The Good Doctor (2017–…): Season 4, Episode 9 - Irresponsible Salad Bar Practices - full transcript

Your primary care
doctor was right.

The mass is
on the smaller side.

We'll confirm
with the new images,

but it should
be manageable
with medication.

No surgery needed.

Well, my fiance
will be so relieved.

He's been worried
I'll look like Frankenstein
in all our photos.

Also that
I might die.

When's the big day?


You've been dealing
with wedding planning

on top of
a pituitary tumor?

You deserve a medal.

Our medical record system,
on the other hand,

it has you listed
as female.

Probably because of
the Pap smears.

Software clearly needs
a trans update.
Deep breath.

I'll fix it so everything
is correct going forward.

Please confirm
your gender
and pronouns.

Male, he/him/his.
Thanks for asking.

We're the ones with
the messed-up software.

Your scans
from this morning
were just uploaded.

In less than two weeks,
the tumor's doubled in size.

** You're just too good
to be true

** I can't take my eyes
off of you

** You'd be like heaven
to touch...

34-year-old female,
Zara Norton.

and delirious.

Dr. Guerin,
update vitals.

Dr. Wolke,
draw blood for CBC
and electrolytes.

** Oh, pretty baby

** Now that
I've found you, stay **

Pupils are dilated,
but reactive.

Ms. Norton,
smells like you've had
some marijuana?

Mmm-mmm. I just unloaded
a shipment at the dispensary.

Test for THC and
a full tox screen.

I am a peddler.

** Not a user **

Run it.

BP's elevated,
180 over 115.

That could explain
the delirium.

Ooh, that sound high.
Better take my meds.

See, I never miss a...
Oh, no.

Oh, no, that's not it.

BP's climbing,
210 over 120.

1.25 milligrams, IV.

Ms. Norton, do you remember
the name of your medication?

You can
call me Zara.

See? It say right here
on the... (GROANS SOFTLY)

forget about the meds.
She is not taking any.

This is untreated
chronic hypertension.

What if you're wrong?
What if she's on a loop
diuretic for her pressure?

This could cause
renal failure.


She's heading into
hypertensive crisis.

What if we try
an angiotensin
receptor blocker?

No drug interaction.

receptor blockers
work too slowly.

I'm giving her
the ACE inhibitor.


going down.

Nice call.


Latest budget report.

Yeah, the PDF's
sitting in my inbox.

I'm trying
to ignore it.

And thus...

A sit-down visit?

Just checking in,
see how you're doing.

Okay. You?

Me? I'm... recovering
from the year,

like everybody else.

the surge.

You were here
for every minute
of every day.

It must have taken a toll.

It... comes with
the territory.

You're not,
uh, stressed
or distracted?

I'm... tired.

Okay. Well,
maybe you should
take some time off.


But thank you.
I'm fine.

You don't seem fine.

Are there issues with
my work performance?

No, you do great work.

Then I'm not sure
why we're having
this conversation.

Because I'm worried
about you.

Because other people
are worried about you.

There's no shame
in struggling
a little bit.

You know,
what would be weird is

if you didn't
struggle at all.

If you need to see someone,
the hospital will
cover the cost.

Great. You'll pay my bills.

And the damage
to my reputation,
who takes care of that?

I don't think that
seeing a therapist

will affect your career.

Says the white guy.


Privacy protections
are there for a reason.

No one needs to know.

Thank you for checking in.


How you feeling?

Be better when
I understand what
landed me up in here.

You had an acute
hypertensive crisis.

Oh, I know
my blood pressure's high.

I'm already
on medication for it.

You probably wanna
know what it is.

There's no medication.

We need to do
an echocardiogram

to make sure your heart
wasn't damaged in the crisis.

Fine by me.

Here's 10% discount

on any purchase
over $50 or more
at Z & B Naturals.

I'm Z.
B is my partner Bill.

You're surrounded by pot
all day, every day,

but you never
touch the stuff?

How? Why?

It's just never
been my thing.


The name always
trips me up.


That's for

Yeah, bottle seems
pretty full.

How long have
you been on this?

About six months.
Just refilled it.

Take it every day.


Head tilt.

Now he smiles.

