The Good Doctor 1x14

1. Morning, doc.

2. Good morning, Kenny.

3. Hey, hey, hey.

4. Brosef, your cable's out.

5. I don't have cable.

6. - I have a digital antenna. - Why?

7. Digital antennae receive superior picture

8. and sound quality, and the channels are free.

9. Yeah, but you only get, like, 10 channels that way.

10. I only watch three.

11. You mind if I run a line to your tube?

12. Cable guy can't fit me in till next week.

13. Mm-hmm…

14. Come on, 10 channels are better than none.

15. - Yes, they are. - All right. Gracias, amigo.

16. What?

17. Mm…

18. Dr. Reznick was orphaned once Dr. Coyle was transferred,

19. so she'll be joining our team.

20. Hi. I'm Claire. Nice to meet you.

21. - Are you the autistic one? - No.

22. That's me.

23. - Dr. Shaun Murphy. - Mm, hi.

24. We've got two pretty straightforward cases,

25. nice level playing field for an eager group.

26. - Not interested. - Competition can foster teamwork.

27. Which can lead to a greater understanding and appreciation

28. of residents' strengths and weaknesses and improve patient care.

29. You're playing the same game Glassman had us do

30. when we were interns. Not interested.

31. Winning team gets first dibs on assisting on all surgeries next week.

32. - In. - Out.

33. Mm-hmm…

34. I pick the boy genius.

35. That's you.

36. Dr. Browne.

37. - Kalu. - Dr. Reznick.

38. Thank you. I'm looking forward to it.

39. Thank you.

40. Same stakes as last time?

41. Absolutely.

42. Hi, Quinn. We hear you've had some stomach pain.

43. Do you mind if we take a look?

44. It doesn't hurt that bad.

45. Poor thing says everything is okay,

46. but when Quinnie didn't want to go swimming today,

47. I knew that something must be wrong.

48. We'll be as gentle with her as possible.

49. Quinn's parents are out of town, so I, I flew in to babysit.

50. Mm-hmm.

51. Okay. Let's see.

52. - That's a… - Penis.

53. She's not a girl. He's a boy.

54. - It's just a phase. - Stop saying that.

55. I'm not a boy. I'm a girl.

56. - You're transgender? - Yes.

57. No. Quinn has XY chromosomes like Jared and me,

58. not XX like you.

59. Science says he's male.

60. No, Quinn has gender dysphoria.

61. Her assigned gender is not the one she identifies with.

62. She's mismatched, Dr. Murphy.

63. - But biologically… - Other than biologically,

64. how do you know you're supposed to be a boy?

65. Your question doesn't make sense. I'm not supposed to be anything.

66. I am a boy. Biologically, that's it.

67. Okay, deep tenderness at McBurney's point.

68. Could be acute appendicitis.

69. Murphy, get imaging to confirm.

70. Mm.

71. Mr. Shaw, your chart says that you passed out in class.

72. - What do you teach? - History.

73. I got a little dizzy because I skipped breakfast.

74. Uh, it's nothing. The school insisted on calling an ambulance.

75. Taken any medications in the last few months?

76. Uh, I took some Vicodin after I threw out my back six weeks ago,

77. and then I had a stomach flu, so I took ofloxacin.

78. But the flu part didn't totally go away, so I took azithromycin

79. and prednisone because my glands were swollen.

80. Uh, but I still had a sore throat, so I took some Cipro.

81. What doctor prescribed you all that?

82. They were leftovers I had in my medicine cabinet.

83. - Uh… - All right, lay back for me.

84. Look, I'm a single dad with twins

85. who bring home every disgusting germ they touch at preschool.

86. Uh, I can't afford to miss work.

87. You've got a fever

88. and you've gone through two IVs,

89. which tells me that you're severely dehydrated.

90. You can't stand me touching your stomach without wincing in pain.

91. Dr. Reznick, let's get Mr. Shaw here an ultrasound.

92. - We've been trying for a while. - Five months.

93. I realize my prime egg days were two decades ago,

94. but I've been vigilant.

95. Ovulation kits, LH and FSH testing, basal body temp.

96. I've checked my estradiol and AMH levels.

97. The old-fashioned way wasn't working.

98. Okay, well, there are a lot of possibilities to consider.

99. Many benign, many easily corrected.

100. So I will take some samples from you both,

101. run some tests, we go from there.

