The Good Doctor (2017–…): Season 1, Episode 12 - Islands: Part Two - full transcript

The twins suffer complications from their surgery forcing the team at San Jose Boneventure Hospital to make a life-changing decision. Meanwhile, Dr. Shaun Murphy returns to the hospital ...

Previously on
"The Good Doctor"...

Lea: You need to take a break,
clear your head.

You need a vacation.

I'm gonna quit my job.

I'm not looking forward
to moving

to Hershey, Pennsylvania.

I don't want kids.


I've just been fired

for physically assaulting
an employee.

Go ahead.
Chop us in half.

When will they wake up?

They should've already.

We were worried about you,

So glad you're back.

I am gonna give you
three words.

Try to remember them.

Apple. Ball. House.

Can you count back
from 100 by 7 for me?

I'm going to Harvard,
you know.

93, 86, 79, 72, 65.

And what city
are we in?

San Jose.

And what were
those three words?

Apple. Ball. House.

Look out, Harvard.

We'll be doing a lot more tests
to know for sure,

but your heart
does sound better.

How's Katie?

You woke up before her,
so too soon to tell.

There's virtually no alpha
or beta brain activity.

We must have missed something
during the separation surgery.

We didn't.

Katie's BP was steady,
sats were fine,

regional blood supplies
were reconstructed.

Just like Jenny,
yet she's awake,

Katie's in a coma.

Ko: Katie's got
the new sagittal graft.

A problem with blood
flow in that vein could
cause her condition.

An MRI angiogram should tell us
if the graft is open or not.

Shaun: Hello.

I will proceed
with the angiogram.


Murphy, you've been gone
for two days.

How about we start there?


Just because you talked
to the president

doesn't qualify
as permission.

Okay. Yes.

I...will notify
Dr. Melendez

next time I go on a road trip
with my girlfriend.


"Road trip"?

Dr. Glassman said you were
dealing with a personal crisis.

That is true.

Do you know the definition
of personal crisis?

Yes. A stage
in a sequence of events

at which the trend of all
future events is determined.

-A death, an illness.

No, not a road trip.


You and Dr. Browne

get going on Katie's angiogram,
unless, of course,

you have any personal
emergencies to attend to.

My crisis is over.

Come in.


How are
the twins doing?

Jenny's in recovery.

Her numbers look good.
She's talking.

Katie -- not so good.

We need to talk
about Murphy.

I told you
he's on personal leave.

Yeah, well,
that's not what he said.

You talked to him?


In the surgical unit
five minutes ago.

There's the sagittal vein graft
we constructed for Katie.

It's open
with good flow.

Graft is fine.

Which means we still have
no explanation for her coma.

Go in closer.

The middle
cerebral vein,

it has low flow
out of the brain.

You're thinking low flow out
means low flow in?

Yes, that is
what I'm thinking.

We should look at
the arterial inflow phase.

We'd like to look at the
arterial inflow phase, please.

Claire: So, what'd you do
on your trip?

Well, sometimes
when we take a road trip,

we're running away
from something.

I kissed Lea.

And Dr. Glassman
is mad at me.

What is he mad
at you about?

It's almost
entirely blocked.

And...there's a malformation
in the Circle of Willis.

Katie is barely getting
any blood to her brain.

Excuse me. Shaun?

May I speak with you,

Dr. Melendez --
He was not angry.

Oh, no, Shaun.
Dr. Melendez is angry with you.

He's also angry with me.


Because I lied to him for you.

Why did you run away?

I didn't --
didn't run away.

When you leave without
notifying your attending,

when you drop all of
your responsibilities
at this hospital...

When you leave without
telling anyone, including me,

then you are
running away.

Did this trip
with this girl help?

Yes, it did.

Okay. How?

I would like to give
two-weeks notice.

Mom, can you ask them
to bring me some more ice chips?

I'll get them, sweetie.

I'll get a doctor.


I'm just...

When you left,
there was no one here.

For the first time in my life,
I was alone.


It felt...cold.

Well, sometimes
it is cold.