Burst of laughter.



Rio Gutierrez, 29,

pituitary mass
went from manageable
with meds

to likely surgery.

So, talking to the new
radiology resident, huh?

I wanted Dr. D'Souza's opinion
on an intriguing set of scans.

She is very talented.

You're crushing on her.

N... No.

I am not.
I love Lea.

Well, those two things
aren't mutually exclusive.

Mr. Gutierrez's blood
has high levels
of prolactin.

Prolactin is produced
in the pituitary gland.

The tumor could be
secreting it.

Or the tumor
could be reacting to
the high levels of hormones

being produced
elsewhere in the body.

The patient is
a transgender man.

Do an ultrasound.

Advance the probe
until you see
the cardiac chamber.

ENRIQUE: Maybe Zara has
secondary hypertension

due to renal
vascular disease.

She doesn't.
Her creatinine
is 1.2.

Her GFR is
in normal range.

Well, that would
make it unlikely,
but not impossible.

It'd also explain why her
prescribed hypertension
meds weren't working

and why she got better
when you gave her
that ACE inhibitor.

Mmm. Simpler explanation,
she's not taking her meds.

Valve looks

Should I move on to
the two-chamber view?


We have no reason to
think that she's lying.

She seems to be
telling the truth
about her pot usage.

in her blood
or urine.

She couldn't possibly
be lying about
something else.

The left ventricle
is thickened,

which is consistent with
untreated hypertension.


Heart rate's

Cardiac output
is dropping.

Stroke volume
as well.

She's in
cardiogenic shock.


Would you mind
if I did an ultrasound
on your abdomen?

For a brain tumor?

This is my fiance,
Eli Simpson.

When I heard about
the new scans,

I kind of
stormed the castle.

My hero.

Your prolactin levels
are very high,

which might be caused
by the tumor,

unless another condition
raised your prolactin,

encouraging more growth.

What condition
boosts prolactin?

Do you think
I'm pregnant?

He can't be.
He's on testosterone.

Except for
a few weeks
last month.

I forgot to take my shot
before our trip.

But there's no way that...

You're pregnant.

You went into
cardiogenic shock

because your heart
wasn't pumping

We did a minor procedure
and installed
an Impella pump,

but it's
a short-term

I do feel a little
out of breath.

But that might be
just 'cause of you,
Dr. Andrews.

Ms. Norton,
I'm a married man
and your doctor.


You have
a rare condition.

Certain parts of
your heart muscle

have become
abnormally thick.

So, this wall
in between the chambers,
that's the septum.

That's a normal one.

This is what
yours looks like.

Oh, wow.

It's gonna
require surgery.

We're gonna run a few
more tests to determine
the best approach.

Wait. You gonna be
my surgeon, Dr. Andrews?

I sure will.

And y'all two
gonna be with him?


My lucky day.

Three doctors of color
taking care of me.

Doctors who won't
talk down to me.

Not exactly
what I'm used to.

You guys know
what I mean.

My mother made me
wear a suit and tie

whenever we went
to the pediatrician.

Put on your Sunday best
just to get on the scale
and touch your toes.

Yeah. Made me so mad,
I wound up
becoming a doctor.


The testing

your tumor is a

And the pregnancy is
about six weeks along.

Do you consider
yourself gay?

I don't think that's...
ELI: Yes.

Because I am gay.

But you have
vaginal intercourse
with your fiance.

That is how
he got pregnant...
Dr. Murphy, that's enough.

I... I just want...
I think you
should leave.

I'm sorry.

That was completely

Our treatment plan
for your tumor

depends on your plan
for your pregnancy.


We've talked
about kids,

but I always
figured that was
way down the road.

And not this way.

I always assumed
we'd adopt.

I'd have go off T,
and stay off.

If Rio doesn't continue
the pregnancy,

then what happens?

Your hormone levels
would drop quickly,

which would cause
the tumor to shrink.

After that,
we'd use medication,
possibly a minor surgery.

I'd like to terminate
the pregnancy.

ENRIQUE: I looked over
all of Zara's labs.

All signs point to her
taking her hypertension
medicine regularly.

