The Good Doctor (2017–…): Season 6, Episode 10 - Quiet and Loud - full transcript

Lea and Shaun get an ultrasound, things show possible complications. Lea gets rushed into emergency surgery and Dr Glassman refuses to let Shaun in. That's all we know for now.

Previously on "The
Good Doctor"...

Glassman found movement
in my psoas and glutes.

He and Murphy found an
endoscopic solution.

- How about I make you dinner?
- Sounds good.

It's a date then.

A date.

Audrey... Will you marry me?

Shaun. I'm pregnant.

My OB told us it isn't
safe for me... or the baby.


No, no, no. Danny.


♪ Let the sun burn my eyes ♪

♪ Awake, my heart is
open wide to you ♪

- Good morning.
- Morning.

I'll get the coffee.

This is my third stay in a week.

I no longer require
guest-level service.

I want the practice.

Two cups, no cane,

no guarantee how
long it'll take.

Well, when it comes to you,
my patience is boundless.

One of the many things
I adore about you.

♪ Oh ♪

♪ Inside my mind, oh ♪

been three months.

The man's a saint.

I have been recovering
from a major surgery

and re-learning to walk.

Your recovery's remarkable.

So is your procrastination.

I am taking the time to consider

the biggest decision of my life.

Clay's fine.

No man... no person...

Is fine waiting this long for
an answer to that question.

Ever done one of
whatever this is before?

No. You?


I've been clean for 92 days.

I went to rehab for two months,

and I go to meetings
every single day.

I don't know if you two
can ever trust me again,

but I am willing to
do whatever it takes

to earn back my place here.

And we'll do everything we can
to support you in your recovery.

But our number-one obligation
is to our patients.

For their safety and yours,

we need to put some
guardrails in place.

You'll be on probation
for six months.

You cannot prescribe
or administer

any controlled substances.

You will be given
random drug tests,

and every step of
your patient care

will be supervised by the
Senior Resident on your case.

Today that is Dr. Allen.

You okay with those
terms, Dr. Perez?


I'm just happy to be here.

How are you?


A lot better.

I hadn't heard from you.

Which is totally understandable.

I just wasn't sure...

I didn't know what to say.

You're not the reason
that... That happened.

As your supervisor on the case,

I will oversee your charting,
your patient interactions,

double-check your med orders.

And this.

movement is good.

Heart rate is normal at 150.

I've been monitoring
the heart rate daily.

It ranges from 146 to 163 BPM.

Her last emesis was
three weeks ago.

So the nausea's getting better.

- Great.
- And the fatigue.

Less improvement on the
constant state of terror.

You made it through
the first trimester.

- You're doing great.
- Mm.

You two want to know
the sex of the baby?

- Yes.
- No. Don't look.

It'll be a fun surprise.


It is fun to be prepared.


What's going on?

There is
a small, thinning area

on your uterine wall.

It is slightly hypoechoic,

likely a result of the scar
tissue from your prior surgery

and Asherman's syndrome.

Is that bad? It sounds bad.


If it progresses, your
uterus could rupture

and we would lose the baby.

But it's very possible the
lining will remain stable

and your pregnancy
will progress normally.

What happens now?

We'll put you on bed rest
and monitor you closely.

You're wrong.

There may be a surgery
that can fix this.

I need to talk to
Dr. Lim and Dr. Glassman.

Hello. I have admitted
Lea for close monitoring

and a follow-up MRI,

which detected a small amount
of free fluid in the abdomen.

This, plus a slight
decline in the hematocrit,

increases the likelihood
of rupture by 3% to 5%.

Shaun, I'm so sorry.

How are you and Lea holding up?

Oh. Fine.

I found a surgery to fix it.

I have spent the
last three months

researching every complication
of Asherman's syndrome.

I discovered an
experimental procedure

to reinforce the uterine
lining with collagen fleece

that will expand as
the uterus grows.

I have studied the technique,

and I will teach
you how to do it.

How many times has this
procedure been done?

Five. Three had good outcomes

and the babies were
carried to full term,

and the odds are better for Lea

because you are
above-average surgeons.

Shaun, I
don't need to remind you,

but this procedure
can induce labor

and can cause major bleeding.

You could lose the baby.

If we wait and the
uterus ruptures,

we will definitely lose the baby

and Lea could suffer a
catastrophic hemorrhage.

Due to the size of
the uterine window,

there's a good chance it won't.

No, with Lea's prior surgery
and the significant scar tissue,

I put the likelihood of
rupture at close to 65%.

Those chances...

not good.

Lea's body, her call.

