The Good Doctor (2017–…): Season 5, Episode 4 - Rationality - full transcript

Dr. Shaun Murphy and the team treat a young girl whose father's personal research complicates their treatment plans. Meanwhile, Dr. Park, Dr. Reznick and Dr. Lim's patient refuses a life-saving lung transplant despite having a family donor.


It's a nice photo.


I did not approve
that billboard.

Section 25 of your
employment contract allows

use of your image
for publicity
and marketing purposes.

I do not want to be the star
of your ad campaign.

Are you ashamed
of your ASD?


It's amazing
what you've accomplished.

Think of all the neurodiverse
people you'll inspire.

The billboard
will inspire no one.

It is not fair
to use my picture,

and it inverts my image.

My hair part is
on the wrong side.

You're emotional.
I'm right.

Pick a random number
between one and ten.

Did you pick seven?

I do not understand
what you think that proves.

We're not nearly as rational
as we think...

Not in the way
we see the world,

not in the way we think
about the world.

I am constantly revisiting
earlier decisions.

Then you should revisit
your decision

to put up the billboard.

I will.

But you need to do
the same.

Let's take 48 hours,
explore all sides
of the issue.

Use reason, not emotion.

Then we'll talk.

important, Shaun.

Only 4% of doctors
are Black.

I get my face out there
whenever I can.

This isn't

It's tokenism.

She's not hiring more
diverse doctors.

She's just
exploiting the ones
who already work here.

"Did you know there are
26 cognitive biases

"and perceptual errors
that affect the business

It says doctors are especially
susceptible to number 5...
Anchoring Bias.

Initial impressions
of a patient's condition

can make us ignore
contrary evidence.

Dr. Murphy, there's
a new patient's dad
asking to see you.

And it's more like

Oh, no.

If you asked for me because
I was on a billboard,

that is not a good metric
for picking a...

No, my metric is that
you co-authored 23 papers,

eight on pediatric surgeries,
four on GI issues.

This is my girl,

Four years
of puking, nausea,

blood when she goes
to the bathroom.

Now, I'm sure
it's visceral myopathy.

You've seen 19 doctors.

Have any diagnosed
visceral myopathy?

They said inflammatory bowel,
but it's not.

She keeps getting
sicker and sicker.

Hmm, your abdomen
is distended.

Have you been vomiting?

Worse than ever.

This doesn't seem to be
a surgical case.

I'll admit you
to internal medicine...

I've done a lot of reading.
It's visceral...

Visceral myopathy doesn't fit
her symptoms well,

and looking up diseases
on the Internet
is very unreliable.

Bowel is hypoactive.

She has a serious

This has now become
a surgical case.



You've had this cough
for a month now?

kept getting worse.

Last week, I had a little
shortness of breath.

Figured it was worth
flying back.

From India.
What brought you there?

Meaning of life.

I'm actually not kidding.

I was a bookkeeper
for the city,
and I just...

Needed something more.

I traveled the world
until I found it.

Mmm, more like spirituality,

but through service
and charity.

I live a very
simple life.

Small village.

Just try and do
as much good as I can.

Deep breaths.

You know, I don't feel
too bad today.

Ugh, I hope I didn't

You didn't.

You're hardly moving any air
in your left lung.

Depending on
when you last
had your carburetor rebuilt,

you will need to determine
which parts need replacing.

you're going to be replacing

all of the seals
and all of the needles.

You haven't been
answering your phone.


...the damper and the float.

Once you're happy
with your choice...

Odd, seeing how
it's a foot away from you.

If you're not, please look
at my other...

Let's talk about
the press interviews

I scheduled for you.

That you scheduled
for me.

You see the problem there?

In my experience,
support from the old regime

is essential for
a smooth transition.

We agreed I'd have yours.

What we agreed on was that
I'd smile and nod.

What do you think
an interview is?

Just a few nice thoughts about
Ethicure, and you're all done.

I don't have
a few nice thoughts,

but I can give you
the thoughts I do have.

I've scripted them for you.

Thank you, but I'm gonna
focus on things

that actually need
my attention.

But thanks for stopping by.

Both sides of the
obstruction are clamped.

Dr. Rendon, please resect
segmented bowel.

GIA stapler.

I'm going to give you $10
to share with Dr. Rendon.

Divide however you like.

If he approves the split,
I'll pay you both
after surgery.

Oh, okay.
And if he doesn't?

Then you both get nothing.


I'm gonna keep eight
and give Mateo two.


Two dollars is better
than nothing,

which is what
you've ended up with.

