The Good Doctor 4x15

1. It's just an hour.

2. Which really means an hour and a half,

3. which means by the time we get to Jason's,

4. - the party will be over. - It's not a party.

5. It's four boys arguing over who's gonna play "Call of Duty's Warfare."

6. Meanwhile, you're gonna be learning how to exercise your First Amendment rights.

7. - By waving signs at cars? - Mm-hmm.

8. And it's "Call of Duty"-- colon— "Modern Warfare."

9. Everyone who sees our signs knows that they're not alone,

10. and when we have numbers, we have a voice.

11. We are heard.

12. At least someone's being heard.

13. This is democracy, Ethan— making a difference.

14. This is how change happens.

15. Yeah, well, change sucks.

16. It's- 30. I will have you at Jason's by- 45, okay?

17. Ooh, I see a spot.

18. Really?

19. - Why'd you let her in?

20. Because the idiot would've smashed our car.

21. How about we go get milkshakes instead, hmm?

22. But I spent three hours making signs.

23. Ooh, there! There's a spot!

24. Sweet.

25. Any hint of trouble, we are leaving, got it?

26. Inspiring speech, Mom. Very Vince Lombardi.

27. I saw his hologram.

28. Oh, here's your very own wristband.

29. Solidarity!

30. Yeah!

31. Yes, they already did the finger prick

32. and gave me the gloop.

33. It's a 50-gram glucose solution.

34. It was gloop, and it tasted awful.

35. Gloop wouldn't tell us if you have gestational diabetes,

36. which is associated with hypertension, preeclampsia,

37. preterm labor, and for the baby, respiratory issues and obesity.

38. Before we buy jumbo baby clothes,

39. let's get the test results, okay?

40. Okay, will you text me when—

41. Whoa.

42. What's this?

43. We know at least two people have been shot,

44. but we have no information on their status.

45. By all reports, the rally in support of Prop 266…

46. That is less than a mile from here.

47. - …was quite peaceful despite the presence.

48. But just about 20 minutes ago, what witnesses described…

49. I have to go to the E.R., STAT.

50. …the passenger opening fire.

51. 9-year-old boy with multiple gunshots to chest and abdomen.

52. He took three rounds of epi, still PEA.

53. Trauma Bay 6. Checking ABCs.

54. Asher, taking over compressions. Claire, assess wounds.

55. - You're the mom?

56. - What's his name? Mason, got it. - Mason.

57. Entry wound left chest.

58. Right over his heart.

59. Emergency thoracotomy?

60. 20 blade.

61. We'll take good care of Mason, but right now, you need to go.

62. - I can't. - Now.

63. Rib spreader.

64. We got a pumper.

65. I can't see a thing. Suction.

66. Hole in right ventricle. I got my finger on it.

67. That's stopped the bleed,

68. but we gotta get the heart pumping normally again.

69. Urinary catheter.

70. Stick it in the hole,

71. inflate the balloon inside the ventricle,

72. and occlude the hole.

73. - We've got a regular heartbeat.

74. Red cells, platelets transfusions. Let's get him to the O.R.

75. Very good, Dr. Browne.

76. Kid took one gunshot to the head, became unresponsive en route.

77. Intubated him.

78. He's bradycardic.

79. Pupils are blown.

80. No response to sternal rub.

81. And the kid's leaking brain.

82. Glasgow Coma Scale— 3T.

83. One gram per kilo Mannitol, 50 milligrams per kilo Keppra.

84. Elevating head 30 degrees and bagging down his CO2.

85. All right, let's take him— O.R. two.

86. And we can now confirm that the shooting victims

87. were young boys, witnesses describing them

88. as both under 10 years of age.

89. According to accounts, one was shot several times

90. in the chest and abdomen,

91. the other shot at least once in the head.

92. The fact it was children who were shot is devastating news.

93. And so we have yet another day

94. in an otherwise peaceful community erupting in violence,

95. the kind of atrocity that has sadly become

96. all too commonplace.

97. And that only makes this attack

98. even more tragic and senseless.

99. We are awaiting updates and will let you know

100. as soon as we have any—

101. Fixed the liver laceration.

102. Let's get the spleen out of there.

103. Suturing the right ventricle. Next up is left ventriculostomy.

104. All that'll leave is the bronchial injury,

105. the diaphragm tear, the VSD,

106. and the hollow-viscous bowel injury.

107. - B.P.'s dropping fast.

108. We're gonna need every unit of O-neg or compatible blood.

109. Do you have someone in surgery?

110. N-No.

111. I'm just here for a test.

112. - Mrs. Wilkie? - What is it?

