The Good Doctor (2017–…): Season 3, Episode 17 - Fixation - full transcript

Wes Keeler, 49,

pricked in the upper right arm
by a cactus four days ago.

Temp 102.5.

Wound is seriously infected.

He was leading
a camping trip on Mount Thayer.

We couldn't leave 'em
up there alone.

BP's 86/51. Tachycardic.

Rapid, shallow breathing.

Signs of sepsis.

You gonna have to
cut his arm off?

I'll be fine!

We need to debride
the wound stat!

Shaun, I've been
looking all over for you.

Hey, uh, h-how about getting
some breakfast? Some pancakes?

No. I'm not hungry.


how about coming over for dinner tonight?

Is Debbie making lasagne?

She could.

No, thank you.

Okay, Shaun.

Um, can we just stop and...

And talk for just a minute?

Why are... Aren't you, uh,
responding to my texts?

Are you upset?

Are you sad because
of Lea? Yes. Yes.

I am very sad.

But it will be okay.

Yeah, of course it'll be okay.

I'm still going to be with Lea.

Wait. What?

She said she loves me.

She also gave you
a hundred reasons

why she can't be with you,
Shaun. Yes. Yes.

She gave me
very specific reasons

why we can't be together,

but I've overcome
other challenges...

No, Shaun, it's not... to become
a good doctor, a good friend.

It's not about
overcoming challenges.

It's not about you.

It's about Lea.

I can't take two steps
without falling down.

Is the issue
balance or weakness?

All of the above.

Fatigue, dizziness,
light-headedness, headaches,

occasional bouts of nausea.

And when d...

Five years ago, just after
the birth of my daughter.

And there's
no discernible fluctuation

based on time of day
or time of the month.

Temp 98.2. BP 111/78.

That'll drop to 80/50
when I'm upright.

I don't drink, smoke,
or take drugs.

I haven't traveled
outside of the country

in the last ten years.

And there's no family history
of a similar condition.

You've been through this before.

Seventeen times. Eighteen if
you count the naturopath in Seattle.

Which I don't.

No one has been able
to give me a diagnosis.

We need to do an EKG
and stress test,

get a CT of your chest,
abdomen, and pelvis.

Let me save you some time.

Five years' worth of tests,
labs, scans, reports...

My entire medical odyssey.


Set up in the lounge

and get me copies
of each of those...


Dash. Oh, my God!

Why are you here?

Uh, you changed your number.

Right. Um, it's a long story.

Uh, Dash, you remember
Dr. Melendez, Dr. Murphy?

Yeah, of course.

Uh, you gave my wife
six more good months.

We considered
renaming our cat after you.

That would have been foolish.
Cats remember their names.

Sorry for your loss.
Wish we could've done more.

Let you two catch up.


I think the
infection spread quickly

because of the underlying
damage to your liver and kidney.

We'll need to keep you on a
prolonged course of IV antibiotics.

Hey, you hear that, guys?

Hep C and heroin aren't
as much fun as they sound.

Although one was more fun
than the other...

For a while.

Don't they have
somewhere else to go?

Not likely.

Most of them haven't seen their
parents in years, so they're with me...

Survivalist training program
for at-risk youth.

We prefer "young adults
with unrealized potential."

I'm supposed to be teaching
these yahoos responsibility

and good decision-making.

Hell of an example.


He's got a new murmur.

BP's dropping.

we need to take a look at your heart.

Wes, the infection's spread.

It's damaged your aortic valve.

You need emergency surgery.

Mm... What about vasculitis?

Or dysautonomia?

Both are consistent
with weakness and fatigue.

Her temporal artery biopsy
was negative.

That rules out vasculitis. Mm.

And I thought I saw something
about dysautonomia in here.

There are 15 different causes
of dysautonomia.

Seven have been ruled out.

The rest are inconsistent
with Alice's symptoms

or have no definitive
diagnostic test.

How did you make Dr. Lim
fall in love with you

after you had been friends
for so long?

I assume that's directed at you.

I don't think you make anyone

fall in love with you, Shaun.

It unfolds naturally over time.

That's not true.

Everyone starts off
not loving you.

Then you say and do things
that make them love you.

Or not. That's the
point of romance.

But romance is harder

if you're already friends
with the person.

You can't hide the less
attractive parts of yourself.

It can be an advantage.

You already know
what pisses them off.

That's very true.


Did Carly tell you she
just wants to be friends?

Or are you talking about
someone else?

