The Good Doctor (2017–…): Season 3, Episode 6 - 45-Degree Angle - full transcript
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Sorry, Dr. Andrews.
I had a patient
with some post-op arm pain.
How can I help you?
What's happened
to all the nurses?
Hello.
My name is
Dr. Shaun Murphy,
surgical resident
year three.
I will be assisted
by Dr. Claire Browne
on today's open appendectomy.
I will not be putting on my
number 7 sterile gloves myself,
as I am lead surgeon.
Nurse Fletch,
can you adjust the overhead light?
How many degrees,
Dr. Murphy?
Ah, yes.
I should be more specific.
A 35-degree angle.
Nurse Hawks,
please hand me the 10 blade.
Straight clamp, please,
Nurse Fletch.
Hello, Dr. Andrews.
I'm going to try
to pretend you're not here.
You have not pretended
to scrub in
and may not be here
when here is there,
there being O.R. 2
later today.
You don't need a full
surgical team to rehearse.
Some of this staff needs
to get back to their stations.
No.
They can stay here.
Chief Lim has assigned me
my second first surgery,
and she assigned
them all to me
and told me to rehearse
with all of them
unless and until there's
an emergency on their floor.
Dr. Browne,
please hand me the Bovie.
Dr. Browne had a dental
appointment this morning.
I'm doing my best to be
annoyingly caring and empathetic
in her stead.
*THE GOOD DOCTOR*
Season 03 Episode 06
*THE GOOD DOCTOR*
Episode Title : "45-Degree Angle"
Sync corrections by srjanapala
There's the baby.
And there's the mass.
Way too close together.
A biopsy
is out of the question.
Best course is to go in
and remove the entire mass.
Will that be dangerous
for the baby?
The odds of your daughter
being harmed are very low.
And what about
recovery time?
How long?
Normal recovery
is about three weeks.
We're opening
a specialty toy store.
I need to be
up and about in a week.
Tell 'em, Andre.
Sustainable natural toys.
Good for the kids,
good for the world.
I don't really want to leave
Andre to fight the crowds alone.
Well, a week
is not realistic.
Too much stress on your
body after the surgery
could put the pregnancy
at risk.
It's okay.
Andre worries.
Thought it was too much to
start a business and a family
all before
our first anniversary.
Business and family
are easy.
If I'd known it was business
and family and cancer,
I... might have waited
on one of them.
Let's just worry about
the surgery right now.
Okay?
Dr. Lim.
Just came from
Dr. Murphy's improv class.
I don't remember Browne
getting a full-team rehearsal
before her first surgery.
Our residents
are not homogeneous.
Each one requires different
attention and training.
I agree.
And for Shaun, that means
less training wheels
and more scabbed knees.
Trust me, his knees
will get scabbed.
I'm trying to prevent
a decapitation.
- If he's not ready...
- Why don't you follow
your own advice?
You think this is the wrong option,
stop telling me.
Let me fail and learn.
But be sure to apologize
when you realize I was right.
The appendix can be
removed in various ways,
including suture ligation,
purse-stringing,
and inversion
appendectomy.
I will be using the
suture ligation technique.
Dr. Browne,
place a clamp just proximal
to the distal ligature
on the appendix.
How's it going
with Carly?
Divide sharply and cauterize
the exposed mucosa.
Isn't dating life
wonderful?
Everything
you hoped it would be?
Please refrain from asking
non-surgical questions, Morgan.
I need to concentrate
on the next step
in my O.R. management.
And I need to be Claire.
Is there any chance
she's not gonna be concerned
about your personal
well-being and inquire?
Repeatedly?
Things are going well,
Dr. Browne.
We make out a lot.
Let's close
the peritoneal cavity.
Did you guys have lots of fun
on your last day off?
I went to the museum.
Mm.
Nurse Hawks, please check
the patient's vitals.
Everything looks normal.
You went alone?
I called Carly
at her house
to see if she wanted
to play Chinese checkers.
Close the external
oblique fascia
with a continuous
2-0 vicryl stitch.
Although they're not
really Chinese.
It's actually a game of German
origin called Sternhalma.
It's very fun.
I will use 4-0 monocryl
subcuticular interrupted sutures
for skin closure.
However, Carly said
she could not hang out
because she was busy.
If the wound
was contaminated,
we could leave in
a Penrose drain
and remove it
two to three days later,
but it is not.
She had friends over.
I could hear laughing
in the background.
Dr. Browne, approximate
all split muscle layers.
That's odd.
Nothing is odd.
We just have
two more steps and...
No. That whatever she was
doing, she didn't invite you.
Why?
She isn't treating you
like a boyfriend.
You don't exclude your significant
other from a get-together.
That's not true.
It could have been a family thing.
Or maybe she thinks it's too early
to introduce you to her friends.
It's also possible that there
was no get-together at all.
I mean, maybe you just
heard the television.
Maybe she just doesn't
see you as her boyfriend.
Has she ever called
you her boyfriend?
We have practiced enough.
You had a dental appointment
this morning.
The reason you're late.
So brush extra well
and don't forget to floss.
Thanks.
Don't take this
the wrong way,
but when did you get
so slutty?
I'm not. Thank you
for covering. Now...
This smells like it's been
dipped in Drakkar cologne.
Do you really care
what I wear or what I do?
I care when you're late.
I care about the amount of extra
work I have to do covering for you.
I was an hour late.
How much extra work
could that be?
One hour's worth.
So, you can thank me by taking
two hours off my hands.
Thank you.
Hey, Shaun.
Hello.
Waiting for Carly?
I want to know why
she did not invite me
to her get-together.
Might have a better chance
of finding out
if you were
physically closer to her.
Maybe later.
This prescription should help
him feel a little bit better.
And if I may suggest,
don't store the chocolate
laxatives in the candy drawer.
- Hi.
- Hey.
I was wondering if you could
get away for lunch.
Yeah. Let me see if I can
move some things around.
- Come on in.
- All right.
I got fired.
- What?
- Mm-hmm.
What happened?
I was giving away
free coffee.
