The Good Doctor 1x8

1. You won't believe the crap Armen pulled last night.

2. He cut the power to my apartment. That's right.

3. No lights, no Wi-Fi, nothing.

4. For 15 minutes.

5. And if I'd have been on a ventilator,

6. I could've suffocated in that time.

7. Right? You're a doctor.

8. You're not on a ventilator.

9. Thank God for that. But I could be.

10. I mean, it was dark. I could've tripped.

11. I should sue him.

12. Sorry, were you gonna eat this? I stress eat.

13. Okay, listen, I go to talk to him

14. and he claims that I was playing my music too loud again.

15. I wear earplugs when your music irritates me.

16. I miss the dripping.

17. You're missing the point here, Shaun.

18. Okay, you knock, you ask. You don't cut someone's power.

19. You'd knock, right?

20. Of course you would knock. Any normal person would.

21. I mean, am I crazy, or is he a total sociopath?

22. You should get headphones.

23. Headphones?

24. They would eliminate the sound—

25. Yeah, yeah, yeah. I got it. Thank you.

26. Thank you for being so objective about this.

27. In fact, why don't you go help Armen write my eviction notice?

28. Yeah, and I'll never drive down that street again.

29. It was a pretty bad memory.

30. Yeah? But that sounds quite fun, I mean…

31. It's kind of hot for a hike, isn't it?

32. We're hiking. We're gonna sweat. It happens.

33. All right, don't do nothing stupid. Open the register.

34. Put everything in a bag. Come on, right now.

35. Hey. Don't move. Give me your wallets, phones, everything.

36. Keep your hands where I can see 'em.

37. I said get out your wallet!

38. Do it now!

39. Wallet, now!

40. Is he okay?

41. We don't know. This was routed through Basecamp.

42. They said Shaun was there, but they didn't say if he was hurt or not.

43. Well, EMS has two critical inbounding.

44. Their hands are a little full to chat right now.

45. Twenty-year-old female, single gunshot wound to the abdomen.

46. Hypotensive and tachy. Two liters of saline en route.

47. Her name's Avery.

48. We'll take good care of her. Jared, you're with me.

49. Blunt-force neck injury. Oxygen sats just dropped below 80.

50. Trachea's crushed.

51. I inserted a laryngeal mask, but the airway is not secured.

52. Are you okay? You weren't hurt?

53. His oropharyngeal anatomy is distorted from the contusion.

54. Subcutaneous emphysema. He's barely moving air.

55. Let's take him to a bay. And get me an OR. Now.

56. I need four units O-negative. Type and cross her.

57. She has decreased breath sounds on the left.

58. Let's get a chest X-ray on her.

59. What the hell is he doing here?

60. It's his fault.

61. This is all his fault.

62. Yeah. Clerk says the guy entered, shouted orders,

63. and apparently, your doctor didn't comply.

64. Girl gets shot and the store clerk

65. clocks the gunman with a bat. That's all we know.

66. All right. What do you need?

67. I need forensics on the gunman and the girl.

68. All right, we'll let you know what we find out.

69. Hey, the police are gonna wanna talk to you. After that, you can go home.

70. I should be helping. My shift is just starting.

71. You were at the shooting. I don't have time to hold your hand.

72. I don't like my hand being held.

73. Small-caliber bullets.

74. They ricochet inside.

75. They can cause multiple and unpredictable injuries.

76. BP's 90 over 50.

77. And what do we need to do about it?

78. Chest and abdominal X-rays,

79. and a focused assessment sonogram.

80. Could use your help over here, Dr. Melendez.

81. Are you okay?

82. Yes, I'm fine.

83. - You're with me. Get a gown on him. - Okay.

84. Entrance wound is down here.

85. The bullet fractured the pelvis on the way in.

86. All right, let's look for an exit wound. We're gonna roll her on three.

87. One, two, three.

88. Right, got it. Between the second and third rib.

89. She's hemorrhaging here, too.

90. Murphy, get us the ultrasound

91. so we can find out what's inside.

92. Focused assessment with sonography and trauma.

93. No chest contusions or secondary injuries evident.

94. Oxygen sats 70.

95. I can't squeeze the camera past this collapse.

96. OR Three's prepped and ready, but that's it.

97. We've got a full house right now up in surgery.

98. - Next show time's 15 minutes out. - I could use it.

