The Good Doctor (2017–…): Season 2, Episode 5 - Carrots - full transcript

When a patient suffering from anorexia can't gain the necessary weight needed to survive heart surgery, Claire suggests they perform an experimental surgery which Melendez strongly opposes. Shaun worries Glassman's refusal to walk the hospital floor will keep him from being discharged and tries to persuade him to ambulate. Meanwhile, Shaun and Lea change the terms of their current relationship.

We should not live together.

That makes no sense.

I rented that apartment, and
neither of us can afford it on our own.

It has a fireplace.

We shouldn't live together.

It has a fireplace.

Do you ever think
about us being together,

as a couple?


I don't want that.

You don't want
us to be a couple?

Or you don't want me
thinking about us as a couple?


If we get an apartment
together, I feel like that's a signal

that you and I might end
up as boyfriend and girlfriend.

And that's not going to happen.

You can't predict the future.

Feelings change.

I used to hate hugs but
now, sometimes, I don't.

But I don't want my feelings to
change. I like being your friend.

And romantic relationships
are unpredictable,

so much can go wrong,
especially when I am involved.

And if we live together,
it's gonna be awkward.

You're bound to walk in
on me when I'm naked,

or hear the weird sex sounds I
make with some out-of-work drummer,

or find me crying when
that drummer dumps me

even though I was
totally gonna dump him.


I was so unhappy when
we weren't getting along.

You were, too, right?


Anything that puts our friendship
at risk isn't worth it to me.

Okay, Shaun?


Our gallbladder removal's off.

Patient took an Ambien last night,
woke up eating a roast chicken.

Let's check the consult list for
something a little more interesting.

See, gallbladders are boring.

You're a resident. You don't
get to call any surgery boring.


This is interesting.

Fizzy urine.

female, syncopal episode

with persistent loss
of consciousness.

On the ride, she went
into PVT, rate of 180.

We shocked her back
to normal sinus rhythm.

I'm starting to feel... (GROANS)

She's going back into PVT.

We need to shock
her, get her into a bay...

No, no.


That was cool, but you may
have just cracked her sternum.

- What happened?
- Get her into Bay Two.

- You're her husband?
- Yes.

Your wife is pretty frail. Any
idea what could have caused that?

She did, she's anorexic.


- I'm Dr. Murphy. This is Dr. Park.

We're here about your urine.
How long has it been fizzy?

I hadn't even noticed.
Is that a problem?

It can be a symptom of several
conditions, many of them minor.

You're here for ortho, a
scope on your right knee?

It's been sore. I've
been training for a race.

Joint pain plus fizzy urine.

You could have emphysematous cystitis,
bladder cancer, kidney problems...

Those sound serious.
Should I call my husband?

Emphysematous cystitis is
a treatable bladder infection.

Your symptoms could also be
from a kidney stone or dehydration.

Could my issues be caused
by gastric bypass surgery?

Depends. When was it?

Fifteen years ago. I
used to be 377 pounds.

SHAUN: That's a lot.

Your surgery wouldn't
cause those symptoms.

But we need to do a
cystoscopy to find out what did.

I'll cancel the ortho,
and get Lim to sign off.

Hey, wait, what... So,
what is a cystoscopy?

It's like a knee scope, except
the camera goes up your penis.

You administered amiodarone?

Her rhythm's normal.

That's good, right?

It's better than
when you came in.

Your heart is failing

as a result of a condition
called "mitral regurgitation."

One of your valves
isn't closing all the way.

Blood keeps leaking
back into your atrium.

That's why you fainted, and why
we need to repair that valve ASAP.

How long have you been anorexic?

I've had issues with food
on and off since I was 14.

Mitral valve issues are a frequent
complication of long-term malnutrition.

This bout started
about a year ago.

Skipping meals, lying about
eating, exercising excessively.

I don't know what else I can do. I
can't monitor her 24 hours a day.

I'm not asking you to.

No, but you are
starving yourself...


Graham-y, come here.

What's he doing here?

When I got home, I heard
about the ambulance.

I made Cindy bring me here.

What's wrong with my mom?

She needs a surgery to
repair a valve in her heart.