Her MRIs show
significant ventricular
septal thickness,

bad turbulence
jet flow.

There's myocardial
edema, too.

The ACE inhibitors
were a bad call.

Which eventually
sent our patient
into cardiogenic shock.


Why'd you ignore
what she was telling us?

I made
a medical diagnosis

based on
pattern processing

that we're taught
in med school,

which involves considering,
you know, race, education,

occupation, BMI.

Always sounded like
profiling to me.


Yes, we have the rain,

but more impressively,
the wind.

That rain's going to be
coming in sideways.

Just take a look at
how the wind increases

as we progress
throughout the day.

So, this afternoon,
we're talking about

gusts possible.

Sorry for crashing.

doesn't have a TV.


You like
The Weather Channel?

I find it soothing.

Would you like
to join me?

And we have more intense
rainfall coming through,

and that's going to
also lead to some
flood potential.

All of us are going
to get into the action.

You got the mountains.

Would you mind
if I lowered the volume
by four output levels?


That would be perfect.

All the areas around here
in Northern California,


The northern part
of San Francisco...


I find the reflection
on the screen
so distracting.

So do I.

Could I

do this?

Nurse paged me.

Is something wrong?

I've changed my mind.

I want to keep the baby.

Since you're continuing
the pregnancy,

we'll need to surgically
remove the prolactinoma.

So, you'll cut
into his brain?

Our safest option
is to go in through
the nasal cavity

in what's known as
a transsphenoidal surgery,
TSS for short.

It's less invasive
than our other option.

That still
sounds dangerous.

I've made up my mind.

Do I get any say in this?

I'm all for us
having a family,
but I'm not ready to...

No one's ever ready
for kids.

Yesterday, you said that
you never considered
getting pregnant,

and now you're willing
to risk your life for it.

When I was about seven,

I had this one refuge.

I'd hang a quilt
over a couple chairs

and hide out
with my two buds,

Foxie the Fox
and Fuzz the Lion,

and I'd imagine,

I was the dad.

And they were
my twin little guys,

fraternal, obviously.

We were a family.

When I transitioned,
I put that dream aside.

At least, as far as
them coming from me.

But now...

Whether we planned it
or not,

this is our baby.

How soon can you
do the surgery?

I'll order
an image-guidance MRI
to get things started.

CLAIRE: Based on
the cardiac MRI
and catheterization,

there are two
treatment options.

Myectomy, basically
open heart surgery,

and alcohol
septal ablation,

where we use the alcohol
to kill targeted sections
of the heart muscle.

Well, what would
you recommend?

The surgery
is more invasive,
tougher recovery,

but better efficacy

The ablation
is less dangerous,

but you're more likely to need
further medical interventions.

Now, you call that
a recommendation?

There are pros
and cons to both.

Uh, you'll need
to weigh them.

I'll give you
some time.

You always want to
take care of people,
Dr. Browne?

Pretty much.

Me, too.

Oh. Well, you run
a marijuana dispensary.

It's not all about
getting people high.

No, maybe not,
but I'm guessing
most of your clientele...

My Great-Aunt Lucy
had pancreatic cancer.

A year, she hung on.

In agony.

Marijuana was the only thing
that helped her eat or sleep.

Doctors didn't
give her anything
for the pain?

They suggested

Now, you know doctors
are 22% less likely

to give pain meds
to Black patients

than to white patients
with the same symptoms.

My point is,
you and I,
we're a lot alike.

We're both strong, Black women
finding our way in the world,

but one of us knows more
about medicine than the other.

So, I'd like to know,
what would you do
in my situation?

The open myectomy
is a bigger risk

but offers more
long-term benefits.

I've made my decision.

I'm with you,
Dr. Browne.

Book the myectomy.

Here's the Rio Gutierrez
imaging for your
upcoming TSS.

Set that
on the table,

I, um...

I noted the tumor's
suprasellar expansion

and surrounding edema
and splaying
of circle of Willis.

That is very helpful.

Bye, Dr. Murphy.

You're safe, Shaun.
She's gone.

Not really.

Dr. D'Souza
is still in my brain.

I don't like it.

We kissed.


I have so many
thoughts about her,

and I have
so many questions
I want to ask Rio.

