The Good Doctor (2017–…): Season 1, Episode 16 - Pain - full transcript

When the team treats a patient who has to decide about getting a dangerous surgery that could change his life, the man asks Dr. Murphy what he would do.

My neighbor Kenny and his
girlfriend go all the time.

The rides were actually fun,

even though they hurl you
through the air very quickly

without a proper
three-point seat belt.

It was worth
the $300 I spent.

What kind of carnival
will cost you that
much money?

It was not
just the carnival.

Kenny's girlfriend wanted to
go to see a movie afterwards,

but I just got
the second edition

of Chaikof's
Atlas of Vascular Therapy

so decided not to go.

And you paid
for everyone?

I had to.
I lost the bet.

Rounds will have to wait.
We have a consult come up.

Hunter Denoble, 38.

Came into the E.R.
this morning complaining
of severe neck pain.

show anterolisthesis.

A herniated disc.
Thirty-eight a little young
for that, isn't it?

Unless there's a history
of spinal trauma.

There is.

Hunter fractured
seven vertebrae
in his neck and back

in a motorcycle accident
10 years ago.

He was one of
my first patients.

Suffered complete paralysis
from the chest down.

...a few months back,
just gnawing pain.

Ibuprofen usually
took the edge off.

Every day?

Uh, yeah, give or take.

It's not that bad.
Last night
things changed.

He couldn't move
his neck at all,

and the pain medicine
had no effect.

So, he wanted to tough it out,
but I dragged him in here.

Yeah, it sounds like you.

Feel that?


And that?

I made partner
at the firm.

I don't like
to call in sick.

And let's face it, I've spent
enough nights in hospital
rooms for five lifetimes.

Can't argue with that.
Squeeze my hands.

You have any tingling
or weakness in your arms?


The plain films showed
what looked like
a herniated disc.

Which would mean...?

disc replacement.

Day procedure, he'd be out
by the morning at the latest.

You married him?

Yes, three years ago
in Cancun.
It was lovely.

Even though
he's in a wheelchair?

Oh, no worries.

I get this all the time.

she can never wear heels,
but think of the parking.

What happened?

Pain shot right down
through my legs.

Your legs?

I haven't felt anything
below my chest in 10 years.

What the hell is going on?

When I saw the break of day

I wished that
I could fly away

Instead of kneeling
in the sand

Catching teardrops
in my hand

My heart is drenched in wine

But you'll be on my mind



Well, there's my girl.

I don't
want to see you.

But I haven't
seen you in years.

Don't run away from me.

Can we talk?
Since I don't
want to see you,

it follows that I don't want
to hear from you, either.

I just came in
to get antibiotics.

My surgeon doesn't work
on Fridays.

It feels fine.

Sorry, it's not fine.

This implant
is definitely infected.

Just that one, though,

Yes. At this point,

your butt lift, tummy tuck,
lipo, and breast augmentation

appear to be healthy.

But I need to remove
this one and clean the area

the bacteria spreads.

can you replace it?

Once the infection
is resolved

and you have
a few months to heal.

I don't want to walk
around with half
of a face for a few months.

Isn't there anything
you can do
to save the implant?

I can't make
any guarantees,

but if I can replace
the implant without
risking re-infection, I will.

Okay, Doctor.

I didn't understand
the lyrics, but I liked
your mom's voice.

Is she
a professional singer?

She is a lot of things.

Great mom
wasn't one of them.

How so?

A lot of people have
issues with their parents,
nothing new.

But everyone's story's

How so?

When I was in high school,

I babysat the kids
in my neighborhood.

I wanted to buy
a laptop for school

like a lot of my friends had,

so I saved up 1,000 bucks.

I came home one day,

and the money was gone
and so was my mother.

And three days later,

she came back from Reno

with a designer dress
and a guy named Ricky.

I never got the laptop.

My mom made pancakes.

They were good.

Mmm, what is that?

I've never seen
anything like that.

a spinal column tumor.

