1. Previously on "The Good Doctor"...
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2. You need to take a break,
clear your head.
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3. You need a vacation.
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4. I'm gonna quit my job.
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5. I'm not looking forward to moving
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6. to Hershey, Pennsylvania.
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7. I don't want kids.
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8. Ever.
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9. I've just been fired
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10. for physically assaulting an employee.
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11. Go ahead. Chop us in half.
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12. When will they wake up?
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13. They should've already.
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14. We were worried about you, Jenny.
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15. So glad you're back.
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16. I am gonna give you three words.
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17. Try to remember them.
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18. Apple. Ball. House.
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19. Can you count back from 100 by 7 for me?
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20. I'm going to Harvard, you know.
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21. 93, 86, 79, 72, 65.
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22. And what city are we in?
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23. San Jose.
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24. And what were those three words?
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25. Apple. Ball. House.
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26. Look out, Harvard.
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27. We'll be doing a lot more tests
to know for sure,
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28. but your heart does sound better.
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29. How's Katie?
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30. You woke up before her,
so too soon to tell.
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31. There's virtually no alpha
or beta brain activity.
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32. We must have missed something
during the separation surgery.
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33. We didn't.
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34. Katie's BP was steady, sats were fine,
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35. regional blood supplies
were reconstructed.
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36. Just like Jenny, yet she's awake,
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37. Katie's in a coma.
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38. Katie's got the new sagittal graft.
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39. A problem with blood flow in that
vein could cause her condition.
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40. An MRI angiogram should tell us
if the graft is open or not.
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41. Hello.
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42. I will proceed with the angiogram.
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43. Whoa!
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44. Murphy, you've been gone for two days.
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45. How about we start there?
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46. Okay.
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47. Just because you talked to the president
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48. doesn't qualify as permission.
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49. Okay. Yes.
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50. I... will notify Dr. Melendez
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51. next time I go on a road trip
with my girlfriend.
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52. Amazing.
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53. "Road trip"?
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54. Dr. Glassman said you were
dealing with a personal crisis.
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55. That is true.
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56. Do you know the definition
of personal crisis?
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57. Yes. A stage in a sequence of events
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58. at which the trend of all
future events is determined.
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59. - A death, an illness.
- Yes.
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60. No, not a road trip.
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61. Okay.
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62. You and Dr. Browne
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63. get going on Katie's angiogram,
unless, of course,
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64. you have any personal
emergencies to attend to.
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65. No. My crisis is over.
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66. Come in.
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67. Hey.
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68. How are the twins doing?
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69. Jenny's in recovery.
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70. Her numbers look good. She's talking.
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71. Katie... not so good.
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72. We need to talk about Murphy.
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73. I told you he's on personal leave.
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74. Yeah, well, that's not what he said.
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75. You talked to him?
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76. Yes.
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77. In the surgical unit five minutes ago.
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78. There's the sagittal vein graft
we constructed for Katie.
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79. It's open with good flow.
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80. Graft is fine.
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81. Which means we still have
no explanation for her coma.
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82. Go in closer.
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83. The middle cerebral vein,
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84. it has low flow out of the brain.
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85. You're thinking low flow out
means low flow in?
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86. Yes, that is what I'm thinking.
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87. We should look at
the arterial inflow phase.
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88. We'd like to look at the
arterial inflow phase, please.
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89. So, what'd you do on your trip?
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90. Well, sometimes
when we take a road trip,
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91. we're running away from something.
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92. I kissed Lea.
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93. And Dr. Glassman is mad at me.
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94. What is he mad at you about?
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95. It's almost entirely blocked.
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96. And... there's a malformation
in the Circle of Willis.
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97. Katie is barely getting
any blood to her brain.
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98. Excuse me. Shaun?
May I speak with you, please?
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99. Dr. Melendez... He was not angry.
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100. Oh, no, Shaun.
Dr. Melendez is angry with you.
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101. He's also angry with me.
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102. W-Why?
