The Good Doctor (2017–…): Season 1, Episode 6 - Not Fake - full transcript

An experimental procedure is devised to save a young groom. Jared tries to connect with a patient.

Previously on
"The Good Doctor"...

Is there something
you're not telling me?

When we're in meetings

don't ever call my ideas

Come on.
I'm being serious.

So am I.

Merrill's son asked
for personal advice.

- And he picked you.
- I know, right?

A surgeon needs to communicate.
Can Dr. Murphy do that?

Can he do that under stress?

Can he do that
knowing that a human life

literally hangs in the balance?

Thank you, Dr. Kalu.

You're welcome.
It's a special blend.

I roast the beans myself.

Smells like leather.

Then none for you,

I don't drink coffee.

It is dead in here.

That's why they call it
the graveyard shift.

Oh, well, I call it paradise.
You my trauma virgins?

Ah, Doctors Murphy,
Kalu, Browne...

Meet Dr. Audrey Lim,

your attending
for the evening.


He roasts the beans

Oh. Kiss ass.


How long?
Got it.

Listen up, everybody!

We got a mass cas
coming in.

It's a bus crash,
two dozen passengers.

Transfer all patients
waiting for beds

up to the nursing units.

Have maintenance
bring down cots.

We're gonna convert
the waiting room into triage.

No one goes home
till we're all clear!

Page everyone on call.
I don't care what department they are.

Tonight, everybody's trauma.
Glove up and line up.



EMTs will have triaged onsite,

so the patients
are gonna come in tagged.

I love these blank faces
right before Armageddon.

Trauma color coding...
Who knows it?

Green... walking wounded.
Yellow... observation.

Red needs immediate

And black go straight
to the morgue.




All right, red tags,
front of the line!

Red tags,
front of the line.

Wedding bus blew a tire
and flipped!

26-year-old female.

Second- and third-degree burns

to her neck,
chest, and left arm.

Kalu, you're up.

Trauma Six.

Guy was ejected
30 feet from the vehicle.

Multiple chest

acute respiratory distress
on the scene,

sluggish pupillary

- How long have you been doing CPR?
- 12 minutes.

- Have you shocked him?
- Three times.

We got to crack him.
Dr. Browne, I got this.

You take the next one.
All right, Bay Five.

We secured the foreign object
and staunched the bleeding,

but didn't want to touch it


- Good thing. It nicked her carotid.
- What is it?

Right now it's
a little Dutch boy

keeping her from
bleeding out.

Pulse ox is dropping.
She's at 87.

O2 sats down to 83.

Forget about the neck,

Treat her like
any other patient.

What are the first

Airway, breathing,

Good. Grab a kit.







I need help here!
Somebody, help!

Murphy, go!

Let's go.

Trauma Three.




I can't stop the bleeding.

- He's bleeding out.
- Do something.


I need a urinary catheter,
14-gauge needle,

arterial guide wire,
occlusion balloon,

and 20 cc of saline,

Season 01 Episode 06
Title: "Not Fake"





- What's he doing?
- I have no idea.

Well, you don't have one,
so I'm making a REBOA.

A what?


Is that even a word?

A REBOA will occlude
the damaged artery

and stop the bleeding.





Release the pressure.

BP is stabilizing.
90 over 60.

Nice work, Dr. Murphy.

I made a REBOA.

Oxygen is dropping to 89.

All right. Light.

Open wide for me.

Throat's swollen
from smoke inhalation.

Cric kit.

Do you see soot in her
mouth or nose?


She doesn't need a cric.
She needs an escharotomy.


Sats are going back up.
92 and rising.

neck burns.

The shrinking charred skin
is acting like a noose.

Escharotomy relieves
the constriction.

Are you getting enough
air now, ma'am?

Yes. Thank you.

Now get her out of
this petri dish

and into an isolation ward
in the burn unit ASAP.

Yes, sir.

Your heart's
a bit muffled.

Am I having
a heart attack?

No, but it's not
completely good news.

Cardiac tamponade.

He needs
a pericardiocentesis.