We work in a hospital,
and I hear a lot
of sad stories.
And sometimes when they're
really, really sad,
I like to give that person
a free coffee,
and it makes them smile.
And yes, okay, I know.
It's against policy.
But you'd think
my asshat boss
would give me
more than two warnings
before giving me the ax.
Okay. What do you
want me to do?
You want me
to beat him up?
I want you to come home
for lunch
and I want to bitch
about my ex-boss
and I want someone
there to...
Listen.
Okay.
Use a
tenaculum to grasp the lesion
to create
countertraction.
I'm gonna separate the mass
from the underlying myometrium.
- Damn it.
- Let's get suction.
The mass has surrounded
the uterine arteries.
We can't remove the mass
without killing the baby.
Dr. Reznick, if you were lead,
how would you proceed?
We're already in, so...
I'd biopsy the mass
for testing.
Then I'd perform an embolization
of the arteries feeding the tumor.
Very good. Dr. Park,
what does that do?
It should allow us
to control the bleeding
so we can close her up and leave
the baby in place for two months.
That'll give the baby time to
become viable outside the womb.
At that point,
we go back in,
safely take out
the baby and the mass.
Sounds like the
right call to me.
We'll be performing
an embolization
of the arteries
feeding the tumor.
- I'll inform Chief Lim.
- Not necessary.
It's protocol
to run all decisions
about complex procedures
by the Chief of Surgery.
There's only
one clear path,
which means
there is no decision.
In my office, please.
I didn't think
you'd mind.
We always complained about
Andrews and his red tape.
Well, I hoped
that our relationship
was better than whatever
you had with Andrews.
It is, but I know
you're busy.
- You don't need to be bothered...
- You know how this makes me look?
You know
how this makes me look?
This job was
on your to-do list.
Lab must have
made a mistake.
I'll deal with it.
We might have
a bigger issue
than you lying
about the blood test.
I'm not lying.
Like I said,
this is a bigger issue.
Shaun is distracted.
Well, why would he be...
Because you were
at the dentist.
Nurse Hawks
asked some questions.
Carly didn't invite Shaun
to something,
and now he's worried that they're
not boyfriend and girlfriend.
So, did you talk to him?
No.
That's what you do.
Think I put it
on your list,
"be kind and care,"
so I don't have to.
Okay.
I'll talk to him.
Talk to Carly first.
You can do it
when you drop off the blood vials
and pretend
it's the second time.
This is good. It's good.
You were wasted there.
I was happy there.
I love that hospital.
I lo... I love the staff
and the patients.
It just...
felt like home.
Here's a thought.
What if
I come work with you?
I saw your waiting room.
You need the help.
We have
an office manager.
She doesn't manage.
She's never there.
I-I was a nurse.
I could schedule
your appointments.
I could, um,
triage the walk-ins.
It's like a win-win.
I don't think
we have the budget for...
for new employees.
Aaron, that's horse crap.
You're the president.
What's the real reason?
I-I think couples that
are apart now and then,
it's a good thing.
Couples together 24/7?
I mean, I don't want to get to
the point where we come home
and we run to opposite
sides of the house.
Okay.
Just a thought.
I'm just gonna...
Keep looking.
Hi, Carly.
Replacement vials.
For some reason,
the bloodwork for Shaun's case
was never processed.
Oh, that doesn't
sound right.
Why is not
all that important.
But if you could just
put a rush on them.
If the tests get delayed
any longer,
then Shaun's surgery
could get rescheduled.
There's no record
of any bloodwork
- being dropped off for Shaun.
- If the surgery gets rescheduled,
then Shaun will lose his team,
the team he's practiced with.
It might throw him,
so if you could just...
Shaun doesn't get thrown
by anything medical.
Shaun is already thrown.
For some reason,
he has it in his head
that you dissed him or something,
that maybe there's a problem,
and now he seems
distracted, upset.
I...
I wondered if you could
speak with him,
let him know
everything's okay.
I'll make sure to put a rush
on the blood tests.
Thank you.
My wife says
that the Earth is a womb
and that when you garden,
you become part
of its birthing process.
Not that I mind
sharing hobbies with her.
It keeps us close.
And I don't mind
the dirt in my eyes.
Just could do with
a little less of the talking.
I feel you.
You don't by any chance
possess the power of flight?
Uh, what?
You have a wing
in your eye.
Sorry?
Just hold still.
Ow.
Congratulations.
Your womb just gave birth to a bee.
Ugh.
Triplets, in fact.
Dr. Glassman,
I need to compartmentalize.
Hi, Shaun.
Nurse Hawks says
girlfriends invite their
boyfriends to get-togethers.
That means it's possible
Carly did not invite me
because I am not
her boyfriend,
but we make out and she
wants to hold my hand
and she lets me
touch her breasts.
Those are things you do
with a boyfriend.
Now all I think about
is Carly,
even when I'm supposed
to be doing my job.
I do not like it.
I tried to talk to her,
but I can't.
You can't talk to her?
I can't.
I need
to compartmentalize.
Well, Shaun, you're...
You're very good
at compartmentalizing.
Were you wearing
your white lab coat
when you tried
to talk to her?
N-No, I was in
my surgical scrubs.
Okay, see,
we all struggle to...
to separate our work life
with our personal life, right?
That's why
we wear uniforms.
It tells us,
it tells the world,
"This is what I have to
focus on right now.
"I can't worry about
anything else."
- That makes sense.
- Good.
So, when Carly's wearing
her white lab coat,
then she's
just a co-worker,
not a girl you happen to
be seeing at the moment.
When you're wearing
your white lab coat,
then you say to yourself,
"I'm a doctor, damn it.
"I'm not gonna worry
about everything else."
Say to yourself,
"I'm a doctor.
"Romance doesn't matter."
I'm a doctor.
Romance doesn't matter.
I'm a doctor.
Romance doesn't matter.
I am a doctor.
Romance doesn't matter.
I am a doctor.
Romance doesn't matter.
Um, you're wearing
a white lab coat.
You want to be a doctor and get
the other bees out of my eye?
You make a fair point.
