The Good Doctor (2017) s06e18 Episode Script
A Blip
1
Previously on The Good Doctor
You going to the club or work?
Yeah, these early calls are
gonna take some getting used to.
Browne retractor.
No Browne retractor.
I thought I put it on
your tray from the supply room.
Dr. Kalu is not your peer.
He's your employee,
and you are his boss.
I do not plan to give Jared
special treatment.
And if I see it, it won't
be good for either of you.
I'm not expecting
special treatment, Shaun,
but I don't appreciate being
treated like an intern either.
Dr. Andrews said he is judging my
performance off of your performance,
and your performance is not good.
You come in with your fancy car
and your old tricks and think,
"Ta-da, I'm a surgeon," but you're not.
I just want to prove that I belong here.
When I checked on Yara post-operatively,
I noticed you only used
eight sutures when you closed,
and she had a small bleed.
You should have used ten.
Dr. Glassman closed the galea and skin.
- Dr. Glassman skipped two sutures?
- Guess so.
At what time did you wake up
yesterday morning?
The usual, 5:30. Why?
At lunch, you had a Cobb
salad with balsamic vinaigrette,
so that's 450 calories ingested,
assuming you kept it down.
Yes, I kept it down.
Did you use a sauna,
engage in rigorous exercise,
and/or experience diarrhea?
No, I didn't do any of those things.
What's with the questions, Shaun?
You made an error
in yesterday's craniotomy.
I'm trying to evaluate various factors
that would negatively impact focus.
I made an error?
You closed with only eight sutures.
The size of the wound required ten.
We need to figure out why.
Why do we need to figure out why?
Two sutures, it's a blip.
It's not a thing.
It could be part of a more
troubling pattern needing attention.
Shaun, the surgery was a success, right?
- Yes.
- The patient had a great outcome.
There is no pattern.
Goodbye.
I'm a surgeon, and I belong here.
I'm a surgeon, and I belong here.
You are a surgeon, and you belong here.
I just keep imagining you in the mirror
like, "You have the hair of Tracee
Ellis Ross
and the swag of Beyonce."
Do not shame my self-care.
Affirmations are backed by research.
fMRI evidence shows a correlation
with positive changes in the brain.
I've just put the finishing
touches on a surprise.
Drum roll please.
Or not.
Well, get your song lists ready
because you are all
officially invited to
Star Karaoke, 7:00 p.m.
until question mark, question mark.
You know it's gonna be a party
when there's double punctuation
involved.
Yeah, just the chance to unwind
and get to know you all a little better.
Sounds fun. Thanks for the invite.
Prepare to be destroyed.
My "Someone Like You" slays.
Need a surgical consult for a clinic
patient with a dislocated patella.
Mm, sorry, ER.
You two are it. Room one.
When did the chest pain start?
I first noticed it Tuesday morning
along with shortness of breath.
Are you taking any medications?
I started with one,
then switched a few times.
These are used to treat ADHD.
And brain fog.
I'm a COVID long-hauler.
Um, and I just started
guanfacine and N-acetylcysteine,
which may actually be helping finally.
- When was your initial infection?
- Eight months ago.
It just felt like a mild flu,
but then it got worse,
like someone poured molasses
on my brain.
I've done cognitive therapy,
memory exercises,
still am,
whatever I can do
to get back in the field.
- Which one?
- Clover.
I'm an evolutionary biologist.
- Oh.
- Wow.
I have been studying how
white clover adapts
to environmental changes
And I'm on indefinite leave.
Please stop talking now.
Bluish skin, low O2 levels,
rapid heart rate.
And increasingly labored breathing.
Possible pulmonary embolism.
Order a chest CTA and echo, stat.
I have to go.
Oh.
You will need this.
I sent one half of a high
volume order to your printer.
These are Glassman's op reports?
For the last three months.
January to March.
October to December is printing
in Park's and my office.
So you sent reports for, like,
100 surgeries to my printer?
No, 176 surgeries.
473 pages.
I've emailed Operations
to replace your toner.
Many elements are in color.
And why, exactly,
do you need all of this?
To find out if his mistake was a blip.
Second time I've dislocated my knee.
Uh, first was a few months ago, I think.
- That was the sprained ankle.
- Ah.
The dislocation was last year.
Your MRI shows no associated
damage to bones or ligaments.
She's also been complaining
about dizziness,
swollen ankles, maybe menopause-related.
Dr. Reznick is looking to get her
on hormone replacement therapy.
Orion insisted I come in
and get everything checked out
before she leaves
and moves 6,000 miles away
to live alone.
I'm moving to Prague
next week for a new job,
and you can come visit me
anytime you want, Mom.
Not with a busted knee.
To move forward with HRT,
I need to confirm all the medications
you've used over the last five years.
Oh, uh, there was a purple triangle one,
but they took me off that last year
and an orange-shaped one.
I'll review it with you.
We need to see how your knee is moving.
Lay back, please.
Go ahead with the exam, Dr. Kalu.
I thought I'd observe.
It's a knee exam,
not a multi-ligament reconstruction.
You told me last time not
to assume I know everything.
This is just making me do your job.
That sounded like an apneic spell.
Check her tonsils.
Ms. Garcia.
Mm?
Oh, did I fall asleep again?
Yes.
Can I take a quick look in your mouth?
Mm-hmm.
Kissing tonsils.
They're so enlarged, they're touching
and obstructing your airway,
causing severe apnea.
You need a tonsillectomy right away.
No pulmonary embolism,
but multiple cardiac issues.
Severe narrowing of the pulmonic valve,
hypertrophied right ventricle
and opening between the lower chambers.
This set of defects almost looks like
- tetralogy of Fallot, but
- It is.
She has the fourth malformation,
overriding aorta.
I've never seen tet in an adult before.
How is she still alive?
Hang on a sec.
I have to write everything down now.
Tet is almost always
diagnosed in infancy.
Doctors somehow missed it in your case.
Oh, you have a rare presentation.
The right ventricle obstruction
has been balanced
by an increased flow
into the left ventricle.
Damage from COVID disrupted the balance.
The virus may have saved your life.