Hey, sorry to interrupt.

I'm... I'm looking
for my dad. Mm.

I just... I'm here visiting,
and I locked mys... Yes. Okay.

Dr. Park is not here,

and we're discussing
something important.

Right. Sorry.

Kellan, your dad's in surgery.

It could be a couple hours.



That was a little harsh.

We're talking
about your love life.

Talking about
my love life is important.

It helps clear my head

so I can focus on the medicine.

Intracranial hypotension.

It is consistent
with Alice's headaches

and dizziness getting worse
when she's upright.

And a leak in spinal fluid
can be triggered

by severe intracranial
pressure during childbirth.

To confirm I'm right,

we need to insert a lumbar
drain into Alice's spine,

infuse her with fluid,
and see if her symptoms improve.

But if you're wrong,

she'll have an
excruciating headache,

massive brain pressure,
temporary vision loss...

She'll give her consent.

It's a reasonable diagnosis,

and the patient's desperate
for an answer.

Can you do the procedure alone?

Only one doctor is needed
to insert a lumbar drain,

and I have a time-sensitive
matter to take care of.


You okay? You look okay.

I'm fine.

Your text said
it was urgent, a...

My text said it was
"time sensitive."

I have to get back to work

before my lunch break is over.

I was at work, too, Shaun.

I know we left things
in a weird place,

but now is not a good time.

The pinto beans
are next to the tomatoes.

That is not
in alphabetical order.

There's more.

The toilet paper
is in the wrong direction.

The way you like it.

You got angry
when we were roommates

because I sometimes
couldn't accept

your way of doing things.

But I can learn to accept things

I'm not comfortable with.

This is not bothering me at all.

I can deal with your messiness

and neediness

and selfishness...


Your way of proving

that you're flexible
and attentive to my needs

is to pull me away from work

with no notice,

make me drive
all the way across town,

just so you can show me you
un-alphabetized your beans?

Doesn't that seem a little...



That is a good point.

I should have waited
until evening,

when you are done with work.

We can discuss this later.

I have to get back
to the hospital.

necrotic tissue around the annulus.

Dr. Reznick,
trim down the patch from the pericardium.

The infection caused a fistula,

and we need to remove it.

Repair the annular defect
with a pericardial patch.

He's gonna have
permanent heart damage.

The guy survives IV drugs,
Hep C, hard time

and gets taken down
by a cactus spike

on his road to redemption.

That's... ironic.


He ignored dangerous symptoms

because he wanted to be
a tough guy for those kids.

He's trying to keep them
from repeating his mistakes.

It's admirable.

Narcissistic waste of time.

You can't undo
a lifetime of abandonment

with a couple weeks
in the woods.

The kids are all still here,
aren't they?

Finish the closure
of the fistula tract

with pledgeted sutures.


I need you to come with me.


Go. We got this.

Security agreed to let us
keep this between us.

No need to call the cops.

Everyone needs to chill.

We weren't cooking meth
in the dumpster.

You have any idea how many
people die from vaping pot?

What were you thinking?

We'll give you two some space.

You. With me.

You have asthma, Kellan.

I know you're not this stupid.

Heart rate's tachy at 148.
Systolic's in the 200s.

I removed the drain
a half-hour ago.

I was wrong.
My idea made things worse.

We need to do a lumbar
puncture to relieve the built-up fluid.

But it didn't make her worse

the way it should have
made her worse.

She should have a headache
or upward brain herniation.

Heart rate should be low.

Something is causing her heart
to beat too hard, too fast.

Mm. I missed something...

Shaun, you need to give her

a 10-milligram bolus
of labetalol now,

or she is going to die.

I missed something.




There was significant tissue
damage from the infection,

but it should be manageable
with medication

and some modifications
to your diet.

So... no more
Flamin' Hot Cheetos?

That's not a thing any
self-respecting adult should eat.

You'll need long-term
follow-up with a cardiologist,

beta-blockers, ACE inhibitors...

What'd you do?

Mr. Reed was found vaping THC
on hospital grounds.

I'm emancipated,
so I'm basically an adult.

You're only emancipated

'cause your parents do even
dumber stuff than you do.

Thanks for letting me know.

There'll be consequences
for his behavior.

Starting with an apology.

And not some smartass one,

Uh, Mr. Keeler,
your hand is swollen.

I need to take a look
at your feet.

Less than a hundred milliliters.

What's wrong with his piss?


What's going on?