99. I gotta get this bleeding under control.

100. What's the status on your guy?

101. Take her up. Take the gunshot.

102. Hold on. This airway's so damaged,

103. I can't even do a tracheotomy.

104. He's got five minutes until anoxic brain death.

105. Mine's got pressure. I'll see what I can do here.

106. You're scrubbing in with me.

107. Go ahead and feed the tube under the collapsed trachea.

108. Starting high-flow O2.

109. And we're good.

110. Now that our patient is actually breathing,

111. we can realign and repair. Four-O on a driver.

112. Scissors, sponge stick.

113. It's a slippery thing letting your feelings about a patient

114. influence your medical judgment.

115. I didn't.

116. I get the instinct. She's a victim, he's a shooter. A racist.

117. Often, we don't even know we're doing it.

118. I would never let my personal feelings impact a patient's care.

119. She was bleeding out.

120. And this guy just drew his first good breath 30 seconds ago.

121. They were both critical.

122. He was dying. You were wrong. Own it.

123. You know as well as I do that that was not an easy call to make.

124. - Do I? - Yes.

125. Clear the field, Dr. Browne.

126. Not my operative field, the surgical field. Scrub out.

127. Excuse me?

128. You're done. Step out of my OR.

129. Gail, can you please relieve Dr. Browne of her instruments

130. and page Dr. Cleland to assist me?

131. Now, isn't this more pleasant?

132. Aside from the spleen, what else are we dealing with?

133. The bullet ruptured her transverse colon at the splenic flexure.

134. Put it on our to-do list.

135. Why does her boyfriend think it's your fault?

136. It punctured her diaphragm here and entered the posterior chest.

137. - She's bleeding again. Clamp the hilum.

138. I already did. It's too damaged to hold.

139. Gauze.

140. Hold this right there. Don't let go.

141. No, this isn't gonna work.

142. It's gonna be like sewing ground beef back into a steak.

143. All right, new plan. She's gonna have to live without her spleen.

144. Metzen and pick-up.

145. I need a ligating suture around the splenic artery while I make the cut.

146. Can you do that for me before this young lady bleeds out on us, Murphy?

147. Yes.

148. Okay, let's move on to the bowel perf.

149. Shaun. Thank God you're all right.

150. I just heard what happened.

151. Shaun? Are you all right?

152. Yes. I wasn't injured.

153. What happened this morning?

154. Lea ate my apple.

155. No, Shaun, at the store this morning.

156. What happened at the store?

157. Wallet, now!

158. - I can't. - Why the hell not?

159. You said keep my hands where you could see them.

160. My wallet is in my pocket. You can't see my hands if—

161. Are you trying to be a hero?

162. I'm a surgical resident.

163. Hey. Hey. Shut the hell up.

164. - Okay. Okay. Okay. - This isn't a game, man. I'm serious.

165. Put your damn phone and wallet on the ground. Right now!

166. Hey, do you see this, man? I am not playing around.

167. Just put your phone and wallet on the damn ground.

168. Come on, man. Just do what he says.

169. Please listen to him.

170. Shut up! Just shut up and get on your knees.

171. Put your hands and knees on the ground.

172. - Yes. - Get your wallet out right now. Hey!

173. I will shoot your crazy ass,

174. - I swear to God. - Okay.

175. - Are you listening to me? I'll do it! - Yes.

176. - Hey! You hear me? Hey!

177. - Oh, my God.

178. Okay, you need to take the rest of the day off.

179. Dr. Melendez said that, too. Why?

180. Why? Because you just experienced a traumatic event—

181. - It's not my fault. - I know that.

182. Avery has multiple injuries. Dr. Melendez wants me to monitor her.

183. Dr. Lim.

184. I was out of line. I shouldn't have argued with you…

185. Primary closure went well.

186. We'll extubate him in a few hours to prevent any further internal damage.

187. Oh, that's good.

188. It is. And you're gonna make sure he stays that way.

189. You'll be baby-sitting him tonight in the ICU.

190. I'm… I'm not on call.

191. Great, then you're available.

192. It should be a quiet night.

193. Just want to keep an eye on those vitals.

194. You never know with trachea tears.

195. Can't one of the ICU nurses do that?

196. Yep, but they didn't lip off in my operating room.

197. And he'd better be breathing in the morning.

198. Excuse me, but why is Shaun on the victim's case?

199. I assessed him and he seemed perfectly capable.

200. You assessed him? What does that mean?

201. You asked him how he was feeling? Are you psychic?

202. Do you have an advanced degree in psychology?

203. You don't know what's going on in his head.

204. When I'm in surgery,

205. my focus is on the person whose guts are open in front of me

206. rather than the soul of the person standing across from me.