102. There's a clock.

103. We need to know if we start with IUI or IVF…

104. Both of you, you need to stop worrying.

105. Isabel, you are not the first 40-something woman

106. to come here and ask these questions.

107. Myself included.

108. You came to me because you trust me, yes?

109. Right. So let me do what I do, and you two focus on each other.

110. Hey.

111. We're a team, babe. In this together, all right?

112. Okay.

113. I'm afraid, Howard, your appendix has already ruptured.

114. Book an OR stat and page Melendez.

115. Wait. I need to figure out who's gonna take care of my kids,

116. call the school, so they can get subs for my classes.

117. Mr. Shaw, if we don't get you into surgery now

118. your infection could spread and you could become septic.

119. Dr. Browne will make all the necessary phone calls

120. while I prep you for surgery.

121. Isn't that so, Dr. Browne?

122. You're in good hands, Mr. Shaw. We've got you covered.

123. Let's go.

124. Hello.

125. - Do you wear dresses? - Murphy, don't.

126. Quinn is a boy who thinks he's a girl.

127. I want to know why he thinks that.

128. Sometimes I wear dresses, but sometimes I wear leggings.

129. Do you like the color pink?

130. I'm more of a purple girl.

131. Do you play with dolls?

132. Since I was five, but I'm super into mermaids.

133. - Do you take dance? - Murphy, 20 questions are up.

134. I only asked four.

135. - Do you wear perfume? - It doesn't matter.

136. - The CT's ready. Let's go. - Do you always paint your nails?

137. Let's go.

138. Perforated appendix is out.

139. Lavage or no lavage, Dr. Browne?

140. Lavage before closing the wound decreases residual fluid accumulation

141. and minimizes residual contamination.

142. Claire's right. Although, a recent study documented a higher abscess rate

143. when irrigation was used for perforated appendicitis.

144. Well, someone did their homework.

145. I'm partial to AMSURG since they published me.

146. As a medical student?

147. It was about the cost and stabilization of disease in patients

148. undergoing transcatheter and surgical aortic valve replacement.

149. Are you thinking of specializing in cardio-thoracic?

150. A girl can dream.

151. Staple up and close up.

152. Well,

153. it's, uh, it's good to have you on board, Morgan.

154. It's great to have another female surgeon.

155. Oh, uh…

156. I'm sorry, you and I are not gonna be friends,

157. and hanging out, having sleepovers, braiding each other's hair.

158. That's not exactly where I was going with it.

159. When residency's over,

160. the hospital's likely only keeping two of us.

161. Shaun is Glassman's pet project, so he's in.

162. Jared is persona non grata, so he's out.

163. Which means every time you win, I lose. And vice versa.

164. Thanks for the heads up.

165. Do you think he's complicated or confused?

166. Dude, you've got to quit calling her a "he."

167. We're never going to win this competition

168. with you disrespecting our patient.

169. Don't they have transgender people in Wyoming?

170. Okay. Transgender patient care

171. was not part of my medical school curriculum.

172. Was it part of yours?

173. No.

174. Quinn doesn't have appendicitis.

175. He has testicular cancer.

176. She.

177. We found a mass on Quinn's left testicle.

178. - She has cancer, but… - Am I gonna die?

179. No, no. Prognosis is very good.

180. We've caught it before it spread,

181. and we'll do surgery on the mass to remove it.

182. The CT also showed he has osteopenia.

183. - Murphy, stop with the "he."

184. Uh…

185. - Quinnie, it's your mom. I have to… - Of course.

186. Osteopenia. That's low bone density, right?

187. Yeah. How'd you know that?

188. Do you know how I got cancer?

189. There are several possible causes, but I would…

190. Microlithiasis, mumps, hypospadias…

191. - Murphy. - Intraepithelial germ cell neoplasia…

192. - Inguinal hernia, HIV… - Murphy? Enough.

193. Your parents are on their way here.

194. Um, they just told me… Quinn, are you on puberty blockers?

195. That's the likely cause of the osteopenia.

196. Are you taking leuprorelin or histrelin?

197. I… I've been on leuprorelin for nine months.

198. Well, why didn't you say anything earlier?

199. Because my parents didn't want my grandma to know.

200. Looks like he has an abscess.

201. You have an infection.

202. We'll drain it, put you on antibiotics.

203. It's nothing to worry about.

204. It just means you might be in the hospital a couple of extra nights.

205. I can't spend a couple of extra nights.

206. I need to get out of here.

207. Are you worried about your kids?

208. Well, they're with my sister, they're safe,

209. but they've never spent a night without me since they were born.