Wouldn't he get
more pleasure for...

Questions you're not
supposed to ask him.

The kiss, Shaun.
When did you kiss?

Last night.
In my dream.

If I can't ask questions,
how do I understand?

My... My brain...

My... My brain isn't behaving
the way I want it to.

How do I make it stop?

You're attracted
to Dr. D'Souza.

Why does that
bother you?

When I was with Carly
and had feelings for Lea,

it meant
I was supposed
to be with Lea.

What if this means
I'm supposed to be
with Dr. D'Souza?

You've loved Lea
for years.

This is just...

But shouldn't loving Lea
make it go away?

Relationships would be
a lot easier
if it worked that way.

You're feeling guilty.

I say take Lea out
for a nice dinner,
something special.

And tell her
about my crush.

I need to
let Lea know.

No, definitely not.
No, you do not.

I want to get your thoughts
on the suprasellar extension
of the tumor

for this TSS.
You remember
Sarah Pepper?

Runs nephrology
at S.F. Regional?

Always wears
a shawl?

So, during the staff
meeting last week,
she fell apart.

Screaming, crying in front
of the whole department.
Totally nuts.

Rough day
at the office.

Wonder how you'd approach
and resect without getting
a CSF leak.


Place a lumbar drain,
then infuse saline
and do Valsalva maneuver.


Pepper's meltdown
was so over the top,

the hospital forced her
to take a leave.

How long?

She's always been
a little crazy.

Last I checked,
eccentric and emotional
didn't qualify as crazy.

Thanks for taking a look.

I read that
cisgender people

often reduce
transgender people
to their genitalia,

and that
that is offensive.

Did I do that
to you and Rio?


I'm sorry.

Rio will be going
into surgery soon.

He's been asking for you.

You haven't been
answering your phone.

Thanks for
letting me know.

He is very confusing
to me, too.

Rio has worked
so hard,

he had a bilateral
subcutaneous mastectomy

and takes hormone
replacement therapy,

but now he is choosing
the most female act.

It's not female
if Rio's doing it.

Y... Yes.

And he must have dealt
with a lot of prejudice

during his transition.

I dealt with prejudice.

My brother helped me.
Does he have a brother?

His family
doesn't talk to him.

And now Rio is
having brain surgery.

He is very brave.

You can stay here.

I have a patient,
Zara Norton.

We, uh...
We diagnosed her
with HOCM.

I saw the file.

Dr. Guerin expressed
some concerns

about my initial handling
of the case in the ER.

He thinks
I stereotyped her,
based on her race.

Do you think you did?

She was crashing.

I had to make a call.
I didn't have a lot
to go on.

Glassman came
to see me
this morning.

Someone told him
I'm unstable
and need help.

Any idea where
he heard that?

I asked for help.
You can, too.

You're a resident.
No one cares
if you need help.

I got this job in part

because my main competition,
a man, backed me.

The second anyone thinks
I can't handle this...

No one is gonna
think that...

They will if you keep
telling them I'm a mess.

You have PTSD.

You shouldn't be ashamed.

Says the women
who just profiled
a Black female patient.

You judged her,

just like people
will judge me

and whisper that I've always
been a little intense,

so no wonder I was asked
to step down.


Nobody needs to know.



You tell me that
it doesn't matter.

You tell me everyone
will understand,

and then you tell me
to keep it to myself.

Should I be ashamed,
or shouldn't I be?

All right, Ms. Norton,
time to head to pre-op.

ZARA: What's in the bag,

I like to know
what goes into my body.

Uh, cefazolin.
It's a prophylactic antibiotic
we give before surgeries.

Makes sense.

Hey, what was the med
y'all gave me when I first
got here to the ER?

It's an ACE inhibitor.

Isn't that
for hypertension?


But I thought
I already told y'all

I was on meds
for my blood pressure.

You did.

So, you figured
I needed more?

Or did you
not believe me?

I'm sorry.

You must be scared.

You shouldn't have to
be scared alone.


I love you.

I love you, too.


I can't see you.

I'm right here, babe.

Can you follow this
with your eyes?

It keeps disappearing.

You've lost
peripheral vision.

