1. Severe Winter Weather Advisories
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2. have been issued from Kansas to western Minnesota.
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3. Severe ice and snow reported.
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4. Temperatures will likely reach below 20 degrees, and wind chill...
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5. Shaun.
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6. Shaun.
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7. Mm. There is a severe weather warning in Minnesota.
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8. You haven't been at work in three days.
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9. I want to be left alone.
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10. I'm sorry she hurt you.
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11. But you are strong.
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12. You're the most determined man I know.
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13. You're gonna get through this.
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14. I wish I was...
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15. Normal.
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16. Everyone wishes they were normal, Shaun.
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17. You need to get up.
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18. You need to do your exercise routine,
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19. then shower, shave, and get to work.
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20. And not because your patients need your help,
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21. but because it'll make you feel better.
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22. I'm not leaving without you.
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23. Your sleep apnea is worse than we'd thought.
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24. You have a condition related to your pseudoachondroplasia
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25. that is narrowing the base of your skull
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26. and compressing the part of your brain
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27. that controls your breathing.
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28. People always say I'm too full of myself.
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29. Guess it's actually true.
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30. Finn, this is serious.
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31. Don't worry. I'm gonna be fine.
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32. DR. We can remove bone from the wall of your skull
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33. and resect a small section of your cerebellum
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34. to reduce brain-stem pressure.
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35. You're... You're gonna cut out a piece of his brain?
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36. It won't affect your intellect,
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37. but it will cause a speech impediment
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38. and some difficulty with balance.
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39. I'd rather you knock a few points off my IQ.
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40. Stop it.
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41. I'm serious.
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42. My "gift of gab" is what you love about me.
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43. Uh, w-what's option two?
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44. I'm sorry, there is no other option.
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45. I'm a salesman. I don't hear the word "no."
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46. Th-There's always another way.
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47. You just got to think outside the box.
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48. We've already done that,
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49. which is how we came up with this surgery.
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50. It's the only way to keep you alive,
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51. so you have no choice but to accept it.
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52. Dr. Murphy is being rude and insensitive,
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53. but he's also right.
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54. Finn, please, I love you.
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55. And I will always be here for you
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56. no matter how you talk or walk.
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57. But you have to listen to your doctors.
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58. I love you, too.
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59. Do whatever you think's best.
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60. Let me guess.
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61. I'm gonna need another surgery.
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62. What's that now, my tenth?
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63. Eleventh.
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64. And I still can't work the farm,
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65. can't drive a tractor, pull a combine lever.
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66. I can't even twist open a bottle of beer.
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67. When we met, you were in an ambulance
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68. and your arms were still in your harvester.
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69. Today you have sensation and almost full mobility.
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70. Now we just need to treat the neuropathy
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71. and improve your strength.
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72. So how do we do that?
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73. I'm thinking a gracilis muscle transfer.
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74. That should improve his grip and relieve some of the pain,
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75. but there's only one way to eliminate all of it.
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76. Tyson, have you given any more thought to amputation
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77. and osseointegrated prosthetic arms?
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78. They'd attach directly to the bones
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79. and nerves in your forearm,
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80. and you can control them just like your own hands.
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81. Function would be reduced in some respects.
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82. Less dexterity, no sensory feedback.
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83. But others, like grip strength, would be better.
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84. And more importantly, you'd be pain-free.
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85. I want to be a farmer,
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86. not a cyborg.
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87. Okay.
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88. The pain's getting worse.
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89. Probably because I've been crazy busy in the O.R.
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90. with Murphy out till today.
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91. He's back?
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92. Only because Browne went to his apartment
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93. and dragged his ass in.
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94. She shouldn't have done that.
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95. He's trying to work this out on his own.
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96. That's a good thing.
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97. DMARDs aren't working.
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98. I know.
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99. Which is why I've been thinking about synovectomy surgery.
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100. You're gonna remove the joint linings in your fingers?
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101. That'll resolve the pain temporarily.
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102. Then what?