This heart thing, is that
why she's so skinny?

SAM: Look, what matters, Graham,

is that these doctors are
gonna help your mom. Okay?

SHAUN: You haven't
moved your bowels.

Thank you, Shaun, for that announcement.
Saves me the trouble of tweeting.

The nurses already knew.

They told me. They also said

you're no longer talking
to your dead daughter.

Constipated but no longer
psychotic. A narrow win.

Your first defecation event

is a vital part of the
discharge criteria.

Event? What is this,
the post-op decathlon,

pooping, peeing,
walking, talking...

Yes, you have to walk
a full lap of the floor.

But you canceled physical
therapy this morning.

Those nurses have big mouths.

I canceled because
my leg is a little sore.

That could be
phlebitis or a DVT or...

It could also be
unsurprising complications

from a surgeon poking
around in my pons.

Every day in the hospital
increases your risk of infection

by 1.37%.

You need to move your bowels,
and we should walk right now.

I'll go very slow.

Shaun, is there any chance that
you are needed elsewhere right now?

I have eight minutes until
my patient's cystoscopy.

Good. Be early.

DR. PARK: Urethra looks clean.

No lesions, no stones so far.

How do we check for
obstructions, or stones further up?

Contrast cystogram.

Since you found this patient,
how about you do the honors?

You know, this guy used
to weigh 370 pounds.

Thread the catheter
further into the bladder.

That's a big drop. Good for him.

He did have gastric bypass.

That makes it less impressive?
Now, infuse the contrast.

Well, yeah. It is the easy way,
compared to just diet and exercise.

SHAUN: The contrast
dye is dissipating.

It's supposed to.

You said he's training for a race.
Obviously, he turned his life around.

SHAUN: Still dissipating.

The bypass made it
physically impossible

for him to eat as
much as he wanted.

It's gone. The contrast is gone.

DR. PARK: That makes no
sense. DR. LIM: Where did it go?

He probably has a fistula.

A tunnel connecting his
bladder to his intestine.

Air and bacteria moving
the other direction

caused bubbles in his urine.

Her liver and thyroid are
normal, but her electrolytes are off.

Her albumin is at 2.1.
She's severely malnourished.

She'll be totally vulnerable
to post-op infections.

She needs a surgery to survive, but
she may be too sick to survive the surgery.

In order to operate safely, we
need to boost your caloric intake,

optimize protein.

Can't you do that through my IV?

It's more efficient to pump
nutritional supplement

directly into your stomach.

We use a tube running
down from your nose.

I had an NG tube once...

It didn't work. She
couldn't tolerate it.

Because it's not really
about food, it's about control.

You've lived for decades
with a condition that has killed

more people than any
other psychiatric illness.

You didn't just
survive, you had a child.

Can you tell us how?

When I got pregnant, it
was like this terrifying miracle.

I mean, the thought of
gaining all that weight...

But I wanted him so much.

We both did.

Every meal, I would sit with
pictures of his ultrasound,

imagining the food
going directly to him.

Can you do that
again? Eat for Graham.


We've determined the fistula
between your bladder and intestine

was caused by Crohn's disease,
an inflammatory intestinal condition.

Once we reverse your
gastric bypass, you'll need...

Wait. What? Reverse
my bypass? Are you sure?

Bypass surgery shortens
the digestive tract.

People with Crohn's disease need
every inch of intestine they have,

or they risk critical,
even fatal malnutrition.

Okay, but I don't want
my husband to know.

And he'll be here soon.

We would never reveal
anything without your permission.

But Crohn's disease is going to
require some major adjustments.

I'll tell Spence
about the Crohn's,

and I'll tell him I'm having
surgery on my bladder.

Your husband doesn't
know you had gastric bypass?

That would require him knowing
I was obese to begin with.

That's not going to happen.

Your husband must
be very shallow.

Even if I don't disclose
that I reversed your bypass,

your scars might. It
requires a separate incision.

I'll tell him there
was a complication.

Our obligation to protect your
privacy doesn't include lying.

And you shouldn't have to
go through this without him...

The single abdominal
umbilical port.

We can repair Wade's
fistula and reverse his bypass,

all through a single incision.