Looking for Murphy?
Yep.
- Blood tests being expedited?
- Yes.
Did you own your mistake or
blame some innocent clerk?
How did it feel?
Is it eating at you?
You mean,
how do I live one moment
behaving how you do
constantly?
At least I'm consistent,
even when I'm going through
my own issues.
Shaun?
Why aren't you wearing
your white coat?
I am a civilian.
Medicine doesn't matter.
You're not leaving.
Your surgery
is in six hours.
Did you speak
to Carly?
I need to talk
to Carly.
Shaun, why did we practice
this morning?
Because I'm not good
at communication.
Exactly.
But with practice,
you can do it.
Talk to me.
Tell me the problem.
Tell me how you feel.
Okay.
I have to talk
to Carly.
Shaun, stop.
You don't have to
talk to Carly.
Everything is fine.
I talked to her earlier,
and it was just
all a misunderstanding.
Why did she not invite me
over to meet her friends?
There were no friends.
Uh, the laughing
you heard,
she thinks it must have been a
podcast she was listening to.
I need to get my lab coat.
Told you you're better
at this than I am.
Though you could have
jumped in earlier.
We were able to do a biopsy,
and the mass is non-malignant.
We've stabilized it,
but it does still need to be removed.
When?
Two months.
By then, the baby will
be viable outside the...
I don't feel well.
My vision's
getting blurry.
Your blood pressure's
tanking.
W... Doctor,
what's happening to her?
Page Dr. Melendez.
Hello.
My name is Dr. Shaun Murphy,
surgical resident year three.
I will be assisted
by Dr. Claire Browne
on today's
open appendectomy.
I will not be putting on my
number 7 sterile gloves myself,
as I am lead surgeon.
Nurse Fletch,
can you adjust the overhead light?
Adjust to
a 35-degree angle.
Nurse Hawks,
please hand me the 10 blade.
The arterial embolization was
rejected above the bladder.
The mass
is seeping blood.
We have to go in again,
or she'll slowly bleed to death.
We deliver
the baby early,
have an incubator and
ventilator ready in the O.R.
Even with
maximal NICU support,
the baby's chance of survival
is around 15% to 20%.
Maybe we were wrong
the first time.
Maybe we can leave the
child and work around her.
We can suction-resect
this friable lesion
and control the bleeding better
with the argon beam coagulator.
Very easy to go too far,
cause a uterine rupture.
But if we don't screw up,
the baby gets to stay in
the womb and grow to term.
Nice.
I'll go book an O.R.
Wait.
There's one more thing
we need to do.
It's a good plan.
But the safest
course of action
is to deliver prematurely
and remove the mass.
By "deliver prematurely,"
you mean
terminate the pregnancy.
Not necessarily.
But yes.
To save her life.
If I place internal iliac
artery balloon catheters,
I can control most bleeding
as it happens.
Most?
I've performed surgeries that
were a lot more complicated
under much more difficult
circumstances.
When you had
no other option.
You have a choice here,
a safer choice.
The mother's life
takes precedence.
That's our policy.
Are we sure it's hers?
Okay.
Go make your case.
Thank you.
Neil?
Thank you
for getting my approval.
It's your job.
I will now
use electrocautery
to incise through
both the fascia and muscles.
Can I please
get a measurement
on the patient's pulse,
blood pressure, and temperature?
Pulse is at 65,
pressure 118/82,
and temp is normal,
at 98.6 degrees.
Thank you for hearing
and responding.
The appendix can be
removed in various ways.
I will be using the
suture ligation technique.
Dr. Browne,
can you identify the ascending colon
and its taenia coli?
I see it.
Thank you.
Please free the
appendix-mesoappendix complex
from its adjacent tissue.
Babcock clamps.
We must have nicked an
ileocolic branch of the SMA.
Get suction on it,
Dr. Browne.
Nurse Fletch, please use
lap sponges to stem the bleed.
If she hemorrhages,
she could die?
That is a possibility.
But if you're successful,
then I complete my pregnancy.
No. It's too risky.
If Dr. Melendez
says he can do it...
Do the other surgery...
The one where you take the
baby out and you save Patty.
I'm the one
carrying the baby.
I'm the one
going through the surgery.
- It's not your choice to make.
- I-I didn't want this baby.
Sorry. I...
Look, we can have another
child some other time.
But I can't replace you.
I don't want
another baby.
I want the one that's been
giving me morning sickness
for the last 23 weeks.
I want the one who's
been giving me heartburn,
constipation,
and insomnia.
That's the baby
that I want to hold.
And I couldn't live
with the guilt
if I killed our baby
to save my own life.
Performing a suture ligation with
two interrupted 2-0 vicryl sutures.
Dr. Browne,
cauterize the exposed mucosa.
I may owe Dr. Lim
an apology.
Continue.
Uh, yes.
We still need to
copiously irrigate the wound
with normal saline,
grasp the peritoneum
with two straight clamps,
and close it all up with a
continuous 3-0 vicryl stitch.
Irrigating.
Straight clamp, please,
N-Nurse...
Straight clamp, please,
Nurse Hawks.
You are handing them
to me incorrectly.
I'm sorry?
You are handing them
to me incorrectly.
This is how
I always do it.
You do it wrong.
Shaun...
I don't know how else to do it.
You can do it
the right way.
What's the right way?
The efficient way.
Efficient?
Yes.
There is historical precedence
to my preference.
Please just take
the clamp.
I can't.
Of course you can.
Take the damn clamp.
You need to leave.
Nurse Hawks...
You need to leave the O.R.
Leave now!
Dr. Reznick,
please cauterize those bleeders
with the argon coagulator.
I nicked an artery.
She's hemorrhaging!
Hang four units
on the rapid infuser.
Get me a vascular clamp.
The surgery
was successful.
The patient's vital
signs are stable...
You can't solve your interpersonal
problems by making people go away.
There was a bleed.
You threw the nurse out of
surgery because of a bleed?
Yes.
Because we nicked the
ileocolic branch of the SMA,
Nurse Fletch was attending
to the lap sponges,
so Nurse Hawks had to hand
me the straight clamp,
and she did it wrong.