113. - And Mrs. Bardo? - What happened?

114. Nothing. I just need you to fill out these forms.

115. Forms?

116. Necessary evil.

117. Do you have copies of your insurance cards?

118. Uh, no, I must've left mine.

119. I work here in I.T.

120. I'll help them with the forms.

121. Thank you.

122. This is not a happy brain.

123. Let's clean out as much as we can.

124. Scalp, hair, skull fragments.

125. And let's not forget bullet shrapnel.

126. Ultrasound.

127. I'm looking for any deeper bullet fragments.

128. - Brain's herniating.

129. CO2 is normal.

130. Is he storming?

131. Heart rate's way too low.

132. We need to take off his entire right skull.

133. Drill with B1 bit.

134. Uh, initial there.

135. And sign here.

136. Thank you…

137. Lea.

138. Lea.

139. I… I think that's the other mom.

140. I'm Carina.

141. Were you

142. at the rally?

143. Yeah. I'm Taryn.

144. Mason's 9.

145. Ethan's 81/2.

146. They'll be fine.

147. I know it.

148. You're one of them.

149. Them?

150. Get away from me.

151. It is so sad that people can't express

152. their views peacefully.

153. The right is so intolerant of political differences,

154. any differences.

155. I think there's some intolerances on both sides.

156. Oh, like there are good people on both sides?

157. What if I told you I belong to the NRA?

158. I'd think you were saying that to make a point.

159. About five years ago, my wife and I went

160. to a very trendy restaurant in a very shady part of town,

161. and on our way back to the car we were mugged at gunpoint.

162. The next day, I bought us both handguns.

163. I'm a card-carrying member.

164. I voted for Trump.

165. Too soon.

166. I'm serious.

167. I liked his stand on Israel.

168. But I've never told anyone

169. because I'd be absolutely vilified.

170. As you should be, especially you.

171. Pooling up. He's hypotensive.

172. Lactate's rising.

173. Okay, crit's down to 17.

174. We could put him into deep hypothermia.

175. No, the low temp would only worsen his coagulopathy.

176. - He just needs more blood. - We've used most of the O-neg and A-neg

177. - from the blood bank. - Start calling other hospitals now.

178. You actually voted for Trump?

179. Once.

180. And then what?

181. You— You— You suddenly discovered

182. he was exactly who he said he was?

183. I don't feel like you want an answer. I feel like you want an apology.

184. This kind of changes how I feel about you.

185. What does that mean?

186. You're saying you don't respect me?

187. We can't be friends because of a vote?

188. It is more than a vote.

189. Yeah. It's a fundamental right that I exercised.

190. This kind of changes how I feel about you.

191. If I can't have a political opinion

192. about the best way to improve all our lives—

193. Do you think anybody's life got better?

194. That's enough.

195. Are you okay?

196. The repairs are almost finished.

197. We can be done with this in two or three hours.

198. We have just enough blood.

199. That's if we want to.

200. Mrs. Bardo?

201. What is it?

202. Uh, we fixed two holes in your son's ventricles.

203. We've removed his spleen and repaired his liver,

204. but he's still in surgery.

205. Your son has lost a lot of blood.

206. We're giving him transfusions,

207. but the blood loss may have caused damage to his brain.

208. If his brain is fine, then we should push on,

209. but if his brain isn't fine,

210. then… continuing the surgery could kill him.

211. Unfortunately, we can't accurately assess

212. for brain function in the O.R.,

213. so we would have to wake him up and do a traditional neuro exam.

214. You need her to decide that?

215. Why put that on her?

216. - You guys are the doct— - Wake him up.

217. If you wake him up, I can be there, right?

218. You can.

219. But he will be confused and stressed.

220. His belly will still have to be open—

221. My husband died in a car accident two years ago.

222. I didn't get to say goodbye.

223. This is not goodbye. This decision should not be based on—

224. Please.

225. Wake him up.

226. Okay. Come with us.

227. Why haven't I heard anything?

228. The brain looks more relaxed now.

229. There are a lot of clots.

230. Kellan play soccer?

231. I'm fine.

232. Two kids shot. We all are.

233. You're not supposed to be here.

234. I know. I am so sorry.

235. Is the baby okay? Did you get your test results?

236. No, but I'm fine. The baby's fine.

237. How's the boy?

238. You can't be here, and we can't tell you.

239. I'm sitting in a waiting room with a terrified mother.

240. Somebody needs to tell her he's being taken care of.

241. Mrs. Wilkie? I'm Dr. Shaun Murphy—

242. Is my son okay?

243. Okay, we have successfully removed

244. half of your son's skull to reduce brain pressure.