There's nothing irrational
about trying to increase

the amount of fairness
in the world.

Number 12 on Salen's list.
"Unfairness Aversion Bias."

It isn't a "bias."
Why reward greed?

Colon wall's
a little weak.

I'll send samples
to path.

But obstruction's
been cleared.

You have idiopathic
pulmonary fibrosis.

Uh, your left lung
is heavily scarred.

The right is functioning,

but it's damaged, too.

Can you fix this?

We can start you on medicine
to help you breathe,

and we can list you
for a lung transplant.

Um, how long do I have
without the... The transplant?

A month or two.

Okay, um...

Oh, I should tell
my son.

You didn't put him
on your paperwork.

I haven't seen him
since I left.

He was...

12 years old.


Number 6,
"Pro-Innovation Bias."

Salen may believe
the billboard is good
just because it's new.

Hard to know what
she believes, but fine.

Number 8.
"Loss Aversion."

People demand much more
to give up an object

than they are willing to pay
to acquire it.

She might be overestimating
the negative impact

of losing the billboard.

How many of your points

end up supporting
Salen's point of view?

Mmm... None.

You might have misunderstood
the assignment.

I don't think it's about
proving her wrong.

She wants
to see you re-examine
your own assumptions.

Holly's pathology

Visceral myopathy.

Her father was right.

Your oxygen saturation
is decreasing faster
than we expected.

I'm gonna increase


So tall.


12-year-olds tend
to grow.

I heard you got married.
I saw photos online...

Why am I...
Sorry, why am I here?


There's something wrong
with my lungs.

Are you dying?


You waited
until you were dying
to call me?

And, what?
Forgive you?

Do you even feel bad
about what you did?

For hurting you?

Yes, of course.

I wanted to keep in touch
with you.

You said it was too painful.

Are you blaming me now?

The transplant coordinator
says there's
a potential match.

Why are you here?

Walt spent four years
researching Holly's illness,

outsmarted every doctor.

No high school degree,
but slept five hours a night

while taking every pre-med
course at a junior college.

My dad's the best doctor
I've seen.

What made you think it was
visceral myopathy, Walt?

Well, I figured it out
last week.

Holly started having
trouble peeing, and...

That's just one data point.
It's not enough.

And her mom died a couple
of days after childbirth.

Complications from
her bowel perforating.

And visceral myopathy is
genetically based.

Treat Walt like
a consulting physician.

Involve this man in all
medical discussions.

Let him watch surgeries.

Hell, give him
a fitness tracker.

Excuse us.


Oh, he is not
a doctor.

20 doctors dismissed me
and my very valid questions

before I was diagnosed
with scleroderma.

Good ideas are good ideas,
no matter the source.

We should involve him after
we talk among ourselves

like we do with all
patients' families.

I don't see any advantage

other than further enshrining
doctors' elitism.

I don't want
to have to
pull my punches

when discussing
that girl's
possible outcomes.

He's been through hell
with her.

We can be honest
with him.

And via our Twitter feed,
we can share
an inspiring story

of how a father's expertise
supplemented our doctors'...

He's not an expert!

Just because
we haven't found
his blind spots

doesn't mean we won't.

That's Number 19...
"Extrapolation Bias.."

But it also doesn't mean
you will.

Number 20.

I do not like this at all.

It's a direct order from our
boss, so I plan to love it.

San Francisco General says
organ procurement's at 1:00.

Lung should be here
by 4:00.

Great. Couple months,
Gina'll be back on her feet

and being a terrible
mother again.


Are you defending
this woman?
I feel for her.

I feel
for her son, too.

Because you're
all about empathy.

She has done a lot of good
in her life.

Maybe she shouldn't
be condemned
to the walk of atonement

for one mistake?

One mistake
for 17 years.

So, moms should give up their
whole lives for their kids?

Actually, yes.
Dads, too.

Is that what you were doing
when you ditched Kellan

to do your residency here?

I made
plenty of mistakes

that I still feel
guilty about.

But unlike this woman,
I tried hard,

really hard,
and stayed in my son's life.


Thank you.

You're the first doctors
who've shown me any kind of...

We need to do
a right hemicolectomy

with an ileotransverse

You want to throw away
half her large intestine?

I agree
it's a bit drastic.

Segmental resection.

We go in using the interop
biopsies as a map,

we'd resect the most
damaged areas.

No, we just need
to get her intestinal motility
going again.

But if she experiences
more obstruction...

I don't want to rip out
a large chunk of
my girl's bowels, okay?