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103. It'll give me at least ten years.
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104. And then you're gonna be bone on bone,
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105. every joint in your hand will be mangled and deformed.
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106. What's your plan then?
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107. Who knows what treatments will be available in ten years?
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108. Have you thought about oncology?
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109. Surgeons do the real work.
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110. They cut out the tumor, they cure the patient.
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111. Oncologists just sweep up after.
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112. You want to know an even better job?
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113. Starting pitcher for the Oakland A's.
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114. You want to know why I didn't get that job?
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115. Because the scouts didn't like the way you wore your hat?
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116. Yeah, that, and I was born with this arm.
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117. You were born with those hands.
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118. What are you gonna do,
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119. practice surgery for a few more years
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120. and then spend the rest of your life
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121. not being able to pick up a pencil?
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122. You can pursue another specialty.
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123. You can practice for the rest of your life.
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124. You get rear-ended on the way to work
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125. or you just hate little people?
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126. Neither. EKG is normal.
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127. So you got dumped.
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128. No, I didn't.
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129. It's nothing to be ashamed of.
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130. We were never even going out.
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131. Finn?
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132. I've been worried sick.
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133. Ohh.
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134. Take it easy.
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135. I told you to stay home.
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136. There's nothing to worry about.
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137. Stop trying to act so tough.
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138. You shouldn't have to go through this alone.
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139. Sorry, baby, but you should wait outside.
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140. Let the doctors finish up, and I'll be right out.
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141. He's not going to the O.R. for a while,
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142. so there will be plenty of time to visit when we're done.
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143. Okay.
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144. I'll be right outside.
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145. Is there any way you could make sure
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146. she and Nathalie stay in separate waiting rooms
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147. and aren't allowed to visit at the same time?
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148. No. We're not helping you cheat.
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149. I'm not cheating.
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150. I've always made it clear I'm not ready to settle down,
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151. but sometimes women m-make assumptions.
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152. Oh, and you don't feel the need to correct that?
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153. I understand you don't approve,
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154. but all I'm asking
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155. is for you to help me get through brain surgery
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156. without emotional turmoil
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157. that I assume would be harmful to my recovery.
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158. Okay.
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159. Thank you.
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160. Are you seeing the same thing I'm seeing?
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161. DR. The tendons are encased in scar tissue.
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162. DR. The gracilis muscle transfer isn't gonna work.
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163. It still could. If we attach the muscle
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164. further down the forearm and bypass the scar ball.
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165. It wouldn't hold.
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166. There'd be too much tension on the graft.
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167. We can figure out a way to work around that.
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168. Let's wake him up and put him back in his room
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169. and pull every paper on free-muscle and nerve transfers.
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170. His only option is double amputation
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171. and the osseointegrated prosthetics.
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172. We don't have a choice.
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173. Yes, we do.
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174. And as Chief of Surgery, I just made it.
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175. He doesn't really look the part.
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176. He's a handsome guy with a great sense of humor
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177. and a high-paying job.
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178. He means because women don't like
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179. to be in relationships with men who are weird.
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180. He's not weird. And neither are you.
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181. And a week ago, you were juggling two women,
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182. so stop feeling so sorry for yourself.
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183. Have you ever dated anyone who wasn't tall,
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184. handsome, and neurotypical?
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185. It's not about me.
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186. DR.Talk to me. He stopped breathing,
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187. and I haven't even administered the paralytics.
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188. What just happened?
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189. DR. Pressure on the medulla must be getting worse.
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190. He's lucky he didn't wait any longer to come in.
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191. Let's tube him and get to work.
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192. Wait. Flex his head into position again.
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193. Extend his neck.
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194. What's going on?
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195. Flexing the neck offsets the posterior compression.
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196. But that should take the pressure off, not make it worse.
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197. DR. Doesn't make any sense.
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198. And we're not gonna do brain surgery on him until it does.
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199. I don't see anything different in the flexed-neck views.
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200. Should his C2 bone be curved inward like that?