245. We've removed blood clots, bone chips,

246. and bullet fragments.

247. But we are still trying to find the less accessible

248. and deeper chunks of the bullet in his brain.

249. Can I see him?

250. Of course not. He's in surgery.

251. We… just needed to let you know his status.

252. I'm sorry.

253. Hey, Mason.

254. I need you to follow my finger, okay?

255. Can you wiggle your toes for me?

256. Your little piggies?

257. You're acing this test, Mason.

258. Now can you squeeze my fingers?

259. Just try to make a fist.

260. Doesn't have to be hard, just a little squeeze.

261. Okay, no, that's okay. Hey, Mason, look at me.

262. You're gonna be okay, pumpkin.

263. Everything's gonna be okay.

264. Hey.

265. There's an indentation

266. on a right M3 segment branch artery.

267. That suggests the presence of a deeper fragment.

268. Nice catch.

269. Yes, but I'm not sure how we get it out.

270. When was Ethan's birthday?

271. Um, October.

272. It was just the three of us.

273. We have a golden doodle named Derber.

274. Ethan wanted to invite a couple of friends over,

275. but I said no, it wasn't safe.

276. He wanted two friends.

277. He has like 100 of them and I said no to two.

278. Feels like all Ethan and I ever do now is fight.

279. Children don't need their parents to be buddies.

280. They need limits, structure.

281. You don't have kids, do you?

282. He'll die hating me.

283. Taryn, you cannot think like that.

284. We found the last bullet fragment.

285. It's deep but stable,

286. so it is very unlikely to cause further brain damage,

287. bleeds, or seizures.

288. We should leave it where it is.

289. You want to leave a bullet in my son's brain?

290. Removing it comes with a high risk

291. of lacerating key brain vessels.

292. You can trust them.

293. They're the best doctors I've ever known.

294. Okay.

295. Leave it in.

296. Did you get to see Mason?

297. They're doing more tests.

298. But I know he'll be fine.

299. He will.

300. Does Mason play any sports?

301. Uh,

302. basketball.

303. Team captain.

304. Likes to be in charge.

305. So mature for his age.

306. When my husband died,

307. it was Mason who kept me going.

308. Brought me coffee every morning,

309. opened my curtains,

310. helped me get out of bed.

311. I'm a single mom, too.

312. Helluva day to be one, isn't it?

313. Mm.

314. When did you lose your husband?

315. We divorced two years ago.

316. But not amicably.

317. Divorced.

318. I know it's not the same, but—

319. I buried my husband.

320. You lost him in the worst possible way, yes.

321. But I doubt you also lost half of your friends,

322. your self-respect,

323. and the love of your son.

324. I doubt you ever had to tell your son

325. that Daddy was never coming home again.

326. Look, I didn't mean to—

327. You figured you know me.

328. You've experienced pain,

329. so you understand all the pain everybody else has ever felt.

330. I understand pain—

331. - Shut up. - Right.

332. Someone disagrees with you and you shut them up.

333. You couldn't let us wave our little signs in peace?

334. You had to come shout us down,

335. and when that didn't work, you had to shoot us?

336. - Yes? - Yes?

337. You can go first.

338. Why?

339. I'm being polite.

340. It won't make any difference who hears their news first.

341. We don't think there is any brain damage.

342. We're gonna take him back to the O.R. to finish the repairs.

343. Wonderful. Thank you so much.

344. Of course.

345. We have to leave Ethan's skull off

346. until his brain swelling has gone down,

347. which could be a couple of days from now.

348. Or months.

349. We've moved him to intensive care.

350. You can see him now.

351. When he was a baby, I used to love watching him sleep.

352. It was the only time he wasn't bouncing off the walls.

353. The only time I could just look at him.

354. When he was older, if he caught me watching him,

355. he would say that I was weird,

356. and…

357. I just told him how beautiful he was.

358. And that only made me weirder.

359. But he is

360. so beautiful.

361. His eyes moved. They moved.

362. He's looking at me. That's good, right?

363. Yes.

364. No, he's not looking at you.

365. His eyes are deviating to the right.

366. What does that…

367. He's squeezing my hand.

368. Ethan, honey, Mommy's here.

369. How hard? Is it getting firmer?

370. Yeah.

371. Ativan. Increase propofol, and we need a C.T. and an E.E.G.

372. He is having a focal seizure

373. which is originating in the left side of the brain,

374. which wasn't the damaged side, which is very strange.

