shouldn't be.
You'll be great.
Thanks.
And I know you'll be
a great dad to our son,
but what if we're
incompatible as parents?
We can't even agree how to wash dishes.
And look at us with this dog.
We're arguing. Buddy hates me.
I lied.
He snapped at me after I petted
too close to his stitches.
I thought so.
We will work as a team
and figure it out.
But what if we don't know how?
We've both had pretty lousy
parental role models.
I don't think I'm like
my parents at all.
And I don't plan to treat our children
like they did me and Steve.
I can see my parents in me
in ways I really don't like.
I can be stubborn like my dad
and flaky like my mom.
I can't tell you how many times
I was the last kid at after-school
because she forgot to pick me up.
What if I mess up like they did?
You probably will mess up sometimes,
in those ways other ways, too.
I probably will as well.
But we will support
each other and each
I know how to help the dog.
I'm gonna inject more Lidocaine.
Turn on the ultrasound probe.
How'd you end up in prison?
When I got back from
Afghanistan, I couldn't sleep.
I would lie in bed
just staring at the door
waiting for someone to come at me and
I-I was in a bar,
and I thought
some guy looked at me wrong.
Are you getting help?
I'm on meds, in therapy.
I don't want to be what I was.
I want to be a good man for my family.
I don't see the bullet.
It must have migrated.
Three centimeters deep
and medial to the femur
in the adductor Magnus.
And what does that mean?
It's harder to get to now.
We can do it.
This'll hurt.
Aah!
Let's amputate. Book the O.R.
On it.
I think we should save the arm.
Did you not hear what Dylan just said?
I heard a son who'll do anything
to make sure his dad lives.
But that's not necessarily
what the dad would want.
Lalo's a poor, undocumented
manual laborer.
No support system.
If he can't work as a gardener,
then what?
Dylan told us what. They'll find a way.
And Dylan will drop out
of school to take care of him.
He just told us how he works
for his dad most mornings.
Already took care of him
when he had a concussion.
The future Lalo spent building
his son would disappear.
You know what else
would ruin his future?
Having a dead dad.
Lalo would take the risk.
Morgan heard everything you did
and came away
with a different impression.
She's not a parent.
That's very patronizing.
But that doesn't mean he's wrong.
- You're confident you can save his arm?
- Very.
Then let's do it.
What a dick move.
I am so sick of being told
that childless people
can't understand
what it means to love someone.
There's love and then
there's being a parent.
In nine months or so, you'll get it.
After drilling the lamina from L4 to S1,
we will use a Kerrison punch
to remove fragments
2 millimeters at a time,
then support the spine
with screws and rods.
And that is how we will fix
the incontinence and leg weakness.
And by we, I mean you.
A little outside my wheelhouse.
That's why they called in the bullpen.
Ah, yes. You're an expert on humans.
I'm still very unsure.
Why can't you just do the surgery?
Buddy is an innocent little guy
who really needs our help.
And I've put in a ton of work
with Shaun and Dr. Glassman
to find a way that could save him.
And And I recognize
you have valid questions.
And I know, my hormones are
probably playing a role right now,
and my attachment to a dog
I met yesterday
probably doesn't make sense
to you, but it is real.
And I really need Buddy to be okay.
So I'm asking you to please
set aside your concerns
and please help us help Buddy.
Who's paying for this?
Um
Seriously?
Gah!
I need longer forceps.
- God.
- We're almost there.
No.
Vince? Vince!
It's cold.
Poor pulses.
The fragment must have caused
a thrombosis.
I'm calling it. Push more fluids.
I need an ambulance at 302
West Holden Drive, Apartment 2A.
We are going to try to save
your dad's arm.
- Did Did something get better?
- No.
But we decided it's worth the risk.
Why did you even ask me then?
So I could screw up
and make the wrong decision?
You didn't screw up.
He hasn't taken
a weekend off in six years.
He He wears old clothes so I
can have new ones for school.
He's given up his whole life
t-to make sure I'm
I'm happy and healthy and safe.
- I'm just trying to help him and
- You did.
You gave us the information we needed.
Right.
Ten-blade.
Twenty's better.
You worried about a scar? It's a dog.
Dogs like scars, actually.
They think it makes them look cool.
A Veterinary Medical Review
longitudinal study
showed that post-op recovery outcomes
Shaun, the man knows
how to cut into a dog.
But he may not have read
the study, which
I've already made the incision
with a ten-blade.
Preparing to place
the 3 millimeter pedicle screw.
A 5 millimeter screw's better.
Removing the bullet.
Slowly release the proximal clamp
and let's look for flow.
It's good flow.
Vascular repair's hemostatic.
Let's finish this up
and get him off to recovery.
Bag the bullet for forensic evidence.
Hey.
How'd it go?
We won't know until he wakes up.
It meant a lot that you came.
How can you say no to a dog?
Yeah.