210. Well, then consider this a blessing. A free vacation from your kids.

211. They're my life.

212. My wife died of ovarian cancer last year.

213. I, uh…

214. I hate hospitals.

215. I'm so sorry.

216. Why don't I find a laptop so you can Skype with them?

217. And I'll rustle up a couple of toy bears from Peds for you to take home.

218. Thank you.

219. I want to reassure you that the puberty blockers

220. are in no way responsible for causing cancer.

221. The leuprorelin did cause your osteopenia.

222. Does this mean I have to stop taking puberty blockers?

223. Yes.

224. We'll get you on dietary supplements to help regain your bone strength,

225. but the puberty blockers are hurting you.

226. You'll be fine without them.

227. Fine?

228. I don't want an Adam's apple or a deep voice

229. or hair all over my body. You can't reverse that, can you?

230. No, I'm afraid not.

231. Girls have body hair, too.

232. Toy bears, Skype with kids? You've got game.

233. "Game"?

234. I believe the name for what I did is "basic human decency."

235. Everyone has an agenda.

236. Sometimes it's conscious, sometimes it's not, but it's always there.

237. And you've got this whole "queen of kindness" thing down pat.

238. Awfully cynical for someone so young.

239. Mm, not cynical. Just the reality of how the world works.

240. It's Howard.

241. He spiked a fever, temp's 105. BP's tanking, 80 over 40.

242. He's soiled his sheets.

243. Site's clean. Infection should be clearing by now.

244. - What's going on? - I don't know. Page Melendez.

245. Give me 500 milligrams acetaminophen,

246. two grams of meropenem IV infusion empirically.

247. Run a full chem panel, CBC, and get cultures ASAP.

248. Hang in there, Howard. We're gonna figure this out.

249. Any word on Quinn Darby's labs?

250. Big backup today. Nothing much I can do.

251. - Text you when they're ready? - Yeah.

252. Hey, Gus.

253. I saw raspberry and rose petal doughnuts in the cafeteria today.

254. Got you the last one.

255. You remembered. Thank you.

256. Howard Shaw's labs. I put a rush on 'em for you.

257. You're the best.

258. Why did you give Gus a doughnut?

259. I was being nice.

260. I needed my patient's labs expedited. Gus likes doughnuts.

261. - It's called bribery. - I call it "basic human decency."

262. See you later.

263. Howard has a superbug.

264. A c. diff infection?

265. It's resistant to all medication.

266. Quinn's pre-op labs are normal,

267. so we can do the surgery first thing in the morning.

268. The procedure is called a radical inguinal orchiectomy.

269. It's radical in that the entire cancerous testicle is removed.

270. Uh, all functionality will remain the same.

271. Quinn should be able to resume her normal activities

272. in one or two weeks.

273. - See? Baby, that's good news. - No, not really.

274. Without the puberty blockers,

275. I'll be the freak in ballet with a mustache.

276. Aren't there any other options?

277. - I wish there were. - If we do a bilateral orchiectomy,

278. Quinn will have the testosterone level of a girl.

279. We are not removing both testicles.

280. You want to castrate my grandson?

281. - No! - No!

282. - Oh… - I'm so sorry for Dr. Murphy's outburst.

283. I'm gonna have gender confirmation surgery when I'm 18 anyway.

284. Why not just do it now?

285. Quinn is a child who still plays dress-up and make-believe.

286. He may want to have children of his own someday.

287. Ew.

288. - We'll give you some privacy. - Thank you.

289. - I will not allow you… - It's not up to you.

290. You are making me doubt the wisdom of drafting you, Murphy.

291. If you go around saying inflammatory things to people,

292. it will only upset them.

293. How will I know if I said something inflammatory until I say it?

294. Test it on Kalu first.

295. Which you can do while the two of you prep an SDA for this case.

296. An SDA?

297. A Shared Decision Aid

298. is a paper presenting the pros and cons of making a difficult…

299. I know what it is, Murphy.

300. But why am I being punished?

301. It's not a punishment, it's necessary.

302. It'll help Quinn's family understand

303. all the options available to them for her care.

304. Understood?

305. Understood.

306. The stool culture and sensitivity tests

307. indicate that you're resistant to every antibiotic.