375. The bullet fragment must've migrated.

376. It was a mistake to leave it in.

377. He's seizing.

378. This is exactly what he said wouldn't happen

379. if we left the bullet in.

380. Exactly.

381. I'm sure he'll figure out what to do, and—

382. Who do you have news for?

383. Ms. Dilallo?

384. Good news?

385. Oh, it's nothing.

386. It's okay for someone to be happy.

387. I'm expecting.

388. And all's good.

389. I gave birth on Christmas Eve.

390. All the nurses were singing carols.

391. Kenny joked that the only thing missing

392. were the three wise men.

393. It was hokey and ridiculous.

394. But it was magical.

395. Ethan was three weeks premature.

396. We were having just one last fun weekend,

397. the two of us, and I guess Ethan didn't like that idea,

398. so I gave birth in a motel room 300 miles from my OB.

399. Left a really good tip for housekeeping.

400. It's very strange.

401. I was wrong.

402. It's… very, very strange.

403. No, you weren't.

404. The fragment's still stable in location,

405. no severe compression on MCA, no new bleeds.

406. That just means we missed something else.

407. There.

408. Deep in the left thalamus.

409. I wasn't wrong.

410. I wasn't wrong.

411. You were.

412. You missed it.

413. No. No, I wasn't wrong.

414. I would've noticed another fragment.

415. There.

416. There was nothing there eight hours ago.

417. Okay, so,

418. it's just new to this location,

419. which means it's moving.

420. And based on its trajectory,

421. it's gonna cause a lot more damage.

422. It's much deeper than the other.

423. So we can't get to it.

424. We can't go through the water drainage system of the brain

425. as we'd have to puncture the ventricular wall at the thalamus,

426. and we can't follow the injury pathway using MRI guidance

427. because the metal in the bullet rules out the MRI.

428. - And we can't— - Shaun, Shaun, just—

429. You are a neurosurgeon, okay?

430. You will know what I have missed.

431. You don't think you missed anything?

432. No.

433. Then you didn't.

434. Okay, then…

435. Ethan is probably going to die.

436. Okay.

437. This one's different, huh?

438. Because he is a child?

439. Yeah, yeah, because he's a child.

440. No.

441. I've lost children before.

442. Shaun, every parent has one job,

443. and that's to keep their kid alive,

444. to keep them from all the horrors in the world.

445. And maybe

446. because you can't protect Ethan,

447. you think…

448. That's not rational.

449. No, it's—

450. It's not rational, the price of parenthood.

451. But you know what? It's worth it.

452. If it makes me upset and irrational,

453. it doesn't sound like it's worth it.

454. You don't mean that.

455. I came here to ask for your surgical advice about Ethan,

456. and all you've given me is emotional advice about me.

457. Yeah.

458. Because that's all I got.

459. Kellan started playing soccer when he was 7.

460. He loved that jersey so much.

461. Wore it to bed every night. Wouldn't let us wash it.

462. Then he spilled grape juice on it.

463. A big purple stain.

464. And I got angry at him.

465. I always get a little like this with kids.

466. You know, I think maybe Shaun and Lim

467. can handle it fine without me.

468. If it was Kellan in that ICU,

469. how would you feel if his doctor bailed on him

470. because his kid had spilled grape juice 10 years earlier?

471. Yeah, it's brutal on you.

472. About a hundredth as brutal as it is on them.

473. So, you agree with Biden on every single issue?

474. No, of course not.

475. But I agree with him on more than one.

476. How many?

477. Where's the line?

478. Every vote is a compromise.

479. We support the things we think are important,

480. and… rationalize the things that aren't.

481. Unfortunately, compromise has become a dirty word,

482. which is ironic since that's the essence of democracy,

483. and the lack of compromise is why I left home.

484. His left foot is cold.

485. It's pulseless.

486. I got a pulse here.

487. Something's happening between here and you.

488. Good.

489. Nothing.

490. Good.

491. Nothing.

492. Nothing.

493. It's his popliteal artery. He must've thrown a clot.

494. We have to fix this now or he loses the leg at best.

495. Ethan's seizures were caused by a different fragment

496. that migrated to the left side of his brain.

497. We weren't wrong about leaving the other fragment in.

498. So you weren't incompetent about that,

499. just about completely missing this other fragment?

500. Yes.

501. But the new fragment isn't stable,

502. and will almost definitely continue to cause damage.