We're gonna need to run
some additional tests.

We've done a lumbar puncture
to remove the excess fluid

and bring your spinal pressure
back to normal.

When will she be able
to go home?

I'm not going home.

Honey, their test
just about killed you.

In front of your daughter.

She wasn't supposed to be here.

That's because you told me
you were visiting your sister.

Since when do we lie to each other,

You have to stop
doing this to yourself.

They're only gonna confirm
the same diagnosis

you've already been given.

You said you don't
have a diagnosis.

They told her she has
idiopathic dysautonomia

six months ago.

It was confirmed
by two other doctors.

You left it out
of your medical records?

"Idiopathic" is just
a doctor's fancy way

of saying that they don't know
why I'm sick or how to fix it.

You haven't given
the treatments a chance.

Because even on them,
I can barely sit up most of the time.

Ruby deserves a mother

who can teach her
how to do a cartwheel...

and scoop her up when
she's having a nightmare.

She deserves a mother
who's around.


doesn't need to learn
how to do a cartwheel.

She needs you to watch her,
cheer her on.

And lay down next to her
when she's scared.

And eat the cookies she bakes
and pretend to be enjoying them.

You're a great mother.


There's good
in the life we have.

And you're missing it

by constantly searching
for something better.

Something that may not exist.

Are you feeling overheated?



No, I'm feeling sad that my
husband thinks there's no hope.

You are sweating.

Sweat is a response
to fear, not sadness.

Your temperature is normal.

You may have an adrenal tumor.

Is that good? Yes.

Tumors can be removed.

I'm not mad.

I'm a little mad.

But I want to understand
what's going on.

Dad, not now.

I mean, it's not like you
to be this reckless

with your health, your future.

I can't...

Kel, are you having
an asthma attack?

Where's your inhaler?

I don't... It's...

It's not the asthma.

What is it?

Tell me what you're feeling.

My heart's... Beating fast.

Do you feel dizzy?

Like the walls are closing in?

I think you're having
a panic attack.

Take a deep breath.

One, two, three...

Now out.

Keep breathing.


Does this happen a lot?

I know vaping is stupid, but...

It helps this feeling go away.

Hey, give it back, asshat!

Victor, Max!

Cut it out.

Mr. Keeler.

We have some test results
we need to discuss.

In private.

Whatever you have to say to him,
you can say to us.

Oh, wish you could.

Would love your input.

But, clearly,
you're far too busy watching...

Pimple-popping videos.

Go away.

The damage to your heart

temporarily cut off blood
flow to your kidneys.

They were already weak
and couldn't handle the stress.

You've progressed
to complete renal failure.

I'm sorry.

You'll need a transplant.

But dialysis can keep you going
until a matching donor is found.

I'm guessing
a guy with a bad heart

and damaged liver,
history of hepatitis

isn't first up.

Your best bet is to
find a living donor,

most likely, a family member.

I'm an addict...

Who stole and lied like one
and then went to prison.

My Christmas card list
is pretty short.

We'll connect
you with our transplant coordinator.

She'll help you
reach out to family

and answer any
questions they may have.

Should've taken those twerps

Her husband's not wrong, Shaun.

Sometimes, people need to accept

that things are
as good as they're gonna get

and make peace with it.

Wanting more can only lead

to disappointment
and heartbreak.

What good does it do to give up

if you're already heartbroken?


You were right. No tumor.

Well, you were also right.

The bright color.

It means there is
an increase in the uptake

of radioactive material
in the medullary space.

Which is enlarged
and overproducing adrenaline,

so the gland itself
is acting like a tumor.

We have a new diagnosis.

The quiet
is a nice change of pace.

I told the boys to get some air,

try to avoid committing more
criminal offenses on hospital grounds.

I know they can be
annoying and loud

and constantly in the way,

but I can't make them leave.

Want me to give it a shot?

I'd like to see that, actually.

Nah, they just scared.

They think if they
leave, then...

I'll be the latest
in a long line of people

they didn't have a chance
to say goodbye to.


Code blue!

You do not have
idiopathic dysautonomia.

You have a rare condition

called bilateral adrenal
medullary hyperplasia.

Unfortunately, Alice,
there's only one cure for this condition,

and that's to remove
your adrenal glands.

You would need to be on
steroid replacement therapy

for the rest of your life.

And that comes with a
whole new set of symptoms.

Fragile bones,
high blood pressure,

G.I. issues, mood disorders,

increased chance of diabetes,
serious infections.