Very few undiagnosed tet patients
survive past childhood.
A mere 2% make it to 40.
You're saying
I would have just dropped dead
at some point?
It's very likely.
We can remove that risk
with two separate procedures.
First, we'll close the extra vessels
that have formed to compensate
for your heart defects.
Then we'll do a surgery
to repair those defects.
Is it possible the tet is connected
to my long COVID symptoms?
Could fixing my heart clear up my head,
the brain?
No. I'm sorry.
You snagged our table.
Beat Hawks and Nunez to it.
You're a champion.
One Splenda, half Sugar in the Raw,
light almond milk.
Now who's the champion?
Mm.
I have something for you.
- Really?
- Mm-hmm.
An agreement acknowledging
a consensual relationship.
I, Marcus Andrews,
would like to take you,
Dalisay Villanueva, on a date.
And as hospital president,
you know, I already signed it.
This is so romantic.
Give me the pen.
- Dinner this weekend?
- Let me see.
Oh, I'm needed on the ward.
Sorry. Lock it down later?
Sure.
Iced coffee?
I'm good.
How about a hot coffee?
In honor of Daphne's
successful tonsillectomy,
I got a few options.
Is that a latte?
Mm.
It was a routine tonsillectomy.
Those were unusually large tonsils.
A good thing her daughter
brought her in.
You think Daphne was
better off not breathing?
I don't think it's a daughter's job
to make sure Mom goes to the doctor.
It's Daphne.
Heart rate spiked. She's hypoxic.
Turn up oxygen to max flow.
Loud murmur from
the right ventricle and atrium.
Chronic damage from apnea
could have increased
the pressure in her lungs,
causing right heart failure.
BP's dropping.
We need to get her to the cath lab.
Positioning coiling system.
Two vessels left to close.
Deploying the coil.
O2 sats are dropping.
Her infundibular muscle
is clamping down.
She is having a tet spell.
Give phenylephrine and 100% oxygen.
I have never seen one in-person before.
We need to move blood up to the lungs.
Give her a bolus and up the opiates.
If we don't stop the spasm,
she could have permanent brain damage.
The chance of a future
infundibular spasm is very high.
Her tet repair surgery
will be much more risky.
Pressure in Daphne's lungs
is still critically high.
Not a routine tonsillectomy at all.
Puncturing the atrial septum.
Right heart is decompressing.
Give nitric oxide to relax
and dilate the vasculature.
Her apnea really did a number
on her pulmonary vessels.
No wonder she's clumsy and forgetful.
She's been sleep- and
oxygen-deprived for decades.
It still doesn't make her
her daughter's responsibility.
Would you want Kellan to put
his life on hold to take care of you?
Not his whole life, no,
but I don't think being overly
devoted is the worst quality in a kid.
Remove the catheters.
I was one of six growing up, only girl.
Mom and dad worked a lot,
so I was basically
second mom since kindergarten.
I love my brothers, but
there's a lot you miss out on
if you're all about taking care
of someone else.
She's throwing a lot of PVCs.
Maybe an electrolyte issue.
BP's dropping. Heart rate 172.
We're barely getting a pulse.
She's in V-tach. Defib pads.
BP and heart rate stabilizing.
Get a new chemistry, chest X-ray, EKG.
We need to figure out what else
is going on with her heart.
Oh, please don't disturb my materials.
Which are what, exactly?
Dr. Glassman made an
uncharacteristic surgical error.
I am determining if it was an anomaly
or part of a pattern.
Glassman must be
really pleased about that.
He is not.
You are being sarcastic.
Performance review
is a standard practice
and benefits both doctors and patients.
I have identified three additional
errors
made in the last four months.
I don't see a pattern.
A dural tear on scarred tissue,
closing with a running nylon
instead of Monocryl
Is that even a mistake?
Dr. Glassman has always used
subcutaneous Monocryl.
These are variations, minor missteps.
You pore through four months
of any surgeon's op reports,
and you'll find discrepancies like this.
- No.
- Yes.
Not in mine.
That's probably true.
Eh, if you're not finding a pattern,
maybe it's because there isn't one.
My patient is awake.
Does this mean you can't move
forward with the tet repair?
There's a medication called propranolol
that will significantly reduce the risk
of having another spasm during surgery,
but because of your long COVID,
you're at risk for some
very rare side effects.
- Are they serious?
- Yes.
Well, some of them are not,
like nausea, vomiting,
muscle aches, and dizziness, but others,
such as hypoglycemia
or visual changes
We'll start you on the propranolol.
There's a good chance you won't
experience the rare side effects,
but we'll need to keep
a close eye on you.
And are those patients ahead of her
also seniors with diabetes?
Do not hang up on me, Phillip,
or I'll head down to do this in person.
I'll wait.
Hey.
There is a great new
Portuguese spot I read about.
I can make reservations for us
Friday or Saturday at 7:00?
Uh, I'm working a double both days.
It's been a nonstop scramble
since Baker and Linh left.
Well, you have two new
travelers starting on Monday.
We need staff nurses.
These nurses are highly skilled. We
It doesn't matter how skilled
they are.
Travel nurses disrupt workflow,
don't build long-term relationships.
Right now, we just don't have the
resources
for permanent replacements.
You just hired a new
full-time surgical resident
to replace someone
who left way more recently.
That was Lim's department. I
Yes, great. I'm sending her down.
Sorry. We'll talk later?
Of course.
So you're watching to see if I throw up?
Or faint, seize, or have muscle spasms.
You know, before COVID, my brain was
I did evolutionary patterns,
genetic, uh
how genes go together.
The sequence.
Now my brain can't handle the
sequence of brushing my teeth.
My focus, my working memory,
all of the
The executive function.
It's not always happening.
Please page Dr. Wolke to
monitor her and stay until he comes.
Push your hand against mine.
The pattern is errors
in executive function.
Shaun, I'm in the middle
of doing something.
Your brain cancer may have returned.
All errors are tied
to executive function.
- Shaun
- Specifically
to working
and procedural memory governed
by the dorsolateral prefrontal cortex,
a common site for a recurrent glioma,
which strongly suggests
your cancer has returned.