Yes, I'm aware of that.

18-gauge and 55 cc syringe,

We need a FAST ultrasound
in here.

They're both in use.

You don't have imaging.
You could puncture his heart.

Is the xiphoid in the same place
as it was 20 years ago?






Could've gone
really wrong.

Yes, well, it didn't.

It's a cowboy move...

Something you would never
even dream of trying.

How many times is Shaun gonna
have to prove himself

before you give him
a shot?

Dr. Rolendez, O.R. 6.



What happened in the E.R.?

Swan girl came in
and you hesitated.

I wasn't hesitating.
I was thinking of a game plan.

Murphy was thinking
of the game plan.

You got overwhelmed.

I wasn't.

- First trauma...
- It happens.

You have to think clearly,
quickly, methodically.

You need to think
a little more like Shaun.

A little more.
Not identically.

How you doing?


That's a stupid question.

You're maxed out
on morphine.

I'll hold off
until it reloads.

How bad is it?

We're making
good progress.

I'll have to, uh, debride
any deroofed blisters

to prevent a secondary
nosocomial and then...

I need a mirror.

It's the least you can do

since you can't even look me
in the eye.



Oh, my God.



Do you know how many hideous
$300 bridesmaid dresses

I've had to buy in
the last two years?

I decided that
when I got married,

my bridesmaids are gonna wear
black cocktail dresses

so they can use them again,
you know?

But now...

now I-I'm Freddy Krueger.

Who's gonna want
to marry this?

I'm gonna find a nurse,

have her adjust your, uh...
Your morphine drip.


You hit your face.

Your jaw got stuck.
It hurts.

So, this shot I just gave you
is gonna knock you out

so that I can fix that.

Hang tight.

Crash patients status check?
23 people total.

One fatality on site,
lost one in the E.R.

Examined all the red tags.

Got 13 yellow and green
still in the waiting room.

I'll take whoever's up next.
Marco Magallenes...

Severed femoral artery,
crushed femur.

I did the REBOA and then
installed a temporary shunt.

Here are his CT
and MRI results.

Find someone else
for whoever's up next.

Oh, finally.



Excuse me.
Are you Marco's family?


We just found out that my cousin
didn't survive the accident.

I'm sorry.

- It's a bit much.
- I'm so sorry.

I'm Dr. Melendez,
and this is Dr. Murphy.

I'm Ricardo.

I'm M-Marco's father.

This is, uh, his mother, Lorena,
and this is Sonia.

They were getting
married tonight.

How's my son?

Marco's femur
was completely shattered,

and his lower leg
isn't getting enough blood.

Can you save his leg?

Marco suffered
too much bone fragmentation.

We can't fix it.

Our only choice
is to amputate.




Bay Five needs
a grade three hyphema.

Head CT and page

You read my mind.

Been a while.

How you holding up
pulling an all-nighter?

I'll manage, but if you
can find me a caffeine IV,

- it'd be helpful.
- Please move!

- Tough night.
- Yeah.

Thanks for coming.

It's part of the job.

So, when's the big day?

Uh, we haven't
set it yet.

Oh, where is
it gonna be?

We'll figure it out.

Maybe a beach

We should talk
about this later.

What? I like beaches.

If you have a more
romantic idea...

My family likes churches.

We should talk
about this later.

Dr. Lim, I think one of your
yellows is about to turn red.


I've got my wedding
all planned out.

I've got the dress,
and I've got the flowers.

All I need is a groom.

You available,
Dr. Murphy?


You don't want
some love?

No. No, I don't.
I don't want love.

Dr. Glassman,
neural consult, bay three.

Thank you.


I was here first.



My patient's scans
are very important.

Well, my patient's
important, too.

I need to see
my patient's scans.

Is your patient
pre-op or post-op?


Okay, I'll give you
the computer,

but you need to
apologize first.

Okay, I'm sorry.
Turn it on.

Why was Marco's family
crying when Dr. Melendez

told them his leg would
need to be amputated?

Well, their son's leg
is about to be cut off.

It's sad.
Crying is normal.