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201. It could exacerbate the narrowing on the front of his...
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202. It's not significant.
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203. Well, if his apnea's getting worse
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204. because of pressure from the front as well as the back...
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205. The treatment is the same.
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206. Surgery to create more room in the skull base.
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207. It's not the same, and stop interrupting me.
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208. If we drill off the C2 in the front,
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209. as well as open the back,
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210. we might not have to resect the cerebellum.
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211. He wouldn't have any speech impediment or balance issues.
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212. We'd have to approach through his mouth,
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213. a bacteria-rich environment,
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214. which can't be fully sterilized.
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215. There would be too high a risk of a post-op brain infection.
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216. So we figure out another approach.
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217. There's only one safe way to access the C2.
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218. Okay, so come up with something outside the box.
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219. No, that's a stupid expression. There is no box.
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220. And you are wasting valuable time
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221. just because you want to be nice to her.
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222. Murphy...
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223. We should do the cerebellar surgery before he has a fatal apnea...
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224. Murphy.
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225. I'm not being nice.
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226. I'm using my experience and judgment to make the call.
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227. That's my job.
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228. You are being nice. And you're being a jerk.
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229. You've got the night.
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230. If you two can't come up with a solution by morning,
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231. we'll proceed with the original plan.
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232. Your patient's in desperate need
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233. of an Oklahoma weather report?
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234. I didn't even want to be here today.
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235. You should try a martial arts class.
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236. Focused distraction is key to dealing with stress
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237. and heartbreaks.
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238. That's just avoiding the problem.
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239. Don't obsess over what you've lost,
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240. focus on what you've gained from the relationship.
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241. I hate to interrupt group therapy,
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242. but what if we approached
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243. through the side of the neck?
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244. We could transpose the vertebral artery,
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245. open up the spine laterally to drill off the C2.
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246. It would leave his spine permanently unstable
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247. and could cause a stroke.
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248. There might be a way to mitigate stroke risk.
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249. And he'd still have the instability and...
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250. Come on, Shaun.
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251. I need help, not criticism.
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252. I have always supported you
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253. when you were trying to come up with
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254. an unconventional treatment option.
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255. You supported me when you thought I was right.
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256. What do you guys think?
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257. We gotta go.
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258. We do?
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259. We remove the scar tissue and the nerves.
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260. Then harvest nerves from his upper arm
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261. to rewire his forearms.
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262. It'll improve his grip,
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263. and with the scar tissue removed,
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264. the pain should decrease, too.
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265. Does nothing to solve the blood-flow problem
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266. that's causing the scarring.
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267. I'm sure we can come up with a solve for that.
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268. That's what you said last time.
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269. And I was right. We're making progress.
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270. Would you two give us a moment?
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271. We'll meet you in the Residents' Lounge when we're done.
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272. Are you so against the prosthetics
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273. because you think it's in Tyson's best interest,
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274. or because it's my idea?
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275. You think I care whose idea anything is?
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276. You're a competitive person
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277. working with the guy who used to hold your job.
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278. I'll admit my competitive drive may kick up a notch
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279. when we work together.
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280. I'll also admit that I admire the courage
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281. of a guy who stumbled a half-mile back to his house
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282. after his arms were ripped off by a combine.
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283. He opened a door with his mouth
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284. and dialed 911 with his nose,
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285. and as long as he wants to keep fighting,
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286. I'm gonna fight along with him.
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287. Which has nothing to do with my ego.
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288. Good.
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289. That's all I wanted to confirm.
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290. But I'm gonna start prepping for the amputation
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291. because that's the only rational choice we have,
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292. which I'm confident you'll realize soon enough.
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293. Make any progress?
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294. Yeah, I figured out a lateral approach,
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295. but Shaun thinks it would leave his spine unstable
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296. and increase his risk of stroke.
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297. I agree. Yeah, me too.
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298. There has to be a way to mitigate the...
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299. Dr. Browne?
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300. These just got delivered.
