The Good Doctor 6x7

1. You're smiling.

2. - Why? - Well...

3. That is your menstrual cycle.

4. It's been a year since we lost the baby,

5. and I finished my anti-coagulants.

6. Which means...

7. We can try to conceive again.

8. Mm-hmm. I have an appointment with Dr. Winkler today.

9. - If she gives us the go-ahead— - A year was the minimum.

10. Good vibes, Shaun.

11. Send good vibes into the universe,

12. good things come back.

13. Vibe with me, babe.

14. I would very much like to have a baby with Lea!

15. Okay.

16. Well, get ready to make one.

17. Okay. We are going to make a baby.

18. Yeah. Mm.

19. - Mm. - Oh.

20. I have 23 minutes until I need to leave for work.

21. Should we save your swimmy guys until I ovulate?

22. Oh, recent research demonstrated

23. frequent ejaculation improves sperm motility.

24. Oh! In that case...

25. Oh, yeah.

26. We can talk about it. Okay? Thanks so much.

27. Isabel.

28. What are you doing here?

29. Gena Cooper. Pregnant with sextuplets.

30. That's what all my calls and texts were about.

31. So you would already know if you'd answered.

32. You show up, ask me for a consult, like you're any other doctor?

33. Whatever the appropriate approach is for ex-wives, tell me, and I'll take it.

34. Couple couldn't conceive, so I prescribed clomiphene.

35. Six babies just after one round.

36. - They won the lottery. - Or lost.

37. Two require immediate surgical intervention.

38. At least. Know any surgeons?

39. Marcus, this family needs your help.

40. If needed, I will step off the case

41. and I will find them another OB.

42. Stay.

43. It wouldn't be fair to the patient.

44. Each of your babies gets their own dedicated team of doctors.

45. Now, since all of the babies will be under two pounds at birth,

46. they will all need a lot of care, attention,

47. and time in our NICU, maturing those lungs.

48. Once they're feeling strong enough to make some demands,

49. you'll hear that beautiful cry.

50. A baby crying is a good thing.

51. It lets us know the baby's healthy.

52. And that's when we name them,

53. once they've cried and we know they're okay.

54. I wish they could stay inside Mom longer and get bigger.

55. Baby Fs airway mass is already causing

56. severe narrowing of the trachea,

57. and her lungs aren't developing properly.

58. A few more days, and her heart could fail.

59. - So we deliver today. - Yes.

60. Everyone ready?

61. Baby A through Baby E will all be born in under three minutes.

62. Baby A.

63. At birth, they'll each be given an Apgar score

64. to let us know how they are doing.

65. Seven or above is reassuring.

66. It's a girl.

67. Baby B.

68. All right. Hello.

69. Baby A, Apgar 7.

70. It's a boy.

71. Surprise. Mono-di.

72. B and C share the same placenta.

73. Very rare. Identical twins.

74. Another boy, obviously.

75. Baby B, Apgar 5.

76. Baby C, Apgar 4.

77. Baby D.

78. It's... a boy.

79. Baby E.

80. Baby D, Apgar 6.

81. Spina bifida.

82. Baby E's a girl.

83. Baby E, Apgar 6.

84. Baby E will go to the OR

85. for her spina bifida surgery after delivery.

86. Exposing Baby F to EXIT procedure.

87. Once Baby A through Baby E are in the NICU,

88. Dr. Barnes will deliver Baby Fs arm and head

89. through the C-section incision, leaving the placenta attached.

90. And, Mom, that allows you to keep providing oxygen to your daughter.

91. Nurse Denning, take Papa to check on his other babies.

92. We're all good here, Jack. Dr. Lim?

93. Then, Dr. Lim will perform the EXIT procedure.

94. First time it's ever been done in a multiple birth.

95. She's got this.

96. Moving through the oropharynx cavity.

97. Baby Fs umbilical cord looks very thin and friable.

98. Placenta's still attached?

99. Yep. Mama's giving her all the oxygen she needs.

100. At the larynx. Approaching the trachea.

101. I've identified the cyst.

102. The pulse is extremely faint.

103. The cyst is causing total obliteration of the airway.

104. Microblator.

105. I've completely lost the pulse in the cord.

106. We have less than a minute to deliver.

107. Having trouble visualizing the base.

108. Maybe you're not there yet?

109. - Probing deeper. - Keep going. Little more.