Hunter's initial
spinal cord injury

from the motorcycle accident
that caused his paralysis
was at T1,

but that part looks
almost completely normal now.

Hunter's phantom pain
is real.

My former mentor, Sonya Kung,

is head of the surgical
residency program

at Denver
Memorial Hospital.

If you want a meeting,
I'll make the call.


You're gonna need a job
after this year.

You just trying to
screw with my head,

or are you actually
being serious?

The opportunity is real.

I'm trying to be nice.

I do that
when it doesn't hurt me.

And this definitely
doesn't hurt you,

you getting rid of
some competition.

True, although you're not high
on my list of threats.

This would be a much bigger
benefit for you.

Look, I fought to stay here.

I'm not going anywhere.

It's very rare,
but after many years

with a bruised cord like yours
that isn't severed,

it can start to
function again.

So, this mass
is causing Hunter's pain?


If the cord is healthy,

why aren't I feeling
more than pain?

The mass is compressing
the healthy cord,

just letting the pain

We still have to do

some more advanced imaging
to map the mass,

but I am fairly confident

that if we removed it
that could change.

You may be able
to walk again.

We were able to
clean out the infection

and swap in a new implant.
I am very pleased.

You think it looks okay?

I love it,
and you are going to
look great at the beach.


We went there
on our honeymoon.

Thank you.


He's taking you to Hawaii.
You should be hugging him.

Oh, I'm so relieved.

Satisfied customers.

This is why cosmetics
is the most fun specialty.

Now, we're gonna
monitor you closely.

There is a risk
the infection could have
seeded to other implants.

Keep me posted.

Yes, Chief.

I'll take the early shift.

Once I'm on my feet,
I'm never sitting down again.

I'm gonna
take Cora dancing.

She's a great dancer.

Oh, no.

I push myself.

No offense. It's my rule.


If this works,

after a considerable amount
of physical therapy

you may be able to walk,

but that doesn't mean
you'll be a very good dancer.

After years of atrophy
from not moving your legs,

you will likely be
very bad.

You know what
the worst part is?

It isn't
being in the chair.

It's that people
see the chair first.

They don't see me.

You know what
I'm talking about.

Why would I know
what you're talking about?

My brother-in-law's
on the spectrum.
So's my assistant.

I make it a priority of hiring
people with disabilities.

Let me guess.
When you first
started working here,

no one believed in you.
They didn't know me.

They didn't know that I was
going to make a good surgeon.


You were different.

I guarantee you
every other doctor

started with a basic
level of respect.

It's implied
they're competent.

We waste our time
and energy trying
to prove that we belong.

I'm fine.

She's just being thorough,

You've been over my body
three times.

Early infections
often mimic blemishes.

It pays to be thorough.

Is this sore?

Maybe a little.

What's wrong?

It could be nothing,

or it could be a carbuncle,
an early sign of infection.

Dr. Andrews needs
to have a look at this.

This varicocele is raising
testicular temperature

and causing your sperm count
to be low.

Surgically, I go in,
ligate the varicocele

and re-check your numbers
in a few weeks.

It's done under a local,

so no anesthesia risks,
minimal blood loss.

There's a risk of
low testosterone
and impotence,

but recovery time's
usually a week at most.

So, I could have kids,
I just might not be able
to make them?

As I said,
it's low risk.

I only mention it because
I'm obligated to inform you.

Well, you're obligated to
inform me because it's a risk.

It's an unlikely complication,
but, yes, it happens.

It's outpatient.

I do it right here
in the office.

What I see here
is a chance to fix a problem.

And I see a chance
to create a new one.

I'm... I'm sorry,
I have to go.
I have a patient.

Look, I see a lot of men
with this issue.

Sure, they come in
because they want kids,

but I think what
they really want is
to reaffirm themselves.

And that's a good thing.

Thank you.

It's a spinal
arachnoid meningioma.

Have you seen
one of these before?

Much smaller.