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103. "Why"? Because I lied to him for you.
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104. Why did you run away?
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105. I didn't... didn't run away.
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106. When you leave without
notifying your attending,
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107. when you drop all of your
responsibilities at this hospital...
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108. When you leave without
telling anyone, including me,
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109. then you are running away.
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110. Did this trip with this girl help?
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111. Yes. Yes, it did.
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112. Okay. How?
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113. I would like to give two-weeks notice.
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114. Synced & corrected by kinglouisxx
www.addic7ed.com
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115. Mom, can you ask them
to bring me some more ice chips?
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116. I'll get them, sweetie.
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117. I'll get a doctor.
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118. No.
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119. I'm just...
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120. When you left, there was no one here.
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121. For the first time in my life,
I was alone.
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122. Sweetie.
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123. It felt... cold.
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124. Well, sometimes it is cold.
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125. But you know what?
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126. Someday, you might find
that you like it.
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127. Wrongful termination.
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128. Dr. Kalu assaulted an attending surgeon.
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129. I don't think you have
strong legal footing here.
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130. There's more to the story.
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131. And I am sympathetic to Dr. Kalu,
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132. but his ends don't justify his means.
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133. Obviously we can't tolerate
staff members...
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134. And yet you do.
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135. Please read on.
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136. The middle cerebral has narrowed.
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137. It's less than 2 millimeters.
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138. We bypass the artery here
and restore blood flow.
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139. Open her back up?
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140. She's just been through
a massive operation.
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141. The brain tissue hasn't settled.
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142. Another could very well
stroke Katie out.
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143. Other options.
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144. Intravascular.
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145. I don't see how
an intravascular ultrasound
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146. - gives us a better picture.
- No, not imaging.
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147. He wants a stent
in the middle cerebral artery
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148. in the angio lab. I like it.
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149. Stenting is usually reserved
for the heart and the carotid.
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150. It's not the usual,
but we are way past the usual.
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151. It would lower the danger of a stroke.
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152. Dr. Murphy, would you like to assist?
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153. Y-Yes.
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154. Dr. Melendez, would you like to write me
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155. a letter of recommendation?
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156. You see the narrowing there,
in the horizontal segment
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157. - of the middle cerebral artery.
- Middle cerebral artery.
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158. Yeah. I've heard about you.
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159. You're the one making
the old guard nervous.
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160. W-Why would I make people nervous?
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161. 'Cause you have a gift.
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162. And surgeons judge themselves
against their peers,
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163. and right now, you're winning.
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164. We're in position.
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165. Dr. Murphy, please inflate the balloon.
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166. Give us another squirt of contrast.
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167. And we should have good blood flow.
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168. Yes, the proximal end
of the artery is dissecting.
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169. The balloon is damaging her artery.
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170. Waveform is worsening.
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171. Stent won't hold.
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172. She's gonna stroke. I'm aborting.
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173. Okay.
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174. Waveform is normalizing.
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175. We're right back where we started.
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176. Katie's brain is starving.
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177. I want to see Katie.
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178. I know she's in a coma.
I still need to see her.
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179. I miss her.
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180. We can't risk contamination
for either of you.
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181. She needs to know I'm there.
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182. We understand.
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183. You can't understand.
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184. No one can.
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185. We have always been there
for each other,
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186. and now when she needs me most,
I'm not there.
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187. You've just been through
a 40-hour surgery.
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188. We need you to focus
on your own healing.
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189. And what about her heart?
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190. We're going to do
a cardiac catheterization test
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191. to see if her heart circulation
has improved.
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192. Inject the contrast to evaluate
the heart's blood supply.
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193. How's my soul looking?
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194. That's a different specialty.
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195. Katie says the eyes
are the window to the soul.
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196. I say the eyes lie. It's the heart.
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197. Well, then, so far your soul
is looking good.
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198. Strong, unobstructed blood flow.
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199. Ventriculogram will tell us how
the muscle function's doing.
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200. So quiet. Is everything okay?