207. And it seems that Shaun doesn't let anything impact his work.

208. So along with his photographic memory,

209. I'm putting cold-hearted in the plus column.

210. Dr. Murphy, do you understand why you're here?

211. Yes. Dr. Glassman said I had to talk to you.

212. After any doctor goes through a potentially traumatic—

213. You have to determine if I am a medico-legal liability to the hospital.

214. Yes. And, more importantly,

215. it's an opportunity to provide you with emotional support.

216. How are you feeling?

217. You don't have apples.

218. I'll try to have some fruit next time we meet.

219. Good.

220. Do you regret anything about this morning?

221. Why?

222. After bad things happen,

223. it's perfectly normal to replay the events,

224. wishing you'd done things differently.

225. It already happened. I can't do things differently.

226. Is talking about this upsetting you?

227. What are you thinking about right now?

228. Systemic inflammatory response syndrome.

229. Surgery went well.

230. After a serious trauma like this, the body can develop

231. a self-destructive inflammatory reaction.

232. Kidneys, liver, lungs, heart.

233. Any, or all of them, can start to shut down.

234. We'll be giving her anti-inflammatories

235. and monitoring her closely, but the next 24 hours are critical.

236. Okay. Thanks. Just get her through this.

237. Whatever you gotta do.

238. Yeah, well, I need consent forms

239. from your girlfriend's next of kin.

240. If you could please get her family in here as quickly as possible.

241. I can't.

242. I don't even know her last name.

243. It was our first date, we met on a dating app.

244. We were going hiking, so she wasn't carrying a purse or ID.

245. Well, then you really don't need to be here.

246. Someone out there cares about her.

247. If she dies, I want them to know someone was with her.

248. I'll have social work try to locate her family.

249. Stay as long as you want.

250. It looks clean, dry, and healthy.

251. My neck is killing me.

252. How long have you been using?

253. What's that got to do with anything?

254. Well, you've likely built up a tolerance to pain meds.

255. And now that you really need them, they aren't there for you.

256. That's why I need fentanyl,

257. 100 micrograms. Are you gonna help me or not?

258. I wouldn't be helping.

259. The worst thing I could do for you is feed your habit.

260. What?

261. You saw my tattoo.

262. Yeah.

263. And now you're punishing me.

264. - You want this to hurt. - I am treating you professionally—

265. If you were treating me professionally, I wouldn't be in so much pain.

266. - I'm sorry, but I won't— - Just give me the damn drugs!

267. Come on!

268. Melendez thinks that he's okay being on Avery's case. I don't.

269. Dr. Melendez may be right.

270. That case seems to be Shaun's primary focus right now.

271. Maybe his condition is a blessing in this situation.

272. "Maybe"?

273. Or obsessing over Avery's health

274. could be his only outlet for a guilty conscience.

275. Watching her suffer could just be worsening those feelings.

276. So either it's a huge problem, or it's not a problem at all.

277. This is your professional opinion?

278. Shaun has a very unique mind and an incredibly introverted nature.

279. Well, thank you for that.

280. I'm sorry, but without a lot more time with him,

281. that's the best I can offer.

282. What did Lim expect me to do?

283. Stand there and smile while she called

284. my medical judgment into question?

285. Your patient nearly died waiting on that OR, right?

286. It was bad. What do you want me to do?

287. - Tell her to back off. - No.

288. - He's a complete and utter— - Not one of those nice racists?

289. - I shouldn't have to be— - Claire…

290. here's what you have to do.

291. Shut up and do exactly what Dr. Lim tells you to do.

292. But, it—

293. Yes, sir.

294. Maybe we could take turns.

295. You keep an eye on my patient, I keep an eye on yours.

296. - No.

297. Her creatinine is 1.6.

298. A mild bump in renal numbers isn't surprising

299. after all her trauma.