And she refused
to do it right.
Did you tell her
how to do it right?
I wanted
my straight clamp
handed to me
at a 45-degree angle
so I do not have to
bend my wrist as much
to go from handoff
to the surgical field.
Did you explain
all of that to her?
I told her to do it
the efficient way.
I want you to apologize
to Nurse Hawks.
N-No. No.
Why would I apologize because
she did not do it right?
Because you didn't,
either.
When you're lead surgeon,
it means you're in charge,
which means if anything goes
wrong, it's your fault.
Do you understand?
You've gotta
make this right.
Okay.
You could have stepped in and kept
the situation from escalating.
You have your way
of dealing with Shaun,
and so do I.
We need better control of
the bleeding.
Clamp off the common iliac.
There's too much
blood to see in here.
We have to
take the baby out.
Page the on-call
neonatologist.
Let them know they're gonna
have a 23-week-old girl
coming their way
very soon.
Second time in as many days
you've dropped by unexpectedly.
I'm starting to think
you like me.
I got a job offer.
Well, there you go.
That was quick.
Let's go celebrate.
Well, I'm not gonna
take the offer.
I want to come
work here with you.
Well, we've already
talked about that.
You talked.
I listened.
Now it's my turn
to talk.
We got married
to be here for each other,
even when the other one
didn't know they need it.
You're so busy
with your patients,
you don't see that the clinic
is starting to suffer.
Right now,
it's double-booked appointments.
Next, it could be the wrong
medication prescribed.
I would never
let that happen.
I'm a good partner.
I'm good at home,
on the weekends.
I could be equally as good
here in this office.
Okay, if it doesn't
work out, I'll quit.
Or you can fire me.
No harm, no foul.
Uh, nothing is ever as simple
as "No harm, no foul."
Got a resume?
Well, I was hoping
to avoid that.
Mm.
I read a study that said sharing
a cup of coffee with colleagues
promotes professionalism.
My cup is empty
because I do not like the
way coffee makes me feel.
I've had a long day.
Can I just enjoy my lunch?
Chief Lim asked me
to apologize to you.
Okay.
Okay.
The earliest
known drawing
of a pivoting
surgical instrument
dates back to 1500 B.C.
on a tomb at Thebes, Egypt...
This does not sound like
the beginning of an apology.
I want to explain why
I prefer the straight clamp
handed to me
at a 45-degree angle.
Putting it in historical
context will help.
You need to stop.
In the ninth century,
Albucasis, known as
"the father of surgery"...
You need to go away.
No.
I need you to understand
because if you see
why I'm right,
you will see there is no
reason for me to apologize.
She's gone into
unstable v-tach.
Dr. Reznick,
we're gonna need the defibrillator.
Charging.
Clear.
Continue compressions.
Give me one milligram
of epinephrine.
She's gone into v-fib.
Shock again.
Charging.
Clear.
All right, crack her chest.
I'm gonna do an open-heart massage.
Heart's exposed.
Starting the massage.
Internal cardiac paddles.
Charging.
Clear.
Again.
Charge. Clear.
Again!
Charge.
Clear.
Let's open the uterus
and get the baby.
All you had to do
was say you're sorry.
I... tried to explain
why the straight clamp...
N-No, I-I don't hear
the word "sorry" in there.
I-I don't hear any
taking of responsibility.
You said
I had to make this right.
An apology seemed to be
just one possible way...
Shaun,
she filed a complaint.
No. No!
Yes. Yes.
- You have a problem with communication.
- I was... Yes, but I am...
So I'm going to make this
very, very clear.
You screwed up.
- No. No!
- Yes. Yeah, you were wrong.
You are wrong.
You screwed up.
This incident will be
noted in your file.
And if this or anything
like this happens again,
that will be the end
of your residency.
Now, what do you
have to say?
You're sorry?
I failed.
I'm sorry.
Good.
Now go say those words
to Nurse Hawks.
And mean them.
I spoke to Carly.
You're a terrible
fairy godmother.
You swoop in, you enchant
the hero with a lie,
and then you carry on like you
made his world a better place.
Shaun was about to
talk to Carly.
That's what
he needed to do.
I think
Carly's pissed at him.
Fine. Then she's pissed at him.
They deal with it.
Shaun's problem
is communication.
You made it worse.
Shaun needed
to get his head straight
before his first
solo surgery.
That is what I did.
I fixed the problem.
You buried a problem.
Which seems to be your general
approach to life right now.
Hey, Shaun.
Hello.
We need to talk.
You're mad at me.
Yes.
Because whenever
you have a problem,
I hear it from Glassman
or Claire or Morgan...
Anyone but you.
I'm sorry.
Good.
Shaun, stop!
This is the problem.
You have to tell me
what's bothering you.
Why did you not invite me
to your get-together last Sunday?
I had
some old friends over.
We were gonna drink
and play a little poker.
My friends are snarky.
They tease and play practical
jokes on each other.
And I knew
that you wouldn't like that
and that
it would get weird,
so I decided
not to invite you.
That's it.
The whole story.
My father
always sent me to my room
when he would play poker
with his friends.
They were loud,
and they would tease me.
They said I talked funny.
Is that what your friends
were going to say?
No, Shaun.
Of course not.
Then what were they
going to do?
Nothing, I guess.
It's just...
Sometimes when you bring
the guy that you're dating
into the mix,
that relationship changes.
It can be a disaster.
Was it a disaster
every time you brought a date
to meet your friends?
No.
Some fit right in.
Then how did you know?
How did you know it would
be a disaster with me?
I didn't.
I made an assumption.
And I shouldn't
have done that.
I'm sorry, too.
Can you forgive me?
I wasn't
a great girlfriend.
Girlfriend?
You're my girlfriend?
Yeah.
Does that mean
I'm your boyfriend?
You are.
I forgive you.
Can I kiss you?
Okay.
I'm glad we talked.
Me too.
I'll introduce you
to my friends next week.
No, thank you.
I would not like
to meet your friends.
- Okay.