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201. Ventricle's strained and dilated.
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202. We were hoping for some
improvement post-separation,
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203. but it's barely pumping.
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204. It just doesn't make any sense.
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205. The separation was supposed
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206. to relieve the stress on Jenny's heart.
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207. Half the need, half the work.
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208. Jenny's heart was even sicker
than it appeared.
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209. Seems we couldn't see that
because Katie's heart
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210. was doing all the work for Jenny's.
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211. What can we do to fix it?
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212. Give her a new heart.
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213. We're not gonna find
a donor match in time.
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214. Yes, we already have
the perfect heart for Jenny.
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215. The sisters are monozygotic
and therefore a genetic match.
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216. On the other hand, Katie is alive.
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217. - She is GCS-3.
- Her heart is still beating.
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218. Yes, but she is unresponsive.
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219. And I don't see a way to return
blood flow to the brain.
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220. In all likelihood,
Katie's not coming back.
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221. Yes, Katie very well may die, but
we can't predict when that'll be.
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222. It could be today.
It could be 20 years from now.
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223. If Katie stays on the ventilator.
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224. - That's not up to us.
- I know.
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225. But I also know that,
based on these scans,
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226. Jenny might not make it
through the night.
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227. We need to propose this to the mother.
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228. There's no chance Katie will wake up?
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229. We can't say with 100% certainty,
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230. but from what we saw
on Katie's brain scan...
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231. we have little reason for hope.
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232. But what we can say with certainty
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233. is that without Katie's heart,
Jenny will die.
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234. Can we wait?
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235. Just a little. Maybe you'll know more.
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236. Maybe something will change.
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237. If we don't do anything, Jenny's
heart will stop before the morning.
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238. How do you...
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239. Would it be painful?
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240. No. We simply power down
Katie's ventilator.
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241. Once off life support,
she will peacefully pass.
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242. Do you want us to explain this to Jenny?
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243. I'm sure she'll want to be present.
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244. No.
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245. I put trust in them from an early age,
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246. thinking responsibility
would build strength.
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247. I think it worked.
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248. But this...
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249. No.
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250. Jenny can't be part of this in any way.
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251. It'd destroy her.
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252. I'll tell her Katie died.
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253. "Dr. Shaun Murphy
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254. exhibits technical skills
beyond his years."
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255. - You wrote that?
- Yes.
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256. That's why I signed
my name at the bottom.
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257. You think Shaun survives
at another hospital?
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258. I didn't think he'd survive here.
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259. Without your endorsement,
Shaun isn't going anywhere.
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260. I may have my issues with him,
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261. but no matter how stupid
an idea this may be,
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262. I'm not gonna stop him
from going after what he wants.
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263. There's another signature line
next to mine.
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264. It's where the president
of the hospital has to sign.
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265. The chief oncologist.
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266. This is before I came here
in December of '14.
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267. Dr. Marshall shoved a scrub nurse
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268. during a post-op discussion
of some sort.
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269. Do you remember that?
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270. I do.
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271. Your response
was to settle with the nurse
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272. while Dr. Marshall
was let off with a warning.
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273. There's another almost identical
instance earlier in that year.
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274. In both cases, the doctors
in question were white.
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275. They were censured. Dr. Kalu was fired.
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276. You think this was a racial matter?
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277. Do you think I'm racist?
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278. That I favor white people?
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279. Then why the leniency then and not now?
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280. They're stars...
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281. that happened to be white.
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282. Doctors like Marshall
allow St. Bonaventure
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283. to compete with other
West Coast institutions.
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284. So, that's our defense?
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285. "We're not racist.
We just allow our doctors
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286. to assault people as long as
they bring in enough donors."
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287. They were reprimanded.
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288. And there were no further incidents.
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289. And how do you think all of this
is gonna play out in court?
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290. Settle.
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291. Okay.
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292. Hi.
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293. Floor?
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294. Four.
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295. Shaun asked Dr. Melendez
for a letter of recommendation.