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301. Enjoy. Thanks.
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302. Dash is a romantic.
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303. Thought you hated romantics.
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304. Yeah, he's... He's teasing me.
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305. I told him I thought guys who sent flowers were lame.
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306. We haven't even kissed yet.
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307. What are you waiting for?
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308. I don't know.
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309. Um...
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310. I enjoy being with him.
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311. Actually, I forgot how funny he is.
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312. Just... hasn't seemed like the right time.
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313. I'm more worried about the stroke risk
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314. than spinal instability,
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315. so focus on fixing that.
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316. Okay.
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317. And, Claire, if he's the right guy,
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318. stop holding out for the right time.
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319. Your vitals are stable.
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320. The nurses will monitor you during the night.
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321. Your problem's simple to solve.
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322. You just need to ask someone else out.
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323. Lea was special.
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324. I'm sure she was.
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325. But there are so many others, just as special.
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326. You just have to get to know them.
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327. No, I don't want to.
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328. Yes, you do.
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329. You think I don't know how you feel?
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330. Afraid of being rejected because you're too...
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331. Different.
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332. Finally I decided, screw it.
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333. I started talking to every woman I saw.
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334. Street corners, elevators, grocery stores.
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335. And I learned I'm pretty good at it.
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336. That's my gift.
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337. Everyone has one.
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338. They just.
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339. have to figure out what it is...
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340. Okay. Code Blue!
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341. Code Blue!
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342. Murphy and I just inserted a diaphragmatic pacemaker on Finn.
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343. It'll only trigger shallow breaths,
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344. so he's at high risk for pneumonia.
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345. You got anything?
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346. Yeah, I was thinking of using
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347. a more inferior transatlas approach.
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348. That would minimize stroke risk.
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349. That won't work.
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350. It would destabilize the C1-2 joint.
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351. You did all you could.
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352. Go home.
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353. We'll do the original cerebellar surgery
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354. first thing in the morning.
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355. So I'll be able to work the farm.
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356. We still need to find a way to increase blood flow.
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357. You should regain most of your grip and forearm strength,
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358. but you'd still be in some pain.
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359. I-I can handle it.
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360. Can you?
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361. How can you know for sure?
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362. As the years go by and the pain doesn't stop,
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363. will you change your mind?
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364. Because it'll be too late.
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365. What's wrong? What are you... What are you feeling?
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366. Like a horse just kicked in my chest.
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367. I need an echo and pulmonary cath kit!
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368. And page Lim, stat!
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369. I think the last time that I was at an actual punk-rock show was, uh...
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370. College.
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371. Patti Smith.
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372. Oh, my God!
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373. I completely forgot about that.
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374. You forgot getting your ass tossed offstage
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375. by a 60-year-old woman?
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376. Yeah.
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377. Remember what you said when we picked you up?
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378. Uh, oh, something about her being, uh, thin but strong?
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379. "Thin but wiry."
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380. Wiry. Wiry.
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381. Okay, well, I, um...
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382. I have an early surgery,
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383. so I should probably get going.
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384. Okay. Okay.
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385. Have a good night.
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386. Good night.
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387. I got an idea.
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388. Actually, you had it first.
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389. It's the right approach, just the wrong route.
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390. We go in from the back, posterior transdural,
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391. gently move your spinal cord out of the way
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392. so we can drill off the misshaped C2.
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393. There is a risk of paralysis,
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394. but we would be monitoring your spinal functions
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395. to help avoid any nerve injuries.
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396. Let's do it. Where do I have to sign?
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397. You shouldn't sign anything.
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398. Consenting to this surgery
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399. would be incredibly shortsighted and reckless.
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400. It is one thing to take your bad mood out on your colleagues,
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401. but to try and undermine my surgical advice...
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402. My opinion's valid.
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403. Well, thankfully, he disagrees.
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404. He's risking paralysis to be charming
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405. because people expect everyone to be perfect.
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406. Everyone's opinion is valid
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407. all the way until we go into the patient room.
