The Good Doctor 3x20

1. This isn't my usual seat in a speeding ambulance.

2. You vomited and passed out.

3. You have a three-inch abdominal bruise

4. and a big bump on your head,

5. - either of which could... - You can check it all out tomorrow.

6. As soon as I'm back at the hospital,

7. I'm going back to treating patients.

8. They must be on overflow.

9. As soon as we're back at the hospital,

10. you are getting a CT.

11. You could have increasing intracranial pressure

12. from contusions, edema, or a hematoma.

13. I don't.

14. I'm pretty sure I know my symptoms better than you do.

15. No headache, no unilateral weakness.

16. The doctor without the head injury makes the call.

17. There's the rupture.

18. The fallopian tube's necrotic.

19. DeBakey forceps.

20. BP's stabilizing at 90 over 65.

21. - I'll take the clamp. - I'm fine. You remove the laps.

22. It's better if you do it.

23. Less likely to damage your hands.

24. We need six hands, we've got four,

25. and you want us to work with two?

26. I need 2-0 chromic catgut.

27. His heart's shifted from the pressure on his chest.

28. Try retracting it to the right.

29. There's nowhere for it to go.

30. Close him up. We'll have to go in through his side.

31. That won't be easier.

32. Well, it better be, 'cause this way is impossible.

33. Hello?

34. Yes. Shaun.

35. Lea?

36. Yeah, it's me. You okay?

37. Why is it still you?

38. I'm fine. I wanted to stay and help.

39. No, I don't need you, okay?

40. I need a rescue worker.

41. They're taking in a lot of scaffolding and stuff

42. hoping to reinforce the walls.

43. The water should be a priority.

44. They shut off the main.

45. They don't know why it's still flowing.

46. We're gonna drown in about five minutes!

47. That's not true.

48. At the rate the water is filling,

49. we have about an hour.

50. And I could leave.

51. I am going to cut the rebar to free you.

52. I didn't do it before

53. because it risks rupturing your posterior tibial artery,

54. but now we need to.

55. Take this.

56. Cutting will intermittently cause your leg to move,

57. which will cause a lot of pain.

58. Ah.

59. How did you deal with your heartache?

60. - Are you just asking to keep me calm? - Yes.

61. Distracting you from the disastrous situation you're in

62. will help keep your blood pressure down.

63. Oh, and reduce bleeding.

64. Honesty was the problem with my ex.

65. I opened up to him, told him everything.

66. In return

67. he didn't.

68. Were you being honest when you said

69. you were going to move on after this?

70. One upside of being impaled on rebar underground

71. in a room slowly filling with water

72. is it focuses your priorities.

73. Yeah.

74. I'm moving on.

75. If you loved him,

76. maybe you can't.

77. - I told you. - What?

78. Be quiet. Be still.

79. The machine is already past the point

80. where you would have seen any damage.

81. The fact that you haven't said anything

82. means you're either trying to figure out

83. how to tell me I'm going to die

84. or you're trying to figure out

85. how to apologize for wasting my time.

86. You're right. I'm glad your brain is fine.

87. I'm not sorry at all.

88. Appreciate the excessive concern.

89. Now I can get out of here and to patients

90. and you can get back to the winery to help.

91. Brewery.

92. Oh, come on. I misspoke.

93. Been a bit of a rough day, you hear?

94. There was an earthquake.

95. I've seen you on a lot of rough days,

96. but not once have I seen you confused.

97. Move your gown.

98. You're bleeding internally.

99. I need baci irrigation, and then we can start closing her up.

100. Dr. Reznick.

101. Please step back, Dr. Andrews.

102. We're trying to keep this area as sterile as possible.

103. Glad you're aware it's not an actual operating room

104. that you seem to be operating in.

105. There weren't any available.

106. And there weren't any surgeons, either.

107. - Suction. - So, you violated Dr. Glassman's order

108. to not use your hands.