- Okay.
Synchronized by srjanapala
---
Sorry, Dr. Andrews.
I had a patient
with some post-op arm pain.
How can I help you?
What's happened
to all the nurses?
Hello.
My name is
Dr. Shaun Murphy,
surgical resident
year three.
I will be assisted
by Dr. Claire Browne
on today's open appendectomy.
I will not be putting on my
number 7 sterile gloves myself,
as I am lead surgeon.
Nurse Fletch,
can you adjust the overhead light?
How many degrees,
Dr. Murphy?
Ah, yes.
I should be more specific.
A 35-degree angle.
Nurse Hawks,
please hand me the 10 blade.
Straight clamp, please,
Nurse Fletch.
Hello, Dr. Andrews.
I'm going to try
to pretend you're not here.
You have not pretended
to scrub in
and may not be here
when here is there,
there being O.R. 2
later today.
You don't need a full
surgical team to rehearse.
Some of this staff needs
to get back to their stations.
No.
They can stay here.
Chief Lim has assigned me
my second first surgery,
and she assigned
them all to me
and told me to rehearse
with all of them
unless and until there's
an emergency on their floor.
Dr. Browne,
please hand me the Bovie.
Dr. Browne had a dental
appointment this morning.
I'm doing my best to be
annoyingly caring and empathetic
in her stead.
*THE GOOD DOCTOR*
Season 03 Episode 06
*THE GOOD DOCTOR*
Episode Title : "45-Degree Angle"
Sync corrections by srjanapala
There's the baby.
And there's the mass.
Way too close together.
A biopsy
is out of the question.
Best course is to go in
and remove the entire mass.
Will that be dangerous
for the baby?
The odds of your daughter
being harmed are very low.
And what about
recovery time?
How long?
Normal recovery
is about three weeks.
We're opening
a specialty toy store.
I need to be
up and about in a week.
Tell 'em, Andre.
Sustainable natural toys.
Good for the kids,
good for the world.
I don't really want to leave
Andre to fight the crowds alone.
Well, a week
is not realistic.
Too much stress on your
body after the surgery
could put the pregnancy
at risk.
It's okay.
Andre worries.
Thought it was too much to
start a business and a family
all before
our first anniversary.
Business and family
are easy.
If I'd known it was business
and family and cancer,
I... might have waited
on one of them.
Let's just worry about
the surgery right now.
Okay?
Dr. Lim.
Just came from
Dr. Murphy's improv class.
I don't remember Browne
getting a full-team rehearsal
before her first surgery.
Our residents
are not homogeneous.
Each one requires different
attention and training.
I agree.
And for Shaun, that means
less training wheels
and more scabbed knees.
Trust me, his knees
will get scabbed.
I'm trying to prevent
a decapitation.
- If he's not ready...
- Why don't you follow
your own advice?
You think this is the wrong option,
stop telling me.
Let me fail and learn.
But be sure to apologize
when you realize I was right.
The appendix can be
removed in various ways,
including suture ligation,
purse-stringing,
and inversion
appendectomy.
I will be using the
suture ligation technique.
Dr. Browne,
place a clamp just proximal
to the distal ligature
on the appendix.
How's it going
with Carly?
Divide sharply and cauterize
the exposed mucosa.
Isn't dating life
wonderful?
Everything
you hoped it would be?
Please refrain from asking
non-surgical questions, Morgan.
I need to concentrate
on the next step
in my O.R. management.
And I need to be Claire.
Is there any chance
she's not gonna be concerned
about your personal
well-being and inquire?
Repeatedly?
Things are going well,
Dr. Browne.
We make out a lot.
Let's close
the peritoneal cavity.
Did you guys have lots of fun
on your last day off?
I went to the museum.
Mm.
Nurse Hawks, please check
the patient's vitals.
Everything looks normal.
You went alone?
I called Carly
at her house
to see if she wanted
to play Chinese checkers.
Close the external
oblique fascia
with a continuous
2-0 vicryl stitch.
Although they're not
really Chinese.
It's actually a game of German
origin called Sternhalma.
It's very fun.
I will use 4-0 monocryl
subcuticular interrupted sutures
for skin closure.
However, Carly said
she could not hang out
because she was busy.
If the wound
was contaminated,
we could leave in
a Penrose drain
and remove it
two to three days later,
but it is not.
She had friends over.
I could hear laughing
in the background.
Dr. Browne, approximate
all split muscle layers.
That's odd.
Nothing is odd.
We just have
two more steps and...
No. That whatever she was
doing, she didn't invite you.
Why?
She isn't treating you
like a boyfriend.
You don't exclude your significant
other from a get-together.
That's not true.
It could have been a family thing.
Or maybe she thinks it's too early
to introduce you to her friends.
It's also possible that there
was no get-together at all.
I mean, maybe you just
heard the television.
Maybe she just doesn't
see you as her boyfriend.
Has she ever called
you her boyfriend?
We have practiced enough.
You had a dental appointment
this morning.
The reason you're late.
So brush extra well
and don't forget to floss.
Thanks.
Don't take this
the wrong way,
but when did you get
so slutty?
I'm not. Thank you
for covering. Now...
This smells like it's been
dipped in Drakkar cologne.
Do you really care
what I wear or what I do?
I care when you're late.
I care about the amount of extra
work I have to do covering for you.
I was an hour late.
How much extra work
could that be?
One hour's worth.
So, you can thank me by taking
two hours off my hands.
Thank you.
Hey, Shaun.
Hello.
Waiting for Carly?
I want to know why
she did not invite me
to her get-together.
Might have a better chance
of finding out
if you were
physically closer to her.
Maybe later.
This prescription should help
him feel a little bit better.
And if I may suggest,
don't store the chocolate
laxatives in the candy drawer.
- Hi.
- Hey.
I was wondering if you could
get away for lunch.
Yeah. Let me see if I can
move some things around.
- Come on in.
- All right.
I got fired.
- What?
- Mm-hmm.
What happened?
I was giving away
free coffee.
We work in a hospital,
and I hear a lot
of sad stories.