We can help
deceive your husband.

Honey, I'm so sorry.

- That's okay, Spence.
- Got here as soon as I could.

It's all right.

And, since my husband is surrounded
by surgeons, what's the issue?

What are you gonna do about it? And
how often have you done it successfully?

How're you doing?

I'm fine.

Graham, would
you mind filling this?

You've had one spoonful of
tuna, two ounces of apple sauce.

That's it? Mom, if that's all I had,
you'd never let me up from the table.

This is different. I
can't eat too quickly.

I don't believe you.

It's true. Your mother's
suffering from severe malnutrition,

and she's trying her best...

I knew it. You're too skinny,
that's why you're here,

that's probably why
your heart's messed up.

- And you still won't eat.
- Graham, I'm trying.

- How hard can it be to eat?
- I'm not feeling well.

Me and Dad are really worried
about you. Don't you care?

Of course, I do,
Graham, so much.

Then do something. Prove it.

Did you provoke that argument?

Yep, and I may have
just saved our patient.

She requested an NG tube.

Understanding is
nice, calories are better.

He's screwing this up.

His husband's scared, and he
just wants to know what's going on.

Nothing like marital
advice from the divorced.

You're divorced, too.

And I'm not advising.

I'm not judging the health of a
marriage based on a single secret,

which is neither shocking nor
a sign of its imminent demise.

What, truth in a
marriage is overrated?

It was in mine. Not
every single insight,

opinion or impulse
needs to be shared.

Marriage sounds confusing.
No wonder you both failed at it.

CLAIRE: How's it going in here?

Not as bad as I remember.

Does it hurt, Mom?

No. Just a little awkward.

Makes it hard to
talk. But I'm okay.

I am so proud of you.

Dr. Glassman hasn't defecated,
or done his physical therapy.

I'm aware, and yet
unalarmed. Who are you?

I'm Dr. Shaun Murphy.

Oh. Right.

You're Dr. Glassman's friend.

Please order him to
do physical therapy.

And give him 15
milligrams of ex-lax.

The ex-lax is a decent idea.

As for the physical therapy,
of course, he's stalling.

Glassman's a proud
man. He ran this hospital.

He's reluctant to feel
weak and vulnerable

in front of people who
used to work for him.

That doesn't make sense. He is
weak, he just had brain surgery.

Well, sensical or not, that's
my take. He'll walk eventually.

Every day in the hospital
increases his risk of infection

- by 1.37...
- You tell him that,

and maybe, he'll
hop right out of bed.

I did. It didn't work.

He didn't respond to the stick.

Try the carrot. Although,
really, I would just advise...


Dr. Glassman
doesn't like carrots.

What should I do with the stick?

It's a metaphor.

Uh, Glassman,
appropriately, is the donkey,

the stick signifies punishment,
the carrot signifies reward.

But he's recovering
nicely and your best bet

- is to just be patient with him.

So, I should use a reward
to motivate Dr. Glassman

to do physical therapy.

Actually, what I'm saying is that
you should be patient and supportive.


And please, please answer that.

Close the door.


We were headed to pre-op
when he started projectile vomiting.

It's green. That could mean bile
and a partial bowel obstruction.

We need an NG tube.

An obstruction? Did
the Crohn's cause that?

It's hard to know for
sure. NG tube, stat.


You're doing great.

You should try
and get some sleep.

I can't.

There's this voice in my
head, and it won't be quiet.

It keeps telling me that this
bag has 60 grams of protein,

forty grams of fat,
1,200 calories in total.

It just won't stop.

Try to think of Graham and Sam.

I'm trying.

I'll get something
to put over that.


Louisa, no!



(SOBBING) I'm sorry,
I just... I can't stand it.

I got your deposit back.


Shaun, I told you that you
and I can't live together.

No. You told me we can't
be boyfriend and girlfriend.

We can still be
friends with benefits.

The benefit is, we
would be living together.

I was clear, it's
too complicated...

You were. We can't
date, or kiss, or have sex.

But I thought you
wanted to be friends.

Yes, of course.

And spend time together.

- Right.
- Then it's simple.

She begged us to reinsert the NG tube,
then pulled it out again an hour later.