You know, when Maddie was a newborn
we were worried that she wasn't
latching on, you know?
But she did.
And then we were worried
that she wasn't crawling,
and she did.
And then we were worried
she wasn't talking,
and
You're gonna be a mom.
You're gonna worry,
that goes with the gig.
99% of the time,
everything works out just fine.
What was Maddie like?
Maddie
She never walked anywhere,
she always ran.
She was angry a lot.
That was her default.
But she loved so deeply.
It was like you were
the only one in the world.
I wish I'd known her.
Why'd you ask me about Maddie?
I just can't imagine
going through what you went through.
And I am so scared
of that 1%.
After Maddie died, I didn't
think that I was gonna make it.
There were times that I hoped
that I wouldn't.
But I did.
And then I met Shaun.
And then I met you.
And I'm grateful every single day
because I love you both so much.
You and Shaun have love,
and you have faith in each other.
If I was a betting man
I would bet the house
on the both of you.
We're on full flow. Removing the spike.
Low blood flow to the brain.
How's the NIRS?
61%.
Graft must have caused an obstruction.
I can fix it. Clamps.
11-blade and 6-0 prolene.
NIRS?
56%. Dropping fast.
Below 50, he risks brain damage.
We should call this off
and ligate the subclavian.
No. We're this close to saving his arm.
- More sutures.
- 52%.
Dr. Park?
Dr. Park.
Get ready to flush and unclamp.
Go.
- Starting flush.
- Unclamping.
Arm's pink.
NIRS at 70% and climbing.
10 spikes to go.
If the surgery fails
and he is still incontinent
I found a waterproof dog bed
he might like.
For our place?
Buddy is
very calming to pet.
Oh.
I think he needs to pee.
We need to get him to the pad.
Hey, Buddy, you gotta hold it in
until we get you over there.
- Okay, not yet, Buddy.
- Almost there, Buddy.
- No pee pee.
- Keep holding it in.
Not yet, no pee pee.
Almost there. Keep holding it in.
There we go. All right.
Time for urination.
Go pee pee.
- Okay, oh.
- Oh, oh!
He did it.
Oh, we did it.
- We got him to pee.
- We did it.
Oh, oh.
Oh, good boy.
I'm thinking letters in their records,
remediation plans,
and a two-month probationary
direct supervision.
One more misstep, they're out.
That's appropriate
for Asher.
It's not easy to draw a line
between what they did.
Asher never picked up an instrument
until you were supervising him.
And Powell has shown
a pattern of disobedience
even from her first surgery.
Wolke's made mistakes of his own.
And he knows that.
Does Powell?
Listen, your department, your call.
But you almost lost Shaun
as a friend this year.
And I'm worried you're acting
out of fear of losing another.
Color looks good.
Strong radial pulse.
Now I want you to try
to move your fingers,
very slow, just a little.
Okay.
Is that good?
It's great.
Muchas gracias, Doctor.
You saved my life.
What's wrong?
Um, they they asked me
what you would
you know, about your arm.
I told them to amputate.
I made the wrong choice.
Mijo, whatever you did,
you were there for me.
I've never been so proud of you.
I love you, too.
So, I started looking for dog walkers.
They're not cheap, but what is, so
Cooper!
You're Lea? We just saw the flier.
We have been searching for days.
We will, of course,
pay you back for any expenses.
Good. It's $22,563.
Yeah, we could work something out.
You saved the arm.
Guess you were right.
Or I was lucky.
I almost lost him.
Well, you didn't.
Yeah, I think I pushed too hard
on this surgery.
And I definitely said things
to you that weren't fair.
Last week Kellan told me
he wasn't coming home for the holidays.
Going on a trip with his roommates.
Feels like I'm losing him.
Like I've been a crappy father.
You're not.
Anyway I'm sorry.
My implantation failed.
It's been, what, nine days?
Blood tests wouldn't be fully accurate.
I could feel I was pregnant
and
then I wasn't.
I'll be here.
Anytime you need a friend.
I just might.
Probation.
I'm sorry.
We're letting you go from the program.
What about Vince?
If you have any leeway
not to report him
The bullet was misplaced.
Misplaced?
So I don't see the point
in alerting the police.
Thank you.
Danni, this wasn't an easy call.
You gotta learn to compromise sometimes.
If you don't, it's gonna hurt you,
not just as a doctor, but in life.
I'm sorry it worked out this way.
I'm not.
If I'd done anything else,
Vince would be dead
or headed back to prison.
And either way, his family
would be destroyed.
So I did the right thing.
I'll live with the consequences.
Good luck.
You, too.
I'm gonna miss you, Buddy.
Cooper.
But I'll write you every week.
- He won't get it.
- I was kidding.
You're a good boy.
Look, I know everyone says this to you,
but I really mean it.
He will be okay.
Yeah, he will.
We still have time to make
the 11:00 a.m. nature walk.
Mmm.