The Good Doctor (2017–…): Season 1, Episode 17 - Smile - full transcript

Dr. Shaun Murphy questions the need for an elective surgery that will allow his young patient to smile for the first time. Meanwhile, Dr. Claire Brown and Dr. Morgan Reznick discover that their patient lied about her identity.

The timing was good.

I just got a job transfer,
Gretchen will start
at a new school.

We're gonna start
a whole new life.

It's very exciting.

In college,
my dad majored
in cheerleading.

That was a joke.

Gretchen's got
a great sense of humor.

I'm laughing
on the inside.

Soon you'll be laughing
on the outside, too.

Dr. Park.

Moebius syndrome

is a paralysis
of the sixth and seventh pair
of cranial nerves.

The seventh pair
controls facial expression.

Luckily, in Gretchen's case,

we haven't found
any limitation
to the sixth pair.

I'm a lucky girl.

We'll be taking two slivers
of muscle from your thighs,

along with their nerves
and blood supply,

and transplanting them
into your cheeks.

There'll be considerable
recovery time

before you'll be able
to smile at will,

maybe three months.

So, what do you say?
Are you up for this?

Can I sleep on it?

See what
I have to live with?

Nobody knows
when I'm joking.

Sorry, Dr. Andrews.
Yes, I am very up for this.

Okay, great.
So unless there are
any other questions...

Do you want to be
a comedian?

People getting your jokes
must be very important to you

if you think
it's worth the risk

of dying
during elective surgery.

I apologize
for Dr. Murphy.

He's still learning
that silence
is the right choice

when you have nothing useful
to offer.

We are required
to have an honest
risk/benefit discussion

with our patients.

We are giving
a lovely young girl a smile.

That's a simple equation.

Well, it's more than
the smile or the jokes.

She can't express
any emotions at all.

No one can tell
if she's happy or sad

or scared, anything.

She's never had
much of a social life.

Ever since her mother died,

she's been
completely withdrawn.

All I want to do
is bring my baby girl
back into the world.

Don't worry, Mr. Milman,
we're gonna take great care
of her, all right?

Lucy has a post-op infection
of unknown origin.

Infusing 900 milligrams
of clindamycin.

It's terrible, isn't it?

Yes, it is.

Have you been changing
your dressing?

Every day.

Soaking it
in clean, warm water?

Taking your antibiotics,
one pill, three times a day?

That's a no.

Lucy, I know I gave you
a scrip for antibiotics,

along with one
for pain meds.

Why haven't you been
taking your antibiotics?

Did you have a bad reaction
to them, or...

I never filled
my prescription.

I didn't think
it was necessary
until it got really bad,

and then I was too weak
to go myself,

and I didn't have anyone
to pick it up for me.

Okay. Mystery solved.

I'm sorry.
I know it was stupid.

Very stupid.


Hey, Shaun.

Oh. Hello.

I haven't seen you
in ages.
What's... What's new?

I'm buying an apple.

I can see that.
Here, I'll get it for you.

No, thank you.

Thank you, Shaun.

What else is new?

You didn't want
to be friends.

Um, yeah, no, I...
We... We... We...
We're colleagues.

You know, we're...
Whatever we are,

we can still talk.
We should talk.

I have a new friend.

Here you go.

Thank you, Debbie.

Kenny, huh?
That's, uh, that's great.

Do you have
a new friend?


Thank you.

Thank you.

We can talk.

You know,
we can talk about sports,

we can talk about weather,
we can talk about...


Why would you want
to talk about Debbie?

Debbie was flirting
with you.

She was?

I noticed her exhibiting
two typical signs.

Not the trifecta, huh?
No, not the trifecta,

and one atypical sign.

I think she's just
trying to be friendly.

She gave you
an extra dollar in change.

And the fact
that you didn't notice
means you like her, too.

Maybe she's just
bad at math.

My dad said that
you're on the spectrum.

That's why you said that
about people getting
my jokes.

People always
get my jokes.

Then you're very lucky.

That was a joke.

I see what you did there.


They call me
"Resting Gretch Face."

