The Good Doctor 6x10

1. Previously on "The Good Doctor"...

2. Glassman found movement in my psoas and glutes.

3. He and Murphy found an endoscopic solution.

4. - How about I make you dinner? - Sounds good.

5. It's a date then.

6. A date.

7. Audrey... Will you marry me?

8. Shaun. I'm pregnant.

9. My OB told us it isn't safe for me— or the baby.

10. Danny!

11. No, no, no. Danny.

12. Danny.

13. - Good morning. - Morning.

14. I'll get the coffee.

15. This is my third stay in a week.

16. I no longer require guest-level service.

17. I want the practice.

18. Two cups, no cane,

19. no guarantee how long it'll take.

20. Well, when it comes to you, my patience is boundless.

21. One of the many things I adore about you.

22. It's been three months.

23. The man's a saint.

24. I have been recovering from a major surgery

25. and re-learning to walk.

26. Your recovery's remarkable.

27. So is your procrastination.

28. I am taking the time to consider

29. the biggest decision of my life.

30. Clay's fine.

31. No man— no person—

32. is fine waiting this long for an answer to that question.

33. Ever done one of whatever this is before?

34. No. You?

35. Mm-mm.

36. I've been clean for 92 days.

37. I went to rehab for two months,

38. and I go to meetings every single day.

39. I don't know if you two can ever trust me again,

40. but I am willing to do whatever it takes

41. to earn back my place here.

42. And we'll do everything we can to support you in your recovery.

43. But our number-one obligation is to our patients.

44. For their safety and yours,

45. we need to put some guardrails in place.

46. You'll be on probation for six months.

47. You cannot prescribe or administer

48. any controlled substances.

49. You will be given random drug tests,

50. and every step of your patient care

51. will be supervised by the Senior Resident on your case.

52. Today that is Dr. Allen.

53. You okay with those terms, Dr. Perez?

54. Absolutely.

55. I'm just happy to be here.

56. How are you?

57. Better.

58. A lot better.

59. I hadn't heard from you.

60. Which is totally understandable.

61. I just wasn't sure...

62. I didn't know what to say.

63. You're not the reason that— that happened.

64. As your supervisor on the case,

65. I will oversee your charting, your patient interactions,

66. double-check your med orders.

67. And this.

68. Fetal movement is good.

69. Heart rate is normal at 150.

70. I've been monitoring the heart rate daily.

71. It ranges from 146 to 163 BPM.

72. Her last emesis was three weeks ago.

73. So the nausea's getting better.

74. - Great. - And the fatigue.

75. Less improvement on the constant state of terror.

76. You made it through the first trimester.

77. - You're doing great. - Mm.

78. You two want to know the sex of the baby?

79. - Yes. - No. Don't look.

80. It'll be a fun surprise.

81. Oh.

82. It is fun to be prepared.

83. Oh.

84. What's going on?

85. There is a small, thinning area

86. on your uterine wall.

87. It is slightly hypoechoic,

88. likely a result of the scar tissue from your prior surgery

89. and Asherman's syndrome.

90. Is that bad? It sounds bad.

91. Mm.

92. If it progresses, your uterus could rupture

93. and we would lose the baby.

94. But it's very possible the lining will remain stable

95. and your pregnancy will progress normally.

96. What happens now?

97. We'll put you on bed rest and monitor you closely.

98. You're wrong.

99. There may be a surgery that can fix this.

100. I need to talk to Dr. Lim and Dr. Glassman.

101. Hello. I have admitted Lea for close monitoring

102. and a follow-up MRI,

103. which detected a small amount of free fluid in the abdomen.

104. This, plus a slight decline in the hematocrit,

105. increases the likelihood of rupture by 3% to 5%.

106. Shaun, I'm so sorry.

107. How are you and Lea holding up?

108. Oh. Fine.

109. I found a surgery to fix it.

110. I have spent the last three months

111. researching every complication of Asherman's syndrome.