Drew Dewitt.

Has recurrent desmoid tumors
caused by Gardner's syndrome.

The one on his liver is benign,

but it hasn't
responded to chemo.

It's encroaching on the stomach
and spleen. It has to come out.

Thus, the surgical consult.

He has almost no
small intestine.

He needed a major
resection a year ago.

He's been living off IV
nutrition ever since.

I've treated him for
post-op infections

and pain management
over the last year.

I've never seen this much
scar tissue in a patient.

How many surgeries has he had?

20. Plus 16 rounds chemo
and 34 hospital stays.

Unfortunately, we have to add
one more surgery to that list.

Will this surgery affect his
place on the transplant list?

We've been waiting over
a year for a small bowel.

Apparently, I'm "too
healthy" to move to the top.

It shouldn't, barring long-term
infection or other organ damage.

When you're ready, we
can take you to pre-op.

- You got this, D.
- You know it.

I have no idea.

Would you
like us to go over

the risks and benefits again?

No, I know everything
that could go wrong.

All I can see is
what can go wrong.

You don't have to
decide right now.

We can continue to monitor.

If we wait, the uterine
window could expand

and make the surgery more risky.

Now is the safest time.

Don't pressure her, Shaun.

Okay. Okay, I
know I trust you.

So if you think surgery is the right
decision, then we should do it.

On one condition.

I want you in the OR.

Not for me, but if
something were to go wrong

and we lose our baby,

I need you to be with her.

Or him.

With my guidance, I think
there is a very good chance

our baby will be fine.


Forceps and Metz.

How's it feel to
be in the OR again?

Very good, sir.

We're all very glad
to have you back.

We've exposed the
surface of the liver.

Tumor's invaded the liver
capsule and parenchyma.

That's twice the size
it appeared on imaging.

If we take out all of the tumor,

he'll only have
half a liver left.

We don't have a choice.

Ultrasonic dissector for resection.

Make sure to
approximate the edges

so it overlaps with
the uterine window.

I internalized that the first
three times you told me, Shaun.

I'm sorry you and Lea
are going through this.

Mm. Dr. Lim was able

to place the fleece patch
seven seconds faster.

But your laparoscopic suturing
technique is superior.

You will be in charge of that.

Practice it now. Please.

Shaun, I've done
it a million times.

You have never done
them on my wife.

Fair point.

Because we had
to take more of your liver

than we'd hoped, your liver
function is declining.

Getting your nutrition through
an IV is tough on your body.

The TPN that's keeping me
alive's also killing me?

That's gnarly.

So, what's the
alternative to TPN?

How do we get him nutrients?

We're looking into it.

For now, we're gonna
manage your symptoms

and keep you stable until a
small bowel becomes available.

There's no way those organ cops
can say I'm too healthy now.

I'll order cholestyramine
for the itching

and liver function
testing every few hours.

I'll call UNOS and do
whatever I have to...

to get him moved up the list.

Where you sneaking off to?

I'm walking down the
hall, in plain sight.

The alarms, the pills,

the classic Morgan
evasion techniques.

You're getting your embryos
implanted, aren't you?

Congrats on cracking that
already wide-open case.

I have to give myself a
time-sensitive injection now,

then yell at some nice
transplant people.

Why didn't you tell
me? I could help.

I'll refer you to the minutes
of our previous meeting...

"We need boundaries."

I remember you put on my hospital
socks for me last time, too.

I hate that we have a routine.

This time is different.

- Hi.
- I love you.

How are you? Do
you need anything?

There's Funfetti cake in Pedes
for Nurse Hawks' birthday.

Do you want me to
get you a piece?

Just this is great.

Please leave.

Having visitors
increases the risk

of perioperative infection,

and stimulation can
raise blood pressure,

which increases the risk of
intraoperative complications.

I need to do your pre-op exam.

He just doubled over.

My gut is trying to kill me.

Please, can you
give him something?

I'll up his morphine. Check
the site for infection.

Hang on. You're gonna be okay.

Dr. Allen, his wound dehisced.

What does that mean?

His muscles couldn't
hold the stitches.

It tore open.

Move the patch three
millimeters to your right.

It should overlap
with the wound margin.

- Got it.
- Yes, there.

That is good.

Dr. Wolke,
take the scope, please.


5-0 Prolene sutures in
the myometrium defect

need to be placed exactly
one millimeter apart.

Dr. Murphy, take
one more step,

I'm gonna have to
ask you to leave.

Applying the glue.

No, no. That's too far.

- The view is obscured.
- Shaun. A little to your left.