"Shaun the Moron."

Not very witty.
I'm obviously quite smart.

I drew this
to their attention.

I'm on a spectrum, too.

Somewhere between
unapproachable, and...

Actively scorned.

I don't want to be
more approachable,

and I prefer people
not reading my emotions.

They're mine.

That's what you do
with friends.

You really think
this surgery's too risky?

Possible complications
include embolism,

collateral paralysis,

asymmetry, brain damage,
and stroke.

It's also expensive
and medically unnecessary.

look straight ahead.

There's a two-hour wait
in the E.R.,
and what are we doing?

Treating a woman
because she willfully
ignored doctors' orders.

I know what a parasite
looks like,
and it's not Lucy.

So this is
a Mom thing with you.

Growing up
with a whack mother means

that you can identify
any and all
problem personalities.

And that is the sole upside
to my miserable childhood,
thank you.

Well, at least
you had a mom.

Mine died
when I was six,

and Dad instantly married
a child-hating bitch

with a butt-load
of debt.

Morgan, I'm sorry.

I didn't tell you
to get sympathy.

Just that I know
parasites, too.

Got you booked
first thing
tomorrow morning.


What? Too soon?


You're nervous.
I get it.

If you have
any more questions,
feel free.

I've changed my mind.

I'm not having
the surgery.



Gretchen's father
is very upset.

It seems you talked her
out of the surgery.

No, I didn't
talk her out of it
or talk her anywhere.

I just gave her
the list
of potential risks.

Embolism, hemorrhage,
collateral paralysis,

asymmetry, brain damage,
and stroke.


Yes, there was a case
in Brazil in 2004,

and the patient suffer...

It seems
that you don't believe

that restoring
this girl's smile
is that important.

Smiles are overvalued.

There are studies
that support that.

And there are studies
that don't.

When we smile,
we produce endorphins.

They make us happy.
They make
other people happy.

When we see smiles,
our basotemporal lobes
are activated,

and we duplicate
what we see.

smiles are contagious.

You see?

I feel good,
you feel good.

Everybody likes smiles.

I don't.

In any case,
your smile wasn't sincere

since it didn't demonstrate
the Duchenne Marker.

There was no involvement
of the orbicularis oculi
muscles around the eyes,

which means you didn't
release endorphins.

You know,
if you can talk her

out of a surgery
she's wanted for years,

I'm pretty sure a conversation
with someone objective

can talk her
back into it.

Get Park, come with,
and keep quiet.


Dr. Kalu.

Remember me?

"Fish girl"?

Uh, hi. Celez. Hi.

Yes, uh, of course I do.

I hope it's okay
that I requested you.

I'm glad you did.

How are you doing?

Oh, that's what
you're going to tell me.

I've been wearing
the, uh, tilapia skins
for five months.

I'm getting really tired
of being followed home
by stray cats.

How's the pain?

Compared to
what it was?


Uh, any... any fever,
itchiness, or swelling?


it looks very good.


How much longer?

Um, how do you feel
about tomorrow?


I never joke
about tilapia.

What's the matter?

I-I just wasn't
expecting that.


I'm afraid of how
I'm going to look.

You're going
to look beautiful.


I know Dr. Murphy
informed you

about the risks
of this surgery,

and some risks
are significant
and some just aren't.

This is as close to risk-free
surgery as we can get.

It'll give you a smile,
it'll let you laugh.


Dr. Murphy didn't
talk me out of it.

He inspired me.

He helped me realize
that this could actually
make me stronger.

I don't want
to run from it anymore.

Yeah, she's lying.

She's a smart,
sarcastic young woman,

not exactly someone
who's prone
to inspirational stories.

Why would she lie
about changing her mind?

when I was a cop,

I had a lot of people
change their minds
about testifying in court,

and it always came down
to one of three reasons.

Fear, confusion,
or they were paid off.

She doesn't seem confused.

And I don't think
she's afraid.

So Gretchen
was paid off?

I admit the analogy
isn't perfect.

It's close enough.

Guess who's back
in the E.R.