300. This morning must have been crazy.

301. Are you okay?

302. This morning, my neighbor Lea came over and ate my apple.

303. That's too bad.

304. Yes, it was my last one.

305. She was upset with Armen, our landlord.

306. She plays her music very loud. I gave her some advice.

307. It seemed to anger her because she left without saying goodbye.

308. And you think you did something wrong?

309. No, it was good advice.

310. Shaun, sometimes a woman wants advice,

311. and sometimes she just wants support.

312. How can I tell which one Lea wants?

313. Err on the side of support.

314. - That's not helpful. - Yes, it is.

315. Dr. Browne, you're being summoned.

316. All right.

317. About time.

318. All your struggling, you've pulled out your IV.

319. Aren't nurses usually supposed to do this kind of crap?

320. They let you go to med school,

321. but they don't trust you with any real responsibility.

322. There must be a competent doctor tucked around here somewhere

323. who can tell someone I need more than aspirin.

324. - "Competent"? - Yeah. You know what I mean.

325. Imhotep was the father of modern medicine. An Egyptian.

326. Yeah? Good for your people.

327. I'm willing to bet there's even been a couple of others

328. over the last 3,000 years.

329. But guess what? On average,

330. you look at most great technological advancements,

331. you'll find a proud Northern European holding the patent.

332. That's what you were trying to do this morning?

333. Get the patent on stealing 30 bucks from the corner store for a drug fix?

334. You don't like drug addicts, do you?

335. There's a lot of people I don't like.

336. Thieves, racists, violent punks. But I'll treat 'em.

337. Was your momma a drug addict?

338. Wow.

339. That's the beauty of cliches, is they're true so often.

340. You don't know anything about me.

341. I didn't go to college.

342. I didn't have no affirmative action to get me in, but you did.

343. All because some bleeding-heart liberal in the dean's office

344. teared up reading your essay about your crack-whore momma.

345. - What the hell?

346. I guess we're all violent punks.

347. All you had to do was give him your wallet.

348. Her urine output is low.

349. Whoa! Whoa! What are you doing? Get away from her!

350. Hey, hey! You can't be in here shoving my doctors around.

351. Me? He's the…

352. Oh, my God.

353. She needs dialysis. Her kidneys are failing fast.

354. This is the first stage of total organ failure.

355. We removed two liters of excess fluid with dialysis,

356. but she's getting worse.

357. Fluid's building up in her chest.

358. She's in pulmonary failure, too.

359. Draining the fluid in her pleural space

360. would reduce airway resistance.

361. Yeah. Let's prep her for a thoracentesis.

362. We're gonna have to work fast.

363. I'll prep the evac drain.

364. I'm gonna need you to put that needle right between—

365. Sixth and seventh rib.

366. - Wait. You're gonna let him do it? - Shut up.

367. Right, careful. Don't put the needle in too deep.

368. - We don't wanna give her— - Pneumothorax.

369. Right, you're in.

370. Now let me see what I can pull out…

371. And, hopefully, she settles down.

372. CO2's down and O2's climbing.

373. We can manage her kidneys and her lungs,

374. but the last stop in multiple organ failure would be her heart.

375. Watch her ventilation pressures like a hawk.

376. Push cardio-protective meds, and page me if anything changes.

377. Think you're being her hero?

378. Fact is, you hardly know her. And you don't know him at all.

379. Go home.

380. - Yep?

381. Okay, I am done. He is a foul-mouthed, spiteful bully.

382. No problem. I'll have the concierge

383. find a patient more suited to your liking.

384. He doesn't need a doctor doting over him. He doesn't want me.

385. I don't care.

386. Look… I am sorry I disagreed with you, okay?

387. But I don't deserve to be scolded like a schoolgirl

388. because your ego can't handle being challenged a little.

389. That is some apology.

390. Look, I had a legitimate—

391. You really don't see the problem here?

392. What? With challenging you?

393. Right now, you are confronting me in front of two nurses.

394. Would you do that to Melendez?

395. Or would you wait five minutes?

396. I have dealt with men undermining my authority my entire career.

397. We shouldn't do it to one another, too.

398. Now go take care of him,

399. like you would any other patient.

400. Hey, hey, hey.

401. Food services, they double-check every order.

402. - What are you looking for? - An apple.

403. - An apple? Who's getting an apple? - I am.