I-I understand. I want to do it.

Medullary hyperplasia is
not terminal or progressive.

You could have
a normal life expectancy

in your current condition.

My "current condition"
is pathetic.

I'm having the surgery.


This could kill you.

I love you.

I won't risk your life.

If you insist on
going through with this...

Ruby and I are leaving.

If you love her,
you shouldn't leave her.

It's not her fault she's sick.

And she just wants
to make things better.

- It isn't fair.
- Shaun.

There is nothing worse than
losing the person you love.

I'm sorry.
This isn't Dr. Murphy's call.

Nor is it mine.

We'll give you two some time.

He's right.

I-I can't lose you and Ruby.

I won't do it. I won't...
I won't do the surgery.

Wes suffered
major cardiac damage.

We can't solve one
problem with this guy

before the next one hits.

He's stable now,
but his heart can't handle

the fluid volume shifts
of standard dialysis.

So the only thing keeping
him alive will also kill him.

We could put him
on low-flow dialysis.

Keep him in the ICU
'round the clock.

That'll buy him a little time.

Very little.

Call UNOS. See if
they'll move him up the list.

Where are we
with family members?

Two of Wes' cousins
agreed to be tested.

We're waiting on
the results. Good.

Get on the phone with
any other family you can find.

Tell them if their man doesn't get
a kidney in the next couple days,

they should make arrangements
to say their goodbyes.

New kicks won't help
you outrun me.

Um, they're recipes.

From Dash.

Well, from Kayla.

Kayla by way of Dash.

It's complicated.

He asked me on a date.

What did you say?

Nothing. I stammered,
and then I fled.

What did you want to say?

Ohh. I don't know.

Shaun was right.

Coming home to an empty
apartment really sucks.


Used men to make me feel better.

Most of them didn't mind.



Don't trust myself not to hurt
someone I care about.

Claire, it's not
that complicated.

You lit up this morning
when you saw him.

He seems to make you happy.

You deserve to be happy.


How you feeling?

I'm not high,
if that's what you're asking.

It's not.

You know, earlier in the car,

I pushed too hard,

made you feel cornered.

I'm sorry.

You didn't know.

I, uh...

I talked to your mom.

Is she totally freaking out?

She's concerned.

And we talked about
finding a therapist in Phoenix

who specializes
in treating anxiety.

So you're pawning me off
on a total stranger?

No. No. I...

I thought you'd be
more comfortable

talking to someone who's not...

She said you've been
pretty withdrawn lately.

I know things between
your mom and I are a little...

Screwed up?


Is that making you feel anxious?


It's not you.

It's nothing. It's... It's okay.

No, it's obviously not.

Some of this is on you.

You know, every time we talk,

you don't tell me anything
about your life.

That's because you don't
want to know anything.

That's not true!

You're busy saving patients
a hundred hours a week.

You don't want to feel guilty
about being a thousand miles away.

You just want to know
that I'm okay.

So I say I'm okay.


That's annoying.

Can you do that some place else?

I'm trying to find a better
solution for my patient.

Your patient
is being discharged.

I'm trying to get a kidney
for a dying guy.

You're watching gross videos.

I'm waiting to hear back
from UNOS.


Do you prefer
being called or texted?


Do you like surprises or
do you find them irritating?

I find this irritating.

It's research.

Lea said we can't be together

because she is too needy and
selfish to deal with my issues.

You are the most
selfish person I know,

so you are a good subject.

Lea's right.
She is needy and selfish.

Find someone who loves you
the way you are.

People always say that,
but shouldn't we be with someone

who makes us a better
version of ourselves?


But trying not to be autistic
won't make you better.

I'm sorry you still don't
feel good, Mommy.

Well, I'll feel better
when I'm home.

Eating those delicious cookies
that you make for me.

You don't have to go home.

I invented a better surgery.

Instead of removing
both your adrenal glands,

we can just squeeze out the
hyperplastic medullary part...

Like popping a pimple.

You "invented" a surgery?

Dr. Murphy's come up
with a surgical plan

that could curb overproduction
of your hormones

while leaving you
some adrenal function.

What are the chances it'll work?

Oh, we don't know.

it's never been done before,

it's difficult
to predict the outcome,

but it is a safe
and viable treatment option.

Is Wes dying?

We're doing everything
we can to help him.

I snuck a look at his chart
when no one was around.

You know that's a crime, right?

Only a misdemeanor.

You should talk to Wes.