The tumor is impinging
on the optic fibers.

We can't perform
the TSS surgery.

With the tumor's
continued growth,

the best remaining option is
the open pterional craniotomy.

But it is higher risk
with a lengthier recovery.

All of which is
on top of the potential
for gender dysphoria

during pregnancy.

Is that
still a concern?

I think back to before
I started taking T,

how terrible
that felt.

The thought
of feeling that
all over again...

We could go back
to the original plan.

You mean terminate
the pregnancy?

The tumor should
shrink on its own.

After everything you've done
to get where you are
in your life,

it's scary to think about
doing something that would
put that at risk.


This is my next step.

I'm ready to take it,
even if I'm scared.

You have to take risks
sometimes, Dr. Lim.

Thank you.

Shouldn't you
be prepping Zara
for surgery?

It's canceled.

She wants to
be transferred to
a different hospital.

One where she won't be
"racially profiled
into heart failure."


Shaun, you okay?

I am having thoughts
I don't want to have.

Both Park and Jordan
say I shouldn't tell you.

But you're going to,
aren't you?

Yes, I am.

I have a work crush.

Also, my patient is
a pregnant trans man...

Okay, one at a time, Shaun.

About this... crush?

Her name is
Dr. Cintia D'Souza.

She is a second-year
radiology resident.

Last night,
I dreamed we were in
the Residents' Lounge,

watching The Weather Channel,
and then we started kissing...

Okay, I got it.

Are you mad?

Park and Jordan were right.
I shouldn't have told you.

No. I'm not mad.

A little surprised,
but that's okay.

I'm still attracted

to other guys

N... No.

No. What? Who?

It doesn't matter.

There... Okay, there is
this one physical therapist...

N... No.



What if we're attracted
to other people

because there is
something wrong
with our relationship?

You're not planning on
kissing Dr. D'Souza
in real life?


Or working late with her,

doing some
X-rays alone,

where you might
end up leaning over
the same light box.

We don't use
light boxes anymore.

And I don't plan to
work late with her.

Then I don't think
either of us has anything
to be worried about.


I have to go prep for
a pterional craniotomy.

I'm Dr. Glassman,
president of the hospital.

Unless you're here
to drive me
to S.F. Regional,

you can head
right back on out.

I apologize
for your experience
in the emergency room.

That's mighty white
of you.


I don't recommend that you
transfer to S.F. Regional,

or any other hospital,
for that matter.

I'm sure they got
the same fancy equipment,

same shiny sets
of diplomas
y'all got here,

and maybe a few less
racist doctors.

Well, apparently,
that doesn't seem
to be the case.

I pulled data on
comparable hospitals
within 100 miles,

did numbers on
surgical outcomes

and patient satisfaction,
aggregated by race.

we're doing well,

Your argument is that
your hospital may be
racially biased,

but it's less racially biased
than these other hospitals?

Yeah. Pretty much.

Stay at St. Bonaventure,

the president of the hospital
will monitor your care
every step of the way.

For whatever it's worth,

I don't think
you can do
better than that.

She's gonna stay,
on one condition.

That you're
off the team.

Dr. Park, please open
Sylvian fissure.

Arachnoid knife
and Rhoton dissector.


Tumor is visible.

What makes someone
a man?

I thought it was
just the chromosomes,

but that must
not be it,

which makes things
and difficult,

and I know Rio
was uncomfortable
when he...

Life is uncomfortable.

It hits you with
tough situations and
you muscle through them.

I see a tiny bleed
in the circular sinus.

Pack it with Floseal.

DR. LIM: Someone give me
an update.

DR. PARK: We got a drop
in end tidal CO2
and oxygen sat.

See any evidence
of exposed air cells?

No. But waxing
bone edges
just to be safe.

But the tumor thinned
the sellar floor
and sphenoid wall.

DR. LIM: Making it
permeable to oxygen.

It's an air embolism.

JORDAN: BP's dropping.

Dr. Lim,
what should we do?





Saline gauze,

tilt the table to
eliminate the negative
air pressure gradient,

and place
a central line.

This will stop
the air leak

and allow us to access
the air bubble.

Inserting Bunegin
air-aspirating cath.