DR. REZNICK: Do we try again
with the tube and restraints?

We'd just be raising
her risk of self-injury,

pneumonia, blood clots.

What about going
back to solid food?

Anything less than
1,200 calories a day,

and her malnutrition
wouldn't be improving.

In fact, she'll
keep losing weight.

We should go ahead
with that valve repair, now.

I think we can improve her
nutrition, without force-feeding or IVs.

I found a small study
where deep brain stimulation

was used to treat anorexia.

You want to use brain surgery
for a psychiatric disorder?

Surgical procedures
have been effective

for depression, OCD, addiction.

This surgery could reduce
her anxiety around eating.

Once she's eating, her
malnutrition will improve

and reduce the risk
of the valve repair.

It could also cause
personality changes.

And this study covers six
subjects, with only 50% success.

This could be Louisa's only
shot at getting free of this illness.

And it was done in the UK.

DBS isn't FDA-approved
for anorexia treatment here.

So, we call an IRB ethics hearing,
and argue emergent use approval.

Which we shouldn't
get off such little data.

Nice work digging this
up, but it's not a real option.

Let's go talk to her
about the valve surgery.

WOMAN: Can I help you?

I'm looking for a carrot.
Seventeen, 18, 19...

No... Sorry, we don't
have any carrot muffins.

How about a lemon-poppy, Shaun?

Hello, Debbie Wexler.

It's a metaphor for
moving a donkey.

I need a carrot because
I don't want to beat

Dr. Glassman with a stick.
He likes blueberry muffins.

How's Aaron...
Dr. Glassman recovering?

He moved his
bowels this morning.

But he doesn't want to appear weak,
so, he hasn't done physical therapy.

I want that blueberry
muffin, please.

It has 23 visible blueberries.

You know, Aaron once told
me that his absolute favorites

were the chocolate-chip ones.
Do you want one of those instead?

Yes, I want one
of those instead.

Oh, hi, Dr. Park.

I have a few questions
about Wade's surgery.

Sorry, I'm pretty busy. I
actually need to get going.

I'll walk with you.

I know Wade's
surgery is this afternoon,

but I've been researching
treatments for Crohn's lesions.

What did we do
before the Internet?

I talked to two experts who
felt that Wade should be put on

Remicade or Azathioprine
before any surgical intervention.

Interesting recommendations,
but considering

they haven't seen
your husband's chart...

Well, this doctor felt strongly that
you should see how he responds

- to medication before...
- Wade's care

is completely appropriate
for his condition. (SIGHS)

But if his Crohn's
lesions could be treated

- without cutting him open...
- That's not what we're treating.

Excuse me?

Go talk to your husband.

I brought you a
chocolate-chip muffin.

I love chocolate-chip.
Thank you.

Where is it?

At the nurses' station.

You can walk out to get it.

Shaun, you see, here, I thought
you were doing something nice for me.

- I am.
- No, you're not.

You're manipulating.
My leg hurts,

and I have a sore throat,
and I don't feel like walking.

Dr. Blaize says you don't want
to seem weak in front of people

who used to work for you.

Dr. Blaize is wrong. I don't wanna
walk because I don't wanna walk.

And this is condescending,
and it's insulting and it's annoying.

Should I get you your muffin?

That would be nice.

An orderly is eating it.

Mr. DeLeon, can I help you?

My wife's decided against
the valve repair surgery.

At least until she's tried

the deep brain
stimulation for her anorexia.

Did Dr. Browne tell you that it's
an experimental brain surgery,

which could alter your
wife's personality forever?

That's if we get the
special approval required.

She's explained all the issues.

I got our apartment back.

I had to pay $300
more as a deposit

because someone else
wanted it, but that's okay

- because it has a fireplace.
- No, Shaun...

Why aren't you listening to me?

You're not listening to me.


I'll be okay running
into you naked.

Or hearing sex noises,

or seeing you cry over
breakups with drummers.

I know that you think you
can, but how can you be sure?

Because living with
you will be good for me.

It makes me happy.

You remember
what you said, Shaun,

that no one can predict the
future, and feelings can change?

What if I end up
hurting you again?