You're happy,
so I'm guessing
it's a non-compliant patient.

You misjudged Lucy.

She made an honest mistake
forgetting her prescriptions.

You called her,
didn't you?

She didn't
spontaneously remember,
you had to remind her.

Is that
a Mom thing, too?

Gretchen, are you worried
that your dad
can't afford this surgery?

The insurance company
is paying for it.


I know it isn't.

It's elective.

It's medically unnecessary.

No one can put a value
on your smile.

Not bullies,
not an insurance company,
not even Dr. Murphy.

In my opinion,
this surgery's
medically necessary.

Gretchen, sweetie...

My first memory
of your mother

was of her smiling at me
from across the room.

And because of that smile,

we ended up with you.

And... And my last
memory of her

is that radiance

lighting up the world
one last time.

I mean,
we never had much money,

but as long
as I had that smile,

I love you, Dad.

And that's why
I can't let you
give up everything for this.

Lucy Callard?

I'm here.

Lucille Elizabeth Callard?

Yes, that's me.

A Dr. Browne called me
to pick up my prescriptions?

You're the victim
of identity theft, Lucy.

There's an impostor using
your name and medical ID
to get benefits.

Did you have your purse
stolen recently?

Six weeks ago.

And you had
your driver's license
and credit cards replaced,

but not your
health-insurance card?

Is this why the pharmacy
refuses to fill
my prescriptions?

I'm on pain meds
for post-herpetic neuralgia.

It's getting really bad.

Once the impostor
filled her prescription
for pain meds,

the pharmacy
must have thought

you were
overfilling opiates.


It always flares up
when I get upset.

Don't worry, Lucy,
we'll get you your meds.

We... We can't.

We're already treating
"Lucy Callard."

Nice game, Tony.

Hi, Jim.

Marcus, hey.
You coming or going?

15-year-old girl
with Moebius Syndrome.

Your company
denied coverage.

No respiratory issues,
deformities, pain,
she doesn't even drool.

She's fully functional.

She can't smile.
That's a function.

I think it's wonderful

you want to give
this little girl her smile,

but if we pay for
everything wonderful,
we'll go bankrupt, huh?

And then
who are we helping?

We all know doctors
cheat diagnoses
to get coverage.

"Deviated septum"
gets you a free nose job,

gets you Botox.

Do you really want me
to play that game?

This isn't a game
for me.

We're a reputable company
with very high standards.

Very high bonuses
that get even higher
with your denial rate.

I was gonna suggest
we end this

before we say something
we'll regret,

but I believe
that just happened.

Gretchen's socially isolated,

and that's only
gonna get worse.

What if she slashes
her wrists?

You'd prefer
to cover that?

Are you threatening me
with a teenage girl's suicide?

And God forbid
something does happen to her,

'cause I'll make sure that
this conversation's part
of the permanent record.

Dr. Andrews said
smiles are contagious,

and I'm testing
that hypothesis.

Well, I'm not sure your study
will prove anything.

It might have
something to do

with the lack
of the Duchenne Marker.

Oh, yes.

But here you go.

That wasn't a smile.

Sure it was.

I want to show you

You need to follow me.


The impostor has poisoned
the real Lucy's
medical record.

We have to go through
every medication,

every notation, every test
to determine whose is whose.

Doing that with
zero tolerance for errors
could take six months.

Well, the paperwork
is our problem, not hers.

Not if the confusion results
in a harmful treatment
or incorrect diagnosis.

Well, we have to
do something.

This woman
is in serious pain.

So we treat her.
Just be clever about it.


Shaun, I've already
had two iced coffees...

Debbie. Hello, Debbie.

You flirted
with Dr. Glassman.

Oh, my God.

'Cause I have a new friend,
and he needs one, too.

I'm so sorry.
SHAUN: Okay.
Look, Dr. Glassman,

Debbie's facial proportions
are close to optimal, okay,

.38 vertical
and .48 horizontal...

I'm so sorry. you should find her

Thank you?

I'm so sorry.

And I think
you're both Jewish.

Tribal commonality
is highly conducive
to social bonding.