My last scan came back
completely clear. I'm fine.
Your last scan was six months ago.
These errors all took place
in the last four months.
So you need another scan.
The evidence is very compelling.
No, it's really not.
I perform complex surgeries, Shaun,
more so than any other doctor
on this staff, by the way.
So yeah, the percentages would dictate
that I might make more minor
and irrelevant missteps,
if that's what you want
to call them, and
And the rate of errors has increased.
Yeah, because I take on
the tougher cases,
the ones no one else will.
No, you need another MRI now.
Shaun, what I need
is to get back to my patient.
And you need to knock first next time.
It's the greening of the
My turn.
I'm trying to get some
of my cognitive exercises in.
What are you memorizing?
It's a poem from
The Carrying, Ada Limon.
Hmm.
The collection is mostly about
not having the life you
thought you'd have, I guess.
The one I was just reading,
it's about spring coming,
Instructions on Not Giving Up.
- Sounds useful.
- Yeah.
Too bad I can't read it all at once.
I've just graduated from haikus.
I never even thought to look
at a poem before I got sick.
Didn't have the patience
for it at the time,
but it's basically all I read now.
I started writing, too.
It's kind of a creative therapy.
Mm.
There was a kind of poetry
to the genetic variations
in white clover too.
I'd give anything to
Your blood pressure is going down,
and your heart rate's climbing.
I feel kind of dizzy.
Let me check your glucose.
She's having a seizure. Crash cart now!
We thought something
else was going on with your heart,
but it's a kidney issue.
You have a narrowing
of your renal arteries,
which was exacerbated
by the pulmonary hypertension,
causing your kidneys to fail.
And this is because of my sleep apnea?
We believe so, yeah.
Uh, can she get a transplant?
I can do a test, see if I'm a match.
Unfortunately, your other health
concerns rule out a transplant,
but a renal artery bypass
would
allow your kidneys to heal on their own.
There's risk of complications,
some quite serious.
But in success, you could live
a full, independent life.
But oh, but serious,
as in I could die?
Some complications can be fatal.
But the risk is relatively low.
Are there other options?
Well, there's dialysis,
but you'd need multiple sessions a week
for the rest of your life.
Um, that's less risky, but I
I don't think I could handle
all that on my own.
Mom, Mom, if you want to choose
the dialysis, I'll stay in San Jose.
I'm sorry.
I don't want to keep you.
No, you have nothing to be sorry for.
All this time you've been sick
and struggling, and I
I judged you.
But your new job.
It's just a job.
So the medication you gave me
to make my surgery safer
will actually make it more risky?
That's right.
But without that medication,
I'm much more likely
to have another tet spell.
Yes, and possibly more severe
than the last time.
The brain fog, all my deficits
could get worse,
for possibly forever?
Yes.
But if we don't do the tet repair,
your heart will stop at some point.
I've already been through
losing my thoughts, my whole self.
I can't do that again.
Find another way to fix my heart.
All right, new idea.
We go back to the old idea
and just do the surgery.
It's a non-starter.
We need to present a way to
help her tet without triggering her tet.
A percutaneous valve and VSD
closure could help with blood flow.
That involves catheters in the heart,
which would cause the muscle to spasm.
All right. It's time for some WWSMD.
Whatever you and Jerome do
on your own time is
It's "what would Shaun Murphy do?"
If a party is what you need ♪
They're dancing ♪
What about a shunt?
It would improve blood flow,
buy a few months
to continue her cognitive recovery.
Once she feels better
about where her brain's at,
maybe she lets us fix her heart.
Her tet will likely kill her
before that,
but placing a shunt
won't trigger a spell,
making it something
she'd actually accept.
I'll take it to her.
I can stay only 45 minutes.
I have to review
Dr. Glassman's OR videos.
Didn't you already review them?
Not for symptoms of glioma recurrence.
New evidence will convince
Dr. Glassman to get a scan.
Okay, you binged months
of data in one day.
You'll have a clearer head
in the morning.
Until then, here we are, karaoke rager.
- Yay.
- It is yay.
We have song lists.
Plus Jared's our friend.
He just moved back.
Celebration is in order.
I will review the videos in the morning.
Yay!
It sounds pretty wild in there.
Because maybe ♪
You're gonna be the one
That saves me ♪
And after ♪
I was just warming up.
- Where is everyone?
- There is a lot of food.
Yeah, I had it catered.
You're the first to arrive.
And so far, last-minute rain checks
from Morgan, Park, Asher, Danny.
Oh, and Jerome.
So it's just us four?
Which means that all these snacks
and song binders are for us.
Oh. Yes.
The low turnout is the perfect
opportunity to discuss symptoms.
In your recent surgeries
with Dr. Glassman,
do you recall observing
any balance issues,
tremors, or motor weakness?
That sounds like the perfect option.
How soon can you do the shunt procedure?
I'll try to schedule it for tomorrow.
I've had a strange year myself.
Eleven months ago,
I was attacked
and paralyzed from the waist down.
I thought it was permanent.
Almost everyone did.
At first, all I wanted
was to walk again.
I was ready to risk my life
to get back to the old me.
But as time went on,
I started to appreciate
my new life, my new self.
I started a new relationship
that wouldn't have happened otherwise.
In many ways, my life improved.
You recognize you walked in
to tell me this story?
I only agreed to do the surgery
once I knew my life wasn't at risk.
And even then, I had doubts.
I liked who I'd become.
I wanted to hold on to her.
I'm not
losing my mind
all over again.
You don't strike me
as someone who's lost her mind.
That covers the thrombectomy.
In February, you assisted on a
Okay, I'm playing
the pregnant lady card.
We're going, Shaun.
Okay.
Thank you. Goodbye.
I should head out, too.
- Early morning.
- Yeah.
Maybe focus on being
a first-year resident
before adding party planner
to your resume.
The catering may have been
a bridge too far.
Yeah.
I bounced around growing up.
Different schools, cities, countries.
But, um, wherever we were,
my parents had a big house,
and I knew how to throw a party.
Closest I'd get to feeling like I fit.