You are 2 centimeters
from the superior
vena cava.

Aspirate the right atrium
until you don't see
any more air bubbles.


Nice save, Dr. Lim.

Let's get this tumor out.

DR. ANDREWS: Make your
transverse aortotomy with
Potts scissors, Dr. Wolke.

ASHER: Extending
the muscular incision
down to the mid-ventricle.

There's the
myectomy site.

There's the aberrant
muscle bundle.

Get her off bypass,

see how she does.


How's the cardiac output?

ENRIQUE: Reduced
and insufficient.

Low output could mean
we need to further reduce
the septum.

Unless it means that
we reduced it too much.

Damaged the cardiac
electrical conductors

that control
the heart rate.

She's having
heart block.

Enrique's right.

We took
too much muscle.

Put her back
on bypass.

We could
augment the wall
with a bovine patch.

Still wouldn't insulate
the electrical system.

She'd still be at risk
of complete heart block
and cardiac arrest.

CLAIRE: We could insert
a dual chamber pacer.

She won't need
the conduction system
in the wall of her heart

to control her heart rate.

Let's go!

How was
the craniotomy?

It went well.

The patient
is in recovery.

Your text said
you have good news.

And by good news, I mean
bad news for Dr. D'Souza.

Plenty of great stuff
to crush a crush.

First observation,

she smells
like cinnamon.


Which is more puzzling
than irritating.

Actually kind of nice.
Which is obviously
not helpful.

Oh, okay.
She does this weird
self-grooming gesture

where she tucks
her hair
behind her ear.

And then sorta
massages her ear.

Also n... not helpful.

Okay. I'm sorry.
I'm sorry.


At the salad bar,

she used the cucumber tongs
to reach for the cucumbers,

and then the tomatoes.

And the olives.


And the pickles.





I can see all of you.

How'd we do?

Great. We got
all of the mass,
vision is restored.

You have every reason
to expect a full recovery

and a healthy pregnancy.

We're gonna be dads.


Are you ready?

I've never been
a pregnant man before.

You'll always be
the best man that
I've ever known.


Came to see
how you were doing.

Dr. Andrews told me
you was the one who
figured out how to save me.

Still don't change
what went down
earlier, though.

When I got to med school,

people took one look at me
and they thought they knew
exactly who I was.

Black girl
on financial aid.

She must not be
that smart.

She must have gotten
a lot of breaks.

She'll probably need
a lot more.

And I worked...

I worked so hard

to prove them wrong,

that I wasn't
who they thought I was,

that I deserved
to be there, that I...

(SIGHS) that I fit in.

When you came
into the ER,

loud and messy,

I saw... (SIGHS)

I saw everything
I have tried hard
not to be.

And I think
it made me angry.

And I'm ashamed of that.

And I'm really sorry.

I used to be that way.

But I got tired of
working that hard to make
white people comfortable.

You two heading out
for the night?


We sure are.

How did
the craniotomy go,

Did you guys get
all the prolactinoma?


Is that
cafeteria salad?

Are there pickles
in there?

Did you want some?

You know,
I'm good.
Thank you.

Shaun, did you...

No, thank you.

It does help to focus
on her irresponsible
salad bar practices

and dietary

I've got
a ton of strategies
to manage discomfort.

So do I.

DR. LIM: Hey.

To replenish
your supply,

and a peace offering.

I wasn't aware
we were at war.

Well, seemed like
my gossip about Pepper
kind of landed wrong.

Bad day.

Sorry to
crash the party.

Dr. Glassman wanted me
to show this to you two.

I asked Lea
to run some numbers on
various metrics by race,

and the results
are not great,

especially when it comes
to pain management.

We are under-treating
and Latinx patients

by a considerable margin.

I think I need a little
of that peace offering.

Help yourself.

Anyone else?
No. Thank you.

Uh... me, neither.


Started taking



Sorry to hear that.

You doing okay?

Not really.

But I'm

working on it.


Dr. Browne,
good work.

Thank you.


I apologized
to Zara.

She pointed out
I spent med school

trying to make
white people

I mean, she's right.

It wasn't
just med school.

isn't it?

But we had to
do it, right?

To be here?