But you know what?

Someday, you might find
that you like it.

Wrongful termination.

Dr. Kalu assaulted
an attending surgeon.

I don't think you have
strong legal footing here.

There's more
to the story.

And I am sympathetic
to Dr. Kalu,

but his ends
don't justify his means.

Obviously we can't tolerate
staff members --

And yet you do.

Please read on.

The middle cerebral
has narrowed.

It's less than
2 millimeters.

We bypass the artery here
and restore blood flow.

Open her back up?

She's just been through
a massive operation.

The brain tissue
hasn't settled.

Another could very well
stroke Katie out.

Other options.


I don't see how
an intravascular ultrasound

gives us a better picture.
-No, not imaging.

He wants a stent
in the middle cerebral artery

in the angio lab.
I like it.

Stenting is usually reserved
for the heart and the carotid.

It's not the usual,
but we are way past the usual.

It would lower
the danger of a stroke.

Dr. Murphy,
would you like to assist?


Dr. Melendez,
would you like to write me

a letter of recommendation?

You see the narrowing there,
in the horizontal segment

of the middle cerebral artery.
-Middle cerebral artery.

I've heard about you.

You're the one making
the old guard nervous.

W-Why would I make
people nervous?

'Cause you have a gift.

And surgeons judge themselves
against their peers,

and right now,
you're winning.

We're in position.

Dr. Murphy,
please inflate the balloon.

Give us another
squirt of contrast.

And we should have
good blood flow.

Yes, the proximal end
of the artery is dissecting.

The balloon
is damaging her artery.

Waveform is worsening.

Stent won't hold.

She's gonna stroke.
I'm aborting.


is normalizing.

We're right back
where we started.

Katie's brain
is starving.

I want to see Katie.

I know she's in a coma.
I still need to see her.

I miss her.

We can't risk contamination
for either of you.

She needs to know
I'm there.

We understand.

You can understand.

No one can.

We have always been there
for each other,

and now when she needs me most,
I'm not there.

You've just been through
a 40-hour surgery.

We need you to focus
on your own healing.

And what about
her heart?

We're going to do
a cardiac catheterization test

to see if her heart circulation
has improved.

Inject the contrast to evaluate
the heart's blood supply.

How's my soul looking?

a different specialty.

Katie says the eyes
are the window to the soul.

I say the eyes lie.
It's the heart.

Well, then, so far your soul
is looking good.

Strong, unobstructed
blood flow.

Ventriculogram will tell us how
the muscle function's doing.

So quiet.
Is everything okay?

Ventricle's strained
and dilated.

We were hoping for some
improvement post-separation,

but it's barely pumping.

It just doesn't make
any sense.

The separation
was supposed

to relieve the stress
on Jenny's heart.

Half the need,
half the work.

Jenny's heart was even sicker
than it appeared.

Seems we couldn't see that
because Katie's heart

was doing all the work
for Jenny's.

What can we do
to fix it?

Give her a new heart.

We're not gonna find
a donor match in time.

Yes, we already have
the perfect heart for Jenny.

The sisters are monozygotic
and therefore a genetic match.

On the other hand,
Katie is alive.

-She is GCS-3.
-Her heart is still beating.

Yes, but she is

And I don't see a way to return
blood flow to the brain.

In all likelihood,
Katie's not coming back.

Yes, Katie very well
may die, but we can't
predict when that'll be.

It could be today.
It could be 20 years from now.

If Katie stays
on the ventilator.

-That's not up to us.
-I know.

But I also know that,
based on these scans,

Jenny might not make it
through the night.

We need to propose this
to the mother.

There's no chance
Katie will wake up?

We can't say with 100%

but from what we saw
on Katie's brain scan...

we have little reason
for hope.

But what we can say
with certainty

is that without Katie's heart,
Jenny will die.

Can we wait?

Just a little.
Maybe you'll know more.

Maybe something
will change.

If we don't do anything,
Jenny's heart will stop
before the morning.

How do you...

Would it be painful?

No. We simply power down
Katie's ventilator.