Old habits die hard, I guess.
Fitting in takes time.
But I never have, anywhere.
Maybe not everyone
finds their place.
Daphne is getting septic. We have to go.
Morning.
Hello.
Mm.
You should not have that.
I'm permitted 12 ounces a day.
Experts agree.
Yes, but that was brewed
when I woke up at 3:30 a.m.
You make it through the videos?
Yes, and integrated the observations
Doctors Kalu and Allen made last night
regarding possible glioma symptoms.
I am now ready to present
Dr. Glassman with the revised evidence,
which is very compelling.
Mm.
Thankfully, your infection is
responding to the antibiotics.
The infection started
around your dialysis port.
That could easily happen again.
The renal artery bypass
is still an option.
It's too risky.
So is sepsis.
Thank you, Doctor,
but I'll settle for being alive.
You shouldn't.
You deserve more than that.
I know you've had a whole life
of feeling sick
and stuck and repeating
the same old, bad patterns,
but your past does not have
to tell your future where to go.
You can choose a different path
and who you're gonna be on it.
And let your daughter do the same.
Prague is beautiful in the spring.
We've scheduled the shunt
placement for this afternoon.
And that whole speech last night?
I stand by it, but it's your decision.
I've been waiting for the
old me to come back, and
That person may not exist anymore.
And
maybe I should be okay with that.
Do the tet repair.
Releasing the proximal clamp.
What made Daphne change her mind?
Dr. Allen has a way
of getting through to people.
Blood flow looks obstructed.
There's a kink in the graft.
We can undo it, but most likely,
it happens again.
We could anchor the bypass
off of the aorta instead.
At that angle, less chance of a kink.
Could work.
- Extending the incision.
- Sternal saw.
Starting the sternotomy.
O2 dropped to 78.
- 65.
- She's having a tet spell.
Give her 500 cc fluid bolus
and 100% oxygen.
Giving a mini bolus
to increase pulmonary flow.
O2 sats are 50.45.
Come on, come on.
Give her more oxygen and up the opiates.
It has stopped registering.
O2's rising.
Heart rate's stabilizing.
She was in prolonged gross hypoxia.
That could extend cognitive deficits
or worse.
We won't know until she wakes.
Let's get her on bypass
before she has another one.
- Okay.
- Mm-hmm.
To a successful renal artery bypass.
Cheers. Facilitated by moving speech
from a wise and persuasive surgeon.
Mm, with a great surgical save by a guy
who's about to have
some life-changing tacos.
Okay.
Mm! Oh, my God.
Okay, these are amaz you're amazing!
Told you. Blue corn tortillas.
Mm-hmm. I can get used to this.
- You have some lettuce there.
- Oh.
- No, no, no, mirror image.
- Mm.
Now?
- No.
- No laughing.
No, right, right, right. Very
Very serious matter.
Here. Um, yeah.
Oh.
Just a little bit more.
- We should go.
- Mm.
- Yeah.
- Um,
we need to get back early
for Daphne's post-op.
Yeah, right. Um, let's go.
The bypass went smoothly,
and post-op labs look good.
We expect a full recovery.
How are you feeling, Mom?
I'm
Breathing.
Kind of feels like
the first time in my life.
The post-op swelling from the
tonsillectomy has gone down.
You're finally breathing
without any obstruction.
You'll need to stay on top of your
medications and follow-up visits,
observe some dietary guidelines,
but the discharge plan lays it all out.
I'll be there to help, Mom.
No.
You won't.
You need to live your own life.
But I I will accept FaceTime calls.
And once I recover,
I'll come visit.
I hear that Prague
is beautiful in the spring.
That sounds like a plan.
Mm, things not go well with Glassy?
He returned the files with a note saying
he did not look at them
and does not intend to.
I'm sorry. He probably
It was a mistake to leave
them for him to read on his own.
Once I reorder the files,
I will go to
his office to review with him in person.
He made it pretty clear
he doesn't want to see them.
But he doesn't know
about the new evidence.
Maybe he doesn't want to know.
Cancer survivors have to
live with that uncertainty that
Knowing is better than not knowing.
If he's not ready to look at this,
you can't force him.
Maybe he's scared, Shaun.
And I think maybe you're scared, too.
We're about to have a baby,
you're about to be a dad,
and I think you're worried about family,
and Glassman is a part of that.
But if you keep pushing,
you risk damaging
one of the most important
relationships in your life.
Hey.
- Hey.
- Hey.
I've been thinking,
and I need a break from our coffees.
Dalisay
I don't think dinner's
a good idea either.
So we have a different point
of view about hospital business.
That doesn't change
the way I feel about you.
On or off the clock,
I'm the same person.
To me, if you don't value
what the nurses do
enough to treat us
like a resource to invest in,
not a line item to be cut,
how much can you care about me?
And to be honest,
if that is your point of view
it undercuts the respect I have for you.
Harper Louise Decrane,
March 30, 1994.
And do you know why you're here?
For my heart issues.
I had another tet spell, didn't I?
We'll need to conduct more tests,
but your speech and memory seem intact.
And with regard to your heart,
we expect a full recovery.
And with time, you may recover
your full cognitive abilities as well.
Maybe.
But for now,
I'll just focus on being here.
"It's the greening of the trees
That really gets to me
When all the shock of white and taffy
Leave the pavement strewn
With the confetti of aftermath
The leaves come
Patient, plodding
A green skin growing over
Whatever winter did to us
A return to the strange idea
Of continuous living
Despite the mess of us
The hurt, the empty"
Shaun, what?
Lea thinks that because
I'm going to be a dad,
I am worried about my family.
Okay.
She also thinks you are scared.
I'm not scared, Shaun. I'm fine.
She says if you don't want to
do the scan, I should let it go.
She
is right.
Good. Thank you.
I am scared.
Dr. Glassman
I am asking you to do the scan
because
the data and the evidence are sound
and because
it would be hard to lose my father
just as I am about to become one.
Do the scan for me.
Shaun, I'll do the scan.
"'Fine then, I'll take it'
The tree seems to say
A new slick leaf unfurling
Like a fist to an open palm
'I'll take it all'"
Previously on The Good Doctor
You going to the club or work?