109. Ectopic pregnancy.

110. The fallopian tube ruptured.

111. Patient would have died.

112. Oh-Maxon sutures.

113. You could have found another way,

114. but you wanted to be a hero.

115. Get your hands out of the patient

116. and take them to your room.

117. I'll finish.

118. He has a traumatic dissection

119. all the way to the ascending aorta.

120. The clamp would tear through the vessel wall.

121. He'd bleed out.

122. And if we clamp proximal to it,

123. he'd lose perfusion to his head.

124. He'll be brain-dead.

125. You should go back to the hospital.

126. I'll stay with the boy.

127. Who's in charge? First Andrews, then Morgan, then Andrews again.

128. She's back in her patient room. He's in surgery.

129. - All right, what do you got? - Bay 4.

130. Otherwise healthy 35-year-old with chest pain.

131. - High sensitivity troponins back? - First was negative.

132. Repeat the tropes in an hour.

133. If there's still no change, discharge him.

134. - Yeah. - Bay 2... 16-year-old.

135. Dresser fell on her leg.

136. - Normal pulse and sensory exam? - Yes.

137. It's a non-displaced fracture.

138. Prep her for a posterior slab and book a follow-up.

139. Dr. Lim.

140. Who is this?

141. Dr. Melendez.

142. Dr. Park.

143. So, how'd it go?

144. Not good, Casey.

145. We couldn't fix things.

146. When we take this off you, you'll start bleeding,

147. and we won't be able to stop it.

148. You're gonna die.

149. No.

150. No, no, no. You're wrong.

151. You gotta... You gotta be wrong.

152. Man, where's...

153. Where's my dad?

154. He's on his way.

155. We're gonna keep you comfortable.

156. I'm not in pain, okay?

157. You gotta be wrong.

158. I'm sorry, Casey.

159. Where's my dad?

160. Mmm.

161. Isn't "moving on" just a euphemism

162. for giving up, for failure?

163. Do you really believe that?

164. Do you think you failed?

165. Accepting... loss

166. makes us stronger.

167. Refusing to accept failure makes us not fail.

168. If we keep fighting till we succeed, then...

169. That's not true!

170. It traps us,

171. prevents us from moving on to other victories.

172. Your hematocrits suggest you're still bleeding.

173. Appears to be in the retroperitoneum.

174. Probably from the pancreas.

175. If we open you up,

176. it means major resections and reconstructions,

177. and you could end up with ostomy or diabetes.

178. I'm well aware of the risks of abdominal surgery.

179. The more conservative approach

180. is an angio for embolization to stop the bleed.

181. Less invasive...

182. Again, aware.

183. Do the embolization.

184. In this case,

185. I don't think it's actually safer.

186. If the bleed isn't from the pancreas,

187. we'll have to keep poking around till we find it,

188. and it might be too late.

189. You want to do the surgery instead?

190. Not really.

191. But Claire's right.

192. We've been able to get a satellite hook-up to your dad.

193. Do you want me to talk to him first?

194. No, I need to talk to him.

195. Son?

196. Dad, I'm sorry.

197. Dad, I'm so sorry.

198. I can't hear you. Say that again.

199. Are you hurt?

200. Dad, it's... it's my fault, okay? I...

201. Can you hear me? Just be strong, okay?

202. - Dad! - Casey!

203. Dad!

204. Get him back.

205. The plane's caught in a storm.

206. - I don't know if it'll... - Get him back.

207. Divide the gastro-colic ligament and expose the pancreas.

208. It's a branch of the superior mesenteric artery that's torn,

209. not his pancreas.

210. Good call.

211. I need to resect the devitalized tissue

212. to get a healthy anastomosis.

213. We need clamps and 6-0 vicryls on Castros.

214. Dr. Lim?

215. Above the SMA, the small bowel...

216. There are three ways to stop a bleeding vessel.

217. Clamp, cauterize, or repair.

218. Since this vessel is made of steel,

219. clamping requires a 60-ton press,

220. and cauterization requires an oxyacetylene torch.