308. Which only happens when you've been exposed to every antibiotic.

309. I…

310. I did this to myself?

311. But I've used those medications before without a problem.

312. Why did this happen now?

313. You weren't under a doctor's care,

314. so you were likely taking the wrong medication

315. for the wrong symptoms.

316. But you can fix this, right?

317. We're gonna have to perform a colostomy,

318. where we attach an ostomy pouching system to your abdomen

319. to collect waste from your body.

320. For how long?

321. Well, with the level of damage we're seeing

322. throughout the colon, indefinitely.

323. I'm so sorry, Howard.

324. I don't understand why you'd suggest the bilateral orchiectomy

325. when you don't even believe Quinn's a girl.

326. I was answering Dr. Lim's question.

327. She said there were no other options, but I found one.

328. - And now we're here. - Yes.

329. You're actually enjoying this scut work, aren't you?

330. Yes. We are being helpful.

331. We're not doing this to be helpful, Murphy.

332. We're doing this because you pissed off Lim,

333. and I'm collateral damage.

334. Okay. We're still being helpful.

335. Doesn't matter.

336. Doesn't matter, competition's over.

337. Is it?

338. We're in here and not with the patient.

339. No face time, plus you calling her a "he", equals crappy survey scores.

340. It's okay. It's a game. It's not important.

341. It is to me.

342. I'm a pariah.

343. These scores are part of our resident evaluation.

344. Our jobs depend on them.

345. Mine does, at least.

346. Then we should do this scut work very well.

347. Finola called.

348. She found an irregularity with one of the tests

349. but wants to re-run it to be sure.

350. Okay, so…

351. We wait until she re-runs it.

352. Marcus, we're both doctors.

353. The results aren't gonna change.

354. I waited too long.

355. It's all my fault.

356. This is the part where you say, "No, babe, it isn't."

357. You had goals, other priorities.

358. You said you supported my career choices…

359. - Just like I supported yours. - I do support you. Always.

360. And I am so proud of you.

361. But it came at a cost that we both knew was possible.

362. We should have started trying sooner.

363. When? When you were 3,000 miles away teaching at Dartmouth?

364. Or, what, when you were chasing down head of surgery?

365. We would have figured it out.

366. "Figuring it out" would have meant me and a nanny raising a baby.

367. I didn't want that.

368. I tried to bring it u four years ago,

369. but you wanted to get your practice up and running.

370. A baby didn't fit in that picture, either.

371. It is not the same.

372. How many pregnant women get hired for anything?

373. Or when they find out a woman's got a child at home,

374. suddenly it's all, "Who's gonna take care of the baby?"

375. No one asks men that question.

376. Well, none of it matters now.

377. Right? Because it's probably too late.

378. And I knew it. I knew this was gonna happen.

379. You've been stewing over this.

380. Resenting me. For how long?

381. I don't resent you, Is.

382. But, you know, if you want me to sit here and tell you

383. that it's not your fault, I…

384. I can't do that, I'm sorry.

385. Li…

386. - Oh. - I love you, my friend.

387. Hey. You like?

388. - That door was locked. - Oh, I know.

389. The cable guy had a cancellation, so he hooked me up,

390. got us a two-for-one.

391. Little thanks for being so chill earlier.

392. Mm, gracias, amigo.

393. So, what kind of doctor are you?

394. - I'm a surgeon. - A surgeon?

395. Your stuff doesn't say surgeon, does it?

396. It's like, uh, Selena and Justin.

397. It doesn't really go together.

398. Furniture's from, like, a dozen different places.

399. Fourteen.

400. Fourteen.

401. The people in Casper knew I didn't have any money,

402. so they gave me things to make a home.

403. The bookshelf is from Jennifer, the town librarian.

404. My table and chairs are from Mr. Grady's diner.

405. The lamp is from Sheryl who teaches Sunday school at Highland Church.

406. Dr. Glassman, he got me my bed…

407. Well, you don't have to tell me the whole list, but…

408. Okay. Yes.

409. Everything I have works. There is no need to change it.

410. Respect.

411. Mm… Hi.

412. - I'm Dr. Glassman. - Hi.

413. - I'm the president of the hospital. - Is everything okay?

414. Sit down.

415. There has been no change in Quinn's condition.

416. However, her grandmother

417. has made a claim of child abuse

418. against you and your husband.