But when your options
are amputation or death,

amputation is good news.

People need time to adjust
to big changes.

Marco's family didn't even get
a chance to pray for a miracle.



It's not possible.

The bone damage
is too severe.

A rod implantation
won't work.

There's nothing
to anchor into,

and the shunt won't
last long enough

to do reconstruction.

There are no
other options.

What if we could replace
the entire femur?

We're making him
a new femur.

With a 3D printer?

3D-printed bones have
only successfully

been done with the - mandible.
We know.

That's a fairly small bone.
We know.

A femur has to support
the weight of the entire body.

This one will be titanium.
It can work.

It's an interesting idea...

but I need to think on it.

Right now we still got seven
yellow tags waiting.

What do you have
to think about?

It's a good idea.
It's a brilliant idea.

The kid has brilliant ideas.
That doesn't mean...

No, it was my idea,
and I'm aware of the risks...

Infection, clotting,
hardware failure...


It wasn't your idea.
It was my idea!

And the risks are significant,
but isn't that their call?

Don't we have to...
Maybe he said something,

and then you said something,
and together, you...

My idea.
Completely my idea.

The "brilliant" idea
is 100% my brilliant idea.

Why is that a problem
for you?

Maybe because I've known you
for six months.

Every day we learn
new things.

Today, you learned
I'm brilliant.

The idea was brilliant.

And it was mine.

And if anyone can do this
brilliant surgery, it's you.


Also brilliant.



Sleeping on the job?

Just needed some
fresh air.

Feels like
I'm suffocating in there.

She's in pain,
spilling her guts out,

and every time I open my mouth,
I sound like an idiot.

Dr. Kalu...
Unable to talk to women.

There's a first.

If you're not gonna be helpful,
Claire, just leave.

You don't need to talk.
Just listen to her.

You get to come out here,
clear your head.

She's trapped in there,
alone with her thoughts, her fears.

You don't think
she wants to get out?

You are her escape.



You want to put a fake femur
into Marco's leg?

It's not fake.
It's real.

It's not a real bone.
We're making it out of titanium.

It's still real.

That's incredible.

And Marco will be able
to walk, run, climb?

And swim.

That's the intention.

Well, have you done
the surgery before?

- I haven't.
- We'll be the first.

Well, nobody has ever attempted
this surgery

with a bone as large
as the femur.

I believe it's a viable option,
but there are risks.

Could Marco die?

In my estimation,
there's a 10% chance

- he won't make it.
- Then no.

I'm not losing my son.

Wait. If there's a chance
we can save Marco's leg,

we should at least
discuss this some more.

That's what he'd want.

He'd want to live.

He'd want to
have a life.

I know him.

He'd want to
take the chance.

I will never forgive myself
if Marco died

because I made
a reckless decision.

Whose decision
is this?

Does he have
a healthcare proxy?

I don't know
what that is.

When the accident

were you on the way to your
wedding or on the way back?

We were headed
to the wedding.

Marco's parents are
the next of kin.

They decide.




amputate our son's leg.


Why is the primary
closure on the stump

so vital in amputation surgery?
For a proper prosthetic fitting.

Why are you
marrying Jessica?

Why does anyone
get married?

I don't know.

I love her.

I don't understand why
having someone to love

is so important
to everyone.

You have to
stand down.

- You can't amputate Marco's leg.
- Why not?

I filed an emergency injunction
to stop the surgery.

You were in
a car accident.

Your neck
was punctured.

The repair surgery
went well.

You're gonna have to
stay put for a week

before we can
release you.

You're very lucky
to be alive.

My wife,
Jenna Hensel... is she okay?

Can I see her?

She's not listed.

That's a good thing.

She's probably still
in the waiting room.

I'll find her
and bring her up.

She'll be relieved
to know you're okay.


What the hell am I
supposed to do with

an unconscious patient

whose leg is a ticking
time bomb?

Judge Singh is en route.

She wants to hear
from both parties

and the doctors
on the case.

I have to testify?

- Hopefully not.
- Hopefully not.

I thought you
would be happy.