110. I see it. You're two millimeters away.

111. Got it.

112. Cyst is decompressed. Airway's open.

113. Placing ET tube.

114. Finally... Baby F.

115. - It's a girl. - Okay.

116. Good work.

117. Baby F, Apgar 5.

118. Thank you for taking this on.

119. The hard part's just beginning.

120. Okay.

121. Baby A's one and five-minute Apgar?

122. Seven and nine.

123. Mom should be coming to. Take her to meet her parents.

124. Keep B and C together.

125. We have two different NICU rooms.

126. Neither boy is crying,

127. and co-bedding identical-twin preemies can be beneficial for both.

128. That's anecdotal.

129. Risks include poor thermoregulation, increased—

130. Just do it.

131. Baby D is not crying,

132. plus he has nevus simplex and meconium-stained fluid.

133. Get the heel stick and go tell the lab it's stat.

134. Spinal lesion covered with sterile wet telfa.

135. Heading to OR 2.

136. Keep me posted.

137. And how's the star of our show? Baby F.

138. Not singing yet, but airway is clear.

139. Take her to NICU. Hopefully she cries soon.

140. Hey. Hi.

141. My hero.

142. Where are my babies?

143. They're in the NICU now.

144. Except for Baby A here.

145. She got a head start on her siblings.

146. Listen to those healthy lungs.

147. Mm. First to cry. She's an overachiever.

148. What do you think about Abigail?

149. Forever Baby A.

150. I love it. And her.

151. How 'bout it, B?

152. Can we get those lungs strong enough

153. to move you to a CPAP?

154. You hear those studies on co-bedding identical preemies?

155. No. C's cyanotic.

156. He's tachypneic and retracting.

157. Check his liver.

158. The research is totally shaded by confirmation bias.

159. Palpable three centimeters below the costal margin.

160. If you'd been more assertive,

161. we wouldn't be stuck together.

162. Systolic murmur.

163. Why weren't you more assertive?

164. If I were a surgical attending, I would have been.

165. I had to fight just to be on this case.

166. You're gonna need an echo, chest X-ray—

167. X-ray, BNP and C to confirm congestive heart failure. I know.

168. Let's make a deal.

169. We only talk to each other when medically necessary.

170. Fine.

171. Inset the needle in the posterior iliac crest.

172. Later, I have to accompany Lea to an OB-GYN appointment.

173. Dr. Andrews will supervise you for a few hours.

174. - Everything okay? - We don't know yet.

175. Last year, she miscarried at 22 weeks.

176. Good precision.

177. When Baby D was first born,

178. you kinda took a moment. That why?

179. Yes.

180. I think I've penetrated the bone.

181. - Syringe? - No, you haven't.

182. You will hear and feel a pop when you do.

183. Go a bit deeper.

184. Dr. Perez, you need to be firmer.

185. More aggressive.

186. Go ahead.

187. Syringe?

188. - Now? - Yes.

189. As a surgeon, you must be decisive and aggressive.

190. Aspirating the bone marrow.

191. Very good.

192. Get it to the lab for microscopic analysis.

193. Good luck.

194. With the appointment. You'll make a great dad.

195. You are not qualified to make that prediction.

196. Incision immediately lateral to the neural placode

197. into the epithelium.

198. Incision tight to the placode.

199. That method avoids leaving the epithelials in the closure.

200. Is the play-by-play really necessary?

201. It helps me to learn by saying it out loud.

202. It helps me to do the surgery if you don't.

203. You can talk. Just not like Vin Scully.

204. - Who's Vin Scully? - All right, scrub out.

205. I'm kidding. Mostly.

206. The parents, Gena and Jack? Heroes.

207. We might throw that word around just a little too easily.

208. Think of the risk they took,

209. bringing six new lives into the world.

210. Refusing to selectively reduce

211. is what got us here in the first place.

212. Delivering 11 weeks pre-term

213. is a little bit less than ideal.

214. Like Dr. Andrews says,

215. we're going to beat the odds and save them all.