221. I don't need to stop the water.

222. Just slow it down.

223. You're good at a-adapting to challenges.

224. Yes, I am.

225. Blindly keeping on sawing wasn't gonna work.

226. No.

227. But it wasn't a failure.

228. Because cutting the rebar wasn't your goal.

229. Saving me was your goal.

230. And your goal isn't Lea.

231. It's love.

232. I think the scar will work with the tattoos.

233. The bleed wasn't from the pancreas.

234. It was from the SMA.

235. But we found additional injuries

236. all the way to the celiac trunk.

237. Ischemic bowel?

238. Early stages.

239. We have restored full blood flow and reperfused.

240. I'm sure the bowel is gonna be just fine.

241. How sure?

242. What's my lactate?

243. Four.

244. Means there's already been some failure of the bowel wall.

245. We're going to re-test your lactate.

246. And I'm sure it'll have gone down.

247. But if it's gone up, it means ischemia is progressing,

248. and there'll be more bacterial leakage.

249. Which in turn will mean septic shock...

250. past the point of treatment.

251. We're not there yet.

252. Let him know it's still gonna be a while.

253. How long is a while?

254. Sorry. I don't know.

255. He says they're gonna drown in 15 minutes.

256. Is "a while" more or less than 15 minutes?

257. That last tremor made things too unstable

258. to send my crew down.

259. You're supposed to be saving lives.

260. You're supposed to be the heroes.

261. If you let me, what I'm gonna do right now

262. is help my crew get in more braces, scaffolding,

263. and heavy machinery.

264. What you need to do right now

265. is convince Dr. Murphy to get out of there.

266. Talk to me, Casey.

267. I'm... I'm tired.

268. Let's just... talk.

269. Why do you need to apologize to your father?

270. What do you think you did?

271. Whatever it is, there's nothing you could have done

272. that he's gonna be mad about right now.

273. You don't know anything.

274. I know how a father feels.

275. I know no matter how mad or how ugly things get,

276. we don't stop loving our children.

277. I killed my mother.

278. You need to get out.

279. - Soon. - Not soon, Shaun.

280. You need to get out now. It's not stable.

281. Vera can't leave.

282. The firefighters told me they're making great headway,

283. and they'll be able to save Vera soon,

284. but you need to get out of the way.

285. Are you lying?

286. You need to go, Shaun.

287. If I leave, you die.

288. If you stay,

289. we both die.

290. You can't cut through the rebar in time.

291. I can't cut through the rebar.

292. But I can cut through your leg.

293. In the Civil War, there was a doctor

294. who could amputate limbs in under three minutes,

295. which kept blood loss and pain to a minimum,

296. thus reducing the effect of shock.

297. Our scalpels are sharper,

298. so I can slice through the skin and muscle faster,

299. and I only sawed the rebar with the top half of the saw.

300. So the bottom half is still pristine

301. to get through the bone.

302. Do you consent to the procedure?

303. No.

304. I have one condition.

305. You have to promise me

306. that if I don't make it,

307. you'll move on.

308. You deserve to find love.

309. You need to.

310. You're down here risking your life for me, right?

311. Well, this is me risking my life for you.

312. Promise me you'll move on, Shaun.

313. Promise.

314. I promise.

315. Let's do this.

316. The year before med school,

317. I took six months off,

318. backpacked across Southeast Asia.

319. Hostels were three bucks a night.

320. Beer was 50 cents.

321. And I found this little island in Thailand,

322. Koh Lanta.

323. Nothing but bamboo huts and palm trees.

324. Stayed eight days.

325. Read Moby Dick.

326. Fell in love.

327. How high?

328. High.

329. 8.1.

330. The place is probably overrun with tourists now.

331. She had an accident.

332. Nothing, really. Mom didn't even report it.

333. But it was big enough to mess with her neck.

334. A lot of pain.

335. But she was dealing with it.

336. I thought.

337. She became dependent on the pills?

338. Going through her purse,

339. looking to steal a couple bucks for the movies...