Now, let's just keep thinking
about other ideas.

Is there a reason you're
snapping your fingers?

It helps me think.

It does not help me think
at all,

and my thoughts
are useful.

We could put her on

I've only heard it used
for cancers

and autoimmune

But it's been shown
to increase motility
in kids by 30%.

It's an interesting idea.

It's a bad idea.

She could have a severe
infusion reaction,

cause more damage,

leading to a much more
drastic surgery later.

Or it will alleviate
her symptoms

without her having to
compromise her entire life.

We'll go with the Rituximab.

It's a reasonable option.

My idea was better.

So was yours.

But the patient's father
is not going to approve

either of our ideas.


They found a cancerous
lesion in the donor's lung

during retrieval.

Wake her up.


Your mother's developing
severe pulmonary hypertension.

In a few days,
she'll no longer be
a transplant candidate.

And there's no chance
you'll get
a new donor before then?

Not realistically, no.

You could be the donor.

We could remove your mom's
bad lung and replace it
with a lobe from your lungs.

A living donor lung transplant
hasn't been done in the US
for a decade.

It's done routinely in Japan,
and it's the only way
to save her life.

And there's a high risk
of surgical complications.

You'll have a lifetime
of labored breathing,

decreased endurance...

Only if things
go wrong.

You'd be in great hands
with Dr. Park.

I just... I need
to think it over.


We put this in to help
give you the medication.

It's called a...
A PICC line.
I've had a few.

Must be tough
being in hospitals
all the time.

Being sick is tough,
but I love skipping school.

I was the girl who always had
to run off to the bathroom,

who threw up on her desk.

You can imagine
what the other kids said.

Mmm, what did we say
about those kids, baby?

Screw 'em.

That's right.

So, this medicine's
my dad's idea, right?


But it's not a good one.

I know it's scary,

but we'll get through this
just like we always do.

You trust your dad.

It'll work out.

But if it doesn't,

it could kill you.


Key is to get the jets
super clean.

You did clean them, right?

You saw the photo
I sent you?

I actually saw
the real thing.

Shaun's furious?

Yeah, he ran
right to Salen.

that didn't go so well.

you wouldn't be here

offering to help
with my carburetor.

Yeah, they're
thinking it over.

I think
she's setting him up.

What does he think?

He thinks he can
talk her into it.

perhaps he can.

Either way,
he can't keep asking
his boss to bend to him.

What's she gonna do,
fire him?

She put him on a poster.

Will you...
Will you just talk to him?

Feel him out.

See if I'm wrong.

He'll be just fine.

But why are you
still in town?

Obviously not.

Seeing friends?
Obviously not.


Mmm, you'd be in Tuscany,
not your garage.

You're here for Shaun.

So, why are you not
helping him?

Maxed out on oxygen.

We're gonna
put you on BiPAP.

I'll do the living donor

I'm going to give you
a lobe of my lung.


Thank you, but no.

I'm not going to allow it.

I would never let you hurt
yourself to help me.

Not after I...

I would rather die.

So, now?

Now you care about me?

About my feelings?

I always did.

Then why did you
leave me?

I hated myself.

First week I brought you home,
I couldn't get you to latch.

I couldn't sleep.
I was completely overwhelmed.

But that feeling...

That panic...

It never went away.

And all the energy
I should have
used loving you...

I used trying
to not to fall apart.

So, I finally just chose...

My own happiness.

But you were strong,

and your father
was a good man,

and I knew
that he would love you
in a way that I never...

Never could.

I knew you would be okay.

You have no right to tell me
that I'm okay.

Every day, I would
walk home from school

praying that
you'd be there.

And every day,
a piece of me was destroyed
when you weren't.

I was a little boy
who loved his mother...

Who thought his mother
didn't love him back.

And now you tell me
I was right?

Oh, I can't...

Florid respiratory failure.


She's puking up blood!

Distended, firm,
rebound tenderness.

Her bowel's perforated.
We gotta get her
back to the OR.

I was wrong.


Your mom is
on a ventilator,

and Dr. Park is
placing her on ECMO.

It will oxygenate
her blood

now that her lungs
are no longer working.

Your mom is unconscious,
and she has no living will.

By California law,
you have power of attorney

over all her
medical decisions.

He's got a clear
conflict of interest.

He wants the transplant...
They want
the same thing.

She said, and I quote,
"I'm not gonna allow it."

She'd rather die.
You finding ambiguity
in any of that?

Her priority was her son's
happiness, not her own.

Do the transplant.