You thought you
could save the leg,

and I didn't want that not
happening because the parents

are afraid to make
a tough call.

It's their call
to make.

And if the accident
happened an hour later,

it would be the wife's.

And she wants
the fake leg.

It's not fake.

I thought
you didn't believe

in just blindly following

He's their son.

Nobody's gonna love
him more than them.


All parents love
all children

more than anybody else?

People get divorced
all the time.

How often do they
give up their kids?

So, if this was us,

you'd want your parents
to decide over me?

I didn't say that.
You kind of did.

I was saying,
there needs to be rules,

that there needs to be
bright red lines telling us

who gets to make
these calls.

It's the parents' call.

Not anymore.

Now it's the judge's.

How much time does Marco have
left on the temporary shunt?

Three hours,

and then his leg
will die.

- Okay.
- Mm.


Dr. Torture returns.

Thought I'd scared you off
for good.

Pick a movie.

You deserve to get out of this
room for a little while, too.

You think "Groundhog Day"
is gonna make a difference?

"I'm torturing you, but, hey,
you get to watch a funny movie."

That is sort of what
I was going for, yeah.

I'm sorry.

I wish there was something else
I could do.

How do you know
there isn't?

This is protocol.
This is what they teach us.

I lucked out.

I got the world's greatest
expert on burn victims?

You know everything
that can be done.

He loves to rock-climb,
scuba dive, bungee-jump.

This is insane.

His leg is literally dying
while we sit here reminiscing.

Please. We're trying to figure
out what your son would want.

He would want to live.
I want that, too,

but if there's a way that
we can save Marco's leg,

he'd want me to do it.

Mija, Do you know what
he wanted most of all?

He wanted to marry you.

He wanted to spend his life with
you, have children with you.

Now, he can do all that.

He can be happy
with a prosthetic leg.

He's young,
and he's strong.

Mija, he can get
through this.



- When we met...
- I don't care about your stories.

I don't care that
you met rock-climbing

or kayaking or whatever.

I just want...
We met in rehab.



Hey, are either of you
Jenna Hensel?

I haven't seen Jenna

since we took pictures
at the hotel.

But she got on the bus?

Yeah, she was sitting
with Noomi.



I think she's still
out there.

- Hey, guys! We've got to go back.
- Where?

To the crash site.

He never wanted
you to know.

He's an addict.

He replaced one addiction for
another one... a healthier one.

- But he needs...
- What?

He needs to wakeboard or
he'll drink himself to death?

This is ridiculous.

No, it's not!

We talked about it
a lot.

It's pretty much
all you do in rehab.

Marco has clarity for
the first time in his life.

He knows what
makes him happy.

He knows his weaknesses.

He's not as strong
as you think.

And that's okay, but...

Marco cheated on you.

It was about
a month ago.

He was overwhelmed with
the wedding and the planning.

He ran into
an ex-girlfriend.

It only happened once.

You're lying.

You're upset that he
had secrets from you, so...

No, she's not lying.

Mija, he... he was...
He was so upset.

He does love you.

Okay, maybe we're digressing
here a little bit.

And we really don't
have the time.

It matters.

She doesn't
know him like...

Maybe none of
us do, but...

but we are his parents,
and you're not his wife.




Okay. Get the cops.
Check everywhere...

Other side of the road,
bushes, trees.

If she was ejected from the bus,
she could be 40, 50 feet

in any direction.


I found her!
I need some help!



she's got a brain bleed.

We need to get her
out of here now!

Dr. Andrews.

I think Celez
may be eligible

for an experimental
bone treatment.

Sell it to me.

Well, I've been
doing some digging.

San Diego Community Hospital's
burn unit

has been following
a Brazilian hospital's protocol

to wrap burns
in tilapia skins.

Now... Now, I know fish skins
sound a bit crazy,

but... but I was thinking we
could do the same thing here.

Dr. Kalu,
I applaud your thinking.

But we... Tilapia skins contain
more collagen proteins...

Both types 1 and 3...
Than even human skin,

which aids in tissue repair,
negating the need for grafts. Dr. Kalu.