340. found three half-full prescription bottles.

341. Same drug.

342. What did you do?

343. Nothing.

344. I didn't say anything to her or my dad.

345. I-I-I didn't know what to say.

346. Three weeks later, she OD'd in her sleep.

347. He would've gotten her help.

348. I need to tell him.

349. You will.

350. I promise.

351. When I was a second-year resident,

352. I was assigned to a Dr. Wilmet Fortingale.

353. Full of himself, sarcastic, thin-skinned.

354. Our first case together,

355. I saw he screwed up.

356. And I called him on it.

357. He lit into me.

358. What kind of ego I must have,

359. what little regard I must have for my superiors,

360. how hard it must be for me to trust anyone in my life.

361. Two days later, the M&M,

362. guess who screwed up.

363. Me.

364. When you're a resident,

365. you think you know everything.

366. I'm sorry.

367. I should've told you about my diagnosis.

368. It's hard. Yeah.

369. And what that showed me is that you don't respect protocol

370. and you don't respect your superiors, your patients.

371. The only thing you care about is your own career.

372. And again, I was wrong.

373. What you did today for your patient was remarkable.

374. You made it clear

375. that saving lives is your first priority.

376. Unfortunately...

377. it may have cost you your career as a surgeon.

378. You've traumatized your joint capsule incisions.

379. I'm sorry.

380. I'm not afraid to die.

381. I was raised a good Catholic

382. altar boy,

383. First Communion...

384. faithfully wore my silver crucifix

385. that Tia Abebe gave me for Confirmation.

386. I was a true believer.

387. Then I went to college.

388. And maybe it's just now that I'm

389. staring into the yawning void,

390. I'm hedging my bet, but...

391. it's coming back to me.

392. Like an old friend with a warm hug.

393. I want you to know that I...

394. Don't.

395. You should go.

396. This place still has a crisis going on.

397. Goodbye, Claire.

398. Goodbye.

399. 96.1.

400. That's okay.

401. Feels way colder than 96.

402. Feels like

403. f-fifty-six.

404. Forty-six.

405. Thirty-six.

406. Casey.

407. - Twenty-six. - Casey.

408. Hey, stay with me just a little longer.

409. I can't give you any more epi.

410. Casey?

411. Dad?

412. Yeah.

413. I'm right here.

414. You had morphine?

415. I saved it in case I needed to do this.

416. Good thinking not telling me.

417. - Yes. - The upside?

418. In three minutes, I'm gonna lose 10 pounds.

419. I'd say only eight, unless you count blood loss and...

420. Do you take everything literally?

421. No.

422. Lea,

423. I need you to count off the seconds from 1 to 180.

424. I want to know how close I am to three minutes.

425. How will that help you?

426. I don't think it will.

427. But it may help distract you from the screaming.

428. - Ready? - N-No!

429. Just do it, for God's sakes!

430. One...

431. two,

432. three.

433. I want to go back in.

434. If we resect more bowel and do a trauma Whipple, I...

435. A trauma Whipple?

436. It's a big surgery.

437. Okay, a huge surgery,

438. and there's obviously no guarantee

439. and lots of complications,

440. - but if we act now, I feel like we... - Hey, whoa, whoa, whoa, whoa, whoa.

441. Let's just hold on for one second.

442. First of all, we are talking about Melendez, correct?

443. Secondly,

444. we do know the numbers.

445. They're terrible.

446. And maybe so's this idea, but that's how this works.

447. You shoot down mine, I shoot down yours

448. until we come up with a viable solution.

449. Okay, here goes.

450. The mesenteric bypass already failed.

451. His lactates have more than doubled, from 4 to 8.1.

452. Any significant revascularization

453. is already out of the question.

454. By some miracle he were to survive the surgery,

455. he'd be tube-fed, a diabetic with an ostomy bag,

456. waiting for a liver transplant.