Yeah, these early calls are
gonna take some getting used to.
Browne retractor.
No Browne retractor.
I thought I put it on
your tray from the supply room.
Dr. Kalu is not your peer.
He's your employee,
and you are his boss.
I do not plan to give Jared
special treatment.
And if I see it, it won't
be good for either of you.
I'm not expecting
special treatment, Shaun,
but I don't appreciate being
treated like an intern either.
Dr. Andrews said he is judging my
performance off of your performance,
and your performance is not good.
You come in with your fancy car
and your old tricks and think,
"Ta-da, I'm a surgeon," but you're not.
I just want to prove that I belong here.
When I checked on Yara post-operatively,
I noticed you only used
eight sutures when you closed,
and she had a small bleed.
You should have used ten.
Dr. Glassman closed the galea and skin.
- Dr. Glassman skipped two sutures?
- Guess so.
At what time did you wake up
yesterday morning?
The usual, 5:30. Why?
At lunch, you had a Cobb
salad with balsamic vinaigrette,
so that's 450 calories ingested,
assuming you kept it down.
Yes, I kept it down.
Did you use a sauna,
engage in rigorous exercise,
and/or experience diarrhea?
No, I didn't do any of those things.
What's with the questions, Shaun?
You made an error
in yesterday's craniotomy.
I'm trying to evaluate various factors
that would negatively impact focus.
I made an error?
You closed with only eight sutures.
The size of the wound required ten.
We need to figure out why.
Why do we need to figure out why?
Two sutures, it's a blip.
It's not a thing.
It could be part of a more
troubling pattern needing attention.
Shaun, the surgery was a success, right?
- Yes.
- The patient had a great outcome.
There is no pattern.
Goodbye.
I'm a surgeon, and I belong here.
I'm a surgeon, and I belong here.
You are a surgeon, and you belong here.
I just keep imagining you in the mirror
like, "You have the hair of Tracee
Ellis Ross
and the swag of Beyonce."
Do not shame my self-care.
Affirmations are backed by research.
fMRI evidence shows a correlation
with positive changes in the brain.
I've just put the finishing
touches on a surprise.
Drum roll please.
Or not.
Well, get your song lists ready
because you are all
officially invited to
Star Karaoke, 7:00 p.m.
until question mark, question mark.
You know it's gonna be a party
when there's double punctuation
involved.
Yeah, just the chance to unwind
and get to know you all a little better.
Sounds fun. Thanks for the invite.
Prepare to be destroyed.
My "Someone Like You" slays.
Need a surgical consult for a clinic
patient with a dislocated patella.
Mm, sorry, ER.
You two are it. Room one.
When did the chest pain start?
I first noticed it Tuesday morning
along with shortness of breath.
Are you taking any medications?
I started with one,
then switched a few times.
These are used to treat ADHD.
And brain fog.
I'm a COVID long-hauler.
Um, and I just started
guanfacine and N-acetylcysteine,
which may actually be helping finally.
- When was your initial infection?
- Eight months ago.
It just felt like a mild flu,
but then it got worse,
like someone poured molasses
on my brain.
I've done cognitive therapy,
memory exercises,
still am,
whatever I can do
to get back in the field.
- Which one?
- Clover.
I'm an evolutionary biologist.
- Oh.
- Wow.
I have been studying how
white clover adapts
to environmental changes
And I'm on indefinite leave.
Please stop talking now.
Bluish skin, low O2 levels,
rapid heart rate.
And increasingly labored breathing.
Possible pulmonary embolism.
Order a chest CTA and echo, stat.
I have to go.
Oh.
You will need this.
I sent one half of a high
volume order to your printer.
These are Glassman's op reports?
For the last three months.
January to March.
October to December is printing
in Park's and my office.
So you sent reports for, like,
100 surgeries to my printer?
No, 176 surgeries.
473 pages.
I've emailed Operations
to replace your toner.
Many elements are in color.
And why, exactly,
do you need all of this?
To find out if his mistake was a blip.
Second time I've dislocated my knee.
Uh, first was a few months ago, I think.
- That was the sprained ankle.
- Ah.
The dislocation was last year.
Your MRI shows no associated
damage to bones or ligaments.
She's also been complaining
about dizziness,
swollen ankles, maybe menopause-related.
Dr. Reznick is looking to get her
on hormone replacement therapy.
Orion insisted I come in
and get everything checked out
before she leaves
and moves 6,000 miles away
to live alone.
I'm moving to Prague
next week for a new job,
and you can come visit me
anytime you want, Mom.
Not with a busted knee.
To move forward with HRT,
I need to confirm all the medications
you've used over the last five years.
Oh, uh, there was a purple triangle one,
but they took me off that last year
and an orange-shaped one.
I'll review it with you.
We need to see how your knee is moving.
Lay back, please.
Go ahead with the exam, Dr. Kalu.
I thought I'd observe.
It's a knee exam,
not a multi-ligament reconstruction.
You told me last time not
to assume I know everything.
This is just making me do your job.
That sounded like an apneic spell.
Check her tonsils.
Ms. Garcia.
Mm?
Oh, did I fall asleep again?
Yes.
Can I take a quick look in your mouth?
Mm-hmm.
Kissing tonsils.
They're so enlarged, they're touching
and obstructing your airway,
causing severe apnea.
You need a tonsillectomy right away.
No pulmonary embolism,
but multiple cardiac issues.
Severe narrowing of the pulmonic valve,
hypertrophied right ventricle
and opening between the lower chambers.
This set of defects almost looks like
- tetralogy of Fallot, but
- It is.
She has the fourth malformation,
overriding aorta.
I've never seen tet in an adult before.
How is she still alive?
Hang on a sec.
I have to write everything down now.
Tet is almost always
diagnosed in infancy.
Doctors somehow missed it in your case.
Oh, you have a rare presentation.
The right ventricle obstruction
has been balanced
by an increased flow
into the left ventricle.
Damage from COVID disrupted the balance.
The virus may have saved your life.
Very few undiagnosed tet patients
survive past childhood.