And sometimes when they're
really, really sad,
I like to give that person
a free coffee,
and it makes them smile.
And yes, okay, I know.
It's against policy.
But you'd think
my asshat boss
would give me
more than two warnings
before giving me the ax.
Okay. What do you
want me to do?
You want me
to beat him up?
I want you to come home
for lunch
and I want to bitch
about my ex-boss
and I want someone
there to...
Listen.
Okay.
Use a
tenaculum to grasp the lesion
to create
countertraction.
I'm gonna separate the mass
from the underlying myometrium.
- Damn it.
- Let's get suction.
The mass has surrounded
the uterine arteries.
We can't remove the mass
without killing the baby.
Dr. Reznick, if you were lead,
how would you proceed?
We're already in, so...
I'd biopsy the mass
for testing.
Then I'd perform an embolization
of the arteries feeding the tumor.
Very good. Dr. Park,
what does that do?
It should allow us
to control the bleeding
so we can close her up and leave
the baby in place for two months.
That'll give the baby time to
become viable outside the womb.
At that point,
we go back in,
safely take out
the baby and the mass.
Sounds like the
right call to me.
We'll be performing
an embolization
of the arteries
feeding the tumor.
- I'll inform Chief Lim.
- Not necessary.
It's protocol
to run all decisions
about complex procedures
by the Chief of Surgery.
There's only
one clear path,
which means
there is no decision.
In my office, please.
I didn't think
you'd mind.
We always complained about
Andrews and his red tape.
Well, I hoped
that our relationship
was better than whatever
you had with Andrews.
It is, but I know
you're busy.
- You don't need to be bothered...
- You know how this makes me look?
You know
how this makes me look?
This job was
on your to-do list.
Lab must have
made a mistake.
I'll deal with it.
We might have
a bigger issue
than you lying
about the blood test.
I'm not lying.
Like I said,
this is a bigger issue.
Shaun is distracted.
Well, why would he be...
Because you were
at the dentist.
Nurse Hawks
asked some questions.
Carly didn't invite Shaun
to something,
and now he's worried that they're
not boyfriend and girlfriend.
So, did you talk to him?
No.
That's what you do.
Think I put it
on your list,
"be kind and care,"
so I don't have to.
Okay.
I'll talk to him.
Talk to Carly first.
You can do it
when you drop off the blood vials
and pretend
it's the second time.
This is good. It's good.
You were wasted there.
I was happy there.
I love that hospital.
I lo... I love the staff
and the patients.
It just...
felt like home.
Here's a thought.
What if
I come work with you?
I saw your waiting room.
You need the help.
We have
an office manager.
She doesn't manage.
She's never there.
I-I was a nurse.
I could schedule
your appointments.
I could, um,
triage the walk-ins.
It's like a win-win.
I don't think
we have the budget for...
for new employees.
Aaron, that's horse crap.
You're the president.
What's the real reason?
I-I think couples that
are apart now and then,
it's a good thing.
Couples together 24/7?
I mean, I don't want to get to
the point where we come home
and we run to opposite
sides of the house.
Okay.
Just a thought.
I'm just gonna...
Keep looking.
Hi, Carly.
Replacement vials.
For some reason,
the bloodwork for Shaun's case
was never processed.
Oh, that doesn't
sound right.
Why is not
all that important.
But if you could just
put a rush on them.
If the tests get delayed
any longer,
then Shaun's surgery
could get rescheduled.
There's no record
of any bloodwork
- being dropped off for Shaun.
- If the surgery gets rescheduled,
then Shaun will lose his team,
the team he's practiced with.
It might throw him,
so if you could just...
Shaun doesn't get thrown
by anything medical.
Shaun is already thrown.
For some reason,
he has it in his head
that you dissed him or something,
that maybe there's a problem,
and now he seems
distracted, upset.
I...
I wondered if you could
speak with him,
let him know
everything's okay.
I'll make sure to put a rush
on the blood tests.
Thank you.
My wife says
that the Earth is a womb
and that when you garden,
you become part
of its birthing process.
Not that I mind
sharing hobbies with her.
It keeps us close.
And I don't mind
the dirt in my eyes.
Just could do with
a little less of the talking.
I feel you.
You don't by any chance
possess the power of flight?
Uh, what?
You have a wing
in your eye.
Sorry?
Just hold still.
Ow.
Congratulations.
Your womb just gave birth to a bee.
Ugh.
Triplets, in fact.
Dr. Glassman,
I need to compartmentalize.
Hi, Shaun.
Nurse Hawks says
girlfriends invite their
boyfriends to get-togethers.
That means it's possible
Carly did not invite me
because I am not
her boyfriend,
but we make out and she
wants to hold my hand
and she lets me
touch her breasts.
Those are things you do
with a boyfriend.
Now all I think about
is Carly,
even when I'm supposed
to be doing my job.
I do not like it.
I tried to talk to her,
but I can't.
You can't talk to her?
I can't.
I need
to compartmentalize.
Well, Shaun, you're...
You're very good
at compartmentalizing.
Were you wearing
your white lab coat
when you tried
to talk to her?
N-No, I was in
my surgical scrubs.
Okay, see,
we all struggle to...
to separate our work life
with our personal life, right?
That's why
we wear uniforms.
It tells us,
it tells the world,
"This is what I have to
focus on right now.
"I can't worry about
anything else."
- That makes sense.
- Good.
So, when Carly's wearing
her white lab coat,
then she's
just a co-worker,
not a girl you happen to
be seeing at the moment.
When you're wearing
your white lab coat,
then you say to yourself,
"I'm a doctor, damn it.
"I'm not gonna worry
about everything else."
Say to yourself,
"I'm a doctor.
"Romance doesn't matter."
I'm a doctor.
Romance doesn't matter.
I'm a doctor.
Romance doesn't matter.
I am a doctor.
Romance doesn't matter.
I am a doctor.
Romance doesn't matter.
Um, you're wearing
a white lab coat.
You want to be a doctor and get
the other bees out of my eye?
You make a fair point.
Looking for Murphy?
Yep.