So, you're just
gonna decide she was wrong

about what she wanted
for herself? For her son?

I'm not.

Her proxy is.
Her son is.

And you'd better hope
this works.

Uh, we need to do
Dr. Murphy's plan
from before.

The right hemicolectomy?

We missed our chance.

Now we have to do
a full colectomy

and a resection of most
of the small bowel.

It's the only way to prevent
another perforation

that would kill her.

But I read a case report
where they're
using prokinetics

And acetylcholinesterase

to strengthen
motility in kids.

That could help,
but it wouldn't be enough

to overcome the pressure
from future obstructions.

We just reduce
the pressure!

I mean, we can put, uh,
tubes above and below.
I'm not following.

Because it makes
no sense.
Shaun, let him talk.

above and below

wouldn't reduce the burden
of a focal obstruction!

Don't tell me
what I'm getting wrong!

Help me find a way
to do this!

Look, this is the affected
part of the bowel.

Stop it. Stop it.

Please, stop it!
Stop it!

Stop it! Stop it!

I am trying to help
your daughter!

Dr. Murphy,
you need to leave.

No, I do not need to leave.
He does!

He made us give her Rituximab,
and it made her sicker!

Why are you even here?
You are not a doctor!


Get out of here now,




Dr. Murphy
was inappropriate,
but he was right.


Let me be the one
to tell her.


We could hand-suture
with a running 4-0 prolene.

No, we need
interrupted sutures
for the cartilaginous portion.

End-to-end anastomosis.

Bronchial sizes
don't match up.

Telescoping technique.

Why not?

I don't know.
I just...

Don't like it.

What are you doing?

I'm obviously feeling
some pressure

to make sure the transplant
comes off safely, and...

Yes, that's the only
thing you've been
doing that makes sense.

Everything else on this case,
you've been unfair, emotional.

I'm sorry.

This has nothing
to do with you.

I... I don't...
Just shut up.

I've... I've been
emotional because...

I'm hormonal,
and I'm hormonal

because I...

I've been sneaking off

and injecting my butt

with insane amounts of HCG
and Gonal-F,

which is making me feel
like a total lunatic.

You've been
freezing your eggs.

Why didn't you tell me?

Like an icebreaker?

"I know we just got together.

"Guess what, I'm two months
into egg retrieval"?

I'm not even, uh...

I'm not even sure
I want kids, or...

Whether I'd even be
a decent mom.

I'm certainly not
the most unselfish person.

And, uh,
who's to say

I'd make better choices
than Gina?

Who knows if anyone
would ever defend me?



I should go.


How you doing?

Very badly.

I have been put on a billboard
and kicked off a case.

Yeah, well, I spoke
with Dr. Andrews,

and there's not gonna be
a note in your file

or anything like that.

What about
this other stuff?

Yes, Salen gave me
48 hours.

I'm going to talk to her
tomorrow morning.

What are you gonna say?

I have 30 bullet points.

Maybe we should
talk these through?

Maybe narrow them down
a little?


I know I was right about
that girl's treatment.

But nothing I said
convinced her father.

I just made him mad.
She just got sicker.


I know I'm right that
this billboard is a mistake.

But I think I won't be able
to convince Salen, either.


I keep knowing I'm right,

but I can't change
anyone's mind.


Excuse me, fellas.

Sorry, guys. Can we have
the room for just one minute?

Thank you.

There is no justification,

for exposing an employee's
personal medical records.

Take the billboard down.

It's noisy.
Makes people talk.

Yeah, about
how awful it is.

It's also possibly

Why are you
coddling Shaun?

Nobody made accommodations
for my ADHD.

That was hard,

but it made me stronger,
smarter, more resourceful.

We have different problems
and different strengths,

but I know if you keep
patronizing him,

it'll backfire.


That is very impressive.

Apparently, your attention
issues give you the power

to see into the souls
of people you've barely met.

I've known Shaun
for 15 years.

You're like a dad to him,

but sometimes, parents make
the wrong choices

when it comes to their kids,
despite loving them.

Or maybe because
they love them.

I'll tell you what...
I'll do the interviews.

And when Shaun
comes to see you,

you'll make him believe
that he convinced you,

and you'll do
what he wants you to do.



Your, um...

Your bowel got sicker
real fast.

And that's why you had
the perforation.

So now we gotta remove
your large intestine

and most of
your small one.

So, I'll have to have
that bag attached to me?


Like, my whole life?

There's improvements
every year
in ostomy care.

But I can still eat,
like, normally, right?

I won't need that
IV nutrition thing?