457. Your turn.

458. It's time to stop being a doctor.

459. Be a friend.

460. Dad, I knew.

461. I, I knew about Mom.

462. I, I knew about the drugs.

463. I should have told you.

464. I knew, too.

465. Of course I knew.

466. When you love someone,

467. you know when something's wrong.

468. But, Dad, if you knew...

469. I did what I thought I could.

470. Sometimes

471. you can help them, but,

472. sometimes there's just nothing anyone can do.

473. And we were the adults.

474. It was our problem, our responsibility,

475. never yours, Casey.

476. It was never your fault.

477. 67...

478. 68, 69, 70...

479. I made it to the bone.

480. 71... 72...

481. You need to stay conscious, Vera!

482. 74...

483. 75.

484. Keep counting!

485. Uh, 80... 81...

486. I'm sorry.

487. I should've been able to do more.

488. Faster, better.

489. I know you want to find blame.

490. If there's blame, there's a reason.

491. Sometimes...

492. there just isn't.

493. It pisses me off, too.

494. I could have spent a lifetime drinking whiskey with you.

495. I was even starting to like it neat.

496. What did we do?

497. No blame.

498. 150... 151... 152... 153...

499. 154...

500. Vera! Vera!

501. Exhale! Breathe out!

502. 172... 173... 174...

503. one-seventy...

504. 179... 180.

505. That's three minutes, Shaun!

506. Shaun?

507. Shaun?

508. Shaun, can you hear me?

509. Shaun!

510. Dad, it's so cold.

511. I know.

512. I'm sorry.

513. We should go snowboarding.

514. If you teach me one of your tricks.

515. You'd break your leg.

516. Mom would kill me.

517. Good point.

518. I love you, Dad.

519. I love you, too.

520. His father's in the squad car.

521. We have him on the line now.

522. Let's get this bar off him.

523. Mr. Taylor. I'm Dr. Park.

524. Lea?

525. It's time to go.

526. I can't.

527. There's nothing left to do.

528. We should get you checked out.

529. We've got something.

530. Hey, you need a helmet!

531. Hey.

532. Hey.

533. I heard the A's picked up another reliever.

534. Yeah.

535. Mmm.

536. I keep thinking, what's gonna happen

537. to the next Theresa Adams?

538. Remember her?

539. Gallbladder.

540. Or so we thought.

541. We get in there, it's completely healthy.

542. I blame it on lousy imaging.

543. You call a duodenal ulcer blocking the duct.

544. Saved her life.

545. Just so you know...

546. you're the best I ever worked with.

547. A bottle of Macallan says they win the division.

548. Twenty-five or Seventeen?

549. Twenty-five.

550. It's a sucker bet.

551. Hey, it's my funeral.

552. I'll look forward to that scotch.

553. I got you something.

554. You saved me.

555. No.

556. I was just in the right place

557. at the right time.

558. That was all you.

559. You're gonna be okay, Claire.

560. There's something I need to tell you.

561. Me, too.

562. I go first.

563. You

564. are

565. a terrible bowler.

566. Maybe the worst I've ever seen.

567. And I wanted to tell you that I hate your tattoo.

568. Way too much antler.

569. I love you.

570. I love you, too.

571. It's the start of a new day.

572. Yes. It is.

573. That was both literally true and a metaphor.

574. Hey, Mia.

575. No, I-I'm fine.

576. I'm just, uh,

577. just tired.

578. Hey.

579. I have to be, uh,

580. closer to you guys.

581. I'm gonna move back.

582. Hey, is Kellan there?

583. I need to hear his voice.

584. Hey, son.

585. We should get a drink sometime.

586. I'd like that.

587. I made a promise to Vera.

588. I don't know what that was.

589. It could be a practice kiss

590. or a pity kiss or a goodbye kiss.

591. That was an "I'm such a stupid idiot for not seeing it,

592. "but I love you with all my heart" kiss.

593. And this is another.

594. Vera didn't die, so the promise doesn't count.

595. You make me more, Shaun.