112. I discovered an experimental procedure

113. to reinforce the uterine lining with collagen fleece

114. that will expand as the uterus grows.

115. I have studied the technique,

116. and I will teach you how to do it.

117. How many times has this procedure been done?

118. Five. Three had good outcomes

119. and the babies were carried to full term,

120. and the odds are better for Lea

121. because you are above-average surgeons.

122. Shaun, I don't need to remind you,

123. but this procedure can induce labor

124. and can cause major bleeding.

125. You could lose the baby.

126. If we wait and the uterus ruptures,

127. we will definitely lose the baby

128. and Lea could suffer a catastrophic hemorrhage.

129. Due to the size of the uterine window,

130. there's a good chance it won't.

131. No, with Lea's prior surgery and the significant scar tissue,

132. I put the likelihood of rupture at close to 65%.

133. Those chances...

134. not good.

135. Lea's body, her call.

136. Drew Dewitt.

137. Has recurrent desmoid tumors caused by Gardner's syndrome.

138. The one on his liver is benign,

139. but it hasn't responded to chemo.

140. It's encroaching on the stomach and spleen. It has to come out.

141. Thus, the surgical consult.

142. He has almost no small intestine.

143. He needed a major resection a year ago.

144. He's been living off IV nutrition ever since.

145. I've treated him for post-op infections

146. and pain management over the last year.

147. I've never seen this much scar tissue in a patient.

148. How many surgeries has he had?

149. 20. Plus 16 rounds chemo and 34 hospital stays.

150. Unfortunately, we have to add one more surgery to that list.

151. Will this surgery affect his place on the transplant list?

152. We've been waiting over a year for a small bowel.

153. Apparently, I'm "too healthy" to move to the top.

154. It shouldn't, barring long-term infection or other organ damage.

155. When you're ready, we can take you to pre-op.

156. - You got this, D. - You know it.

157. I have no idea.

158. Would you like us to go over

159. the risks and benefits again?

160. No, I know everything that could go wrong.

161. All I can see is what can go wrong.

162. You don't have to decide right now.

163. We can continue to monitor.

164. If we wait, the uterine window could expand

165. and make the surgery more risky.

166. Now is the safest time.

167. Don't pressure her, Shaun.

168. Okay. Okay, I know I trust you.

169. So if you think surgery is the right decision, then we should do it.

170. On one condition.

171. I want you in the OR.

172. Not for me, but if something were to go wrong

173. and we lose our baby,

174. I need you to be with her.

175. Or him.

176. With my guidance, I think there is a very good chance

177. our baby will be fine.

178. Mm.

179. Forceps and Metz.

180. How's it feel to be in the OR again?

181. Very good, sir.

182. We're all very glad to have you back.

183. We've exposed the surface of the liver.

184. Tumor's invaded the liver capsule and parenchyma.

185. That's twice the size it appeared on imaging.

186. If we take out all of the tumor,

187. he'll only have half a liver left.

188. We don't have a choice.

189. Make sure to approximate the edges

190. so it overlaps with the uterine window.

191. I internalized that the first three times you told me, Shaun.

192. I'm sorry you and Lea are going through this.

193. Mm. Dr. Lim was able

194. to place the fleece patch seven seconds faster.

195. But your laparoscopic suturing technique is superior.

196. You will be in charge of that.

197. Practice it now. Please.

198. Shaun, I've done it a million times.

199. You have never done them on my wife.

200. Fair point.

201. Because we had to take more of your liver

202. than we'd hoped, your liver function is declining.

203. Getting your nutrition through an IV is tough on your body.

204. The TPN that's keeping me alive's also killing me?

205. That's gnarly.

206. So, what's the alternative to TPN?

207. How do we get him nutrients?

208. We're looking into it.

209. For now, we're gonna manage your symptoms

210. and keep you stable until a small bowel becomes available.

211. There's no way those organ cops can say I'm too healthy now.

212. I'll order cholestyramine for the itching

213. and liver function testing every few hours.

214. I'll call UNOS and do whatever I have to...

215. to get him moved up the list.