A mere 2% make it to 40.
You're saying
I would have just dropped dead
at some point?
It's very likely.
We can remove that risk
with two separate procedures.
First, we'll close the extra vessels
that have formed to compensate
for your heart defects.
Then we'll do a surgery
to repair those defects.
Is it possible the tet is connected
to my long COVID symptoms?
Could fixing my heart clear up my head,
the brain?
No. I'm sorry.
You snagged our table.
Beat Hawks and Nunez to it.
You're a champion.
One Splenda, half Sugar in the Raw,
light almond milk.
Now who's the champion?
Mm.
I have something for you.
- Really?
- Mm-hmm.
An agreement acknowledging
a consensual relationship.
I, Marcus Andrews,
would like to take you,
Dalisay Villanueva, on a date.
And as hospital president,
you know, I already signed it.
This is so romantic.
Give me the pen.
- Dinner this weekend?
- Let me see.
Oh, I'm needed on the ward.
Sorry. Lock it down later?
Sure.
Iced coffee?
I'm good.
How about a hot coffee?
In honor of Daphne's
successful tonsillectomy,
I got a few options.
Is that a latte?
Mm.
It was a routine tonsillectomy.
Those were unusually large tonsils.
A good thing her daughter
brought her in.
You think Daphne was
better off not breathing?
I don't think it's a daughter's job
to make sure Mom goes to the doctor.
It's Daphne.
Heart rate spiked. She's hypoxic.
Turn up oxygen to max flow.
Loud murmur from
the right ventricle and atrium.
Chronic damage from apnea
could have increased
the pressure in her lungs,
causing right heart failure.
BP's dropping.
We need to get her to the cath lab.
Positioning coiling system.
Two vessels left to close.
Deploying the coil.
O2 sats are dropping.
Her infundibular muscle
is clamping down.
She is having a tet spell.
Give phenylephrine and 100% oxygen.
I have never seen one in-person before.
We need to move blood up to the lungs.
Give her a bolus and up the opiates.
If we don't stop the spasm,
she could have permanent brain damage.
The chance of a future
infundibular spasm is very high.
Her tet repair surgery
will be much more risky.
Pressure in Daphne's lungs
is still critically high.
Not a routine tonsillectomy at all.
Puncturing the atrial septum.
Right heart is decompressing.
Give nitric oxide to relax
and dilate the vasculature.
Her apnea really did a number
on her pulmonary vessels.
No wonder she's clumsy and forgetful.
She's been sleep- and
oxygen-deprived for decades.
It still doesn't make her
her daughter's responsibility.
Would you want Kellan to put
his life on hold to take care of you?
Not his whole life, no,
but I don't think being overly
devoted is the worst quality in a kid.
Remove the catheters.
I was one of six growing up, only girl.
Mom and dad worked a lot,
so I was basically
second mom since kindergarten.
I love my brothers, but
there's a lot you miss out on
if you're all about taking care
of someone else.
She's throwing a lot of PVCs.
Maybe an electrolyte issue.
BP's dropping. Heart rate 172.
We're barely getting a pulse.
She's in V-tach. Defib pads.
BP and heart rate stabilizing.
Get a new chemistry, chest X-ray, EKG.
We need to figure out what else
is going on with her heart.
Oh, please don't disturb my materials.
Which are what, exactly?
Dr. Glassman made an
uncharacteristic surgical error.
I am determining if it was an anomaly
or part of a pattern.
Glassman must be
really pleased about that.
He is not.
You are being sarcastic.
Performance review
is a standard practice
and benefits both doctors and patients.
I have identified three additional
errors
made in the last four months.
I don't see a pattern.
A dural tear on scarred tissue,
closing with a running nylon
instead of Monocryl
Is that even a mistake?
Dr. Glassman has always used
subcutaneous Monocryl.
These are variations, minor missteps.
You pore through four months
of any surgeon's op reports,
and you'll find discrepancies like this.
- No.
- Yes.
Not in mine.
That's probably true.
Eh, if you're not finding a pattern,
maybe it's because there isn't one.
My patient is awake.
Does this mean you can't move
forward with the tet repair?
There's a medication called propranolol
that will significantly reduce the risk
of having another spasm during surgery,
but because of your long COVID,
you're at risk for some
very rare side effects.
- Are they serious?
- Yes.
Well, some of them are not,
like nausea, vomiting,
muscle aches, and dizziness, but others,
such as hypoglycemia
or visual changes
We'll start you on the propranolol.
There's a good chance you won't
experience the rare side effects,
but we'll need to keep
a close eye on you.
And are those patients ahead of her
also seniors with diabetes?
Do not hang up on me, Phillip,
or I'll head down to do this in person.
I'll wait.
Hey.
There is a great new
Portuguese spot I read about.
I can make reservations for us
Friday or Saturday at 7:00?
Uh, I'm working a double both days.
It's been a nonstop scramble
since Baker and Linh left.
Well, you have two new
travelers starting on Monday.
We need staff nurses.
These nurses are highly skilled. We
It doesn't matter how skilled
they are.
Travel nurses disrupt workflow,
don't build long-term relationships.
Right now, we just don't have the
resources
for permanent replacements.
You just hired a new
full-time surgical resident
to replace someone
who left way more recently.
That was Lim's department. I
Yes, great. I'm sending her down.
Sorry. We'll talk later?
Of course.
So you're watching to see if I throw up?
Or faint, seize, or have muscle spasms.
You know, before COVID, my brain was
I did evolutionary patterns,
genetic, uh
how genes go together.
The sequence.
Now my brain can't handle the
sequence of brushing my teeth.
My focus, my working memory,
all of the
The executive function.
It's not always happening.
Please page Dr. Wolke to
monitor her and stay until he comes.
Push your hand against mine.
The pattern is errors
in executive function.
Shaun, I'm in the middle
of doing something.
Your brain cancer may have returned.
All errors are tied
to executive function.
- Shaun
- Specifically
to working
and procedural memory governed
by the dorsolateral prefrontal cortex,
a common site for a recurrent glioma,
which strongly suggests
your cancer has returned.