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408. We are a team with one opinion.
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409. I...
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410. I don't feel better!
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411. I feel worse!
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412. And doing the wrong surgery
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413. is not going to help anyone.
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414. I don't want to do it, I'm going home.
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415. You're not walking out on your patient.
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416. Or your team.
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417. I still have two sick days
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418. and 76 hours of unused P.T.O.
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419. You're not sick, and you're in the middle of a case.
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420. I don't care about the case or the patient.
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421. I don't care about anything.
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422. I've had my heart broken twice
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423. in the last few years.
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424. You want to know what I did?
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425. I came to work every day
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426. and pretended everything was fine.
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427. Until, eventually,
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428. I wasn't pretending anymore.
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429. That's not helpful at all.
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430. How about this?
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431. Go back in there
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432. and help Claire prep Finn for surgery,
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433. or you won't be my resident.
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434. Or anyone else's at St. Bonaventure.
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435. And I know you care about that.
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436. We were able to clear the clot,
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437. but due to the restricted arteries in your arms,
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438. we're gonna need to keep you on blood thinners...
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439. Indefinitely.
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440. Okay.
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441. The blood thinners
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442. make the reconstructive surgery impossible.
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443. We have no choice but to amputate.
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444. I'm sorry.
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445. No.
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446. I'm not letting you cut off my arms.
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447. I don't want false limbs.
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448. I don't want to be that guy.
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449. I want to be who I am.
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450. You are the toughest,
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451. most tenacious person I've ever met.
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452. And that is not gonna change
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453. because we replace your hands with titanium.
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454. It's time to let go.
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455. Okay.
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456. Okay.
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457. Any way you could draw a skull
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458. with a cobra coming out of its eyes while you're back there?
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459. Would you settle for a lame smiley face?
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460. Because that is the only thing I can draw.
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461. There's my favorite nurse.
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462. Did you check out that Ethiopian place
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463. I told you about last night?
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464. Actually, I did,
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465. and the kik alicha was delish.
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466. Now, if you want a truly life-changing meal,
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467. you need to try Lennon's on Sixth.
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468. Is it expensive? Outrageously.
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469. But worth it.
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470. Now, it's all white tablecloths and candles,
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471. so you'll need a date.
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472. How 'bout Dr. Murphy?
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473. You told me yourself he's a gifted surgeon.
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474. That's pretty high praise.
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475. And he told me you're cute.
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476. Good luck today.
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477. Thanks.
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478. I totally teed you up.
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479. All you had to do was take a swing.
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480. I'm not interested in her.
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481. If she's not your type,
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482. I'm sure there are plenty of other cool nurses
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483. roaming around here
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484. who could make you feel better about yourself.
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485. He's miserable because he's had two relationships blow up.
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486. I don't think jumping into another one is the answer.
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487. No, no, no!
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488. Finn, you can't exert yourself like this.
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489. Just take it easy.
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490. I ran into a woman in the cafeteria.
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491. Real nice. But seemed stressed.
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492. Turns out that her boyfriend
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493. is having spinal surgery, too.
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494. Big coincidence, huh?
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495. But get this.
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496. He also has pseudoachondroplasia.
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497. I mean, what are the chances?
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498. Nathalie, don't you dare.
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499. Stop!
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500. Just slow down.
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501. You called me the love of your life!
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502. I do love you!
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503. Don't say that!
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504. I don't want to hear any more of your garbage.
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505. Please...
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506. You have to... listen.
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507. You need to get back to bed now, or you'll pass out.
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508. DR. What's up?
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509. What are you doing in here?
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510. Once you get a patient on the table,
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511. there's too much going on
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512. to appreciate what this place is.
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513. Mm. It's nice.
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514. It's perfect.
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515. Time to scrub in.
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516. This will be my last surgery.
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517. Five months ago, I was diagnosed with rheumatoid arthritis.
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518. I'm not responding to medication.
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519. Why did you do that?
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520. I felt like it.
