The Good Doctor (2017) s06e19 Episode Script

1
Previously on The Good Doctor
I want to do another
embryo transfer ASAP.
You have some lettuce.
- Oh.
- No, no, no. Here.
Dr. Glassman, it would be
hard to lose my father
just as I am about to become one.
Do the scan for me.
Please hold still.
I'm breathing.
You moved your head.
Shaun, go away and let
the technician do his job.
I sent him out for coffee.
I am now scanning the location
of your prior tumor.
Did you decline
maintenance chemotherapy?
It's hard to hold still
while I'm talking.
Dr. Blaize recommended
six cycles of temozolomide.
The slight benefit of that stuff
wasn't worth the constant nausea.
The benefit is statistically
Shaun, I made my choice.
You chose wrong.
There's a spot on your brain.
There's the right ovary.
And that looks like the
Corpus luteum.
The endometrium is smooth
and around 13 millimeters,
which means my uterine
infection is cleared.
Carrying the pregnancy to term
should be a lot easier this time.
Your transfer is on my
schedule for tomorrow evening.
Fantastic.
And you have two
high-grade embryos available.
Do you want a boy or a girl?
You don't have to decide now.
Just let me know
before the embryo transfer.
Seven and a half hours.
Uninterrupted?
Didn't even have to wake up
to use the bathroom.
So?
Six hours, 45 minutes.
Oh, winner, winner, pancakes for dinner.
I really thought I had it in the bag.
How'd you do, Danny?
How much sleep you get? Over or under?
No clue.
Hold up.
- Morning, all.
- Morning.
Dr. Allen.
Good morning, Dr. Kalu.
Park is doing a hip arthroscopy today.
I'd like to scrub in.
Sorry, I'm already assigned to Park.
I'm thinking about
specializing in ortho,
so how about a trade?
How about no?
Sorry I asked.
Go, team.
Brady Sullivan. Oil rig worker.
Metal sheet hit him.
Severe chest and pelvic injuries.
O2 sats are critical.
Brady, I'm Dr. Andrews.
He's non-responsive. Sluggish pupils.
There's major hemorrhage.
GCS six, no head trauma.
Three-inch right-sided sucking
chest wound. Collapsed lung.
That's from the support hook.
The metal sheet he was welding
caused another injury.
How deep does this go?
Down to the spinal column.
He's nearly cut in half.
It's scar tissue from the radiation.
Could be, but the FA value
Is more consistent with
a glioblastoma recurrence.
That's right, and the path
of the radiation
they blasted me with,
that Swiss cheese look,
textbook necrosis.
The irregular shape implies
a multifocal cancerous lesion.
I've been looking at brain scans
since before electricity.
I think I know what
scar tissue looks like.
You are not objective here.
Oh, right, and you are?
Neither of you are.
If that lesion is cancer,
a DNA spinal fluid analysis
will confirm it.
Yes.
That is objective.
I'll do a spinal tap
and send it to the lab.
Should have results in 24 hours.
Fine.
I'll set it up.
O2 sat's 68.
Chest tube's in,
draining a lot of blood.
Every time I clamp a bleeder,
another one pops up.
Dr. Lim? Where do you want us?
We're busy with the chest trauma.
I need you guys on the pelvic injury.
How do we remove it?
You don't. It's the only
reason he didn't bleed out.
I need you four to figure out a plan
to reattach his lower half.
Read every journal.
Study every case report.
Check all the international
surgery registries.
Look everywhere.
PA ruptured. Gotta move him.
OR one, now.
- Give me the baby.
- No, no, no, no, no, no.
I'm here for Jazz.
- Just hand her to me.
- I don't know you.
I don't know you. I don't know you.
- Sir, please.
- Hold on, let me talk to him.
I'm a doctor here. I can help you.
I don't need a doctor. I need Jazz.
Jazz. Is Jazz the mother?
Yes.
You're trying to help the baby?
Jazz Jazz passed out
and then the, uh
the flashing lights took her.