216. Where you sneaking off to?

217. I'm walking down the hall, in plain sight.

218. The alarms, the pills,

219. the classic Morgan evasion techniques.

220. You're getting your embryos implanted, aren't you?

221. Congrats on cracking that already wide-open case.

222. I have to give myself a time-sensitive injection now,

223. then yell at some nice transplant people.

224. Why didn't you tell me? I could help.

225. I'll refer you to the minutes of our previous meeting—

226. "We need boundaries."

227. I remember you put on my hospital socks for me last time, too.

228. I hate that we have a routine.

229. This time is different.

230. - Hi. - I love you.

231. How are you? Do you need anything?

232. There's Funfetti cake in Pedes for Nurse Hawks' birthday.

233. Do you want me to get you a piece?

234. Just this is great.

235. Please leave.

236. Having visitors increases the risk

237. of perioperative infection,

238. and stimulation can raise blood pressure,

239. which increases the risk of intraoperative complications.

240. I need to do your pre-op exam.

241. He just doubled over.

242. My gut is trying to kill me.

243. Please, can you give him something?

244. I'll up his morphine. Check the site for infection.

245. Hang on. You're gonna be okay.

246. Dr. Allen, his wound dehisced.

247. What does that mean?

248. His muscles couldn't hold the stitches.

249. It tore open.

250. Move the patch three millimeters to your right.

251. It should overlap with the wound margin.

252. - Got it. - Yes, there.

253. That is good.

254. Dr. Wolke, take the scope, please.

255. Sutures.

256. 5-0 Prolene sutures in the myometrium defect

257. need to be placed exactly one millimeter apart.

258. Dr. Murphy, take one more step,

259. I'm gonna have to ask you to leave.

260. Applying the glue.

261. No, no. That's too far.

262. - The view is obscured. - Shaun. A little to your left.

263. She's bleeding.

264. No signs of rupture.

265. You may have placed the sutures too deep

266. because you didn't have a clear view.

267. The sutures are fine.

268. I should take over.

269. - Shaun. - There, a small bleed underneath the patch.

270. Must've nicked a vessel.

271. I'll clip it.

272. Suction.

273. Okay, we can continue to close.

274. Yes. Lea and the baby are fine.

275. In spite of the avoidable errors.

276. His abdominal wall is too weak and damaged

277. from prior surgeries to hold the sutures.

278. We covered the wound with plastic,

279. but we need to take him back to the OR

280. and close him up before it gets infected.

281. The tissue will just tear open again.

282. His skin and muscles need time and nutrition to heal.

283. I have a small bowel for Drew.

284. Drew's wound dehisced.

285. We can't take that organ.

286. I'm not turning it down.

287. This is Drew's only chance.

288. Tell UNOS we need to run some more tests.

289. Buy us a few hours.

290. That's how long we have to figure out

291. how to stitch this kid back together.

292. What about component separation?

293. That could weaken the tissue even more.

294. Right.

295. Maybe a four-step Fabian procedure.

296. Except Drew doesn't have time for four steps.

297. Hi.

298. Here to check Lea's post-op vitals.

299. I also brought supplements.

300. Mm.

301. Thank you.

302. All right, your post-op ultrasound looks good.

303. Oh.

304. Fetal movement and heart tones are great.

305. Oh, thank God.

306. When can I go home?

307. You need to be here for monitoring

308. for several more days.

309. I can't go days like this, Shaun.

310. I hate it here.

311. You are here for work every day.

312. Not in this room, in this bed,

313. thinking about everything.

314. Jerome and I can visit on our lunch break.

315. Oh, we could take the "What Yankee Candle Are You?" quiz

316. that's on page 17.

317. Rest will help you recover faster

318. so you don't have to be here anymore.

319. Her ultrasound does look good.

320. Thank you. You can go.

321. Thank you.

322. UNOS called again.

323. I told them we have to re-run Drew's liver function test

324. and get a CT scan.