We all got tested.

I'm a match.

I'm gonna give Wes my kidney.

We've discussed your offer
at length, Max.

It's incredibly admirable
and generous.

But you're 16.

Living donors have to be
18 years old.

I'm emancipated.

I can give consent for myself.

But it's still
up to the hospital

to decide
if this is a good idea.

We don't feel this is
in your best interest.


The surgery's much harder
on the donor than the recipient.

You could have postoperative
bleeding or infection.

And it's incredibly painful.

I've been through more crap
than any of you.

I can handle it.

There are also
long-term consequences...

High blood pressure,
renal failure.

If something happens to your other kidney,
you don't have a spare.

I know how to subtract.
I'm cool with it.

And the recovery
is long and hard.

You would need someone to
help you get dressed and bathe

and make sure you take
all your medications.

I've been taking care of
myself just fine for a long time.

Actually, Max,

you've been in juvie
and on drugs.

You're not
taking care of yourself.

Okay, I get it.

I'm a screw-up.

But Wes isn't.

He's bailed me out of jail.

He's picked me up
in the middle of the night

when I was
too messed up to drive.

He's cleaned me up after fights.

He came
with me to my sister's funeral.

If I manage to stay out of jail,

it's because of Wes.

If I'm a halfway decent
father someday,

if I'm not a lost cause,

it's because
Wes never gave up on me.

He shouldn't die

because I made
dumb-ass decisions.

It's your surgery.

And we have the exact same
amount of experience with this.

Free up the medulla along
the inner cortical surface.

Careful not to penetrate
the cortex.


Nothing's coming out.

Try using your fingers
to pinch the gland.

Use a circular motion
to coax it out.

I've popped my share of pimples.

That's cool.

One down, one to go.

Wes is like a father to Max.

If he were his actual father,

we wouldn't hesitate
to let him do it.

I think we should.

Me, too.

The little punk got to me.

We've explained all the risks.

Max was unwavering.

I vote yes.

One admirable decision

doesn't wipe away
a lifetime of bad ones.

It's three against one.

This isn't a democracy.

I'll tell the patient.

One of the boys
get into trouble again?


No, they've given you
a reason to be proud.

They all got tested to
see if they were a match.

Max is.

He wants to give you his kidney.

That little turd is full of

I can't approve
the transplant, Wes.

I'm sorry.

Max is a good kid.

He's gonna make a good man
one day, thanks to you.

But, for now,

he still needs grown-ups
to have his back.

The risks to his health...

It's okay.


It's the right call.

It's my job to save those kids.

Not the other way around.

You're still on the UNOS list.

We'll keep reaching out
to your family.

We're not giving up.

I need you to do
one other thing for me.

Sorry to interrupt.

It's okay.

No one's probably
listening anyway.

Your kidney's not a match.

They said I was.

Your blood and tissue type
were good.

But the serum crossmatch showed

that Wes produces antibodies
in reaction to your cells.

His body
would reject your kidney.

I'm sorry.


I can't do
one stupid thing right.

That's not true.

You did everything you could.

Wes is so proud of you.

Any dizziness or nausea?

No. No headaches, either.

You need to try
getting out of bed

to see if your symptoms return.

She ready for that?

No cartwheels yet,
but hopefully.

How's it feel?

Room's not spinning.

Mommy! You're all better!

Whoa! Careful, sweet pea.

Mama's still recovering.

I'm okay.


Here's the Big Dipper.

If you extend a straight line
through these two,

this bright star is Polaris.

All of our phones
have compass apps.

Hey, just shut up and listen.

This crap's important.

Polaris is your true north.

You keep your eye on that,
you're gonna find your way out

of whatever mess
you've gotten into.

O... kay.

All right. Mm.

That's, uh...

Even worse than it looks.

It's so bad. It's so bad!

Mm. Cooks, we are not.

I think we should go on a date.

A real date.

Shaun, I already said no.

Yes, because you think there
are problems that can't be fixed.

But I am very good
at solving problems.

I saved a woman today who
nobody thought I could save.

I don't need saving, Shaun.

Okay. I understand.

I can fix this.

Yes. You have to
give me a chance.

You need to let me try.

No. I don't need to do anything.

You need to listen to me.

No. No... This is
only proving my point.

I have... I have a plan.

I can fix it!

I-I will fix it!

Shaun, you're autistic.
You can't fix that.

You are who you are.

And I am who I am.

And the two of us
will never work.