An ambulance?
There's an encampment over on Elm.
Is that where you and Jazz were?
Then she's a patient here.
They didn't see the baby in her tent.
She didn't sound good.
She she needs her mama.
You did the right thing
bringing her here.
Can I examine her?
Uh
and you'll you'll find
you'll find Jazz?
I promise.
We have a code pink.
The baby's in heart failure.
You may have saved her life.
Found another tear
in the pulmonary artery.
A big one.
Every major
artery in this lung is damaged.
His body needs to divert
every resource it has
to his vital organs.
We should amputate his lower half.
- We're not there yet.
- It's barely hanging on.
But it is. We're gonna try to save it.
It's a big job to hand the residents.
Good thing I hire the best.
This vessel's too damaged to repair.
I need to clamp the trunk.
Start the clock on lung ischemia.
I think we should sack
the upper segmental pulmonary artery.
That would mean
he'd lose his upper lung lobe.
He has a physical job.
If we end up amputating,
he's not gonna be working oil rigs.
But he could be
playing wheelchair basketball.
PTFE graft on his artery
could save his lung.
Okay.
Central line is in.
Pushing milrinone
to increase cardiac output.
Severely decreased heart function,
but her chambers look normal.
Increasing high flow oxygen.
BP is improving a little.
Found it. In her posterior chest,
there's a critical
Narrowing of her aorta.
Her eye spacing is approximately
six millimeters wider
than the upper limit of normal.
She also has slightly low-set ears
and her hands are swollen.
She has Turner syndrome.
If we don't get that narrowing
fixed in the next few days,
she'll die.
It won't be easy to access,
but I need an angio
for a better view.
I'll locate the mother and get consent.
Brady's pelvis is broken
and separated from the spinal column.
So to reattach his lower half,
we need to repair the pelvis,
plus all the damaged organs,
plus the major vascular injuries,
and then find a way
to ensure it all heals.
Are we even doing the
right thing by trying to fix this?
You want to give up
before we even start?
I've just never read anything
supporting reattaching
this kind of injury.
Could kill him.
Amputation is the safest thing to do.
Lim already knows about that option.
- Our job is to find a better one.
- No, our job
Danny's right.
We need to divide and conquer.
I will work on organ damage.
I'll focus on public fractures.
I need intraoperative imaging
to build a 3D model.
Oh, well, I'll go with you.
I need to see the full extent
of the vascular injuries.
That leaves you to figure out
how these repairs heal.
I'll see what I can find.
- This is the baby's mom?
- We think so.
She was brought in a few hours ago
from a homeless encampment
with a delayed postpartum infection.
She's septic.
They're optimistic she'll pull through.
Soon, let's hope.
We've got some big decisions
to make for her baby.
Her name's Jasmine West.
She's homeless and has bipolar disorder.
County records show the baby
was born seven weeks ago.
No dad in the picture, no other family.
And this was all she had on her
when EMS brought her in.
We need your consent
for the baby's diagnostic angiogram.
Sure.
The baby's Turner syndrome
makes every procedure,
even a diagnostic test,
a little riskier.
Well, this is your area of expertise.
Her baby's name is Eden.
Pretty close
to the upper lung bifurcation.
I reinforced it with sealant.
With a synthetic wrap?
Are you questioning my surgical skills?
Are you getting defensive?
Okay. We're done.
Let's test it.
Good job.
Cardiac function stable.
You're good to go.
Inserting the catheter.
What a cute little girl.
Little girls are cute.
- Mine would be really cute.
- Yeah, she'd be adorable.
A boy could be adorable too.
Are you trying to pick your embryo?
I'm leaning towards a girl.
I have a playbook to work from.
My playbook didn't help me much.
A lot of my issues with Kellan came
from me trying to stop him
from making the mistakes I made.
If I'd had a daughter,
maybe I wouldn't have
dumped all my baggage on her.
You should choose a girl.
But you're having a boy.
We didn't get to choose.