404. - No. - Shaun,

405. forget the apple, please.

406. I'm sorry, can I have a minute?

407. Shaun?

408. Okay.

409. Shaun, there's no need to get defensive, okay?

410. - Do you wanna sit down? - No, thank you.

411. I want you to tell me again exactly what happened this morning.

412. I told you exactly what happened this morning.

413. Yes, but people have told you that it's your fault, haven't they?

414. My actions and the shooting were associative incidents.

415. It is not a causal relationship.

416. I paced and she got shot, but pacing doesn't cause shootings.

417. Otherwise, every time someone paced a shooting would soon follow.

418. Okay, that's a very good point.

419. When someone has a gun and it's a dangerous situation, right?

420. You don't wanna upset the situation, you don't wanna make it worse.

421. You think this is my fault, too?

422. No. No. It was the shoot…

423. It was the shooter's fault,

424. but your actions may have contributed to it.

425. Okay, Shaun, wait a second. Wait a second.

426. I know your behavior is not completely in your control,

427. but I also know it's not completely out of your control. Is it?

428. So, yes, maybe it is a little bit your fault.

429. And definitely… mine.

430. You weren't even there.

431. That's right, I wasn't there.

432. Can we sit down, please? Just for a second.

433. Shaun, I convinced myself that everything was fine,

434. because in here it is.

435. It's great.

436. But you need help.

437. Shaun?

438. You need guidance.

439. Much more than I can give you.

440. I'm supposed to be with my patient.

441. I'm supposed to be watching her like a hawk.

442. It's my fault.

443. I didn't like her.

444. When I first saw her this morning, she just…

445. didn't look…

446. I don't know, I…

447. I mean, I wanted to blow her off, so I said I forgot water.

448. And I figured we'd go to the store,

449. and then I'd pretend that I forgot my wallet.

450. I knew she didn't have her purse, so…

451. You can't go hiking without water, right?

452. I mean, no harm, no foul.

453. She was there because of me.

454. She's here because of me.

455. It's not a causal relationship.

456. Wait, excuse me?

457. It's not a causal relationship. Lying and shootings.

458. Lying doesn't cause shootings, otherwise, every time someone lied—

459. Her pulse pressure is narrow.

460. Wait, what does that mean?

461. She's dying.

462. Page Melendez. Stat.

463. Your respiratory rate is up.

464. Are you having trouble breathing?

465. Yeah, it's tight.

466. Find Dr. Lim.

467. Narrow pulse pressure indicates a reduced cardiac output.

468. The inflammation is affecting her heart.

469. She's in end-stage organ failure.

470. Yes, we can insert an intra-aortic balloon pump.

471. That may reduce some of the workload on her heart,

472. but it's failing fast. Really fast.

473. It only needs to work overnight.

474. The inflammatory reaction will improve after that.

475. What if it's failing so fast because it's not her heart?

476. Her hemoglobin's dropped from 14 to 12 between her last two draws.

477. What if the real problem is she's bleeding somewhere?

478. Given what she's been through, a two-point drop could mean nothing.

479. Or it could mean a bleed,

480. which would account for the narrow pulse pressure.

481. Her heart could be fine.

482. If you're right, that means we'd have to open her back up.

483. I don't know if her body could handle another operation.

484. No, it can't.

485. Treating heart failure with an aortic pump

486. is also a simple procedure.

487. So we're going to diagnose based on which procedure is simpler?

488. If I'm right, there could be no more blood to pump. She'll be dead.

489. She's crashing.

490. We should prepare the cath lab for a pump.

491. We should prepare the OR.

492. Let's get her into an OR. Now.

493. Hemoglobin's dropped to eight.

494. She is bleeding out.

495. Yes, she is. But where?

496. Gotta find where the bleeder's coming from

497. and clip it before she dies.