Once off life support,
she will peacefully pass.

Do you want us
to explain this to Jenny?

I'm sure
she'll want to be present.


I put trust in them
from an early age,

thinking responsibility
would build strength.

I think it worked.

But this...


Jenny can't be part of this
in any way.

It'd destroy her.

I'll tell her Katie died.

"Dr. Shaun Murphy

exhibits technical skills
beyond his years."

You wrote that?


That's why I signed
my name at the bottom.

You think Shaun survives
at another hospital?

I didn't think
he'd survive here.

Without your endorsement,
Shaun isn't going anywhere.

I may have my issues
with him,

but no matter how stupid
an idea this may be,

I'm not gonna stop him
from going after what he wants.

There's another signature line
next to mine.

It's where the president
of the hospital has to sign.

The chief oncologist.

This is before I came here
in December of '14.

Dr. Marshall shoved
a scrub nurse

during a post-op discussion
of some sort.

Do you remember that?

I do.

Your response
was to settle with the nurse

while Dr. Marshall
was let off with a warning.

There's another almost identical
instance earlier in that year.

In both cases, the doctors
in question were white.

They were censured.
Dr. Kalu was fired.

You think
this was a racial matter?

Do you think I'm racist?

That I favor
white people?

Then why the leniency then
and not now?

They're stars...

that happened
to be white.

Doctors like Marshall
allow St. Bonaventure

to compete with other
West Coast institutions.

So, that's our defense?

"We're not racist.
We just allow our doctors

to assault people as long as
they bring in enough donors."

They were reprimanded.

And there were
no further incidents.

And how do you think all of this
is gonna play out in court?






Shaun asked Dr. Melendez
for a letter of recommendation.


All I have to do is sign it
and off he goes.

I think...

he might think
that you're mad at him.

If you don't sign,
it reinforces what he thinks.

But if you do,

it lets him know
that you believe in him.

Can I touch her?

Of course.

Goodbye, baby.

Are you ready?

She's stabilizing.

I don't understand.

What's going on?

Katie's not ready
to go.

She's breathing on our own,
which means Katie has

normal brain stem
function, correct?
When a ventilator is removed,
life can continue.

It's rare,
but it can happen.

It doesn't change
the prognosis for awakening.

Off the ventilator
with normal vitals

suggests long-term
vegetative state, right?


We just lost our remedy
for Jenny's heart.

What about ECMO?

Use the machine as a replacement
for Jenny's heart.

Buys us...
two weeks of life?

I don't like it.

ECMO requires blood thinners.
She just had brain surgery.

It could cause
a catastrophic bleed.

Well, ECMO and its complications
may be our only avenue.

R-Re-conjoin them.

You want -- You want to put
their heads back together?

Not the heads.

The thighs,
the femoral vessels.

Is it a funny idea?

I think it's funny
that I didn't think of it.

The girls' blood
is identical.

No need for anti-clotting meds,
so no possibility of a bleed.

As long as they're
attached, Katie's heart
will beat for Jenny.

When Katie dies, we sever
the femoral connection

and transplant Katie's heart
into Jenny.

We just spent 40 hours
separating them,

and now we want
to put them back together.

You tried
to kill Katie?


You took her off
life support.

What do you call that?

Not just for her.

You need a heart
or you're going to die.

Katie's alive.

She was then,
and she's even more now.

Katie's alive in the sense that
she has basic organ function,

but she has no higher-cognitive
brain activity.

She's surviving,

but she is not living.

Hours ago,

you thought she'd die

as soon as you
pulled the plug.

You were wrong.

How do I know you're not wrong
this time, too?

The demand on --
on Katie's heart

is minimal
in her resting state.

She can easily tolerate
helping you.

I won't ask Katie to be
my life-support machine.

Dr. Andrews.

Let's put the sisters
in the same room overnight.

I don't think that Jenny sees
herself as an individual yet.

You know, I'm thinking
the only thing that'll
change Jenny's mind

about the reattachment
is Katie.

Being close might help Jenny
to see her as lifeless.