She's bleeding.

No signs of rupture.

You may have placed
the sutures too deep

because you didn't
have a clear view.

The sutures are fine.

I should take over.

- Shaun.
- There, a small bleed underneath the patch.

Must've nicked a vessel.

I'll clip it.


Okay, we can continue to close.

Yes. Lea and the
baby are fine.

In spite of the
avoidable errors.

His abdominal wall is
too weak and damaged

from prior surgeries
to hold the sutures.

We covered the
wound with plastic,

but we need to take
him back to the OR

and close him up before
it gets infected.

The tissue will just
tear open again.

His skin and muscles need
time and nutrition to heal.

I have a small bowel for Drew.

Drew's wound dehisced.

We can't take that organ.

I'm not turning it down.

This is Drew's only chance.

Tell UNOS we need to
run some more tests.

Buy us a few hours.

That's how long we
have to figure out

how to stitch this
kid back together.

What about component separation?

That could weaken
the tissue even more.


Maybe a four-step
Fabian procedure.

Except Drew doesn't have
time for four steps.


Here to check Lea's
post-op vitals.

I also brought supplements.


Thank you.

All right, your post-op
ultrasound looks good.


Fetal movement and
heart tones are great.

Oh, thank God.

When can I go home?

You need to be
here for monitoring

for several more days.

I can't go days
like this, Shaun.

I hate it here.

You are here for work every day.

Not in this room, in this bed,

thinking about everything.

Jerome and I can visit
on our lunch break.

Oh, we could take the "What
Yankee Candle Are You?" quiz

that's on page 17.

Rest will help
you recover faster

so you don't have
to be here anymore.

Her ultrasound does look good.

Thank you. You can go.

Thank you.

UNOS called again.

I told them we have to re-run
Drew's liver function test

and get a CT scan.

I bought us an hour at most.

What about a
Sure-Closure device?

Too high a risk
for ventral hernia,

which could lead to us needing
to resect his large intestine,

leaving him even worse off.

I already played it out.

For your embryo thing, you
know, whenever that is,

I can give you a
ride, if you need one.

I'll get an Uber.

You really want to go to the
most important appointment

of your life with a
stranger in a Camry?

I've chosen to do this
alone, and I'm fine with it.

And I'm... I'm trying very hard

not to care about what anyone
else thinks about that.

So having you imply how sad it
is that I have to take a cab

to a doctor's office
is not helpful.

He threw up, and his
pain is getting worse.

He's already maxed out on
morphine. I'm overriding.

There's increased redness
and swelling on the edges.

Early signs of infection.

I love you, Mom.

- You're gonna be fine.
- It's okay.

We knew we'd get here someday.

I'm ready.


I am not giving up on you.

Don't give up on me, D.


Oh. I-I will take those.

They're from all the nurses.

We just want you both to know
that we're thinking about you.

I will pass that along.

But not these.

Baby's breath has a
strikingly unpleasant odor.

Is there anything you need?

We're fine.

Uh, 502's family
is on their way in.

Heads up... They
are a loud bunch.

They're very excited to
be taking Meemaw home.

I don't think Lea's fine.

She's lonely and bored,

and being back in that room

is bringing up a lot
of painful memories.

And I know you're just...
You're trying to protect her,


but it's making you kind
of a pain in the ass.

Your wife, who's
carrying the tiny human,

she needs her loud bunch.

People asking how she is
doing and being worried

will only make Lea worry
more, and that is not helpful.

Not for you,

but I think Lea needs more
than just you right now.

She needs lots of people
showing concern and love.

And maybe you do, too.

More than you think.

♪ I think of when... ♪

Question for you.

Does it bother you that
this has been sitting here

for three months?


- Does it bother you?
- No.

I'm feeling a little pressured.

I've barely brought it up.

And I appreciate that.

But it sitting here
is kind of pressure.

It was meant to
be a cute gesture.

A subtle...

Not so subtle reminder

that the offer is
still "on the table,"

which has clearly
overstayed its welcome,

and the last thing I want is
for it to come between us.

Are you un-proposing?

No, I'm un-pressuring.

I love you, and I'm
not going anywhere.

When you're ready, we'll
put it back on the table.

What about a Velcro
biocompatible patch?

It would facilitate his
granulation tissue growth.

How do we keep it from
adhering to other organs?


This should be turmeric
chicken with asparagus.

That's what I was gonna
make you for our date.

And after work, all I had to do was
go to the store and get some chicken.

But instead, I-I
texted my dealer.

For a thousand reasons,

none of which excuse
nor explain anything.