I don't want to risk our friendship
over an apartment. Do you?

If we don't live together,

you will have to buy
your own batteries.

- We'll still see each other.
- That will be hard. I work a lot.

We'll find a way.
I know we will.

I need to go to work.

I'll stop on the way
home and tell the manager

we don't want the apartment.

No, I'll do it.

The subjects who
responded in this study

are all long-term sufferers
with a target BMI of 13 to 16,

who actively pursued this
treatment, much like our patient.

Additionally, DBS surgery
requires lighter sedation

and places less strain on her
system than an open chest procedure.

You're referring to the valve repair
recommended by Dr. Melendez?

Yes, I propose delaying that
surgery by a couple weeks.

Which would be well worth

it in terms of the reduction of
risk if the DBS is successful.

Excellent presentation,
Dr. Browne. Very thorough.

Agreed, though I do have concerns
about approving this procedure

based on the small subject
pool. But I'll confer with...

There is one more person I
want you to hear from. The patient.

This is an IRB, not
a therapy session.

Actually, patients who had the
opportunity to air their concerns

are eight times less
likely to sue their hospital.

You paged me?

You can step out.
Dr. Park's got this.

Grab the sheet.

You talked to Wade's husband.

Maybe we should
discuss this later.

I can patch him up
while tearing you down.

You violated our
patient's confidentiality.

I told him what we weren't
treating, that's not a violation.

And their marriage is better off for
having his secrets out in the open.

That'd be meaningful if you
were a marriage counselor

instead of a surgical resident.

Whatever lie blew up your marriage
won't be undone if Wade tells the truth.


I was just trying
to help our patient.

Our former patient.

Wade's demanding a
transfer to another hospital.

I have tried cognitive
behavioral therapy,

food psychodynamic therapy,

family therapy,

inpatient treatment,
outpatient treatment,

antidepressants, NG tubes, TPN,

and yet, here I am, dying.

Killing myself.

And I can't stop on my own.

Please, help me to stop.

Are you aware DBS has been
known to cause personality changes?

In your case, the electrode would
be at the nucleus accumbens...

Dr. Browne explained
all of the risks.

It's important we know
that you understand.

The nucleus accumbens plays
a role in maternal attachment,

delivering dopamine when
moms interact with their children.

Now, what if in trying to
overcome your eating disorder,

you lose the ability to
feel love for your son?

My son is everything to me.

For the past year, he has been
watching me starve myself to death.

I'll risk anything to keep
him from seeing me succeed.

Thank you, Ms. DeLeon.

We'll need a few
minutes to talk.

You kept it a secret
because you think I'm shallow.

I said the same thing.

I kept it a secret because
of "friendly fatties."

Any news on my transfer?

San Francisco General
should have a bed tomorrow.

- Come on. It's a joke.
- I'm here to clamp

- your nasogastric tube.
- A joke?

About a couple we've
known for years?

We were at their wedding, and
yet, you treat them like a punch line.

SHAUN: This used to be
green, and now, it's brown.

You're the one who lied. If I'd
known you were offended, I...

The point is, is that's
why I didn't tell you.

Red and green makes
brown. Your bowel is bleeding.

You need surgery now.
Page Dr. Park and Dr. Lim.

- He has a strangulated bowel.
- Spence...

It's gonna be okay.

We need to open up an OR now.

By a margin of two to one,
this Internal Review Board

has decided in favor of
allowing this procedure.

- Nicely done.
- CLAIRE: Thank you.

Hope the surgery goes well.

Use the 45
millimeter gold stapler.

The truth coming out
didn't help Wade's marriage.

DR. PARK: Well,
hopefully, with some time.

Secrets are corrosive. Wade
should've been honest from the start.

Maybe, Wade thought
Spencer would feel the same way

you did about his bypass.

That he lost weight
the easy way.

Okay, it's time.


You are the
highlight of my life.

You know that, right?

Yeah. I love you, too.

I love you more than
any person on the planet

ever loved any other
person on the planet.

(STAMMERS) I know.

- Mom, you're gonna be okay, right?
- LOUISA: Of course, baby.

Of course.

We'll see you
guys in a few hours.

I love you.