498. I got nothing.

499. It must be hidden underneath the retro peritoneum or mediastinum.

500. That's a lot of real estate to cut open and just go blindly looking.

501. We should start with the abdomen. She was shot there.

502. The bullet passed through the posterior thorax.

503. BP's 40 over palp. She's dying, Neil.

504. Whatever you're gonna do, you need to do it now.

505. We need to look everywhere. Give me a knife and sternal saw,

506. I'm gonna open her up from chest to pelvis.

507. Prep the sternum and abdomen with betadine.

508. We're gonna need a sponge stick to control the bleeding when we find it.

509. Stop!

510. Open her between the second and third rib on the left side.

511. The bullet nicked the left supreme intercostal artery.

512. The wall has blown.

513. How do you know?

514. I followed the injuries.

515. Pelvis to bowel to spleen to diaphragm.

516. Next target has to be left supreme intercostal artery.

517. All right. Prep the left intercostal space.

518. I can't breathe. Why aren't you helping me?

519. Dr. Lim will be along in just two minutes.

520. You're a damn doctor. Do your job.

521. I can't breathe.

522. I need to open up the left neck compartment,

523. relieve the pressure. Procedure tray.

524. Have you done this before?

525. Nope. Scalpel.

526. It's too swollen, I can't see the Adam's apple.

527. Okay, cut along the soft divot

528. between the carotid sheath and the trachea.

529. Soft divot. Got it.

530. Update me.

531. What did you do?

532. He had a cervical hematoma, I had to relieve the pressure.

533. Here?

534. Oxygen sats are going up.

535. It's rare, but post-op swelling can happen with tracheal tears.

536. That's why we watch them so closely the first 24 hours.

537. You mind if we finish this off in the operating room?

538. I don't see anything, Shaun. No blood and no arterial tear.

539. You're too high. It's near the bifurcation.

540. Get some light in.

541. I got something. Blood's pooling

542. right under the bifurcation. Clamp, now.

543. She wasn't in heart failure.

544. That means her heart is still strong enough to get her through the night.

545. I was wrong.

546. Yeah, and you just made up for it.

547. You were right, Jared.

548. Good work.

549. You know what? You were right, my mother had problems.

550. So I couldn't afford to sit around

551. expecting everything to be handed to me,

552. or whatever else it is that's holding you back.

553. And yeah, I got some breaks. But I worked my ass off.

554. Two jobs, two roommates, every step of the way.

555. And that is what got me to the place where I could save your life.

556. Your daughter's not out of the woods yet,

557. but I do expect her condition to improve day by day.

558. - Thank you, Doctor. - Thank you.

559. You're welcome.

560. Hey. Avery.

561. Sorry we weren't here for you.

562. How are you feeling?

563. I probably won't be hiking any time soon.

564. Hey.

565. Are you sneaking out before I can thank you?

566. Please, you don't need to thank me.

567. Yeah, I do.

568. And apologize.

569. I was wrong about you.

570. I thought you were trying to ditch me.

571. I was hoping you were trying to ditch me.

572. I'm sorry.

573. When you're feeling better,

574. I'd like a second chance at a first date.

575. I'm sorry.

576. You were right. I publicly disrespected you.

577. And so I thought it only right to publicly respect you.

578. I am grateful for the chance to learn from you.

579. I know you needed this victory.

580. Glad you saved a life today.

581. Just wish it wasn't a Nazi.

582. Lane number two.

583. Maddie always took that lane.

584. She'd tuck in behind me and draft until the last 200 meters.

585. It's a dirty little trick.

586. - And it worked. - Every time.

587. Thirteen years ago today.

588. Yeah.

589. I miss her, too.

590. I gave her space.

591. Right? I gave her space.

592. And she just drifted farther and farther away.

593. Everything I did, I did wrong.

594. You did your best.

595. I was practically living…

596. …at your house back then.

597. And, I mean, if I hadn't…

598. You were both…

599. …teenagers. You were idiots.

600. You got lucky, she didn't.

601. If I… was there more,

602. if I… stayed on her…

603. You're there for him.

604. Here's your extended forecast for the week.

605. Starting off with a little bit of cloud cover in San Francisco…

606. …expect dry conditions for the next seven days here in—

607. I, uh… saw your light.

608. I'm sorry.

609. Claire told me to apologize because you didn't want me to tell the truth.

610. You only wanted me to support your position,

611. even though it's wrong.

612. Well, I don't accept.

613. I may have overreacted this morning.

614. A little.

615. And you were honest.

616. Brutally honest,

617. but you shouldn't have to wear earplugs in your own home.

618. And don't start lying to me to make me feel good.

619. You're the only honest guy I know.

620. So…

621. Have a good night, Shaun Murphy,

622. and I will try not to keep you up.

623. I made a mistake today.

624. And someone got hurt.