325. I bought us an hour at most.

326. What about a Sure-Closure device?

327. Too high a risk for ventral hernia,

328. which could lead to us needing to resect his large intestine,

329. leaving him even worse off.

330. I already played it out.

331. For your embryo thing, you know, whenever that is,

332. I can give you a ride, if you need one.

333. I'll get an Uber.

334. You really want to go to the most important appointment

335. of your life with a stranger in a Camry?

336. I've chosen to do this alone, and I'm fine with it.

337. And I'm— I'm trying very hard

338. not to care about what anyone else thinks about that.

339. So having you imply how sad it is that I have to take a cab

340. to a doctor's office is not helpful.

341. He threw up, and his pain is getting worse.

342. He's already maxed out on morphine. I'm overriding.

343. There's increased redness and swelling on the edges.

344. Early signs of infection.

345. I love you, Mom.

346. - You're gonna be fine. - It's okay.

347. We knew we'd get here someday.

348. I'm ready.

349. No.

350. I am not giving up on you.

351. Don't give up on me, D.

352. Please.

353. Oh. I-I will take those.

354. They're from all the nurses.

355. We just want you both to know that we're thinking about you.

356. I will pass that along.

357. But not these.

358. Baby's breath has a strikingly unpleasant odor.

359. Is there anything you need?

360. We're fine.

361. Uh, 502's family is on their way in.

362. Heads up— they are a loud bunch.

363. They're very excited to be taking Meemaw home.

364. I don't think Lea's fine.

365. She's lonely and bored,

366. and being back in that room

367. is bringing up a lot of painful memories.

368. And I know you're just— you're trying to protect her,

369. but...

370. but it's making you kind of a pain in the ass.

371. Your wife, who's carrying the tiny human,

372. she needs her loud bunch.

373. People asking how she is doing and being worried

374. will only make Lea worry more, and that is not helpful.

375. Not for you,

376. but I think Lea needs more than just you right now.

377. She needs lots of people showing concern and love.

378. And maybe you do, too.

379. More than you think.

380. Question for you.

381. Does it bother you that this has been sitting here

382. for three months?

383. No.

384. - Does it bother you? - No.

385. I'm feeling a little pressured.

386. I've barely brought it up.

387. And I appreciate that.

388. But it sitting here is kind of pressure.

389. It was meant to be a cute gesture.

390. A subtle...

391. Not so subtle reminder

392. that the offer is still "on the table,"

393. which has clearly overstayed its welcome,

394. and the last thing I want is for it to come between us.

395. Are you un-proposing?

396. No, I'm un-pressuring.

397. I love you, and I'm not going anywhere.

398. When you're ready, we'll put it back on the table.

399. What about a Velcro biocompatible patch?

400. It would facilitate his granulation tissue growth.

401. How do we keep it from adhering to other organs?

402. Yeah.

403. This should be turmeric chicken with asparagus.

404. That's what I was gonna make you for our date.

405. And after work, all I had to do was go to the store and get some chicken.

406. But instead, I-I texted my dealer.

407. For a thousand reasons,

408. none of which excuse nor explain anything.

409. You don't owe me an explanation.

410. I do.

411. And I wish I could give you one.

412. Every day for the past 92 days, I've asked myself,

413. "Why didn't I just go get the chicken?"

414. I mean, we would have had a great dinner.

415. I mean, you would have been funny and beautiful.

416. And I would have tried way too hard to be charming.

417. And then...

418. who knows?

419. I'd give anything to go back, start over.

420. Give us a clean slate.

421. Me too.

422. What if we did that for Drew?

423. What if, along with a new bowel,

424. we gave him a whole new abdominal wall?

425. Clean slate.

426. Has it ever been done before?

427. I'm gonna look down and see... someone else's abs?

428. Replacing it is the only way to get you a new small bowel.

429. You'll be able to eat again. You'll get stronger.

430. What are the chances it'll work?

431. It's never been done in tandem with another transplant.

432. There are increased risks of rejection or infection.

433. But both organs are in great shape and a good match.

434. It's our best shot to save your liver

435. and give your body time to heal.