My last scan came back
completely clear. I'm fine.
Your last scan was six months ago.
These errors all took place
in the last four months.
So you need another scan.
The evidence is very compelling.
No, it's really not.
I perform complex surgeries, Shaun,
more so than any other doctor
on this staff, by the way.
So yeah, the percentages would dictate
that I might make more minor
and irrelevant missteps,
if that's what you want
to call them, and
And the rate of errors has increased.
Yeah, because I take on
the tougher cases,
the ones no one else will.
No, you need another MRI now.
Shaun, what I need
is to get back to my patient.
And you need to knock first next time.
It's the greening of the
My turn.
I'm trying to get some
of my cognitive exercises in.
What are you memorizing?
It's a poem from
The Carrying, Ada Limon.
Hmm.
The collection is mostly about
not having the life you
thought you'd have, I guess.
The one I was just reading,
it's about spring coming,
Instructions on Not Giving Up.
- Sounds useful.
- Yeah.
Too bad I can't read it all at once.
I've just graduated from haikus.
I never even thought to look
at a poem before I got sick.
Didn't have the patience
for it at the time,
but it's basically all I read now.
I started writing, too.
It's kind of a creative therapy.
Mm.
There was a kind of poetry
to the genetic variations
in white clover too.
I'd give anything to
Your blood pressure is going down,
and your heart rate's climbing.
I feel kind of dizzy.
Let me check your glucose.
She's having a seizure. Crash cart now!
We thought something
else was going on with your heart,
but it's a kidney issue.
You have a narrowing
of your renal arteries,
which was exacerbated
by the pulmonary hypertension,
causing your kidneys to fail.
And this is because of my sleep apnea?
We believe so, yeah.
Uh, can she get a transplant?
I can do a test, see if I'm a match.
Unfortunately, your other health
concerns rule out a transplant,
but a renal artery bypass
would
allow your kidneys to heal on their own.
There's risk of complications,
some quite serious.
But in success, you could live
a full, independent life.
But oh, but serious,
as in I could die?
Some complications can be fatal.
But the risk is relatively low.
Are there other options?
Well, there's dialysis,
but you'd need multiple sessions a week
for the rest of your life.
Um, that's less risky, but I
I don't think I could handle
all that on my own.
Mom, Mom, if you want to choose
the dialysis, I'll stay in San Jose.
I'm sorry.
I don't want to keep you.
No, you have nothing to be sorry for.
All this time you've been sick
and struggling, and I
I judged you.
But your new job.
It's just a job.
So the medication you gave me
to make my surgery safer
will actually make it more risky?
That's right.
But without that medication,
I'm much more likely
to have another tet spell.
Yes, and possibly more severe
than the last time.
The brain fog, all my deficits
could get worse,
for possibly forever?
Yes.
But if we don't do the tet repair,
your heart will stop at some point.
I've already been through
losing my thoughts, my whole self.
I can't do that again.
Find another way to fix my heart.
All right, new idea.
We go back to the old idea
and just do the surgery.
It's a non-starter.
We need to present a way to
help her tet without triggering her tet.
A percutaneous valve and VSD
closure could help with blood flow.
That involves catheters in the heart,
which would cause the muscle to spasm.
All right. It's time for some WWSMD.
Whatever you and Jerome do
on your own time is
It's "what would Shaun Murphy do?"
If a party is what you need ♪
They're dancing ♪
What about a shunt?
It would improve blood flow,
buy a few months
to continue her cognitive recovery.
Once she feels better
about where her brain's at,
maybe she lets us fix her heart.
Her tet will likely kill her
before that,
but placing a shunt
won't trigger a spell,
making it something
she'd actually accept.
I'll take it to her.
I can stay only 45 minutes.
I have to review
Dr. Glassman's OR videos.
Didn't you already review them?
Not for symptoms of glioma recurrence.
New evidence will convince
Dr. Glassman to get a scan.
Okay, you binged months
of data in one day.
You'll have a clearer head
in the morning.
Until then, here we are, karaoke rager.
- Yay.
- It is yay.
We have song lists.
Plus Jared's our friend.
He just moved back.
Celebration is in order.
I will review the videos in the morning.
Yay!
It sounds pretty wild in there.
Because maybe ♪
You're gonna be the one
That saves me ♪
And after ♪
I was just warming up.
- Where is everyone?
- There is a lot of food.
Yeah, I had it catered.
You're the first to arrive.
And so far, last-minute rain checks
from Morgan, Park, Asher, Danny.
Oh, and Jerome.
So it's just us four?
Which means that all these snacks
and song binders are for us.
Oh. Yes.
The low turnout is the perfect
opportunity to discuss symptoms.
In your recent surgeries
with Dr. Glassman,
do you recall observing
any balance issues,
tremors, or motor weakness?
That sounds like the perfect option.
How soon can you do the shunt procedure?
I'll try to schedule it for tomorrow.
I've had a strange year myself.
Eleven months ago,
I was attacked
and paralyzed from the waist down.
I thought it was permanent.
Almost everyone did.
At first, all I wanted
was to walk again.
I was ready to risk my life
to get back to the old me.
But as time went on,
I started to appreciate
my new life, my new self.
I started a new relationship
that wouldn't have happened otherwise.
In many ways, my life improved.
You recognize you walked in
to tell me this story?
I only agreed to do the surgery
once I knew my life wasn't at risk.
And even then, I had doubts.
I liked who I'd become.
I wanted to hold on to her.
I'm not
losing my mind
all over again.
You don't strike me
as someone who's lost her mind.
That covers the thrombectomy.
In February, you assisted on a
Okay, I'm playing
the pregnant lady card.
We're going, Shaun.
Okay.
Thank you. Goodbye.
I should head out, too.
- Early morning.
- Yeah.
Maybe focus on being
a first-year resident
before adding party planner
to your resume.
The catering may have been
a bridge too far.
Yeah.
I bounced around growing up.
Different schools, cities, countries.
But, um, wherever we were,
my parents had a big house,
and I knew how to throw a party.
Closest I'd get to feeling like I fit.
Old habits die hard, I guess.