They usually
don't get this big

because the pain and weakness
brings the patient
into the E.R. fast.

But in this case,
no pain,

no E.R. visit
until it got this big.

And it's wrapped around
the spinal cord tightly
and fused with the dura.

Can we get a fiber-optic laser
and take it out in segments?

No, I don't think so.

It stopped growing
and settled in this position.

But I do think
that we can dissect along
the subarachnoid plane

down to the largest
segment at T2

and remove it
in one piece.

That's an extension
of the mass.

Mmm, no.
It's the medullary pyramids.

It's an extension of the mass.

The pyramids are more central
and the color is wrong.

Murphy's right.

The extension's
tightly adhered
to the brainstem.

Who caught it?

Jared did.

Nice work.

Most first-year residents
would have missed this.

It's very small
on the surface,

but I can feel the fluctuance
under the skin.

What do we
need to do to fix it?

We need to remove
all of the implants

and some of the healthy
underlying tissue as well.

Unfortunately, it will
cause significant
permanent scarring.

No, no, no, you...
You can't do that.

I'll look worse
than I did before.

I... I don't get it.
You removed the bad
part from her face,

and it's fixed.
Looks good,
no more infection.

Let's just do the same
with the rest of 'em.

It's not that simple.

When we removed the infection
from Emma's cheek,

it was under the pretense
it was a localized issue.

If we just take out
the infection from
the new area,

it could jump again.

I won't do it.

When an infection spreads,
it often moves very quickly.

What Dr. Andrews
is saying...

I understand
what he's saying.

I'm 50 years old.

When I went
to drop my daughter
off at Michigan,

we went to that bar
on Liberty Street,

where we first met.

I saw myself sitting there
25 years ago,

young, confident,
full of potential.

Then you raise a kid

and look after
your husband,

a home.

You lose touch
with who you were.

You... You said it was
an infection, right?

Like strep throat
or something.

That's what
antibiotics are for.

Couldn't we just
use that?

We could try strong,
broad-spectrum antibiotics,

but I really don't
want to do that.

You could become septic.

You could die.

It'll work.

It has to.

The brainstem is complex.

Even our best imaging can't
provide a complete picture.

So, then, you would just
leave the cyst in him?

Other than the pain,
it's not harming Hunter.

It's stabilized now
and done growing.

But what about
the pain?

An implanted nerve inhibitor
will completely remove the

But I won't
be able to walk.


Exactly how risky is removing
the mass from the brainstem?

Everything that
keeps your heart beating

and you breathing
is right there.

The nerve inhibitor
is a day procedure.

You'd sleep
in your bed tonight

Give me a percentage
on this thing.

Don't do this
to yourself.

I don't like to give
those kinds of numbers.

They're population-based,
and they don't apply to
your exact circumstance.

I understand
how statistics work.

But there's a number,
and it's relevant.

There's a 15% chance
the surgery would kill you.

I remember
the moment I accepted
I'd never walk again.

It wasn't when Dr. Melendez
told me after the accident.

It was a few months later
when I was in rehab

and I was trying to
get up in the standing frame.

I looked out the window
and there's all these people
just living their lives.

I'm trying to fix something
that I can't change,

and life was going on
without me.

So I started
living again.

But now there's
something I can do.


I want to talk
to Dr. Melendez.



Just go get Dr. Melendez.

You curious?

About why
I gave you the credit?

I assume you thought
it was a set-up,

that Andrews thought
you were wrong and you tried
to throw it on me.

That's very cynical.

The other alternative
is that you were being kind,

which seems
very unlikely.

There is
a third possibility.

I'm proving a point.

When you lose their respect,
no matter what you do,

no matter how many wins
you chalk up,

you'll never get it back.

The game's already over.

You lost.

Does anyone like you?

I like me.

I've got results.

I know this is her first cycle
of antibiotics,

but I'm not seeing
any improvement.

Her neutrophils
are through the roof.