You don't owe me an explanation.

I do.

And I wish I could give you one.

Every day for the past 92
days, I've asked myself,

"Why didn't I just
go get the chicken?"

I mean, we would have
had a great dinner.

I mean, you would have
been funny and beautiful.

And I would have tried way
too hard to be charming.

And then...

who knows?

I'd give anything to
go back, start over.

Give us a clean slate.

Me too.

What if we did that for Drew?

What if, along with a new bowel,

we gave him a whole
new abdominal wall?

Clean slate.

Has it ever been done before?

Not exactly.

I'm gonna look down and
see... someone else's abs?

Replacing it is the only way
to get you a new small bowel.

You'll be able to eat
again. You'll get stronger.

What are the chances it'll work?

It's never been done in tandem
with another transplant.

There are increased risks
of rejection or infection.

But both organs are in great
shape and a good match.

It's our best shot
to save your liver

and give your body time to heal.

Thank you so much.


Well, let's do this.

If we don't keep quiet,

Shaun is gonna come down on us
with the hammer of Thor, okay?

It's so nice to laugh.

Enter Shaun with a chest plate

and a red cape with the Mjolnir.

I don't want to get kicked
out before I know...

Boy or girl?

I have to start scoping out
the latest baby fashions.

I don't know.

I don't want to know.

Last time, when we found
out we were having a girl,

Shaun and I were
choosing her name.

I liked Sage and
Skylar and Sofia.

Something with an "S,"
after my grandma, Susie.

And then she was... gone.

And I can't do that again.

Maybe you should tell
Shaun about this.

He's already so worried,
no matter what he says.

And what if talking
about it just...

I have something for you.


My faith.

Not just in God.

I have faith in the
surgery you had.

I have faith in you and Shaun,

and that your baby,

whatever it is,

is going to be okay.

Your 10-minute
visit has run over.

I have to scrub in anyways.

Pencil me in for the next
10-minute opening, Thor.

Thank you. I-I needed that.

Mmph. Pfft.

But not that.

I kind of feel nauseous.

We should do another ultrasound.


This surgery could buy
you a year, maybe more,

give you back some
quality of life.


it should be what you want.

You're 17 and
you've suffered more

than some people
their whole lives.

No one would fault you
for deciding you're done.

I can't.

Your mom has given you all
the support in the world,

but this is your fight.

Do you want to keep going?

The worst part about
all of this is knowing

one day, it'll end,

and my mom will be alone.

She's been with me through all
the hardest parts of my life,

and I won't be around when she has to
go through the hardest part of hers.

If I can put that off,

if even for a little bit,
then I'm gonna do that.

And hope that makes the
days she'll face alone...

a little easier.

You're all set.

We'll take you to surgery soon.

I love you.

And whatever happens...

you don't need to
worry about me.

I'll be okay.

I love you, too, Mom.

She was feeling
nauseous, so I did an ultrasound,

which detected increased
fluid in the abdomen,

but then she lost consciousness.

It is almost certainly
internal bleeding.

I'll scrub in, right away.

No, no, no. You can't come in.

- This is likely a complication from the first surgery.
- Shaun...

It is my fault, and
I need to fix it.

Shaun, if we can't
stop the bleeding,

we may have to take Lea's uterus
in order to save her life.

If we get there, we're gonna
make the decision quickly

and with medical factors
only, no emotion.

Lea would want me in there
in case we lose the baby.

If that happens...

If that happens,

I'll come back and
get you, I promise.

Surgical site looks
good. Patch is intact.

No signs of acute
placental abruption.

Bladder's clean.

No blood coming from the
ovaries or the fallopian tubes.

And the bowel is intact.

It's gotta be coming
from the uterus.

If we clamp the uterine vessels,
we may slow down the bleeding.

But we put the baby at risk.

If we don't stop it soon,
we're gonna put Lea at risk.

I'll clamp the internal iliac
on the side of the bleed.

Buys us some time.

Give two more units of
blood and stay four ahead.


If the
site is hemostatic,

they will look for
placental abruption.

Next, they will check
the bladder, ovaries,

and fallopian tubes.


They can't clamp
the uterine vessels

without hurting the baby,

but they can place an
atraumatic vascular clamp

on the internal iliacs,

which will slow down the bleed
while they try to locate it.

Once they stop the bleed,

they should be able to repair it

and be done by...


The surgery went really well.

You should be able to start
eating real food again

in a few days.

Better make sure my new
six-pack is looking good.

The abdominal wall
is holding together.

No signs of infection.

We'll see how long that lasts.