216. Well, if we pull that off, then we are the heroes.

217. Oxygenation dropped below 90.

218. We can't turn her over to assess or treat her lungs.

219. We can't even do imaging.

220. We're gonna have to tell the parents. Prepare them.

221. I'll do it.

222. Are you sure?

223. You can't sugarcoat it.

224. Administer 2 mils surfactant, prophylactically?

225. No indication of RDS. She's on minimal settings.

226. I'd actually like to decrease support and remove CPAP.

227. Yeah?

228. No reason she can't breathe on her own now that her airway is clear.

229. Come on, Baby F. Deep breaths.

230. Your basketball rival Clay texted me.

231. - Asked me out. - Get out.

232. I assure you, this guy knows it's a real date.

233. If I go.

234. You're going.

235. That's our girl.

236. Baby E's lungs are filled with fluid,

237. and she's in early heart failure.

238. She may need to be reintubated,

239. which would mean placing her on her back.

240. That would make it harder for her surgical wound to heal.

241. That doesn't sound good.

242. She's very sick.

243. It's possible she may not survive.

244. Mm.

245. We'll pray for a miracle.

246. It wouldn't be our first.

247. I can arrange a visit from the hospital chaplain if you like.

248. - You can baptize the baby. - No.

249. You're asking me to let her go. I'm not ready to do that.

250. You can't, either.

251. Please.

252. Of course.

253. O2 sats improving.

254. Way to go, Baby B. You'll be shouting in no time.

255. Tell me you're not on Tinder.

256. You're in violation of the medicine-only agreement that you proposed.

257. And I'm not on Tinder.

258. My baby's on the mend. Yours is the one with the heart problem.

259. Don't be afraid to ask for help.

260. Then what's with all the handsome dudes' faces you're scrolling through?

261. Your screen is reflected in the window.

262. Not that it's any of your business, Columbo,

263. but they're not dates. They're donors.

264. Organ donors? Finally getting a heart?

265. Mm. Sperm.

266. Oh.

267. Yeah. "Oh."

268. Snowman sign on the chest X-ray.

269. It could be TAPVR, transposition of the great vessels,

270. Ebstein anomaly, or pulmonary atresia.

271. I don't see differential cyanosis.

272. That rules out transposition of the great vessels.

273. No boot-shaped heart, either.

274. Or gallop.

275. So it is TAPVR.

276. Which we can fix.

277. I'll get the parents' consent and book an OR right away.

278. Thanks for the help.

279. - Lucky I was a match. - Yes.

280. As Baby D's father, there was only a 38.5% chance you'd be a bone-marrow match.

281. Why are you here?

282. Being on your feet promotes blood flow,

283. and she wanted to be with her husband.

284. I'm just glad I can do something.

285. Gena's handled all the heavy lifting for our family.

286. You have no idea how hard this kind of stuff can be.

287. I do.

288. My wife and I have also struggled to have a child.

289. Modern medicine's a miracle.

290. I hope you'll be blessed like us.

291. I hope so, too.

292. But not as blessed.

293. I will insert the large bore needle into your hip now.

294. Ugh. I hate needles.

295. How'd you two meet?

296. He was my prom date.

297. Been together ever since?

298. Uh, no.

299. Gena ran off to New York for a decade to join the City Ballet.

300. Until I broke my ankle, ended my career, came home.

301. We reconnected at our ten-year high school reunion.

302. It was like no time had passed.

303. I never forgot her.

304. I never forgot you, either.

305. Done!

306. You get me yammering on about Gena,

307. and I barely even notice a needle going into my bone.

308. You did great.

309. We'll get this to the lab and then transfuse it into Baby D right away.

310. Nice work in there.

311. Baby C should be crying in no time.

312. Are you sure you want to raise a baby on your own?

313. Because I'm too careerist to be a good mom?

314. Like I was too ambitious to be a good girlfriend?

315. No.

316. You'll love your kid more than any job or partner.

317. I sure do.

318. But if you don't have the guy when you have the kid,

319. he might be tough to find.

320. I shouldn't have a kid 'cause I may never find a man?

321. Okay, caveman.

322. Well, I never said I wouldn't date a single mom,

323. but I am remarkably sensitive.

324. I want a kid, and I'm done waiting.

325. See you back in the NICU.

326. She's improving.

327. And hungry.

328. All ready for some colostrum.

329. Did you text Clay back yet?

330. After this, we can start introducing a pacifier.

331. I didn't have sex for 17 months after I lost my leg.

332. And then, when I did, I thought,

333. "Oh, yeah. I remember this. It's awesome."