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521. It didn't change the fact that he cheated on you.
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522. It won't make your life any better.
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523. You can't control how you feel about someone.
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524. But you can control what you do with those feelings.
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525. I ended the relationship on my terms.
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526. More importantly...
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527. It made me feel better.
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528. A Louisville Slugger to a Porsche?
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529. It was insane.
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530. I like her.
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531. What is to like?
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532. I don't know.
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533. I just do.
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534. A sudden complete loss of any SSEP and MEP signals.
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535. B.P. and heart rate are tanking.
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536. We've injured his cord.
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537. Push high-dose steroids and pressors.
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538. Remove the retractor to take the pressure off.
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539. DR. That's the last of the vessels and nerves ligated.
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540. DR. Mayos.
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541. DR. Specimen bag.
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542. DR. We have healthy bone-anchor sites.
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543. DR. Same here.
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544. Time to give him functional arms.
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545. Not me. Give it to her.
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546. DR. She's a third-year resident...
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547. A talented one, but I wouldn't...
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548. I'm sure she's read every article written on osseointegration,
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549. spent countless hours in the Skills Lab,
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550. and could probably do this with one of her own arms tied behind her back.
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551. Blindfolded.
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552. Get to work.
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553. Push another milligram of atropine.
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554. We may have just paralyzed him trying to avoid a stutter.
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555. We won't know anything until we wake him up.
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556. Where's the pressure still coming from?
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557. Laterally now.
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558. So if we remove the joints of the C1 and C2 bones,
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559. that should make enough room
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560. so we could drill off the odontoid.
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561. We could replace them with screws and rods
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562. to stabilize his spine. That's...
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563. A good idea.
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564. Yes, it is.
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565. If he's not already paralyzed.
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566. Colleen Brown.
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567. Freshman year.
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568. I took her to the roller-skating rink
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569. 'cause I thought that's what you're supposed to do,
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570. take girls to the roller-skating rink.
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571. I didn't know how to roller-skate,
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572. she ended up leaving with Bobby K.'s little brother.
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573. Broke me up.
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574. Couldn't go to school for a week.
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575. Convinced my mom that I was sick
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576. for the first three days,
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577. and the last two I spent in a double feature all day...
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578. Where's Poppa? and Twelve Chairs.
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579. To this day, I can quote both films verbatim.
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580. So you think I should've stayed home for two more days?
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581. No, I don't think it would've mattered.
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582. It doesn't make a difference.
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583. And then I made a list
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584. of all the things that annoyed me about her.
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585. The way she chewed her gum,
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586. the way she used to sit in the front row of every class
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587. so that the teacher would call on her
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588. when she raised her hand,
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589. the way she said, "Excuse me?"
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590. instead of just "What?" or "Huh?"
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591. None of it makes any difference.
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592. Then why are you telling me?
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593. Maybe it'll make you feel a little bit better to know that,
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594. what you're going through,
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595. every other young man in the history of the world has gone through.
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596. You're trying to make it work with Lea and with Carly,
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597. and you're getting a little beat up, and that's okay.
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598. Join the club.
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599. You're in the mix. That's a good thing.
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600. I'm proud of you.
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601. DR.You ready?
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602. It's gonna take some getting used to.
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603. But they're the same nerves you used before.
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604. All you have to do is think about using the arms
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605. the way you normally would.
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606. Whoa.
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607. That's pretty cool.
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608. It's not a beer,
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609. but you got to start somewhere.
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610. Now pinch your forefinger and thumb and twist off the cap.
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611. I-I can't feel the thing.
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612. You'll get used to it. You got this.
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613. Nice.
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614. You want me to say you were right?
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615. About the patient, or you?
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616. When you offered me a job,
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617. you said it was to help me get back on the horse.
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618. But what you really wanted was a mentor.
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619. Which I'm fine with,
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620. but I think maybe you feel threatened by that need.
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621. Well, maybe that's true.
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622. But maybe also you enjoy it a little too much.