Baby, that...
that's not clear yet.

No, my dad's wrong.
Tell him he's wrong.

I'm so sorry, Holly.

You promised me.

You said you'd fix this.
I know.

You said to trust you.

I know I did.

But I failed.

I'm so sorry.




I thought
you'd be different.

That's why
I asked for you.

You did not ask
for me.

Your father did,
and that was because...

He had like six doctors
that he liked,

but I saw the billboard
and said it had to be you.

Because you were

like me,
and you'd think different.

And we needed that.





We've cleared
the omentum covering.

Let's proceed to prep
for the excision.


I was wrong
about the billboard.


That's good, right?

No, it's not.

When I saw it,
I thought it was dumb

and my ASD
would inspire no one,
but it did.

It inspired the very first
patient I saw,

and if I wasn't being
rational about that,

maybe I wasn't rational
about this case.

Maybe my emotions
got in the way.

I shot him down.
I wasn't open.

I'm sure you were fair.
No, I wasn't.

The whole time.

Okay, Shaun...

I yelled at him.

I... I yelled at him

when he was talking about
the pressure in her colon.

It made no sense.
He did not know how it worked.

Well, if it made
no sense, then...
It must have made sense.


He's very smart.

He must have been
thinking of something.
Something that...






I'm going
to begin the excision
of the large intestine.

What the hell?

Have you ligated
any critical vessels?

We were just about to.
That is good.

You need to insert
a PC tube to the colon.

A feeding tube?
She can't absorb nutrients.

Not to feed her.
As an outflow mechanism.

Pressure valve
for emergencies,.

It'll keep her
GI tract viable.

What about
the muscle weakness?

It's what Walt said.

We use the prokinetics
and acetylcholinesterase

to increase contractility
and movement.


Walt, I'd like
to revise the surgical plan

and invite Dr. Murphy
to scrub in.

Yes, to both.


No bleeding, no bruising,
no signs of infection.

Oh, thank you
so much. Both of you.

We wouldn't have gotten here
without you.

Dr. Murphy, don't you think my
dad would make a great doctor?

Mm, I'm not sure.

He had some very good ideas,
but also some bad ones.

He is a very good father,

One of the best
I have met.



Hey, careful.
The sutures.

Oh, what happened?

Hi, Mom.

I didn't want you
to die.

I have to make this up
to you.

You don't.

I'll move to California.
I'll do whatever...

You'll never be happy.

I don't deserve
to be happy.

You shouldn't love me.

When you left us...

...I really acted out.

I would fight with Dad
all the time.

But he would remind me

He was gonna love me

no matter who I was
or what I did.

Because he was my dad.

I'm gonna love you
like that.

Because you're my mom.




My baby boy.

Yes, uh, well, um...
uh, indeed.

I am, uh, using
my custom fitness tracker

because healthy doctors
make healthy...clients.

Paint? Really?

Are we gonna be talking
about paint?

Can you ask me an--
a-another question?

Yeah... Yeah, well, d-- uh,
different kind of d-doctor,

different kind of hospital.

Very inspiring.



That one?
When did you see "that one"?


Um, you know what?

We're gonna have to do this,
uh, another time.

Thank you.



We had a deal, didn't we?
Didn't we have a deal?

What was supposed
to happen was,

you were supposed to
take down the billboard.

Did you forget?
Calm down.

I'm not gonna calm down!

You don't treat Shaun
like this.

Shaun's the one who asked me
to keep the billboard up.

I don't believe that.

"Dear Salen, I have changed
my mind about the billboard.

It can stay up."


"As long as
you fix the image

so my hair part is
on the correct side."

Haven't had a chance
to do that yet.


He handled this on his own
without you.

And he's better off
because of it.






The truth is,
I'm not young.

And I never would have
chosen to be a dad again.

But I also didn't choose
to fall in love with you.

So, now I'll do
what it takes to make
this relationship work,

whatever you decide
to do.

Prove it.

I-I-I plan to with, uh,
caring, with...

Prove it right now.



Buckle up.


And you wouldn't just be
a decent mom. You'd be
a great one, because...

Not now, please.



Maybe I was wrong.

Maybe I don't need them
to fix my hair.

Nah, it does look
a little off.







♪ Oh, there's something
in my mind that's killing me

♪ There's something that
this life's not giving me

♪ Would you say

♪ There's something in my mind
that's killing me

♪ There's something that
this life's not giving me

♪ Would you say

♪ Oh, we don't know if we
leave, will we make it home

♪ But we all know, if there's
hope, then we'll be okay ♪