503. So you'll remove it as soon as possible.

504. It's too deep to remove.

505. Which means

506. you'll do what?

507. We'll keep him on anti-seizure meds

508. and, uh, we'll monitor him,

509. hope for the best.

510. Monitor?

511. An 8-year-old boy is dying and you're gonna monitor him?

512. If this was your child, you could live with that?

513. - Taryn, they're doing their— - They're doing nothing!

514. - Lea! - It's okay.

515. It's okay, Shaun.

516. You're a couple?

517. I made a decision about my son's life

518. based on your opinion of your boyfriend?

519. Taryn, I'm so sorry.

520. Isolating popliteal artery. Next?

521. Incise vessel transversely,

522. use Fogarty catheter to complete the embolectomy,

523. confirm flow with the angiogram.

524. How's our blood?

525. Maxing out on pro-coagulants,

526. anti-hemophiliacs, and recycling

527. every last drop of cell saver suction.

528. And we're still down to our last 100 CCs.

529. What about other hospitals?

530. There was a multi-vehicle crash on the 280.

531. Nobody has anything to spare.

532. I'll just have to work a little faster.

533. Removing catheter.

534. - B.P.'s falling.

535. Damn it.

536. Catheter tore the artery. Clamp and suction.

537. There's not enough blood.

538. His hematocrit is on the floor. He's dying.

539. You got your test results hours ago.

540. You need to go home.

541. I can't.

542. Mason is hanging on,

543. but we have used up all the O-neg and A-neg blood.

544. We're having some medevacked from L.A.

545. How long will that take?

546. Another couple of hours.

547. You don't think he'll last that long.

548. We're hoping.

549. I'm A-negative.

550. Sometimes we can't.

551. Every parent has an overwhelming need

552. to protect their child from horrors.

553. It's the price of parenthood.

554. Taryn donated twice the typical amount of blood

555. and Mason needed every drop of it.

556. It's gonna be a long night.

557. Where are you going?

558. Yeah, you should come with.

559. - Where? - Ever read Hansel and Gretel?

560. That's what you were reading?

561. I thought you were doing research.

562. The scan showed no sign that the fragment

563. tore major brain tissue,

564. and there are no significant bleeds or clots as it migrated,

565. which means it didn't cut a new route.

566. It took a trail that was already there.

567. Okay. How is that helpful?

568. It weaved through CSF spaces or sulci

569. in between the brain parenchyma.

570. If so, it left us some breadcrumbs…

571. Heme products staining.

572. …along the way, and we can use a rigid 3-millimeter endoscope,

573. find the trail, and take that trail

574. all the way to the bullet without damaging the brain.

575. It's okay, it's decaf.

576. You shouldn't feel guilty about being happy.

577. I didn't feel happy, not right then.

578. I felt… scared.

579. For us?

580. And for me.

581. You two, you're so different

582. and so… angry.

583. Hmm.

584. But you are so strong,

585. and I'm…

586. You don't think you're strong?

587. No.

588. Not strong enough for this.

589. This doesn't usually happen.

590. This isn't supposed to happen.

591. And the way we've been coping with it

592. has nothing to do with whether we're good parents.

593. Strength doesn't matter. It's compassion.

594. And… the way you've treated us

595. you're gonna be a great mother.

596. Mason made it.

597. Thanks to Taryn.

598. Ethan made it.

599. Thanks to Park.

600. They're in the ICU.

601. They want to see their moms.

602. Buy you a cheeseburger?

603. It's00 a.m.

604. Mm-hmm.

605. Well…

606. I figure we should talk.

607. I'd like that.

608. You saved Ethan's life.

609. Nice job.

610. I was ready to walk,

611. and most people would've felt for me,

612. supported that decision.

613. You saved his life.

614. Thank you for that nice, albeit completely inaccurate, thought.

615. You just needed some encouragement.

616. You wanna come back to my place for a little more?

617. It's been a long day. And night.

618. I think we should stop seeing each other.

619. You're good for me,

620. but…

621. just sleeping with you isn't.

622. I want to give Heather a chance.

623. Good for you.

624. She's such a wimp. She'll make you very happy.

625. You know how I feel right now?

626. No.

627. I don't know how I feel right now.

628. Lucky.

629. I think I feel

630. tired.

631. And lucky.

632. - Lea?

633. - Lea? - Shaun.

634. - Lea? - Shaun, Shaun.

635. - Okay. - No.

636. Okay. Help.

637. Help! I need help!

638. Please, help!

639. Help!

640. Okay.