- Blood tests being expedited?
- Yes.
Did you own your mistake or
blame some innocent clerk?
How did it feel?
Is it eating at you?
You mean,
how do I live one moment
behaving how you do
constantly?
At least I'm consistent,
even when I'm going through
my own issues.
Shaun?
Why aren't you wearing
your white coat?
I am a civilian.
Medicine doesn't matter.
You're not leaving.
Your surgery
is in six hours.
Did you speak
to Carly?
I need to talk
to Carly.
Shaun, why did we practice
this morning?
Because I'm not good
at communication.
Exactly.
But with practice,
you can do it.
Talk to me.
Tell me the problem.
Tell me how you feel.
Okay.
I have to talk
to Carly.
Shaun, stop.
You don't have to
talk to Carly.
Everything is fine.
I talked to her earlier,
and it was just
all a misunderstanding.
Why did she not invite me
over to meet her friends?
There were no friends.
Uh, the laughing
you heard,
she thinks it must have been a
podcast she was listening to.
I need to get my lab coat.
Told you you're better
at this than I am.
Though you could have
jumped in earlier.
We were able to do a biopsy,
and the mass is non-malignant.
We've stabilized it,
but it does still need to be removed.
When?
Two months.
By then, the baby will
be viable outside the...
I don't feel well.
My vision's
getting blurry.
Your blood pressure's
tanking.
W... Doctor,
what's happening to her?
Page Dr. Melendez.
Hello.
My name is Dr. Shaun Murphy,
surgical resident year three.
I will be assisted
by Dr. Claire Browne
on today's
open appendectomy.
I will not be putting on my
number 7 sterile gloves myself,
as I am lead surgeon.
Nurse Fletch,
can you adjust the overhead light?
Adjust to
a 35-degree angle.
Nurse Hawks,
please hand me the 10 blade.
The arterial embolization was
rejected above the bladder.
The mass
is seeping blood.
We have to go in again,
or she'll slowly bleed to death.
We deliver
the baby early,
have an incubator and
ventilator ready in the O.R.
Even with
maximal NICU support,
the baby's chance of survival
is around 15% to 20%.
Maybe we were wrong
the first time.
Maybe we can leave the
child and work around her.
We can suction-resect
this friable lesion
and control the bleeding better
with the argon beam coagulator.
Very easy to go too far,
cause a uterine rupture.
But if we don't screw up,
the baby gets to stay in
the womb and grow to term.
Nice.
I'll go book an O.R.
Wait.
There's one more thing
we need to do.
It's a good plan.
But the safest
course of action
is to deliver prematurely
and remove the mass.
By "deliver prematurely,"
you mean
terminate the pregnancy.
Not necessarily.
But yes.
To save her life.
If I place internal iliac
artery balloon catheters,
I can control most bleeding
as it happens.
Most?
I've performed surgeries that
were a lot more complicated
under much more difficult
circumstances.
When you had
no other option.
You have a choice here,
a safer choice.
The mother's life
takes precedence.
That's our policy.
Are we sure it's hers?
Okay.
Go make your case.
Thank you.
Neil?
Thank you
for getting my approval.
It's your job.
I will now
use electrocautery
to incise through
both the fascia and muscles.
Can I please
get a measurement
on the patient's pulse,
blood pressure, and temperature?
Pulse is at 65,
pressure 118/82,
and temp is normal,
at 98.6 degrees.
Thank you for hearing
and responding.
The appendix can be
removed in various ways.
I will be using the
suture ligation technique.
Dr. Browne,
can you identify the ascending colon
and its taenia coli?
I see it.
Thank you.
Please free the
appendix-mesoappendix complex
from its adjacent tissue.
Babcock clamps.
We must have nicked an
ileocolic branch of the SMA.
Get suction on it,
Dr. Browne.
Nurse Fletch, please use
lap sponges to stem the bleed.
If she hemorrhages,
she could die?
That is a possibility.
But if you're successful,
then I complete my pregnancy.
No. It's too risky.
If Dr. Melendez
says he can do it...
Do the other surgery...
The one where you take the
baby out and you save Patty.
I'm the one
carrying the baby.
I'm the one
going through the surgery.
- It's not your choice to make.
- I-I didn't want this baby.
Sorry. I...
Look, we can have another
child some other time.
But I can't replace you.
I don't want
another baby.
I want the one that's been
giving me morning sickness
for the last 23 weeks.
I want the one who's
been giving me heartburn,
constipation,
and insomnia.
That's the baby
that I want to hold.
And I couldn't live
with the guilt
if I killed our baby
to save my own life.
Performing a suture ligation with
two interrupted 2-0 vicryl sutures.
Dr. Browne,
cauterize the exposed mucosa.
I may owe Dr. Lim
an apology.
Continue.
Uh, yes.
We still need to
copiously irrigate the wound
with normal saline,
grasp the peritoneum
with two straight clamps,
and close it all up with a
continuous 3-0 vicryl stitch.
Irrigating.
Straight clamp, please,
N-Nurse...
Straight clamp, please,
Nurse Hawks.
You are handing them
to me incorrectly.
I'm sorry?
You are handing them
to me incorrectly.
This is how
I always do it.
You do it wrong.
Shaun...
I don't know how else to do it.
You can do it
the right way.
What's the right way?
The efficient way.
Efficient?
Yes.
There is historical precedence
to my preference.
Please just take
the clamp.
I can't.
Of course you can.
Take the damn clamp.
You need to leave.
Nurse Hawks...
You need to leave the O.R.
Leave now!
Dr. Reznick,
please cauterize those bleeders
with the argon coagulator.
I nicked an artery.
She's hemorrhaging!
Hang four units
on the rapid infuser.
Get me a vascular clamp.
The surgery
was successful.
The patient's vital
signs are stable...
You can't solve your interpersonal
problems by making people go away.
There was a bleed.
You threw the nurse out of
surgery because of a bleed?
Yes.
Because we nicked the
ileocolic branch of the SMA,
Nurse Fletch was attending
to the lap sponges,
so Nurse Hawks had to hand
me the straight clamp,
and she did it wrong.