Could backfire...

and cement her feelings
that she's killing her sister.

Yeah, possibly.

And then we're in
the same position anyways.

Okay, do it.

Well, what about

that this girl
caught at a Giants game

signed by
Mr. Hunter Pence?

He didn't hit it,
but that doesn't matter.

So, where is
the sporting-goods one?

Oh, no, that does not
go in sporting goods.

It doesn't?

I'm applying
to move my residency

to Hershey, Pennsylvania.


Penn State Medical Center.

Are you following me?

I need to make sure

you're not just doing
this to stay close to me.



I want my own life.

I want a life that I control,
not Dr. Glassman.

Dr. Glassman is just
trying to help you.

I don't want help.

But what if...
you need help?

How will I know
if I stay?

Too much stuff.
You have too much stuff.

We should book a trip.

Maybe somewhere warm.

You are so slow.

You're only folding underwear.
Underwear's easy.



No, Neil,
I don't want to...


Let's go, Preston.

I'm ready.



You're the only good thing
about my day.

I couldn't sleep last night.

I couldn't even
close my eyes until...

...I could feel Katie's heart
beat in my hand.

If I do this,

at some point Katie's heart
will beat for me, right?

That's the plan.

Then wherever I go,
she will always be with me.

Okay. I'll do it.

How you doing, Jenny?

I can't feel anything.

That would be the magic
of local anesthetic.

Vessels are clamped.
Okay, Doctor.

We're ready to proceed
with the anastomotic grafts.

It's done, isn't it?

I can tell.

Let's put both the girls' vitals
next to each other, please.

Come on now.

Give it a few cardiac cycles
to adjust.

How'd we do?

You did great.

Why Hershey?

Lea is moving there.


Well, they -- they make
good candy bars.

I don't like
candy bars.

I love pancakes.

Well, they make those,

I brought you here

I thought this place

would provide a challenge
for your abilities.

But I realized
I really brought you here

because I thought
you needed me.

This is a now signed
letter of recommendation.


I don't want you to go.

If you stay,
I'll -- I'll back off.


I'll let you make
your own choices,

your own mistakes.

I believe in you,

Their blood pressure

5 millimeters of Mercury.

I like when you say

Melendez: You're gonna see
some fluctuation.

BP drops 5 millimeters every
complete cardiac circulation.

Shouldn't the fluctuation
be inconsistent?

Maybe Katie's heart isn't
picking up the workload
for Jenny as expected.



I'm -- I'm right h-here,

Right next to you.
It's hard to take
all of this hate

It's hard to take
all of this
Take Murphy and get
a shotgun work-up on Katie.

I want everything --
EKG, EEG, and labs,

and an echo on Jenny.


This hate

Mm, mm

Katie has an awake
alpha rhythm on her EEG.

She's doing
remarkably well.

We're still not entirely
sure what caused Katie
to regain consciousness.

Attaching them again could
have redistributed fluid
into Jenny's system,

possibly decreasing
the swelling in Katie's brain.

Just don't know.

I know.

They need each other.
They always have.

The issue right now
has become Jenny and her heart.

When Katie was in a coma,
the metabolic demand on
her heart was very low,

but now that she's alert
and active,

there just isn't enough heart
for both of them.

What does that mean?

We're awaiting
test results.

We're not sure
how long Katie's heart

can tolerate the strain of
supporting Jenny's circulation.

We'll closely monitor them
with cardiac labs and echoes.

We need to find a donor heart
for Jenny as soon as possible.



I've had CEOs settle for half
of what I just got for you.

I don't care
about the money.

That's beautiful.
It's admirable, even.

But, you see, this is how
it works because we live
in a civilized society --

they hurt you,

we hurt them by making them
cut you a massive check.

I don't want them
to hurt.

I want them to give me
my job back.

A third
of "your job back" is,

by my calculation,
uh, almost nothing.

I'll pay you
a third of this settlement.

What are you
talking about?

You'll be paying me more
than you earn in a year.

I want my job back.

Lunch is on you.

Lunch is on me.