334. It's a first date. I'm not even thinking about sex.

335. Liar.

336. These make these chairs that glide.

337. And wedges.

338. This is not a death sentence to your sex life.

339. Okay, I will text him back, mostly to stop this conversation.

340. - Hmm. - But it's just dinner.

341. For now.

342. Damn. She's not tolerating the colostrum.

343. I haven't started it yet.

344. So you guys ready to start trying again?

345. Oh, yes. We put up a calendar this morning.

346. And practiced.

347. I think she gets it, Shaun.

348. Visualizing the uterine wall.

349. That's scar tissue.

350. That sounds bad.

351. It's from the fetoscopic surgery

352. and D and C after your miscarriage.

353. You should do a hysteroscopy to remove the adhesions.

354. Thank you, Dr. Murphy.

355. He's right. Uh, we can attempt that, but—

356. You have Asherman's Syndrome.

357. Most likely, yes.

358. Well, can— Can we still start trying?

359. I wouldn't advise it.

360. How much longer do we have to wait?

361. I recommend continuing birth control.

362. Getting pregnant right now wouldn't be safe for you

363. or the baby.

364. When will it be safe?

365. Maybe another year?

366. Maybe two.

367. Maybe never.

368. Severe edema,

369. fluid in the lungs, but no obstructions, just as we expected.

370. So we've eliminated brain, spine, abdomen, anything congenital.

371. I shouldn't have let you talk to them.

372. Miracles? Really?

373. I was direct and honest.

374. How's that being honest?

375. They think there's a chance here.

376. As long as she's breathing, her heart is beating,

377. her brain is functioning, there's still hope.

378. This infant is under two pounds,

379. eleven weeks premature, with a major birth defect.

380. She's more than likely too small, too weak, and too sick to survive.

381. Stop being a cheerleader. Start being a doctor.

382. O2 sats and heart rate are improving.

383. Come on, dude. Cry for me.

384. You got this.

385. Who's a star?

386. Baby B is. He's coming off the vent.

387. Yes, you are. And then you're gonna wail.

388. Those guys you were looking at earlier,

389. how much do you really know about them?

390. You'd be surprised.

391. Well, besides their physical attributes and what diseases they carry.

392. Genetics can also determine your sense of humor, your values—

393. You want me to have the sperm bank

394. ask them all to write a knock-knock joke

395. and an answer to the trolley problem?

396. Or ask me.

397. I'm not suggesting I'd be the kid's dad.

398. I just want to help.

399. No strings attached.

400. Uh, Baby B's on CPAP. O2 sats rising.

401. Hope to hear a cry soon.

402. Excellent. Still no cry from C, either?

403. Okay. Scope the baby.

404. TAPVR repair may have caused vocal cord palsy.

405. No missed or new obstructive issues.

406. Upper airway's clean.

407. Why are her O2 sats plummeting?

408. Could be some sort of fistula,

409. bronchopulmonary dysplasia.

410. RDS.

411. Or it could be neurological.

412. She's too fragile to start testing blind.

413. I'll stay with her. Put her back on CPAP.

414. I'll put together a full differential.

415. Eat something while you're at it.

416. Marrow transplant seems to be working,

417. but I couldn't pass the NG tube into the stomach.

418. How'd the appointment go?

419. Not well.

420. Are you okay?

421. No.

422. How long has he been drooling?

423. I don't know. I... thought that was normal.

424. - It's not. - Any luck with the NG tube?

425. No. That is a symptom. This baby cannot swallow.

426. He has a congenial tracheoesophageal fistula.

427. We need to operate.

428. Camera is in position.

429. Fistula's between the distal esophagus and the trachea.

430. You were right.

431. I know. Now reconnect the esophagus.

432. Forceps.

433. Repositioning thoracoscope.

434. Got it.

435. Mobilizing the esophagus to the level of the trachea.

436. Have you already isolated the fistula?

437. Yes.

438. I didn't tell you to do that.

439. - Uh... - You should have first mobilized

440. the proximal pouch of the esophagus.