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296. Yeah.
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297. All I have to do is sign it
and off he goes.
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298. I think...
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299. he might think that you're mad at him.
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300. If you don't sign,
it reinforces what he thinks.
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301. But if you do,
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302. it lets him know
that you believe in him.
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303. Can I touch her?
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304. Of course.
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305. Goodbye, baby.
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306. - Are you ready?
- Yes.
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307. She's stabilizing.
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308. I don't understand.
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309. What's going on?
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310. Katie's not ready to go.
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311. She's breathing on our own,
which means Katie has
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312. normal brain stem function, correct?
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313. When a ventilator is removed,
life can continue.
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314. It's rare, but it can happen.
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315. It doesn't change
the prognosis for awakening.
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316. Off the ventilator with normal vitals
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317. suggests long-term
vegetative state, right?
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318. Yeah.
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319. We just lost our remedy
for Jenny's heart.
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320. What about ECMO?
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321. Use the machine as a replacement
for Jenny's heart.
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322. Buys us... two weeks of life?
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323. I don't like it.
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324. ECMO requires blood thinners.
She just had brain surgery.
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325. It could cause a catastrophic bleed.
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326. Well, ECMO and its complications
may be our only avenue.
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327. R-Re-conjoin them.
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328. You want... You want to put
their heads back together?
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329. Not the heads.
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330. The thighs, the femoral vessels.
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331. Is it a funny idea?
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332. I think it's funny
that I didn't think of it.
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333. The girls' blood is identical.
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334. No need for anti-clotting meds,
so no possibility of a bleed.
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335. As long as they're attached,
Katie's heart will beat for Jenny.
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336. When Katie dies, we sever
the femoral connection
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337. and transplant Katie's heart into Jenny.
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338. We just spent 40 hours separating them,
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339. and now we want
to put them back together.
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340. You tried to kill Katie?
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341. No.
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342. You took her off life support.
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343. What do you call that?
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344. Mercy. Not just for her.
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345. You need a heart or you're going to die.
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346. Katie's alive.
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347. She was then, and she's even more now.
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348. Katie's alive in the sense that
she has basic organ function,
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349. but she has no higher-cognitive
brain activity.
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350. She's surviving,
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351. but she is not living.
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352. Hours ago,
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353. you thought she'd die
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354. as soon as you pulled the plug.
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355. You were wrong.
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356. How do I know you're not wrong
this time, too?
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357. The demand on... on Katie's heart
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358. is minimal in her resting state.
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359. She can easily tolerate helping you.
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360. I won't ask Katie to be
my life-support machine.
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361. Dr. Andrews.
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362. Let's put the sisters
in the same room overnight.
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363. I don't think that Jenny sees
herself as an individual yet.
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364. You know, I'm thinking the only
thing that'll change Jenny's mind
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365. about the reattachment is Katie.
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366. Being close might help Jenny
to see her as lifeless.
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367. Could backfire...
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368. and cement her feelings
that she's killing her sister.
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369. Yeah, possibly.
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370. And then we're in
the same position anyways.
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371. Okay, do it.
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372. Well, what about baseballs
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373. that this girl caught at a Giants game
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374. signed by Mr. Hunter Pence?
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375. He didn't hit it,
but that doesn't matter.
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376. - So, where is the sporting-goods one?
- There.
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377. Oh, no, that does not
go in sporting goods.
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378. It doesn't?
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379. I'm applying to move my residency
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380. to Hershey, Pennsylvania.
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381. Really?
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382. Yes. Penn State Medical Center.
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383. Are you following me?
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384. I need to make sure
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385. you're not just doing
this to stay close to me.
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386. No.
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387. Shaun.
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388. I want my own life.
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389. I want a life that I control,
not Dr. Glassman.
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390. Dr. Glassman is just trying to help you.
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391. I don't want help.
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392. But what if... you need help?
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393. How will I know if I stay?
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394. Too much stuff. You have too much stuff.
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395. We should book a trip.