Are you moving to Pennsylvania
to be with Lea?

Does she know that?

Lea knows
I'm moving to Hershey.

Yeah, but does she know
you're going there

because she
is going there?

I'm not.

Lea makes me happy.

Well, Lea's not the only one
that can do that.

I'm gonna miss you.

Lab tech: Your BNP.

Jenny Kunkler's
cardio protein levels are --

I've never seen
anything like it.

That's because the levels
are for two hearts, not one.

Now Jenny
is killing Katie!

-What's going on?
-We got to separate them now

or we're gonna lose them both.
-We got the twins on the way?

In transit.

J.L.'s gonna do a local
on the fly.

Ko: On my count.
Three, two, one.

We can't do this.
You'll die.

We're gonna do it.


We're in this

The way
we've always been.

The way
we were meant to be.

It's Jenny!
He's in v-fib!

Push a milligram
epinephrine now!

Prepping Ambu bag.

Murphy, start chest

It's Jenny.

Her heart had nothing left
to give.


She's stable.

Her vitals are good,

but we have an issue
that we need your help with.


Um, Katie won't allow us
to separate her from Jenny.

If she doesn't acquiesce,
Katie will clot and die.

Nurse: Bring 10,000 units
on board.

We'll clear out
and give you some privacy.


We have
to let her go.

I won't let them
separate us.

I never
wanted to do this.

You used to say we were
made this way for a reason.

I won't let them
do this.

Even if it kills me.

I want you
to look at your sister.

Look at her.

I can't lose
both of my daughters.

Dr. Andrews.

I, uh, checked out
the twins' file.

It's an amazing case.

To be clear, Jared,
I don't want you here.

What we presented
to Miss Preston was the truth.

I understand that.

And those problem doctors
and the ways we police ourselves

will be dealt with, should have
been dealt with a long time ago,

but you stepped over
a line.

I fought for my job.

You compromised
your integrity.

The incident with that
jerk Coyle had nothing
to do with black or white,

but that's what you and
your lawyer sold for leverage.

And when you misrepresent racism
for something it's not... sets us
two steps back.

She's ready.

you're on suction.


You were alone

Left out in the cold

Clinging to the ruin
of your broken home
I'm cold.

Too lost and hurting

To carry your load

We all need someone to hold

You've been fighting
the memory all on your own *

Gone fishing.

Nothing worsens,
nothing grows
Store's closed.

I spoke to Claire.

I know how it feels
being by yourself in the rain

We all need someone to stay

We all need someone to stay

Hear you, falling and lonely,
cry out

Will you fix me up?

Will you show me hope?

At the end of the day,
you were helpless *

Can you keep me close?

Can you love me most?


I want to break up.


Because I love you.

Odd reason to break up
with somebody.

I want you to have everything
in your life.

Which includes kids.

I told you
I was willing to not have kids.

You're gonna regret
that decision one day.

-I won't.
-Yes, you will.

You're just too decent
to think it, but you will.

So what?

We all have regrets.

I-I wanted to play third base
for the Astros.

It's not the same.
That is a child's dream.

This is your life!

This is my life,

and it'd be more devastating
to be resented by you

than to have
my heart broken.

And you are going to be
a great dad.


I wanted to give you

I'm letting you
borrow it.

Bring it
when you come visit?



You're gonna
come visit, right?

I promise.
I like Hershey.

You've never been
to Hershey.
Lea's there.

Can I put
my arms around you?

Are you
a good doctor?

'Cause when I think of you,
I think you are.

You were alone

Left out in the cold

Clinging to the ruin
of your broken heart

You were falling and lonely,
cry out *

Will you fix me up?

Will you show me hope?

At the end of the day,
you were helpless *

Can you keep me close?

Can you love me?
Remember, I said borrow.

I know how it feels
being by yourself in the rain

We all need someone to stay

We all need someone to stay

Hear you, falling and lonely,
cry out

Will you fix me up?

Will you show me hope?

At the end of the day,
you were helpless

Can you keep me close?

Can you love me most?