The chocolate-chip muffin didn't
work. The donkey won't walk.

I told you that Glassman's
probably embarrassed...

No. He's not. I asked him,
and he said you were wrong.

Doesn't mean I'm actually wrong.

Yes, he needs help recovering.

I'm trying to help,
but it's not working.

He got angry at me.

Dr. Glassman is your patient.

- You need to fix his lack of mobility.
- This is your problem.

I don't know what to do. I
don't know how to help him.

Being sick is hard. Being
around sick people is hard.

We wanna help.

We all struggle with what
to do. Your obsession...


More than a muffin,
or a bowel movement,

or a walk around the ward,

what Glassman needs is
someone to be there for him.

A patient, supportive friend.

I know the perfect person.



Hey, there. How are you feeling?

I'm okay.

I feel like I want
something to eat.

I'm hungry.

All right, buddy.

Let's get you home, get
you a decent night's sleep.

I'll see you in the morning.

I'll go get you some food.

Are you sure you're all right?

Yeah. I just...

I wonder if that hug
felt different for him.

Did it for you?

Your husband's
surgery went well.

He's in recovery now.
I think he's awake.

Thank you.

Wade told me
where to find these.

DR. PARK: This is
him before bypass?

He said that seeing these
would help me understand

why he never told me.

Which I said was ridiculous.

Is he gonna end
up like this again?

It's possible.

I wish I didn't know that.



Debbie, hi.

Oh, um...

Shaun thought you
could use a visit.

- Huh.
- Oh, and, uh...

And another muffin.

Thank you. I wish I'd
known you were coming.

I would've slipped into
something a little less comfortable.

- You look good.
- Huh!

- Yeah, well...
- Unlikely, but thank you.

I'm sorry that I've
been out of touch.

Well, I had a brain tumor.

Understandable we
both dropped the ball.

Okay. Here we go.

- What's happening?
- We're taking a walk.

Oh, no, no. Thank you.
No, my leg hurts... Ow, ow!

Yes, sweetheart. Yeah.
That... Which is exactly

- why you need to take a walk.
- Yeah.

- Wow. You're really good at this.
- Now, here we go.

Are you sure you
haven't done this before?

Well, I spent a
little time as a nurse.


I always liked the night shift.
Everything gets really quiet.

It's almost peaceful.

I just came from Louisa's
room. She's eating.

That's great news.

Yeah. Hopefully, we'll be able to
do the valve repair in a couple weeks.

I hope you're right.

But you won't be a
part of the surgery.

Or any of my surgeries.

You went around me,
directly to the patient.

I had a good idea that
you didn't take seriously.

I considered it, and then I decided
against taking it to the patient.

And yet, I managed to get Aoki
and Andrews to sign off at the IRB.

You didn't get Andrews.

You voted for me?

You made a strong case.

But you're booting
me off your service?

Disagree with me all you want.

I expect my residents to.

I expect them to argue
passionately for their position.

And I expect them to
then accept my decision.

Even when you're wrong.

I can't run my
team any other way.

You know what was insane,
was the 1928 Torpedo Roadster.

- With the purple-heart trim?
- Oh. And the lizard skin interior?

DR. GLASSMAN: My neighbor
in Wyoming had a Silver Arrow.

DEBBIE: Oh, I'd love to
drive one of those, just once.

Good job. You got him walking.

Debbie Wexler did it.

She's a better carrot than I am.

She's a better friend.

Hey, it's me.

Yeah, just making sure
the check got there okay.

Great, great.

I have a question about Phil.

I know, I know, he's long gone.

I was actually wondering,

what do you think would've happened
if I hadn't seen you two together?

I found my next apartment.


It has a fireplace,
and natural lighting...

No... No...

And a really great
roommate who's also a friend.

He works a lot, so, it might
be hard to see him, otherwise.

I'm talking about you, Shaun.

I don't want to risk anything
hurting our friendship.

If you say you can handle
living together, I trust you.

We're going to be roommates.


- It has a fireplace.
- Yes, it does.

Oh! We're going to be roommates.

We're going to be
roommates! (CHUCKLES)


- Yes!
- Okay!


- Yes!
- Yeah!