419. She's claiming that putting Quinn on puberty blockers,

420. and, these are her words…

421. "Making her think that being trans is okay,"

422. is a form of emotional and physical abuse.

423. Now, just to be clear,

424. we don't believe any of these allegations

425. have any merit whatsoever.

426. I know my mom, okay? She's not gonna drop this.

427. She'll go to court.

428. Could she get custody?

429. Well, she could try, but, uh, Dr. Lim would testify.

430. - They could put her in a foster home. - Hey.

431. Ty, she won't make it.

432. If we let Quinn do the surgery she wants now, it'll all be over.

433. There will be no reason for Ruth to fight us.

434. Yeah?

435. Yeah.

436. Do what Quinn wants.

437. Do the bilateral surgery.

438. There is an issue.

439. Your tests confirmed abnormalities in the semen parameters.

440. - I beg your pardon? - The semen analysis.

441. It showed that you have a low sperm count and low motility.

442. - It's my fault? - No.

443. We… We do not speak in terms of fault.

444. 15% of all couples struggle with infertility,

445. and of those, 50% have a male factor component.

446. It's not great news, but it's not a dead end.

447. So what's the next step?

448. I'm gonna refer you to Dr. Arjun Dhillon.

449. He's an excellent urologist, and he'll give Marcus a full physical,

450. do some blood work, and an ultrasound.

451. - That can't be right. - Marcus.

452. - It can't be right. - Marcus. We got this. Okay?

453. We're gonna get through this together.

454. Hey. Hey!

455. Why didn't you tell me Howard's labs came back?

456. I should have been there when you broke the bad news to him.

457. So Melendez could see your touching bedside manner?

458. - It doesn't matter anyway. - Oh, it doesn't? How the hell not?

459. The poor guy's getting a colostomy.

460. There's no way we're winning this competition.

461. You really have no sympathy for what Howard's going through.

462. It's a major bummer, no doubt.

463. But we don't have time to get emotionally invested

464. in every patient that we treat.

465. Our job is to go in, do the surgery, and get out.

466. Afterwards, his poop, someone else's poop, it's not our problem.

467. Hey, well, wait.

468. What if we could get Howard a fecal microbiota transplant?

469. FMT for a surgical case?

470. Theoretically, we transfer healthy feces to him,

471. it restores good flora to the body, kills off the CDI,

472. and he avoids surgery altogether.

473. We could actually win this thing.

474. I'm gonna pull all the research before pitching it to Melendez.

475. So, this meeting is called

476. a Challenging Patient Consultation Process.

477. The name sucks, but there are things about it I do like.

478. All you got to do is talk and listen

479. and try to understand each other.

480. What's to understand? Ruth accused us of being child abusers.

481. And what's to discuss? We are Quinn's parents.

482. We get to make her medical decisions.

483. What if Quinnie's better off as a boy?

484. You have no idea what Quinn has been through.

485. Every kid goes through rough patches.

486. Every kid is confused.

487. Quinn has always told us exactly who she was, ever since she was three.

488. So you let Quinn play with dolls. Big deal.

489. You don't make life-altering decisions because a child wants to be a princess.

490. We used to let Quinn do whatever she wanted at home.

491. But when she went out in public, we made her present as a boy.

492. It felt false to her.

493. She hated it.

494. She hated herself.

495. She became reclusive, depressed.

496. And then a year ago, Quinn tried to kill herself.

497. Sorry I'm late.

498. Howard might not need the colostomy

499. if we give him a fecal microbiota transplant.

500. Hasn't the FDA gone back and forth on that?

501. We could be introducing new bacteria into his system that could kill him.

502. The likelihood of that is low.

503. But not zero.

504. But if we do the colostomy, we may not really be helping him.

505. 15 to 30% of patients get recurrent CDI after the initial bout.

506. That's a good point.

507. I believe 65% of that time, recurrent CDI becomes chronic,

508. which can lead to repeated hospitalizations and death.

509. Are my numbers right, Claire?

510. Yes.

511. But recent studies show better than a 95% success rate with FMTs.

512. Howard is a good candidate.

513. We should try it before he develops a toxic megacolon.

514. Don't we owe it to him, to his twins,

515. to at least try an experimental treatment

516. before doing an invasive surgery which will alter his life forever?

517. You're right. Prep him for the procedure.

518. I appreciate your passionate advocacy for your patient.

519. Good work, both of you.

520. - Oh, now you're a team player. - When it benefits me, yes.