You'd be under anesthesia
for nine hours,

and I'll need to make sure
that your body's healthy
enough to handle the stress.

Will you tell him
not to do this, please?

You don't care
what I think?

I'm the one in the chair.

You have no idea
what that's like.

I'm right there with you.

Who carries you
up the stairs?

Who pushes you out
through the sand

so you can put your feet
in the water?

Well, this way you
won't have to do
those things anymore.

So you just want to gamble
the life that you have
for the life that you had?


We have a great life,

but I want to walk again.

And I want you
to see me walk.

I'm not gonna stand by
and watch you die.

If you want to selfishly
gamble your life away,

you're doing it
on your own.

I'm doing this for us.

No, you're doing this
for you.

She'll be back.

(ON PA) Dr. Tolles
to Obstetrics, please.
Dr. Tolles to Obstetrics.

Hey. Uh, I got a page?

I'm busy, and I don't like
being tricked into coming
down here.

Yeah, I know you hate me...
I don't hate you.

Seeing you
is not healthy for me.

Okay, wait...
Well, I just need to
tell you that I was sick.

I am sick.

I know, you've been telling me
that for years.

You were right.

I got help.

They have me
on mood stabilizers.

I'm doing better now.

I mean, sometimes the meds
make me feel flat.

You know, no highs, no fun.

No lows, though, either.
It's worth it.

I'd like to try again
to be your mom.

I mean, maybe we could just
talk some more?

I'll think about it.

Well, take these.

They need water
or they're gonna die.

My number's on the card.

I think I just won
the Tour de France.

It's a long surgery.
It will put a lot of strain
on your heart.

Your cardiovascular fitness
is excellent.


You get it, right?

Get what?

Why I want this surgery
so bad.

You'd jump at
a cure for autism,
wouldn't ya?

There isn't
a cure for autism.

Well, last week I didn't
think there was a surgery
to help me.

The surgery isn't guaranteed
to help you walk.

Why would you risk

losing a person
who accepts you
the way you are?

You may not
find another one.

There are a lot of reasons
to marry me, you know?

I'm sure there are a lot of
reasons to marry you.

Yes. I'm organized,
I have excellent
visual-spatial memory,

and Lea says I'm refreshingly
honest and fair.

I suppose Cora loves me
because I'm determined...

I'm pretty smart,

to helping others,

and most of all,
probably because I'm patient.

Were you always
those things?

Were you those things before
you were in the wheelchair?

Your autism helped you.
That's your point.

You're saying this chair
made me a better person.

The difference is
losing this chair now

won't make me lose
the lessons it gave me.

The antibiotics
aren't working.

I told you if they didn't,
we'd be doing surgery next.


She's going to die
if we don't act now.

Honey, we need to
listen to the doctors.

I need you to
trust me.

I can't go back to being
like it used to be.

You don't have a choice.

She wants
a second opinion.

She's going to die.

I told her that.

it's tough to actually get out
of those doors.

When I was a kid,

my little sister
had an accident
climbing a tree,

a traumatic brain injury,

and I woke up every morning
dreaming that she was better,

but she wasn't.

I took care of her a lot.

Brushed her teeth,
combed her hair, fed her.

Hunter was my first patient
as an attending,

and I had to walk
in that room
and tell him

that there was nothing
I could do for him,

nothing I could do
to fix him.

And now there is?

But there's no guarantee.

There is never
a guarantee.

I'm sorry,
but I can't risk

losing the man
that I fell in love with.

You're not just afraid that
the surgery will kill him.

You're afraid
that it might work.

You've only known Hunter
in a wheelchair.

Walking would be a fundamental
change in who he is,

a fundamental change
in who you are as a couple.

You're worried that
no matter what happens,
you're gonna lose him.

Hunter seems to
have a great life.

I don't know if I'd risk
giving that up.

What if there was an operation
to make you a perfect doctor,

never make a mistake,
but it had a, you know,
5% of killing you?