One step at a time, D.

We'll let you get some rest.

No alcohol in that
new gut of yours.

Not for four more years.

One step at a time, Mom.

Hey, I don't want to help
because I feel bad for you.

I feel bad for me.

You're gonna be an amazing mom

because you're amazing at
whatever you put your mind to,

and I'm a little
conflicted, I guess,

because I won't be a part of it.

Making my single-mother
IVF journey about you

is uncharacteristically

I'm impressed.

You changed me.

And doing things
alone isn't sad.

Still doesn't mean you
have to do them that way.

From here on, I'm gonna request
not to be supervised by you.


I didn't OD because
of you, or us.

But I knew I
couldn't be with you

if I wasn't okay.

So I convinced myself I was.

Jordan, if I let myself
get close to you,

I will fall for
you again, and...

and I will want so
badly to be okay,

to be ready for us.

I can't risk that.

I wouldn't want you to.


I can't believe how much
I'm gonna miss somebody

I'll still see every day.

Lea's in emergency surgery.

Two more
units, right away.

Removing the
packing over the uterus.


Fetal heart rate 101.

Intermittent decels.

No injury to the vena cava.

Where is all this coming from?

Art line BP is 75 over 43

and falling.

♪ Waiting for the breaks ♪

♪ I could be lost
here forever ♪

♪ If I didn't have my faith ♪

♪ If I don't keep it together ♪

♪ I'll never take
a breath again ♪

♪ But I see hope
in the shallows ♪

♪ And the rush of
blood in my veins ♪

♪ And if I go down
with the devil ♪

♪ Well, that would
be my mistake ♪

♪ Waiting for the breaks ♪

♪ I'm stuck in the
middle of the waves ♪

♪ I'm lost in the current ♪

♪ Need a break ♪

♪ I'm stuck in the middle ♪

♪ Waiting for the breaks ♪

Lea's BP is 67 over
35. She's bleeding out.

Hysterectomy tray.


♪ Looking back there
now, what a blur ♪

After you ligate the uterine
vessels, I'm gonna go get Shaun.

I told him I would.

♪ I remember looking
up, and there you were ♪

Clamping the uterine horn.

♪ Those eyes said everything's
gonna be all right ♪

Ligated the round ligament.
Preparing to transect.

Metz scissors.

♪ Those arms said it's
okay to stay the night ♪


♪ We were feeling our
way through the dark ♪

♪ Feeling our way
through the dark ♪

♪ Looking for places
to fall down hard ♪

♪ Never knowing
where to start ♪

♪ Feeling our way
through the dark ♪

Lea and the baby are
gonna be just fine.

♪ Those arms said it's
okay to stay the night ♪

Lea's left uterine artery was
tethered to some scar tissue.

As the uterus grew, it ruptured.

That was inevitable.

Had nothing to do with
your first surgery.


Had Lea not been in the
hospital when this happened,

she might not have survived.

Shaun, your surgery
saved both their lives.


♪ We're feeling our
way through the dark ♪


♪ If you show me
what's underneath ♪

Thank you, Dr. Glassman.

I got you.


♪ Feeling our way
through the dark ♪

♪ Looking for places
to fall down hard ♪

♪ Never knowing
where to start ♪

♪ Feeling our way
through the dark ♪

♪ Feeling our way
through the dark ♪


Good morning.

Can I get that to go?

I gotta stop at my place
and grab a shirt for work.

I'm sure you have
a minute. Stay.

- Am I about to be punished for something?
- No.

- I was just thinking.
- Mm-hmm.

I love you.

I love you, too.

And I love us.

Same. Always good to hear.

And I've decided I want
us to move forward.

At my own, learning-to-walk
kind of pace.

Clay Porter...

will you move in with me?

I would kneel, but I'm not sure

I could gracefully
get back up again.

It's so sparkly.

Love it.


Audrey Lim...

you've made me the
happiest man alive.

This is a one-time thing.

Don't expect me to drive you
to your next colonoscopy.

And here I was looking
forward to that.

Take McLaughlin
to William Street.

The freeway's backed
up this time of day.

Alright, just don't
forget the tip.

The fleece patch is holding well
and expanding with the uterus.

Everything looks great.

Your baby is very
cute and squirmy.

So, you wanna know what it is?

Y-You already know, don't you?

I have been looking
at your uterus a lot.


But... But I can keep a secret.

The light blue is very...


I was going to say pastel.

But, yes, that too.

I think he's gonna like
something in the gray palette.

Calming but warm.

Elegant yet understated.

I think our son would
like that very much.