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623. Maybe because you're having a hard time giving up being Chief.
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624. Maybe we're both right.
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625. How did it go?
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626. Can you lift your arms for me?
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627. Okay.
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628. I'm gonna push your arm, and I need you to resist.
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629. Good. More.
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630. Stronger.
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631. That's great.
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632. You should make a full recovery.
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633. Thank you.
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634. H-How's Nathalie's hand?
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635. There was no nerve or tendon damage.
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636. She'll be fine.
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637. She's a good person.
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638. A little spirited,
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639. but that's what I loved about her.
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640. Are you going to try to win her back?
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641. I'm confident but not stupid.
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642. You gotta know when to call it, Dr. Murphy.
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643. I mean, there's a-a whole world
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644. of amazing people out there.
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645. Don't get bogged down with this notion of a soulmate.
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646. Finn's exam was normal.
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647. But I am not sure it was worth the risk.
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648. We did a good thing today.
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649. Mostly because of you.
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650. That's kind of you to say but...
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651. Your commitment to your patients
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652. reminds me of why I got into medicine.
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653. Being around you makes me a better surgeon.
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654. A better person.
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655. Well, good night.
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656. Good night.
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657. You did good work today.
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658. And I understand you're leaving surgery.
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659. And I know that's a... That's tough.
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660. But it's the right call.
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661. No, I don't think it is.
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662. I love operating.
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663. So I'm gonna keep doing it as long as I can.
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664. I'm gonna have the synovectomy surgery.
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665. That's really stupid.
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666. That's incredibly stupid.
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667. Not every dream comes true.
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668. You have other opportunities.
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669. You have another chance.
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670. Not everybody does. Be grateful for that.
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671. Pick another passion and pursue that.
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672. I'm doing the surgery.
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673. Enjoy.
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674. Another, please.
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675. Well, that's one way to start the night off right.
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676. Hello, Nurse Fletch.
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677. You can call me Julie.
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678. Are you here alone, or are you meeting someone?
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679. I'm alone.
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680. Well, to us.
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681. You have beautiful eyes.
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682. Thank you.
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683. Or did someone just tell you that
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684. that's a good opening line?
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685. It's right in our backyard,
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686. and I've never even been there.
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687. Have you? No.
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688. It's, uh, time we unleash our inner tree-hugger.
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689. You're off next weekend.
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690. I think we should go to Yosemite.
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691. What do you think?
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692. Yeah, sounds fun.
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693. I need to get me some hiking boots.
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694. Mm. And, uh, like a fleece.
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695. Mm-hmm. Beanie.
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696. Mm. I'm rocking the full lumbersexual look.
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697. 'Cause I gotta blend in.
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698. I hear a bear can spot a tourist a mile away.
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699. Mm. Mm-hmm.
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700. You okay?
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701. Uh, you're, uh...
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702. You're here, but, you know, not.
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703. You're right. I'm sorry.
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704. It's... It's just been a long week.
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705. I'm a bit exhausted.
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706. Yeah, I think I might call it an early night.
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707. Oh, you sure?
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708. I... You know, we don't have to go to the club.
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709. We can chill here. We can watch a movie.
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710. I'm sorry.
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711. I just...
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712. I just think I should go home.
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713. Okay.
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714. Shaun?
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715. I want to smash your car up.
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716. I think that's a bad idea.
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717. I want to hurt you the way you hurt me.
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718. I'm s-sorry.
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719. You...
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720. You...
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721. You're...
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722. I can't.
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723. I can't.
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724. You acted like you cared about me,
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725. but you don't even respect me.
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726. You're flaky.
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727. And...
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728. And you can't keep a boyfriend.
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729. And you can't keep a job.
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730. And no one likes you.
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731. And... And you're going to end up alone,
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732. and you deserve it!
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733. Because you're a superficial,
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734. selfish, and prejudiced person!
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735. You ready to tell me what's on your mind?
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736. Not really.
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737. I...
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738. I think I'm in love with my boss.
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