Would you do it?

That's not
a fair comparison.

Well, you said Hunter's
doing fine the way he is,

but we're talking about
giving him something more.

What about 2%?

I don't think
there's a number for me.

Oh, of course
there's a number.

Every time
you get in your car,

hell, every time
you leave your home,

you take a risk
something bad could happen.

But you do it anyway,

you know,
to make yourself better,

to make the world better,

sometimes just to have fun.

Sometimes to go
to a carnival.

Kenny's not your friend.

He's using you.

I...don't think so.

We have fun.

He's got a rap sheet.

Mostly misdemeanors,

but there's a couple
felony theft cases

that were bargained down.

Wait, you ran
a background check
on Kenny?

Well, you start by talking,
I start by gathering evidence.

I'll forward it to you.

In my experience,
there are only two reasons

why a married person has
this kind of cosmetic surgery.

Either you're halfway
out the door or she is.

Emma loves me.

That's what I figured.

The antibiotics
aren't working,

so your wife is going to die

unless you get in there
and you convince her

that she doesn't need
any of this cosmetic surgery

because you are a faithful,
loving husband.

How's the pain?

You know,
I think the adrenaline

of actually doing this
is helping.

It's the oxycodone.

That's good.

I'm glad you came back.

I never left.

I don't want to do this
without you.

I don't want to do anything
without you.

If you can walk,

you'll be different.

You won't need me anymore.

You think I married you
'cause I was having trouble
hanging clothes in my closet?

You're my girl.

I will always need you.

Even if I could fly,

who's gonna remind me to
call my mom on her birthday?

Or to floss?
God, I hate flossing.

Who's gonna remind me
to be a better person?

Who's gonna hold my hand
when I'm scared?

That was nice.

You have to
have the surgery.

You were distant before.

Since the surgery,
you can't get enough of me.

It worked.
You're happy, I'm happy.

I love you.
I always have loved you.

I always will.
You stopped loving me.

No. Never.

If you were in love with me,
you never would've
cheated on me.


please, no more lies.

You were never home.
We never talked.

You were never there.

There was never
another woman.

I was gambling... A lot.

I did it because I was ashamed
of the man that I'd become.

When we got married,
I promised you the world,

and instead I gave you
a mediocre life.

When I was up,
it made me feel like a winner.

And I was too embarrassed
to let you see me like that,
so I hid it from you.

She's gonna do the surgery.

Thank you.

Andrews needs an O.R.
for Emma Newton.

Claire, you're beautiful,
smart, and very good
at your job.

Thank you, Shaun.
That's a very sweet thing
to say.

Would you ever date someone
with a disability?

Yeah, sure.

You could choose
the ideal mate,

Why would you want
the unnecessary burden?

Everyone is dealing
with something.

We just have to love
other people for who they are

and hope they love us,

O.R. 1's prepped for Hunter.

I'll join you
in a minute.

So, what changed her mind?

Jared did.

you're my first assist.

Make the call.


This is as far
as you can go.

Nurse Matthews will take you
to the waiting room.


Can I, uh...
Can I give him a kiss?

Of course.

I can't do this.

Yes, you can.

This is what you do
in a relationship, right?

You take chances,


That's a large tissue
defect in the left breast.

If we'd
been in here
six hours ago,

I could have salvaged
more underlying muscle tissue.

I'm noticing
her heart rate jump.

You seeing that, JL?

I am now.

How's her surgical sites?

I'm not seeing
any bleeding.

what about your side?

looks good here.

the anesthesia's light?

Nope. No, something's
definitely happening.

Jared's right.

Suction, Claire.

Give me a 25 on a 130.

All right, Murphy,
I want you to cut
right under my forceps

very carefully.

SHAUN: Section's cut.

How are
the motor evoked potentials?

Signal's coming through,
spinal cord's
functioning normally.

The mass
has fully encased
the medullary cord.

Give me
the ferromagnetic wand.