Bullies can't put a value
on your smile,
nor can Dr. Murphy,

but it seems
the insurance company can.

They've agreed to pay

about 85%
of the entire cost.

I can cover
the rest of that.

I swear.

Oh, sweetie, please,
let me do this for you.



"Jane Doe"?

That's the only way
that we can treat you
right now.

Go home
and get some rest.

The records department
will call you
to sort all this out.

A year ago,
I was playing tennis.

And then
the shingles hit,

and I was laid up
for six weeks,

and I've been
on pain meds ever since.

I lost my job,
my husband treats me
like I'm an old lady,

and my daughter
thinks I'm too medicated

to be around
the new baby.

Maybe I'll be better off
as "Jane Doe."

The impostor returns.

Lucy, can you squeeze
my fingers?


She's in septic shock.

Order a lactate level,
blood cultures,

and a broad-spectrum

I'll tell Melendez
we've initiated
Sepsis Protocol.

We should report her.

She's a criminal
and a flight risk.

And very, very sick.

We should put someone
outside her door

and arrest her
when she's stable.

We don't report patients
we find with drugs

or non-violent people
with guns.

We do report people
who steal from us.

What would happen
if people who needed our help

thought they would
be arrested?

If they thought they would be
arrested for stealing an ID,

maybe they wouldn't
steal an ID.

I don't remember anything
in the Hippocratic Oath

about checking payor sources
before treatment.

Strongly suggesting
there was no health insurance
in 4th century B.C., Greece.

We have
a duty to treat,

and we have the right
to get paid.

But first things first.

Oh, God, I really
do not want to be sued

by either one
of these women.

Maintain the pretense.

And as soon
as she's stabilized,
we're gonna press charges.

Dr. Park,
pull the muscle, please.

We don't want any excess
gathering in the suture line.

Thank you.

remove retractors.


Are you sure you don't want
something for the pain?

No. No, I'm good,
as long as you keep
talking to me.

Especially if you share
something, uh, very painful.



Like the time
I mistook my biology teacher

for my girlfriend
and picked her up
in the hallway?

Yeah, twirled her around
three times

before I realized
my mistake.

That kind of painful?

You may have to dig
even deeper than that.

How about

the time
I finally found myself
in the perfect situation?

You know, work,
friends, future,

I never really had before.

Maybe that's why
I screwed it up.

You're not responding
to the antibiotics
like we'd hoped...


You know, don't you?

When the real Lucy Callard
showed up,

it kind of
gave you away.

Is there anyone
we can contact?

Do you have
any children?

A son.

But he'd be
so ashamed of me.

Where is he?


First one in our family.

I had to choose between
premiums and tuition.

Your son is very lucky
to have such a loving mother.

I just wish
you got your antibiotics

when you got
your pain meds.

I didn't get
either medication.

Are you sure?

Because the real Lucy
was having problems
with the pharmacy.

I didn't want to risk
using the card again.

Is she okay?

Maybe it's time
to move on,

take the lesson with you,
find new friends.

I went to Denver
for an interview last week.


And... We're done.


Take a look.

Hey, trust me.

See? Beautiful.

The kid, college,
it's just
a convenient sob story.

Why would she lie
if she may be dying?

Here's what we don't know
about fake Lucy,

whether her story
is true.

Here's what
we do know.

She's a liar
who just found out
she's busted.

Speaking of lies,

that shingles virus that
the real Lucy had last year?

According to Dr. Spindler
at Santa Clara General,

she had it
the year before, too,

and according to
Dr. Millhouse at SF Muni,
the year before that.

She wasn't denied
the pain meds
because of our impostor.

She was denied
because she is
a garden-variety addict.

Well-played, sir.

Dr. Park says
the surgery went well.

It's been too long.

What has?

She should be breathing
on her own by now.

Even after
prolonged anesthesia,

it should only take
60 to 90 minutes.

Is she okay?

She should have
protective airway reflexes,

motor activity,
and a return of consciousness.

I need to page
Dr. Andrews, STAT.

What's going on?

Something bad.