In all long-term health metrics,
females are more likely
to outperform males,
although they'll probably
make less money.
The narrowing is longer
than it measured on echo.
We should resect the narrowed segment
and do an aortic anastomosis.
Huge surgery for a baby.
It's the only definitive treatment.
Very definitive
if she dies on the table.
Balloon dilation is safer.
We can do a bigger procedure in a
few years when Eden can tolerate it.
Her heart failure could
relapse between surgeries.
Your two-step approach is safer,
but only if the baby gets
daily medication
and regular follow-up care.
That's a lot to ask of a homeless mom.
I'll page CPS and get consent.
You two practice the surgery.
A lot.
His pelvis looks like a jigsaw
puzzle with a 100 missing pieces.
Jared may be right.
You're taking his side.
I'm not taking anyone's side.
- Scans don't lie.
- Okay.
I'm not sure if you're mad at him or me,
but we all need to get along.
Well, you two seemed to be getting along
pretty well at the taco truck
the other night.
That was nothing.
Mm-hmm.
You're spying on me?
I was getting a taco.
This green-eyed monster thing
is not a good look for you.
I'm not jealous.
But you're right.
We're supposed to be a team.
He's just not a good fit.
Let's just focus on the patient.
Fine.
Can't see how we're gonna
repair all of that arterial damage.
What if we don't?
They could bypass it.
All of it.
This paper by Dr. Alice Chen features
interesting data on tumor
treating fields, for GBM tumors.
I'm trying to enjoy my tuna melt.
Dr. Chen is starting a new study soon.
You should call her.
I'm not gonna spend the day
chasing down cancer treatments
because I don't have cancer.
Okay, there is a higher
probability of cancer relapse
because you refused
maintenance chemotherapy.
I'm not gonna talk about this.
Recurrent GBM causes much
worse symptoms than temozolomide.
That's the decision I made.
I'm going crazy.
There are three crib sets I like.
I just can't decide.
Could you guys go to the store
after work tonight
and pick your fave?
Okay.
I have to go practice
the baby's surgery.
I will see you after work.
Oh, my God!
Should I be worried?
About me? No.
We're going to kill him
trying to save the lobe of his lung.
Removing it still leaves him
with 4/5ths capacity.
When there's a chance
you might lose half your body,
everything you have left matters.
I need lobectomy instruments.
This is my OR, my department.
My hospital.
And when a doctor's judgment
is compromised,
it's my responsibility to step
in and protect our patients.
In what possible way am I compromised?
Are you implying that my time in a
wheelchair is affecting my objectivity?
How could it not?
This is my patient.
And I'm your boss.
You can either do this with me,
or I'll find someone who will.
Deaver retractor.
After they fix the colon, Lim can use
some preserved bowel
to create a new bladder
like these Korean surgeons did.
That would work perfectly
with what I found.
We can bypass all of the artery injuries
through two Dacron conduits
directly to his lower extremities.
And the improved blood flow
would help with my idea
with his pelvis.
So skin flaps,
Dacron artery bypass, neo-bladder,
bowel repair with biomaterials, and
a badass, Wolverine-like
adamantium skeleton.
It's experimental,
but it's pretty damn cool.
Now, how do we make sure all this heals?
There's one study in Canada.
A cocktail of recumbent growth hormones
and pentoxifylline showed
a threefold increase
in traumatic wound healing rates.
That's great.
There's only four patients,
and none of them had
the same injuries as Brady.
So no one got cut in half
with a metal sheet on an oil rig?
Great, I guess we just
toss that study out.
I'm just saying,
I wish we had something better.
I'll happily take a threefold increase.
This is a workable plan.
Good, because Lim wants an update.
Some promising ideas,
but there's a lot
of frail tissue to heal.
I found a study using growth hormones
to accelerate the healing.
Interesting. Would that work here?
There was a threefold plan
that we had
Well, hang on, I want to hear
from the guy who did the research.
I'm not confident it would.
You guys said you had a workable plan.
- It can work.