521. Speaking of which, while you were doing your research,

522. I found Howard a match at the stool bank.

523. - Sample arrives in a couple of hours. - Great.

524. I let them know you'd be the designated doctor

525. to handle the medical chain of custody when the sample arrives.

526. So?

527. So you're the only person who can handle the sample.

528. You'll have to dilute it, blend it, strain it all on your own.

529. To safeguard against cross-contamination, of course.

530. Of course.

531. Your temperature and BP are normal.

532. Normal, whatever that means.

533. Typical. Usual.

534. Expected.

535. Yeah, I don't feel like any of those things.

536. What does it feel like to be a girl?

537. Are you angry? Was that an inflammatory question?

538. I'd rather people ask questions instead of pointing and staring.

539. When I used to look like a boy,

540. I felt different.

541. The kids at school didn't understand me, so they picked on me.

542. I spent a lot of time alone.

543. When my parents let me be me,

544. I felt like I didn't have to pretend anymore.

545. I felt free, like when you're in a pool and you just let go and float.

546. I'm not a very good swimmer.

547. I don't know what it feels like to be anyone but me.

548. Me, too.

549. Is the bilateral more risky than the unilateral surgery?

550. The big issue with the bilateral is

551. Quinn will never be able to have biological children.

552. If Quinn's parents think that Quinn's mature enough

553. and strong enough in her beliefs,

554. then they should do it now.

555. It's an elective surgery on a child.

556. There is no medical necessity.

557. Except with a previous suicide attempt, she's still at risk.

558. Her situation is different now.

559. She's socially transitioned and living as a girl.

560. But there just isn't enough good data on trans kids and their outcomes.

561. On the other hand,

562. there's very good reason to preserve future fertility.

563. Dr. Lim and Dr. Andrews are both very excellent surgeons,

564. and they very clearly have some passionate points of view,

565. but their views are their own.

566. You all need to decide what's best for Quinn.

567. Whatever we decide,

568. Quinn is still gonna be a girl.

569. I don't know if I'll ever be able to accept that.

570. I know that makes me sound horrible.

571. I know what it's like to not put your family first.

572. And it cost me.

573. It cost me a great deal.

574. And if I had to do it all over again, I'd ask myself,

575. "Is it really worth sacrificing a life

576. with someone I love

577. over an idea that may never be?"

578. Why don't we give them the room?

579. Hey. I got the page. What's going on?

580. She started screaming in pain and vomiting. Temp's 104.

581. Increased groin pain could be attributed to

582. epididymitis, kidney stones, inguinal hernia.

583. The extra weight of the tumor could be causing

584. the testicle to twist on itself.

585. There'd be no blood flow.

586. Thank you.

587. She has a testicular torsion. She needs surgery now.

588. Excuse me. Have you made a decision?

589. Not yet. I mean, there's a lot to work through…

590. We need one now.

591. Quinn has testicular torsion.

592. The spermatic cord is twisted and cutting off blood supply.

593. We need to operate.

594. If you want Quinn to live the way she wants,

595. don't limit her future now.

596. You heard her when my mom said she might want kids someday.

597. She can't even fathom the thought because she's just a child.

598. Just do what's medically necessary.

599. Doesn't appear to be any palpable lymphadenopathy.

600. It's likely a stromal tumor, but get that to pathology right away.

601. Yes, sir.

602. Quinn has tachycardia and hypotension.

603. - I'm not seeing any bleeding. - EKG's normal. It's not coronary.

604. CO2 and O2 are normal, so it's not a PE.

605. It must be a reaction to the anesthesia.

606. I'm already pushing fluids and vasoconstrictors.

607. Six syringes in, and no sign of leakage.

608. Okay, we're wrapped up here.

609. Let's get Howard into recovery.

610. - Well done. - Thanks.

611. I was thinking of writing up the procedure,

612. possibly submit it for publication?

613. I'd be happy to assist,

614. seeing as I've done it before.

615. Thanks, but I think I can…

616. I read your paper in AMSURG, Dr. Reznick. You continue to impress.

617. Coming from you, I take that as a huge compliment.

618. When you get a chance, Dr. Browne, you should read it.

619. Will do.

620. I've given vasopressors and reduced her meds as much as I can.

621. She's losing volume somewhere.

622. It was dry when we ligated the spermatic cord.

623. I'm still not seeing the bleed.

624. Could be vagal stimulation from the severed nerve.

625. But she's not responding to epi. Sepsis?

626. It's too early for an infection.

627. Her MAP is 20. She's barely profusing.

628. All right.

629. Okay, excuse me, guys.

630. - You're breaking scrub. - I'm so sorry.