441. I'm s— I'm so— I'm sorry.

442. You may have interrupted the blood supply.

443. The risk of anastomosis leaks and tissue breakdown are greater now.

444. Give me the instrument.

445. Step back.

446. Move.

447. Take the camera.

448. Suturing.

449. Is he gonna be okay?

450. I don't know.

451. When I said "yes" to dinner, I didn't mean tonight.

452. Patience is not my greatest virtue.

453. I'm in the middle of this preemie case.

454. So you fasting until it's done?

455. Brought your favorite.

456. Roast chicken.

457. Oh. It's like the first time you asked me out.

458. Mm-hmm.

459. She's breathing on her own.

460. Nice.

461. I don't envy anyone who has to try to sleep in a house with six infants.

462. - Mm-hmm. - No matter how cute they are.

463. I feel that way about one.

464. Oh.

465. Are you opposed to kids?

466. I mean, not politically.

467. But?

468. I'm not sure I want any of my own.

469. Is that bad?

470. Being one of four, I...

471. I always saw myself with a big family.

472. Being one of eight,

473. pretty much why I don't want one.

474. Ice Cube, Guy Fieri, Tom Hanks.

475. - Everybody loves Hanks. - Not Tom Hanks.

476. Raider Nation is deep and eclectic.

477. I promise I don't paint my face.

478. Unless it's the playoffs.

479. Oh. So only one day per decade.

480. Okay. Opposite sides of the Bay.

481. That's why they have a bridge.

482. I can't believe you were actually there for "The Catch."

483. Were you sitting on that side of the field where Clark caught it?

484. Yep. You're distracted.

485. Want to walk me through your case so far?

486. EXIT procedure for CHAOS. Cyst was decompressed.

487. We weaned her off CPAP, O2 sats improved,

488. then started crashing.

489. Not sure why.

490. Pass me the ghost pepper sauce, would ya?

491. Ooh. Feel like that stuff's gonna burn a hole in my chest.

492. What if your preemie's breathing troubles

493. aren't from above? What if it's from below?

494. Diaphragmatic hernia.

495. Could allow the baby's lower organs to protrude

496. into her chest, crowd her lungs.

497. If it started as a small defect,

498. we could easily miss it on ultrasound with all the crowding in that womb.

499. Mm-hmm.

500. Smart, handsome, and you brought me food.

501. I might actually let you take me out on a real date.

502. This is a real date.

503. I mean, it will be once we kiss.

504. Then we should probably do that now.

505. My thought exactly.

506. Thank you for your offer.

507. But?

508. It would hurt too much to see you every time I looked at my kid.

509. The live birth rate in pregnancies

510. after Asherman's treatment is 67%.

511. She should have mentioned that.

512. Yeah. I guess so.

513. And hysteroscopy

514. improves the odds of conception.

515. Our prognosis for conception may still be very good.

516. I'm "sending good vibes into the universe, so good things come back."

517. Thank you, Shaun.

518. Maybe later.

519. Right now I'm just very sad.

520. I know.

521. O2 sats are falling.

522. I need suction and a ventilator.

523. Page Andrews. She's bradycardic.

524. She's not getting enough oxygen.

525. O2 sats are rising. Heart rate's normal.

526. She's fine.

527. Just forgot to breathe.

528. It happens when they're this little.

529. - I'm gonna go home. - You're giving up?

530. I'm accepting the situation.

531. There's still hope.

532. Stop with the hope already, will ya?

533. It's not gonna save this child.

534. Hypnagogia.

535. Thomas Edison believed the thoughts generated as we drift off to sleep

536. were the most likely to generate a breakthrough.

537. All right, Thomas Edison, the Wizard of Menlo Park,

538. the same guy who believed that if he sat on a goose egg,

539. he could actually make the goose egg hatch.

540. There was an experiment published in Science.

541. Subjects tried to solve a difficult math problem

542. late at night while holding something heavy.

543. When they drifted off to sleep, they dropped it,

544. and when they woke up, they solved the problem.

545. Okay, when I go to bed tonight,

546. I'll cuddle with a barbell while holding onto a light bulb. How's that?

547. Any breakthroughs on Baby E?

548. We've exhausted all our options.

549. We're moving on to "watch and wait."

550. We were just talking about hypnagogia.

551. The Edison sleep theory from Science magazine?

552. Thought we might stay all night

553. and take turns waking each other.