436. Thank you so much.

437. Okay.

438. Well, let's do this.

439. If we don't keep quiet,

440. Shaun is gonna come down on us with the hammer of Thor, okay?

441. It's so nice to laugh.

442. Enter Shaun with a chest plate

443. and a red cape with the Mjolnir.

444. I don't want to get kicked out before I know—

445. boy or girl?

446. I have to start scoping out the latest baby fashions.

447. I don't know.

448. I don't want to know.

449. Last time, when we found out we were having a girl,

450. Shaun and I were choosing her name.

451. I liked Sage and Skylar and Sofia.

452. Something with an "S," after my grandma, Susie.

453. And then she was... gone.

454. And I can't do that again.

455. Maybe you should tell Shaun about this.

456. He's already so worried, no matter what he says.

457. And what if talking about it just...

458. I have something for you.

459. Mm?

460. My faith.

461. Not just in God.

462. I have faith in the surgery you had.

463. I have faith in you and Shaun,

464. and that your baby,

465. whatever it is,

466. is going to be okay.

467. Your 10-minute visit has run over.

468. I have to scrub in anyways.

469. Pencil me in for the next 10-minute opening, Thor.

470. Thank you. I-I needed that.

471. Mmph. Pfft.

472. But not that.

473. I kind of feel nauseous.

474. We should do another ultrasound.

475. Mm.

476. This surgery could buy you a year, maybe more,

477. give you back some quality of life.

478. But...

479. it should be what you want.

480. You're 17 and you've suffered more

481. than some people their whole lives.

482. No one would fault you for deciding you're done.

483. I can't.

484. Your mom has given you all the support in the world,

485. but this is your fight.

486. Do you want to keep going?

487. The worst part about all of this is knowing

488. one day, it'll end,

489. and my mom will be alone.

490. She's been with me through all the hardest parts of my life,

491. and I won't be around when she has to go through the hardest part of hers.

492. If I can put that off,

493. if even for a little bit, then I'm gonna do that.

494. And hope that makes the days she'll face alone...

495. a little easier.

496. You're all set.

497. We'll take you to surgery soon.

498. I love you.

499. And whatever happens...

500. you don't need to worry about me.

501. I'll be okay.

502. I love you, too, Mom.

503. She was feeling nauseous, so I did an ultrasound,

504. which detected increased fluid in the abdomen,

505. but then she lost consciousness.

506. It is almost certainly internal bleeding.

507. I'll scrub in, right away.

508. No, no, no. You can't come in.

509. - This is likely a complication from the first surgery. - Shaun—

510. It is my fault, and I need to fix it.

511. Shaun, if we can't stop the bleeding,

512. we may have to take Lea's uterus in order to save her life.

513. If we get there, we're gonna make the decision quickly

514. and with medical factors only, no emotion.

515. Lea would want me in there in case we lose the baby.

516. If that happens—

517. if that happens,

518. Surgical site looks good. Patch is intact.

519. No signs of acute placental abruption.

520. Bladder's clean.

521. No blood coming from the ovaries or the fallopian tubes.

522. And the bowel is intact.

523. It's gotta be coming from the uterus.

524. If we clamp the uterine vessels, we may slow down the bleeding.

525. But we put the baby at risk.

526. If we don't stop it soon, we're gonna put Lea at risk.

527. I'll clamp the internal iliac on the side of the bleed.

528. Buys us some time.

529. Give two more units of blood and stay four ahead.

530. Retractor.

531. If the site is hemostatic,

532. they will look for placental abruption.

533. Next, they will check the bladder, ovaries,

534. and fallopian tubes.

535. Shaun.

536. They can't clamp the uterine vessels

537. without hurting the baby,

538. but they can place an atraumatic vascular clamp

539. on the internal iliacs,

540. which will slow down the bleed while they try to locate it.

541. Once they stop the bleed,

542. they should be able to repair it

543. and be done by...

544. 5:26.