Fitting in takes time.
But I never have, anywhere.
Maybe not everyone
finds their place.
Daphne is getting septic. We have to go.
Morning.
Hello.
Mm.
You should not have that.
I'm permitted 12 ounces a day.
Experts agree.
Yes, but that was brewed
when I woke up at 3:30 a.m.
You make it through the videos?
Yes, and integrated the observations
Doctors Kalu and Allen made last night
regarding possible glioma symptoms.
I am now ready to present
Dr. Glassman with the revised evidence,
which is very compelling.
Mm.
Thankfully, your infection is
responding to the antibiotics.
The infection started
around your dialysis port.
That could easily happen again.
The renal artery bypass
is still an option.
It's too risky.
So is sepsis.
Thank you, Doctor,
but I'll settle for being alive.
You shouldn't.
You deserve more than that.
I know you've had a whole life
of feeling sick
and stuck and repeating
the same old, bad patterns,
but your past does not have
to tell your future where to go.
You can choose a different path
and who you're gonna be on it.
And let your daughter do the same.
Prague is beautiful in the spring.
We've scheduled the shunt
placement for this afternoon.
And that whole speech last night?
I stand by it, but it's your decision.
I've been waiting for the
old me to come back, and
That person may not exist anymore.
And
maybe I should be okay with that.
Do the tet repair.
Releasing the proximal clamp.
What made Daphne change her mind?
Dr. Allen has a way
of getting through to people.
Blood flow looks obstructed.
There's a kink in the graft.
We can undo it, but most likely,
it happens again.
We could anchor the bypass
off of the aorta instead.
At that angle, less chance of a kink.
Could work.
- Extending the incision.
- Sternal saw.
Starting the sternotomy.
O2 dropped to 78.
- 65.
- She's having a tet spell.
Give her 500 cc fluid bolus
and 100% oxygen.
Giving a mini bolus
to increase pulmonary flow.
O2 sats are 50.45.
Come on, come on.
Give her more oxygen and up the opiates.
It has stopped registering.
O2's rising.
Heart rate's stabilizing.
She was in prolonged gross hypoxia.
That could extend cognitive deficits
or worse.
We won't know until she wakes.
Let's get her on bypass
before she has another one.
- Okay.
- Mm-hmm.
To a successful renal artery bypass.
Cheers. Facilitated by moving speech
from a wise and persuasive surgeon.
Mm, with a great surgical save by a guy
who's about to have
some life-changing tacos.
Okay.
Mm! Oh, my God.
Okay, these are amaz you're amazing!
Told you. Blue corn tortillas.
Mm-hmm. I can get used to this.
- You have some lettuce there.
- Oh.
- No, no, no, mirror image.
- Mm.
Now?
- No.
- No laughing.
No, right, right, right. Very
Very serious matter.
Here. Um, yeah.
Oh.
Just a little bit more.
- We should go.
- Mm.
- Yeah.
- Um,
we need to get back early
for Daphne's post-op.
Yeah, right. Um, let's go.
The bypass went smoothly,
and post-op labs look good.
We expect a full recovery.
How are you feeling, Mom?
I'm
Breathing.
Kind of feels like
the first time in my life.
The post-op swelling from the
tonsillectomy has gone down.
You're finally breathing
without any obstruction.
You'll need to stay on top of your
medications and follow-up visits,
observe some dietary guidelines,
but the discharge plan lays it all out.
I'll be there to help, Mom.
No.
You won't.
You need to live your own life.
But I I will accept FaceTime calls.
And once I recover,
I'll come visit.
I hear that Prague
is beautiful in the spring.
That sounds like a plan.
Mm, things not go well with Glassy?
He returned the files with a note saying
he did not look at them
and does not intend to.
I'm sorry. He probably
It was a mistake to leave
them for him to read on his own.
Once I reorder the files,
I will go to
his office to review with him in person.
He made it pretty clear
he doesn't want to see them.
But he doesn't know
about the new evidence.
Maybe he doesn't want to know.
Cancer survivors have to
live with that uncertainty that
Knowing is better than not knowing.
If he's not ready to look at this,
you can't force him.
Maybe he's scared, Shaun.
And I think maybe you're scared, too.
We're about to have a baby,
you're about to be a dad,
and I think you're worried about family,
and Glassman is a part of that.
But if you keep pushing,
you risk damaging
one of the most important
relationships in your life.
Hey.
- Hey.
- Hey.
I've been thinking,
and I need a break from our coffees.
Dalisay
I don't think dinner's
a good idea either.
So we have a different point
of view about hospital business.
That doesn't change
the way I feel about you.
On or off the clock,
I'm the same person.
To me, if you don't value
what the nurses do
enough to treat us
like a resource to invest in,
not a line item to be cut,
how much can you care about me?
And to be honest,
if that is your point of view
it undercuts the respect I have for you.
Harper Louise Decrane,
March 30, 1994.
And do you know why you're here?
For my heart issues.
I had another tet spell, didn't I?
We'll need to conduct more tests,
but your speech and memory seem intact.
And with regard to your heart,
we expect a full recovery.
And with time, you may recover
your full cognitive abilities as well.
Maybe.
But for now,
I'll just focus on being here.
"It's the greening of the trees
That really gets to me
When all the shock of white and taffy
Leave the pavement strewn
With the confetti of aftermath
The leaves come
Patient, plodding
A green skin growing over
Whatever winter did to us
A return to the strange idea
Of continuous living
Despite the mess of us
The hurt, the empty"
Shaun, what?
Lea thinks that because
I'm going to be a dad,
I am worried about my family.
Okay.
She also thinks you are scared.
I'm not scared, Shaun. I'm fine.
She says if you don't want to
do the scan, I should let it go.
She
is right.
Good. Thank you.
I am scared.
Dr. Glassman
I am asking you to do the scan
because
the data and the evidence are sound
and because
it would be hard to lose my father
just as I am about to become one.
Do the scan for me.
Shaun, I'll do the scan.
"'Fine then, I'll take it'
The tree seems to say
A new slick leaf unfurling
Like a fist to an open palm
'I'll take it all'"