Gretchen's glucose
is within normal limits

and her electrolytes
are also normal.

And we've ruled out hyper-
and hypothermia.

It doesn't leave much.
What about hypoxia?

Uh, she maintained
normal oxygen,

as well as end tidal CO2
throughout the entire case,

and we've given
reversal agents,

which we will repeat.

Do you feel bad?

It's okay.

You told them
it was close to risk-free.

They knew there were risks,
and I told them, too.

Get a CT.
Rule out clots, hematoma,
bleeding, and stroke.

WBCs and lactate
are rising,

O2 sat and MAP
are falling.

The Sepsis Protocol
isn't working.

Multiple Organ
Dysfunction Syndrome.

Another antibiotic,
ah, continue crystalloids,

her vasopressors?
Low-dose steroids?

Give 'em all at try,
and intubate her
and insert a swan.

And, yes, I understand
this is out of our own pocket.

Um, do anything exciting
for Purim?

Purim. Uh, no.

Yeah, you know, the usual.


Ate a little matzah,

and celebrated
our exodus from slavery,

which I think is Passover
and not Purim.

The truth of the matter is,
I'm only half Jewish,

so only
half the knowledge.

The truth is
I-I'm not Jewish at all.


my first husband was.

So I guess we have
our lack of Jewishness
in common.

You know what, Debbie?
I think I-I should get going.

Okay. Well, it was...

It was nice, uh, finally
meeting you, officially.


Oh, no,
look at that!

A 1975 300D,

one of the most
perfect Mercedes ever

just got
a little less perfect.

I beg to differ.
If you're looking
for perfection,

you look no further
than the 1967 280SE.

Cabriolet or coupe?

The coupe,
an all-time classic.

Well, an owner
of a 300SL Gullwing
might argue otherwise.

A Gullwing?

Can I get you
another coffee?


Iced, large, black.

That's it.
I know.

That's a little bit
unsettling, Murphy.


Why are you studying
the current of ions
during electrolysis?

Uh, it's not the chemical
kind of transference.

It's the
doctor-patient kind.

I'm dealing with
a personal situation.

I don't think
the Internet is very helpful

for solving
personal situations.


But I can't exactly
ask Claire
for her advice,

and I barely know Park,
and Morgan...

Morgan would be bad.

Very bad.

I'm a person.

Yeah. No, no.
Yeah, of course, Shaun.

I'd, uh,
I'd love your advice.


Uh, so I think Celez,
my burn patient,

has feelings for me,
and I...

...may have feelings
for her, too.

But there's a good chance
her feelings aren't real,

and if they are real,
then they may not
be permanent.

Uh, you know, it's kind of
textbook transference.

She's grateful
and she's vulnerable.

And all I've ever known
in my life
is unrequited love...

...from Claire
and from my parents.

And that makes me
vulnerable, too.

You should
call in sick.

Lea says calling in sick
is all you need

to gain superior wisdom
and knowledge.

She was right.

The CT showed
no abnormalities,

and the reversal agents have
been repeated without effect.

So what else
could it be?

Anoxic brain injury,
a complication
of anesthesia.

we believe...

...your daughter
is brain-dead.


All for a smile.

I made her think she wasn't
good enough the way she was.

I should've listened
to you.


There's just no predicting
how individuals will react
to anesthesia.


Park! You just walked out
on that man.

The last thing
a grieving family member needs

is to see
their doctor tap out.

Maybe she's still
under anesthesia.


It was one of the anesthetics
Gretchen was administered.

Now, what if she has

a Plasma Cholinesterase

It'd mean her body
couldn't break down
that specific drug.

Complete deficiency
is extremely rare.

I've never
personally seen it,

and I don't know anyone
who has.

but if she does have it,
she's just gonna wake up.

Should I tell
the father?

No, not yet.

No way we're letting him
grieve twice.

Your labs
are not improving.

Your organs
are shutting down.

You're running
out of time.

I'd like to stop
calling you "Lucy."

You're welcome...


What are you doing?

Corneal reflex.

It's mediated
by the nasociliary branch
of the ophthalmic branch.