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396. Maybe somewhere warm.
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397. Wow. You are so slow.
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398. You're only folding underwear.
Underwear's easy.
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399. Mnh-mnh.
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400. Okay.
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401. No, Neil, I don't want to...
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402. Fine.
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403. Let's go, Preston.
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404. I'm ready.
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405. Go.
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406. Boom.
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407. You're the only good thing about my day.
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408. I couldn't sleep last night.
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409. I couldn't even close my eyes until...
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410. ...I could feel Katie's heart
beat in my hand.
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411. If I do this,
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412. at some point Katie's heart
will beat for me, right?
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413. That's the plan.
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414. Then wherever I go,
she will always be with me.
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415. Okay. I'll do it.
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416. How you doing, Jenny?
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417. I can't feel anything.
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418. That would be the magic
of local anesthetic.
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419. Vessels are clamped. Okay, Doctor.
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420. We're ready to proceed
with the anastomotic grafts.
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421. It's done, isn't it?
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422. I can tell.
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423. Let's put both the girls' vitals
next to each other, please.
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424. Come on now.
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425. Give it a few cardiac cycles to adjust.
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426. How'd we do?
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427. You did great.
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428. Why Hershey?
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429. Lea is moving there.
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430. Ah.
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431. Well, they... they make good candy bars.
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432. I don't like candy bars.
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433. I love pancakes.
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434. Well, they make those, too.
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435. I brought you here because...
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436. I thought this place
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437. would provide a challenge
for your abilities.
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438. But I realized I really brought you here
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439. because I thought you needed me.
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440. This is a now signed
letter of recommendation.
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441. But...
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442. I don't want you to go.
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443. If you stay, I'll... I'll back off.
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444. I'll...
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445. I'll let you make your own choices,
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446. your own mistakes.
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447. I believe in you, Shaun.
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448. Their blood pressure dropped.
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449. 5 millimeters of Mercury.
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450. I like when you say "their."
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451. You're gonna see
some fluctuation.
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452. BP drops 5 millimeters every
complete cardiac circulation.
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453. Shouldn't the fluctuation
be inconsistent?
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454. Maybe Katie's heart isn't picking up
the workload for Jenny as expected.
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455. Jenny.
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456. Jenny.
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457. I'm... I'm right h-here, Katie.
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458. Take Murphy and get
a shotgun work-up on Katie.
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459. I want everything... EKG, EEG, and labs,
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460. and an echo on Jenny.
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461. Katie has an awake
alpha rhythm on her EEG.
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462. She's doing remarkably well.
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463. We're still not entirely sure what
caused Katie to regain consciousness.
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464. Attaching them again could have
redistributed fluid into Jenny's system,
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465. possibly decreasing
the swelling in Katie's brain.
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466. Just don't know.
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467. I know.
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468. They need each other. They always have.
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469. The issue right now
has become Jenny and her heart.
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470. When Katie was in a coma, the metabolic
demand on her heart was very low,
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471. but now that she's alert and active,
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472. there just isn't enough heart
for both of them.
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473. What does that mean?
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474. We're awaiting test results.
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475. We're not sure how long Katie's heart
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476. can tolerate the strain of
supporting Jenny's circulation.
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477. We'll closely monitor them
with cardiac labs and echoes.
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478. We need to find a donor heart
for Jenny as soon as possible.
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479. No.
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480. "No"?
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481. I've had CEOs settle for half
of what I just got for you.
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482. I don't care about the money.
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483. That's beautiful. It's admirable, even.
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484. But, you see, this is how it works because
we live in a civilized society...
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485. they hurt you,
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486. we hurt them by making them
cut you a massive check.
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487. I don't want them to hurt.
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488. I want them to give me my job back.
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489. A third of "your job back" is,
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490. by my calculation, uh, almost nothing.
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491. I'll pay you a third of this settlement.
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492. What are you talking about?
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493. You'll be paying me more
than you earn in a year.
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494. I want my job back.