631. Grey-Turner sign.

632. Could be a retroperitoneal hemorrhage.

633. Jared could be right.

634. It is possible that there is internal bleeding.

635. The testicular artery can retract up into the pelvis.

636. It's rare, but it can happen.

637. Rare is an understatement. Dr. Andrews?

638. I don't think we have any other choice. We need to do an ex-lap. 10 blade.

639. Murphy, retract.

640. Internal bleeding. Jared was right.

641. - Nice call, Dr. Kalu. - Thank you, sir.

642. Kalu, suction. We need a clear view of the field.

643. Fever's down, and the flora in your system seems to be returning to normal.

644. - We expect a full recovery. - Thank you. For everything.

645. Do you know when I can have visitors?

646. I thought you might ask that question.

647. There are a couple of eager preschoolers who'd like to say hi.

648. - Oh. Keira! Sammy! - Daddy!

649. Oh, I think you guys have grown.

650. Hey. Hey, these are the doctors that saved Daddy.

651. Dr. Reznick, and this is, uh, uh, uh…

652. I'm sorry, I forgot your name.

653. Dr. Browne.

654. - Thank you! - Thank you!

655. You're welcome.

656. Okay.

657. Who's this guy?

658. - Bear Bear. - Bear Bear?

659. Did you do it? Did you remove both?

660. No. Just the cancerous one.

661. What? Why not?

662. That's on me.

663. I couldn't, in good conscience, remove a healthy organ.

664. Quinnie, this was our decision.

665. - No! You said you were on my side. - Hey, we are.

666. Always.

667. We haven't had enough time to talk,

668. not with each other, with your therapist, with your doctors.

669. So I'm gonna turn into a boy?

670. Not right away.

671. Your endocrinologist will talk to you

672. about the right timeline for starting feminizing hormones.

673. You know…

674. The thought of having your own kids someday is a big decision,

675. but you never know what you will or will not want once you get older.

676. Cis people are always so worked up about having bio kids.

677. If I really want a kid that bad, I can just adopt.

678. You know, I'll be back when I'm 18 for my gender confirmation surgery.

679. And when you do, I'll be here to help you.

680. Patient satisfaction survey scores are in, and it was very close.

681. Not really. She's being kind.

682. Congratulations go to Dr. Reznick and Dr. Browne.

683. - Yes. - Thank you.

684. - Congratulations. - Thank you, Shaun.

685. Claire and I make a nice team.

686. - You should be psyched. - Yeah. I should be.

687. To the victor belong the spoils. Pay up.

688. Oh, humility was never your strong suit.

689. Thank you, Mortimer.

690. Don't spend it all in one place.

691. Spend it? I'm gonna frame it.

692. What made you think of a retroperitoneal hemorrhage?

693. Homework. You were right.

694. Prepping for an SDA was important.

695. We make a good team.

696. Quinn doesn't like pink.

697. - Oh… - Uh, I think she will like these.

698. I hope so.

699. She's more of a purple girl.

700. Did you read Morgan's AMSURG article yet?

701. It is on the top of my to-do list.

702. I didn't tell you to read it to rub it in.

703. I told you to read it so you knew what you'd be up against.

704. You think I need to be more cutthroat?

705. No. That's Morgan's MO. You're different.

706. You're smart, you're special.

707. Rise up, play the game on your own terms.

708. Don't wait for it.

709. I heard you saved Quinn's life.

710. Jared and I did. I like her.

711. "Her."

712. So you get that she is a "she"?

713. I have lots of questions.

714. Yeah, well, questions are good.

715. Leads to awareness and understanding.

716. And, who knows, maybe even acceptance.

717. Being a kid is tough enough, but being a trans kid?

718. Oh, man, that's off the chart.

719. I can't imagine how it must feel to be so

720. different on the outside than you are on the inside.

721. Hey, Shaun. I can give you a lift.

722. Mm…

723. We could grab a bite.

724. You said you can't be my friend.

725. So, no, thank you.

726. Okay.

727. - Hey, amigo. What's up? - I need your help.

728. You're not gonna do any laps or nothing?

729. No.

730. Then what are you doing?

731. Understanding.