545. The surgery went really well.

546. You should be able to start eating real food again

547. in a few days.

548. Better make sure my new six-pack is looking good.

549. The abdominal wall is holding together.

550. No signs of infection.

551. We'll see how long that lasts.

552. One step at a time, D.

553. We'll let you get some rest.

554. No alcohol in that new gut of yours.

555. Not for four more years.

556. One step at a time, Mom.

557. Hey, I don't want to help because I feel bad for you.

558. I feel bad for me.

559. You're gonna be an amazing mom

560. because you're amazing at whatever you put your mind to,

561. and I'm a little conflicted, I guess,

562. because I won't be a part of it.

563. Making my single-mother IVF journey about you

564. is uncharacteristically self-absorbed.

565. I'm impressed.

566. You changed me.

567. And doing things alone isn't sad.

568. Still doesn't mean you have to do them that way.

569. From here on, I'm gonna request not to be supervised by you.

570. Why?

571. I didn't OD because of you, or us.

572. But I knew I couldn't be with you

573. if I wasn't okay.

574. So I convinced myself I was.

575. Jordan, if I let myself get close to you,

576. I will fall for you again, and...

577. and I will want so badly to be okay,

578. to be ready for us.

579. I can't risk that.

580. I wouldn't want you to.

581. Mm.

582. I can't believe how much I'm gonna miss somebody

583. I'll still see every day.

584. Lea's in emergency surgery.

585. Two more units, right away.

586. Removing the packing over the uterus.

587. Suctioning.

588. Fetal heart rate 101.

589. Intermittent decels.

590. No injury to the vena cava.

591. Where is all this coming from?

592. Art line BP is 75 over 43

593. and falling.

594. Lea's BP is 67 over 35. She's bleeding out.

595. Hysterectomy tray.

596. Clamp.

597. After you ligate the uterine vessels, I'm gonna go get Shaun.

598. I told him I would.

599. Clamping the uterine horn.

600. Ligated the round ligament. Preparing to transect.

601. Metz scissors.

602. Audrey.

603. Lea and the baby are gonna be just fine.

604. Lea's left uterine artery was tethered to some scar tissue.

605. As the uterus grew, it ruptured.

606. That was inevitable.

607. Had nothing to do with your first surgery.

608. Okay.

609. Had Lea not been in the hospital when this happened,

610. she might not have survived.

611. Shaun, your surgery saved both their lives.

612. Okay.

613. Oh!

614. Thank you, Dr. Glassman.

615. I got you.

616. Okay.

617. Okay.

618. Good morning.

619. Can I get that to go?

620. I gotta stop at my place and grab a shirt for work.

621. I'm sure you have a minute. Stay.

622. - Am I about to be punished for something? - No.

623. - I was just thinking. - Mm-hmm.

624. I love you.

625. I love you, too.

626. And I love us.

627. Same. Always good to hear.

628. And I've decided I want us to move forward.

629. At my own, learning-to-walk kind of pace.

630. Clay Porter...

631. will you move in with me?

632. I would kneel, but I'm not sure

633. I could gracefully get back up again.

634. It's so sparkly.

635. Love it.

636. Mm.

637. Audrey Lim...

638. you've made me the happiest man alive.

639. This is a one-time thing.

640. Don't expect me to drive you to your next colonoscopy.

641. And here I was looking forward to that.

642. Take McLaughlin to William Street.

643. The freeway's backed up this time of day.

644. Alright, just don't forget the tip.

645. The fleece patch is holding well and expanding with the uterus.

646. Everything looks great.

647. Your baby is very cute and squirmy.

648. So, you wanna know what it is?

649. Y-You already know, don't you?

650. I have been looking at your uterus a lot.

651. Mm.

652. But— But I can keep a secret.

653. The light blue is very...

654. Heteronormative.

655. I was going to say pastel.

656. But, yes, that too.

657. I think he's gonna like something in the gray palette.

658. Calming but warm.

659. Elegant yet understated.

660. I think our son would like that very much.