I can't get the caudal end
clear of the underlying cord.

Got a big
drop in potentials.

We are compressing
his brainstem.

What's his pressure?

Mean arterial pressure's 70.

I got nothing now.

Push IV fluids.
Keep that MAP above 90.

Hunter's going
into neurogenic shock.

We need to
stop the surgery.

I'm almost there.
20 seconds.

Push vasopressors.

The last piece is right there.

It's probably edema.
Push 100 of dexamethasone.

Still nothing.

He's dying.

It's one
damn centimeter of tissue.

All clear.

That's her
second dose of amiodarone.
She's not responding.

She's thrown her
septic embolism.

I'm cracking her chest.

Ten joules. Clear.



cardiac massage.

It's time to call it.

Time of death, 10:23.

Welcome back, Hunter.

The mass was tightly adhered
in some spots,

so we're not exactly sure
what to expect moving forward.
But the cord looked healthy.

We're gonna be bringing in
several specialists
to work with you.

The first will be
a neurophysiatrist...

Thank you.
Thank you.

Thank you.
I'm grateful to all of you.

Would you mind if we talked
about the rest of this later?

I just want to
sit with my wife.

Thank you.

Hey. Hey. Hey.

I met a couple today
that lost their way.

They loved each other,

but by the time
they remembered
what really mattered,

it was too late.

I don't want us
to be like them.

I want to be
fully committed to you.

I love you, too.

There's a surgery I could have
that should make me fertile,

but there's a risk
of impotency.

What do you want to do?

I want to give you
what you want,

what we want,
a family.

We are a family.

Yes, I want children,

and there are many ways
to do that,

which we'll explore

But I draw the line
at anything
that risks our sex life.

It's just
one night a week,

but I think this could be
my big break, you know?

Well, you always had
a beautiful voice.

Well, everyone's
got one thing, right?

But enough about me.
I want to hear about you.

Do you have a man?

I did.

Pretty young thing
should have plenty of choices.

Hmm, I'm not looking to
complicate my life right now.


Still looking after
everyone else but yourself,

like you did for me.

Set your dreams
where nobody hides

You know,
I know brag to everyone.

"My baby.
She's a surgeon."

Surgical resident.

Right, sorry.

You like it?

I love it.

Give your tears to the tide

Where are you staying?
Are you in town for a while?


I'd like
to be closer to you.

I found a place.

You'd like it,

but I just need to put up
first and last.

No time

I'll pay you back.

How much do you need?


Plus I have to get furniture
and, you know, all of that.

I thought maybe you could
help me pick that stuff out.

You've always been
so good at that.

I really appreciate it.
I'm good for it.

Set your dreams
where nobody hides

Uh, Celeste isn't coming.
She broke up with me.

I hate her.

But I'm not gonna let that
ruin our night.

That's what friends are for.

They got each other's backs,
rain or shine.

By the by, I found a $20
in your battery drawer,

so I got us
Chinese food.

Don't thank me.
I don't like Chinese food.

Aw, come on now.

Trust me, everybody likes
Ma Jong's Kung Pao.

Set your dreams
where nobody hides

There you go.

I'm pretty torn up
about that Celeste thing.
She was a real keeper.

You said
you hated Celeste.

I do.
I... I hate her 'cause...

I don't know...
I kind of love her.

This tastes terrible.

then he hates Chinese food.

More for me.

Plain white rice?

No time

Oh, uh,
I got a gaming console,

and I hooked it up to
your bad boy over there.

We can play some
Mortal Kombat.

Come on.

No time

We doing this or what?

It sounds fun.

Yeah, there you go.

This one's you.

That's you on the left
right there.


You got four arms,
but you're naked,
so here we go.

I gave you
a pneumothorax.

Ah, I didn't
realize how bloody
this game was.

Ooh, a fireball.
I got you there.

Have you played
this before?

That looks like
a spinal fracture.

Yeah, I'd say...
I'd say there's
a huge fracture there.

You died.