- Jared's being overly cautious.
If you close the pelvis
without good vascular support,
all these repairs will get necrotic.
We will have good support.
The
Dacron conduit to restore blood flow
Not normal flow and not quick enough.
Oh, dude, you've been
doom and gloom from the start.
- I've been
- Enough.
Find a way to heal him.
I don't care who it comes from,
but I need it soon.
The nurse said she's
responding to the medication.
How long will Eden be in
the hospital after the surgery?
Two weeks.
Jasmine's on the wait list
for long-term housing.
She might have a place by then.
Also, uh,
is this safe if she keeps breastfeeding?
The police found this in her tent.
This is a bipolar mood stabilizer.
It's safe.
How long has she been taking this?
She saw her psychiatrist
for the first time in years
about five weeks ago.
She responded to it in the past.
She had a follow-up
scheduled with him tomorrow.
There's another
treatment option for Eden.
I know, I know. It's disgusting.
You're gonna think,
"What are the percentages?"
Trust me, you change his diapers
and you are gonna bond with your son.
Okay, here is the Angelic Dream Set.
And be attentive to Lea.
Be extra attentive.
She's gonna be sleep-deprived.
You are gonna be sleep-deprived.
You're both gonna
want to lose it. Don't.
This mattress is very comfortable.
This dark wood is a little bit funereal.
The baby won't care about the color.
It's all about first impressions.
It's a newborn, you know? Clean slate.
You want to surround it
with beautiful things.
A stuffed, soft No,
you don't want to do that.
That's a hazard.
But these spinny things
what do you call these?
Mobiles, mobiles.
You know, everywhere he looks,
you want him to be interested,
stimulated.
Beautiful sounds. Beautiful music.
Mozart. Joni Mitchell.
If you want to talk about something
other than selecting a crib,
it should be brain cancer treatments.
Oh my God!
I don't want to think about that.
I can't not think about it.
In 12 hours, we will have results
- Exactly.
- We should be prepared.
Okay, Shaun, stop. Just
just stop for a second
Sit down.
Okay.
If I have cancer,
I'd be at stage four, right?
There's no miracle cure for that.
You still haven't called
Dr. Chen in Cleveland.
I read her paper.
It doesn't work with recurrent GBM.
How can you think about teddy
bears when you might be dying?
If you're right, Shaun,
then I won't be here
when your son is born.
I won't be here to help you.
We'll know when we know.
I like the lighter wood.
So do I.
What else should I know about diapers?
Lung lobe is out.
These segmental vessels are damaged.
Running 7-0 sutures should fix them.
Why bother? The upper lobe is out.
If we can get
Perez's Dacron graft to work,
we could use them
to save his lower half.
Very unlikely.
The residents are working on it.
And obviously not succeeding.
First, I'm compromised,
now you're slagging on the residents?
Two are on probation,
you let another one go,
and her replacement is someone I fired.
He's also the world's
most experienced first-year,
and he brings a new perspective
to the mix.
And training these guys is my job.
Your job is to make my job easier.
I thought it was to
run a great surgical department.
If you were doing that,
I wouldn't have to think
about that department
as much as I have recently.
Vessel loops.
You changed the baby's surgery?
We weren't giving Jasmine enough credit.
She's done a lot to turn her life around
since Eden was born.
For seven weeks.
And with this new treatment plan,
she has to keep it up for seven years.
A baby can change a person.
Code pink, NICU bed three.
That's Eden.
Code pink, NICU bed three.
Lim asked for my opinion.
I met so many rich, entitled
guys like you in college,
and I couldn't stand them
even the ones I slept with.
If you can't handle the hard work,
just get in your Lamborghini
and go home.
Sherry Lewis.
One of my last patients in Denver.
Late-stage ovarian cancer.
Treatment's pelvic exenteration.
You remove everything.
The bladder, colon, uterus, and vagina.
Now, in success,
the patient lives with
colostomy and urostomy bags,
severe menopause,
and absolutely no sex life.