554. - Well, that's— - Absurd? Silly? Ridiculous?

555. I was gonna say that's better than "watch and wait."

556. You were right. Baby F has a diaphragmatic hernia.

557. It didn't show up in the initial X-ray.

558. Anybody would have missed it.

559. It was Clay's idea.

560. I'm glad that I texted him to bring you dinner.

561. You did not.

562. I did.

563. Well played.

564. After we get consent, you can scrub in,

565. help me make that little girl all better.

566. - Hypnagogia! - Ahh! What?

567. The groin.

568. - What? - The groin?

569. If we can't access the baby's chest, we can check the groin.

570. If she has bounding femoral pulses—

571. It would indicate a patent ductus arteriosus.

572. Which would explain the fluid in her lungs and the—

573. the heart failure, which could be fixed with a Piccolo Occluder.

574. Go get consent. And an aspirin.

575. Uh, wait.

576. What is it?

577. If we can't put the baby on her back,

578. how are we gonna insert the device?

579. I'll get comfortable.

580. You scream in my face this time.

581. He's swallowing now.

582. But still not crying.

583. Ready to show your brother how it's done?

584. Very polite of you to wait for your brother.

585. Maybe there was something to that shady co-bedding research.

586. Maybe you being a wuss was a blessing in disguise.

587. It would have hurt me, too,

588. having a kid with you and not being part of your lives.

589. Gaining access through the umbilical vessels, that was inspiring.

590. - I credit Thomas Edison. - As you should.

591. Seriously, thank you for humoring my crazy idea, Dr. Glassman.

592. Thank you for helping me to not give up on hope.

593. Come on, buddy.

594. Let me hear that cry.

595. Heart rate 110 BPM. Respiratory 65.

596. Look. I'm so sorry.

597. I thought I was... being decisive.

598. You were.

599. It was the wrong decision.

600. He will be okay.

601. You should feel bad, but not too bad.

602. Sextuplet births are incredibly rare,

603. one in almost four billion,

604. and the odds of 100% survival are even rarer.

605. But I'm happy to report all six babies are healthy

606. and all six babies will be going home.

607. It wasn't easy, but because of all of you...

608. they made it.

609. Some of our friends...

610. Mm-mm. That's a thicket of chest hair.

611. - Mm. - Chances are, his back...

612. Mm.

613. Because of your hard work, we're able to now...

614. Breakfast on me if you help me make a list of acceptable prospects.

615. I just wanted to personally thank you.

616. And the parents, Gena and Jack,

617. they want to thank you, as well.

618. This is a time to celebrate.

619. B's competitive. He likes to do everything before his brother.

620. And C's an empath, waited until he knew

621. his brother would be okay before doing his thing.

622. Hi.

623. Hi.

624. Byron and Christopher?

625. Yeah.

626. EJ.

627. Her name is EJ.

628. It stands for Erin Jordan.

629. Thank you both.

630. Meet Baby F.

631. Hi.

632. Francesca?

633. But Gena and Jack are first-time parents

634. who will be bringing home six babies,

635. so they're gonna need lots of help.

636. Now, for those of you who are willing to continue,

637. once the babies are at home,

638. there's a volunteer sign-up sheet at the check-in desk.

639. I'm sure Gena and Jack would be grateful

640. for any help you're willing to give.

641. So you had a goth mom?

642. She sang you "Boys Don't Cry" as a lullaby, right?

643. Oh, yeah.

644. She'd pick me up at school blasting Joy Division, too.

645. Humiliated me at the time.

646. But... she was a good mom.

647. My dad used to sing "Ein Keloheinu"

648. louder than everyone in shul.

649. I... hated it.

650. Which was probably the point.

651. Could be fun to embarrass our kids some day.

652. Far, far in the future.

653. Thank you. Okay.

654. I'm glad I brought this case to you.

655. Me too.

656. Marcus. I'm sorry.

657. For giving up on us. For cheating.

658. It's the worst mistake I ever made.

659. It wasn't all you.

660. I don't know that I gave up,

661. but I certainly didn't pay enough attention.

662. Gena and Jack grew apart...

663. but they found each other again.

664. It's a nice story.

665. Yeah.

666. Nice.

667. Derek.

668. Say "grilled cheese" six times!

669. Grilled cheese.