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495. Lunch is on you.
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496. Lunch is on me.
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497. Are you moving to Pennsylvania
to be with Lea?
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498. Does she know that?
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499. Lea knows I'm moving to Hershey.
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500. Yeah, but does she know
you're going there
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501. because she is going there?
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502. I'm not.
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503. Lea makes me happy.
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504. Well, Lea's not the only one
that can do that.
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505. I'm gonna miss you.
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506. Your BNP.
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507. Jenny Kunkler's
cardio protein levels are...
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508. I've never seen anything like it.
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509. That's because the levels
are for two hearts, not one.
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510. Now Jenny is killing Katie!
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511. - What's going on?
- We got to separate them now
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512. - or we're gonna lose them both.
- We got the twins on the way?
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513. In transit.
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514. J.L.'s gonna do a local on the fly.
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515. On my count. Three, two, one.
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516. We can't do this. You'll die.
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517. We're gonna do it.
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518. No.
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519. We're in this together.
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520. The way we've always been.
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521. The way we were meant to be.
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522. It's Jenny! He's in v-fib!
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523. Push a milligram epinephrine now!
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524. Prepping Ambu bag.
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525. Murphy, start chest compressions!
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526. It's Jenny.
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527. Her heart had nothing left to give.
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528. Katie?
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529. She's stable.
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530. Her vitals are good,
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531. but we have an issue
that we need your help with.
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532. Okay.
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533. Um, Katie won't allow us
to separate her from Jenny.
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534. If she doesn't acquiesce,
Katie will clot and die.
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535. Bring 10,000 units on board.
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536. We'll clear out
and give you some privacy.
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537. Baby.
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538. We have to let her go.
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539. I won't let them separate us.
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540. I never wanted to do this.
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541. You used to say we were
made this way for a reason.
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542. I won't let them do this.
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543. Even if it kills me.
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544. I want you to look at your sister.
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545. Look at her.
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546. I can't lose both of my daughters.
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547. Dr. Andrews. Evening.
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548. I, uh, checked out the twins' file.
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549. It's an amazing case.
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550. To be clear, Jared,
I don't want you here.
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551. What we presented
to Miss Preston was the truth.
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552. I understand that.
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553. And those problem doctors
and the ways we police ourselves
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554. will be dealt with, should have
been dealt with a long time ago,
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555. but you stepped over a line.
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556. I fought for my job.
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557. You compromised your integrity.
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558. The incident with that jerk Coyle had
nothing to do with black or white,
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559. but that's what you and
your lawyer sold for leverage.
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560. And when you misrepresent racism
for something it's not...
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561. ...it sets us two steps back.
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562. She's ready.
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563. Jared, you're on suction.
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564. Mayos.
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565. Gone fishing.
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566. I spoke to Claire.
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567. Hey.
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568. I want to break up.
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569. Why?
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570. Because I love you.
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571. Odd reason to break up with somebody.
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572. I want you to have everything
in your life.
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573. Which includes kids.
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574. I told you
I was willing to not have kids.
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575. You're gonna regret
that decision one day.
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576. - I won't.
- Yes, you will.
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577. You're just too decent
to think it, but you will.
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578. So what?
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579. We all have regrets.
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580. I-I wanted to play third base
for the Astros.
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581. It's not the same.
That is a child's dream.
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582. This is your life!
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583. This is my life,
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584. and it'd be more devastating
to be resented by you
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585. than to have my heart broken.
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586. And you are going to be a great dad.
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587. Shaun.
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588. I wanted to give you something.
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589. I'm letting you borrow it.
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590. Bring it when you come visit?
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591. Okay.
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592. Promise?
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593. You're gonna come visit, right?
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594. I promise. I like Hershey.
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595. - You've never been to Hershey.
- Lea's there.
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596. Can I put my arms around you?
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597. Are you a good doctor?
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598. 'Cause when I think of you,
I think you are.
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599. Synced & corrected by kinglouisxx
www.addic7ed.com
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