Well, it's brutal but effective.
Would have been.
But I talked my attending out of it,
in favor of an experimental surgery.
A wide excision of all the tumors,
then you reconstruct the entire
pelvic floor with TRAM flaps.
Incredibly advanced.
The type of stuff you're
talking about doing to Brady.
Sherry, um
Sherry died on the table.
And I left Denver.
We take risks and people die.
But if we play it safe,
they die too.
I'd rather regret
fighting too hard for a patient
than not hard enough.
Why would your daughter shave your cat?
Long story.
Point being, don't get a cat.
Kids are gonna tell you they're
gonna clean the litter box.
They're not gonna clean the litter box.
Don't fall for that trap.
You made a lot of mistakes.
Yeah.
It all boils down to
Maddy's mom basically raised her
while I focused on work.
You were a surgeon.
She was a real estate agent.
I love surgery.
I love poking around in people's brains.
It's very exciting.
And I get to save some lives
while I'm at it.
Saving lives is very exciting.
So were Maddy's first steps,
her first words,
her first piano recital, or so I heard.
Work over family,
and that's what you get.
You're not gonna make the same mistakes.
I don't think I will.
We are very different people.
Are we?
I have learned some
very useful things from you.
Well, right back at you.
The baby needs surgery.
The crib needs to be assembled.
Go.
But you chose work way too often.
When should I prioritize family?
When you have a sick baby
and a piece of furniture,
the sick baby wins every time. Go.
I got this.
Serial debridement.
Helps healing a little, but
it increases infection risk a lot.
Well, then I'm tapped out.
Me too.
I guess we should tell Lim.
Lamborghinis.
Lamborghinis.
Now, most sports cars use
pressurized combustion
to achieve that kind of performance,
but not Lambos.
No, no, no, no.
To reduce engine wear, they use vacuums
to pour gas into the pistons.
Now, Brady's organs won't heal
because we can't get
enough flow to them,
but if you force more blood
into the area, well,
then we cause lethally high
abdominal compartment pressure. So
Let's pull in the blood
passively by creating a vacuum
using internal suction devices.
A low pressure system with low
tissue stress is better for healing.
That's
That's a brilliant idea.
But it won't work.
Not without blood
coming into the right areas.
I need your help with that.
Where do you need the blood?
It's what we proposed earlier,
plus a healing plan that Jared
I can read.
Good work.
It's four experimental techniques
rolled into an eight-hour surgery
with lousy odds of success.
Let's give it a try.
Dacron conduits
are connected to the aorta.
Do the anastomosis sites
look secure enough?
Any weak spots in there
will move that metal.
He'll bleed out.
They know.
On three.
One, two, three.
We have hemostasis.
And good
blood flow through the conduits.
Tissue's perfusing.
Yes! Yes!
Time to move on to the pelvic fractures.
This is much more important
than assembling a crib.
But patients will always need surgery,
and my family will
always need attention.
If there's no clear choice
between a patient
and your family, pick the one
that's related to you.
Hmm.
Obviously, choose family when you can,
but sacrifice is part of the job.
That's a good point.
But you are divorced.
That is more sacrifice than I want.
Fair.
Eden's O2 sat just dropped a bit.
I'm nowhere near her lungs.
Turner syndrome causes leaky vessels.
The stress on Eden's body is
causing lymph fluid to build up.
We can drain it with a chest tube.
Her chest is so small, you'd risk a
collapsed lung
and pleural infection.
I could clear the lung with diuretics.
The risks and benefits of both
treatments are nearly identical.
But that also means it doesn't
matter which one we choose,
which makes the choice easy.
I find inserting chest tubes
particularly satisfying,
so I will do that.
The risks and benefits of a boy
and a girl are nearly identical too.
But girls kick ass.
This implant's gonna be a tight fit
around the cauda equina.
The bioengineer's mapping algorithm
was designed to optimize stability.
Well, Brady's not an algorithm.
His nerves are gonna run where they run.
I'll set it in position.
Nerve impingement.