What does it mean?

It means we were wrong.

She's gonna be
just fine.

Thank you, Doctor.
Thank you.

Thank you... Oh.

Thank you, Dr. Murphy.

you're gonna be okay.

You're gonna be
just fine.

I was drawing a bath,
and I leaned over
to turn it off,

and I dropped
the pill bottle,

and before
I could fish it out...

All the pills were ruined.
So you need a refill.

My pain has made me
so clumsy.

Lucy, you're a liar

and a cheat
and an addict.

We know about
the frequent prescriptions,

the multiple doctors,
and the ever-recurring

You have
a serious medical problem.

Let me help you.

Three months?


But we might
be able to give you

a pretty good idea
of what
you're gonna look like.

Those things by your ears
are neuro-stimulators.

When we activate them,
instant smile.

Sound good?

Dr. Murphy.

It's your mother's smile.

She seemed like
a good template.

There is
no Duchenne Marker.

Her smile is not real.

Thank you. Thank you.

But all the other ones are.

All the other ones are.

I spoke
with Jim Ransler,

who made it very clear that
we owe him big time for this.

Don't worry, Marcus,
I can handle him.

I'm very impressed.

It was all
very presidential of you.

You really went
above and beyond.

Yes, I did.

I thought
I was saving her life.

I nearly ended it.

Celez, hi.

This is the brilliant
Dr. Murphy.

He'll be assuming your care
from here on,

though I don't expect
you'll need much.

I understand.

I don't think you do.

You see,
doctors aren't allowed
to date their patients.

What are you
doing tomorrow?

Uh, I'm calling in sick.

I think you may still have
some friends here.

I guess there is one upside
to all this.

If she hadn't bought
the stolen insurance card,

the real Lucy wouldn't be
in rehab right now.

Surprisingly nice.

I told her what she needed
to hear to get help.

Trust me, I get it.

Too soft,
people take advantage
of you.

But with your
badass upbringing,

no one messes with you.

Upsides everywhere.

You have way more street cred
than, say,

someone whose mom's
a Johns Hopkins cardiologist,

whose dad's
a pathologist,

and whose parents have been
happily married for 37 years.

Coming from privilege,
zero respect.

Must be really hard
to overcome.

I'll call a code.

There's nothing left
to save.

Time of death, 8:14 p.m.

I'll notify her son.

Oh, oh, oh

We're gonna show you
that we're tough

We're gonna show you
that we're tough

Knock us down,
we'll get back up

Yeah, we're gonna show you
what we've got *

Oh, hey.

Um, my homies
decided to pop by

and, uh,
play some Texas Hold'em,

so I'm gonna have to
take a rain check
on that pizza night.

You got
a 70-inch flat-screen, too.

Uh, no.
I borrowed yours.

Makes no sense for us both
to have one, right?

Plus homies got to watch
March Madness.

Oh, um, sorry, amigo.

It's four-player
Texas Hold'em.

I don't like poker anyway.

Hey, Shaun.

Look, you're a great guy,

um, but you got a few,

like, quirks, you know?

And that...

It doesn't really...

...jive with
this kind of face time.

You get what I'm saying,

Oh, oh, oh

I love you, man.

Oh, oh, oh

I once drove a 300SL...

Thank you.
A 300SL Gullwing.

On the road?

No. For 200 feet
at the Concours d'Elegance.

Oh, in Pebble Beach.
That's just as cool.

The car show,
you know it.

Of course, yeah.

This year, they're featuring
a Rollston Coachwork display.

Including the Mercedes SS?

I don't know.

But we should find out.

Do you want to go?

I couldn't.

Yeah, no, I...


No reason.

I just... I just thought

that I should make that
my first response
before I accepted.

Can I get you
anything else?

No, thank you.
We'll just take
the doorstop.

I'm sorry. Um, well...

Well, you can bring
the doorstop.


Sorry. Um...

The thing...

The thing... The thing...
The thing that... That...

That t-tells you how much
to pay, the... The doorstop.

Could you call a...

Can you call
an ambulance, please?

Thank you.