- It's shown to accelerate healing,
- Dr. Kalu would reduce...

The risk of infection
and cut down on

the patient's
physical pain.

Are you finished, or would
you like to cut me off again?

Okay, let's follow this
through, shall we?

You have to come up
with a proposal

for the experimental

get it approved by our
institutional review board,

get your hands
on medical-grade tilapia skins,

- and then we...
- Well, I thought you could help

expedite the process.

You think I could bring it down
from three months to two hours?

You finish
the debridement?

Okay, I'll take over
from here.


Keep thinking
outside the box.

Initiative is good.


I'm in. Bag her.

Did you get me
the drill?

The fire truck had one.
What's going on?

Her pupil's blown.

She has a subdural

causing increased
intracranial pressure.

If I don't
alleviate it now,

there's no way she makes it
to the hospital alive.






Unconscious female.
Flail chest.

I had to do a burr hole
in field.

Her sats are in
the low 70s.

She's good to go
to the O.R.

Subdural hematoma?

She had decerebrate posturing,
a blown left pupil.

When I passed the drill bit
through her skull,

a whole lot of blood
pooled out.

Good call.

Uh, San Diego Community Hospital

They're sending
the tilapia skins.

They're medevacing
them in.

Should be here
within the hour.


you meet the criteria
for an experimental treatment

that I think will
prevent you

from having to undergo
skin grafts.

Hold up.
How did this even happen?

Well, I found out
San Diego's trial

allows for multi-site

So, there's no need for us
to get our own I.R.B.

They give us the skins,
we provide the patient data.

Fish skins?

The tilapia skins have been
cleaned and sterilized.

perfectly safe.

You'll do it?

I'll do it.

Well done, Dr. Kalu.

Well done.

So help you God?


Dr. Melendez can
tell you... He has.

But the fake femur is yours,
though, right?

How confident are you in its design?
It's not fake!

Shaun, she needs to know... I
know what she needs to know.

She needs to know
will it work.

She needs to know
how long it will last.



He's his doctor?

He is a surgical resident.
He's very gifted.

Is he going to answer
my questions?

Shaun, I really need you
to focus.


- Marco is running out of time!
- Just let him answer!

- No, we already know the answer.
- They don't know.

This thing has never
been done before.

Be quiet!



His toes are changing color.



He's clotting. That's bad.
Page Dr. Melendez stat!

- Murphy, what do we got?
- The shunt is clotting.

It's restricting blood flow.
It is failing.

All right, we need
a decision now.

Are we cutting off the leg
or replacing the bone?

There's no doubt in my mind
that Marco's parents

and fiancée all love Marco,
but it's become clear...

I need a decision now.

His parents know him
as their child.

Sonia knows him
as a man.

Replace the femur.

Let's go!

Thank you!
Thank you.



- And there's the bleed. See it?
- Yes, sir.

You ever clip
an intracranial artery before?

No, sir.

Go for it.



Just like every
first time...

You're a little excited,
a little nauseous.

Hopefully nobody
gets hurt.





Is it good to go?

It's very good.



You ready?










Be careful the clip blades
don't catch

any perforated arteries.

I don't seen any vessels
in the way.

Then what are you
waiting for?



Very nice.

Thank you.

Everything's dry.

Say goodbye
and close the roof.

We need to get blood
back into his leg

in the next minute or so,

or I'm gonna have
to amputate after all.

Insulin's hanging,
loaded him with calcium.

Best I can do.

Let's release
the clamps.

Check for capillary





Blood flow is restored.

EKG is normal.

Okay. Kim,
I want to hear words like

"variability" and "Delta".

Give them to me.

I'm waiting patiently.

I'm not getting

Show me.


Check the leads.



Still nothing.

Maybe there will be
some neuroplasticity.

Her brain...
It-It could rewire itself.


Zero brain activity.

I don't know why,
but she's gone.






Your neurosurgery patient
that died tonight...

There's something
you should know.




Now, Marco, I want you
to try and move your toes.



I can't.

Is he okay?

We're not sure
if the bone...