And she refused
to do it right.
Did you tell her
how to do it right?
I wanted
my straight clamp
handed to me
at a 45-degree angle
so I do not have to
bend my wrist as much
to go from handoff
to the surgical field.
Did you explain
all of that to her?
I told her to do it
the efficient way.
I want you to apologize
to Nurse Hawks.
N-No. No.
Why would I apologize because
she did not do it right?
Because you didn't,
either.
When you're lead surgeon,
it means you're in charge,
which means if anything goes
wrong, it's your fault.
Do you understand?
You've gotta
make this right.
Okay.
You could have stepped in and kept
the situation from escalating.
You have your way
of dealing with Shaun,
and so do I.
We need better control of
the bleeding.
Clamp off the common iliac.
There's too much
blood to see in here.
We have to
take the baby out.
Page the on-call
neonatologist.
Let them know they're gonna
have a 23-week-old girl
coming their way
very soon.
Second time in as many days
you've dropped by unexpectedly.
I'm starting to think
you like me.
I got a job offer.
Well, there you go.
That was quick.
Let's go celebrate.
Well, I'm not gonna
take the offer.
I want to come
work here with you.
Well, we've already
talked about that.
You talked.
I listened.
Now it's my turn
to talk.
We got married
to be here for each other,
even when the other one
didn't know they need it.
You're so busy
with your patients,
you don't see that the clinic
is starting to suffer.
Right now,
it's double-booked appointments.
Next, it could be the wrong
medication prescribed.
I would never
let that happen.
I'm a good partner.
I'm good at home,
on the weekends.
I could be equally as good
here in this office.
Okay, if it doesn't
work out, I'll quit.
Or you can fire me.
No harm, no foul.
Uh, nothing is ever as simple
as "No harm, no foul."
Got a resume?
Well, I was hoping
to avoid that.
Mm.
I read a study that said sharing
a cup of coffee with colleagues
promotes professionalism.
My cup is empty
because I do not like the
way coffee makes me feel.
I've had a long day.
Can I just enjoy my lunch?
Chief Lim asked me
to apologize to you.
Okay.
Okay.
The earliest
known drawing
of a pivoting
surgical instrument
dates back to 1500 B.C.
on a tomb at Thebes, Egypt...
This does not sound like
the beginning of an apology.
I want to explain why
I prefer the straight clamp
handed to me
at a 45-degree angle.
Putting it in historical
context will help.
You need to stop.
In the ninth century,
Albucasis, known as
"the father of surgery"...
You need to go away.
No.
I need you to understand
because if you see
why I'm right,
you will see there is no
reason for me to apologize.
She's gone into
unstable v-tach.
Dr. Reznick,
we're gonna need the defibrillator.
Charging.
Clear.
Continue compressions.
Give me one milligram
of epinephrine.
She's gone into v-fib.
Shock again.
Charging.
Clear.
All right, crack her chest.
I'm gonna do an open-heart massage.
Heart's exposed.
Starting the massage.
Internal cardiac paddles.
Charging.
Clear.
Again.
Charge. Clear.
Again!
Charge.
Clear.
Let's open the uterus
and get the baby.
All you had to do
was say you're sorry.
I... tried to explain
why the straight clamp...
N-No, I-I don't hear
the word "sorry" in there.
I-I don't hear any
taking of responsibility.
You said
I had to make this right.
An apology seemed to be
just one possible way...
Shaun,
she filed a complaint.
No. No!
Yes. Yes.
- You have a problem with communication.
- I was... Yes, but I am...
So I'm going to make this
very, very clear.
You screwed up.
- No. No!
- Yes. Yeah, you were wrong.
You are wrong.
You screwed up.
This incident will be
noted in your file.
And if this or anything
like this happens again,
that will be the end
of your residency.
Now, what do you
have to say?
You're sorry?
I failed.
I'm sorry.
Good.
Now go say those words
to Nurse Hawks.
And mean them.
I spoke to Carly.
You're a terrible
fairy godmother.
You swoop in, you enchant
the hero with a lie,
and then you carry on like you
made his world a better place.
Shaun was about to
talk to Carly.
That's what
he needed to do.
I think
Carly's pissed at him.
Fine. Then she's pissed at him.
They deal with it.
Shaun's problem
is communication.
You made it worse.
Shaun needed
to get his head straight
before his first
solo surgery.
That is what I did.
I fixed the problem.
You buried a problem.
Which seems to be your general
approach to life right now.
Hey, Shaun.
Hello.
We need to talk.
You're mad at me.
Yes.
Because whenever
you have a problem,
I hear it from Glassman
or Claire or Morgan...
Anyone but you.
I'm sorry.
Good.
Shaun, stop!
This is the problem.
You have to tell me
what's bothering you.
Why did you not invite me
to your get-together last Sunday?
I had
some old friends over.
We were gonna drink
and play a little poker.
My friends are snarky.
They tease and play practical
jokes on each other.
And I knew
that you wouldn't like that
and that
it would get weird,
so I decided
not to invite you.
That's it.
The whole story.
My father
always sent me to my room
when he would play poker
with his friends.
They were loud,
and they would tease me.
They said I talked funny.
Is that what your friends
were going to say?
No, Shaun.
Of course not.
Then what were they
going to do?
Nothing, I guess.
It's just...
Sometimes when you bring
the guy that you're dating
into the mix,
that relationship changes.
It can be a disaster.
Was it a disaster
every time you brought a date
to meet your friends?
No.
Some fit right in.
Then how did you know?
How did you know it would
be a disaster with me?
I didn't.
I made an assumption.
And I shouldn't
have done that.
I'm sorry, too.
Can you forgive me?
I wasn't
a great girlfriend.
Girlfriend?
You're my girlfriend?
Yeah.
Does that mean
I'm your boyfriend?
You are.
I forgive you.
Can I kiss you?
Okay.
I'm glad we talked.
Me too.
I'll introduce you
to my friends next week.
No, thank you.
I would not like
to meet your friends.
- Okay.
- Okay.
Synchronized by srjanapala