I'll expand the narrowing with a rod.
Wait, there's an alternate
algorithm that can fix that.
Settle down, Dr. Allen. I got this.
That's $100,000 worth of tech,
and she's using a rod.
Nerve activity flattening.
One more minute.
The old cantilever maneuver.
Nice work.
Can't beat the classics.
Eden's surgery went well,
so I was hoping Jasmine might
V-fib.
Ran a code for an hour, but
she'd just been through too much.
Vacuum devices are in position.
Let's see if they work.
Keep a close eye
on his intra-abdominal pressure.
We have vacuum.
IA pressure's okay.
Time for the tissue flaps.
Looking good, Lambo.
There's a small spike in IA pressure.
Increasing vacuum suction.
Still climbing.
Pressure's compressing his organs.
He's getting ischemic.
I'm going up to 55.
He's in shock.
I did this.
You didn't do anything.
We're in this together.
We need to amputate.
Not yet.
Audrey, pressure's
too high. We're killing his organs.
I think he's wrong.
Then fight for your patient.
We need to amputate.
- Okay.
- All right.
We need a Liston amputation knife,
a bone saw, and a set
of 5 1/2-inch hemostats.
He can handle 75.
With that kind
of pressure, he'll bleed out.
Normally, yes.
But the Dacron conduits Dr. Perez chose
are more rigid than typical vessels.
They'll hold up.
Let's do it.
I trust my residents, Marcus,
and I need you to trust me.
Let's go to 75.
Brady's family are here.
Is my husband
The surgery was a success.
It will be a long recovery, but
Oh.
Thank you for saving my dad.
I'll take you to him.
I should be dead on my feet,
but I just feel
- Awesome?
- Yeah.
It's been 24 hours.
Yeah.
I just need a minute.
A minute won't change the results.
No, it won't.
No cancerous DNA detected.
I was wrong!
Yes, you were.
Everybody ♪
Yeah ♪
Rock your body, yeah ♪
Yeah ♪
Everybody ♪
Rock your body right ♪
What?
Backstreet's back, all right ♪
I'm gonna keep up this same energy
with some Whitney.
You were right.
You always are.
You're learning.
Oh, my God, we're back again ♪
You know, before when I was
bitching about Jared,
it's because
Well, I am a little jealous.
A little?
Okay.
What you saw between Jared and I
It's none of my business.
You deserve somebody
who's ready to fully commit.
Somebody who makes you happy.
Whoever that may be.
- Yeah ♪
- Danny!
We need your boy band face
for the chorus.
- Come here.
- Yeah, we need those abs.
Get up here, baby!
Am I everything you need ♪
You better rock your body now ♪
Everybody ♪
Yeah ♪
Rock your body ♪
Yeah ♪
Everybody ♪
Backstreet's back, all right ♪
The new surgical robot is operational,
and I just landed
the perfect nephrectomy
for its inaugural run.
Dibs.
Ah, you did the last cool case.
This one's going to Dr. Murphy.
This is cool.
Dr. Park should take it.
I have to finish setting up our nursery.
Hey.
Good job today.
Thanks.
I've been under the microscope
with the board lately,
and I am stressed.
Things were said that
probably shouldn't have been.
Things weren't said. You said them.
If you don't trust me, fire me.
And if you do, then stay out of my way.
Hey.
Dalisay?
The baby's upset.
Her heart?
No, everything's fine there.
I just
I think she needs some company.
I'll get to her when I can,
but I'm slammed.
I'm here, Eden.
You can open your eyes now.
It's so sweet.
The crib.
The dresser.
It's the Angelic Dream Set.
The dark walnut was funereal,
but it also came in natural pine.
Oh, our little peanut is gonna love it.
Oh.
Whatcha got there?
There are
two screws missing.
That is not good.
No Biggie, Shaun.
It's just a couple screws.
No, that means
Dr. Glassman missed a step.
Dr. Glassman doesn't have brain cancer,
but there is something wrong
with his brain.