He's not gonna die?

H-He's not gonna
get an infection?

- His body's not gonna reject...
- No, no. We're monitoring him

very closely.

- The biggest threat is behind...
- He moved.

He moved.



It worked.

You'll have a long
recovery ahead...

Months of physical therapy.

But for now, all you
have to do is rest.

Thank you.

Thank you for saving my life...
For saving my leg.

Thank you.
You're welcome, sir.

Are you ready to finish
what we started?

Get well first.

There's plenty of time
for a wedding.



- Thank you.
- You're welcome, sir.

Thank you.



You look good.

Like Aquaman.

I look like sushi.

Everybody loves sushi.

It's only for
six months.

Your new skin should have
completely grown in by then.

Should have
minor scarring.

Thank you.

I misjudged you.

You judged me
just right.



Is she still sleeping?

You haven't
told her yet?


Can I have a moment

Of course.



How soon after you found
Jenna at the crash site

did you intubate her?

Almost immediately.

I did a sternal rub.

Uh, she had decerebrate

Her left pupil
was blown.

I knew she had
a subdural hematoma,

so I intubated,
did the burr hole.

She also had
a flail chest.

Did you check her breathing
after you intubated her?


Well, at least
I-I think I did.

Dr. Lim told me that when
Jenna came into the E.R.,

she wasn't ventilating

You inserted the tube
too deep

into her right
main stem bronchus

of her injured lung.

We had no way of knowing

how long she was hypoxic
before we gave her the EEG.



I drilled a perfect
burr hole into her skull

on the side of the road
in the middle of the night,

and I-I-I screw up
her intubation?

Yes. It was tough conditions
for anyone... resident or not.

Any one of us could have
made the same mistake.



I had a woman come
into the E.R. once...

a mother,
51 years old.

Francine Parker.

She had two boys.

She had a cough...

A bad one...
But a cough.

I checked her out, gave her some
antibiotics, sent her home.

Six hours later,
she was rolled into the E.R.

She had had a heart attack,
and I missed it, and...

she died.

Not one day... goes by
when I don't think about her.

She was your first.

My fourth, actually.

You're not gonna
forget this.

You never forget.

But I don't know,
maybe we're better off for it

the next time around.

You got to find a way
to keep going.


Go home.
Get some rest.

I haven't even
told her yet.

You're not going to.

You made a mistake.
You're too close to this.

I'm not gonna allow you
to talk to the family

or anyone else outside
this hospital about this.

Do we understand
each other?

Yes, sir.



♪ I don't have
all the words to say ♪

♪ I'm still healing
from my mistakes ♪

♪ I'll take the weight
if it makes you stronger ♪

♪ I don't want to leave you
in this place ♪

I called San Diego Community
Hospital and thanked them

for including us
in their study.

They said they were
happy to do it.

And they asked that I pass along
their thanks to you

for your very generous donation
to their burn unit.

I know you come from
a wealthy family.

I don't begrudge that,
but you...

can't open your wallet
every time a patient's in need.

The lines can get real blurry
real fast.

Yes, sir.





♪ Who am I to try
and save you? ♪

♪ I ain't gonna hide ♪

♪ You have to fight today ♪

What's this?

My healthcare proxy.

Jess, nothing's
gonna happen.

That's good to know.

♪ I won't let you down ♪

♪ I won't let you down ♪

♪ No, no, no ♪

♪ But I won't let you down ♪

♪ I won't let you down ♪

♪ No, no, no ♪



Well, that was quite a night.

Been a doctor
for a long while...

Don't remember a night
quite like that one.

Why did Nurse Farrar ask
if I wanted love?

'Cause she's a nosy...

Shaun, you really
don't want love?

I loved Steve
and my rabbit.

Not anymore.

You don't love them

No, I don't.
They're dead.

You can't love someone
if they're dead.

Well, I've lost
people I love.

I miss them, and it hurts,
but I still love them.



I don't want love.


You want breakfast?

Can I have four pancakes
instead of three?

You can have five.

I only want four.



Sync corrections by srjanapala