The Good Doctor (2017–…): Season 1, Episode 7 - 22 Steps - full transcript
Shaun has to confront prejudice from an unlikely source when he takes on the case of a patient with autism, and Dr. Kalu has to learn to accept his limitations as a surgeon.
Come on. Is the system down?
Worked fine for me.
I don't have time for this.
How you doing?
The computer is not working.
That's not what I'm talking about.
I know. I'm fine.
A patient died
because of something you did.
I think it's safe to say the
one thing you are not is "fine."
I'm dealing.
How exactly are you dealing?
I'm getting back to work,
I have a diabetic toe to debride,
and I'm putting it behind me.
How do you do that... put it behind you?
By moving forward.
- I appreciate your concern.
- You're welcome.
I'm gonna make an appointment
for you for grief counseling.
Dr. Mohan... She's an expert
in dealing with hospital staff
who have experienced stressful events.
That's not necessary.
You agree you had a "stressful event"?
And while I am comforted by your
commitment to move forward
by not looking back,
I still want you to see Dr. Mohan.
If she says that you are fine,
then... and only then...
can you go back to surgery.
It's working now.
You just have to be patient.
Heart rate 36.
Push another five milligrams of
morphine and prep a nitro drip.
We need atropine on board stat.
What do you got for me?
An MI with severe bradycardia.
He's had aspirin, nitro,
and now we're trying to give him
a real rate with atropine.
Cardiology see him?
He's got a broken pacemaker
and probably needs his coronary
arteries cleared...
feels like a triple bypass,
but you're the expert.
BNP is sky high.
What do you see?
His ventricles are barely pumping.
He's had two massive prior Mls.
End stage heart failure.
His heart's way beyond repair.
What are our options?
He's 73 years old.
His age is an absolute
contraindication for transplant.
- He's dying.
- Well, he's not dead yet.
What else?
How about cardiac resynchronization?
That will get what's left of
both ventricles
working together.
A biventricular pacer?
It should make him feel a little better
in the few months he's got left.
His rate drops any lower, he'll arrest.
Claire, prep his jugular to
float in a temporary pacemaker.
Shaun, call up to the cath lab
and have them get an estimate
on how long it'll take
to get the bipacer in house.
Something wrong?
Um, not at all.
Just a little bit too much
coffee this morning.
Let's go. Do it now.
Restraints, please!
I don't want to get stuck with a needle.
You're scaring him.
You're scaring him.
Haldol, five milligrams.
You're scaring him!
- Who are you?
- Dr. Shaun Murphy.
This patient is psychotic, Dr. Murphy.
He's not psychotic.
You don't like people touching you.
He's not psychotic. He's autistic.
You're being an excellent patient.
Okay. We're finished.
You're ssame as...
me.
Can we release his hands?
Dr. Murphy? His hands?
I'm here, son... Mom and Dad are here.
You can let go of his hands.
He won't hurt you.
Wrong stop. Wrong stop.
Can someone tell me what happened?
Liam has a 5.4 centimeter
laceration on his forehead,
probably from a fall.
The wound was infiltrated
with five milliliters of 1% lidocaine...
7... 7 singleinterrupted
50 Prolene sutures.
He will a small scar,
but no other longterm effects
from this injury.
You're my son's doctor.
I am. Dr. Shaun Murphy...
"Shaun" with a U.
Got lost... got lost, got lost,
got lost, got lost!
- Yes, yes. Yes. But you're okay.
- Got lost. Got lost, got lost.
You won't be taking that bus again.
This light is too bright.
These rooms make him anxious.
Can we take him home?
No.
Your son is jaundiced,
clenching his right abdominal
muscles when touched
and febrile.
He should not go home.
Why am I here?
Your pacemaker malfunctioned.
You had a heart attack.
I... I think I get that part.
Your neighbor's gardener
saw you on the ground
inside your house...
called 911, saved your life.
Well, I must remember to thank him.
How old are you?
Me?
I know how old I am.
I'm 28.
We have, a biventricular
pacer on its way,
and it's gonna make you feel
a lot better.
Is it?
I will be back to prep you for surgery.
Liam has elevated bilirubin
and liver enzymes,
a white cell count of 23.
Abdominal ultrasound shows
dilatation of the bile ducts.
Sounds like ascending cholangitis...
can lead to sepsis
if the bacteria gain access to his blood.
Is he stable now?
Yes, his vital signs are stable.
Cause could be anything
from cancer to diet, so...
Liam's parents have him
on a special ketogenic diet.
Highfat diets can cause
obstructive gallstones,
which could have set the whole thing off.
Do an ERCP to clear him.
After that, a few weeks
of broad spectrum antibiotics
should take care of things.
I want you help.
With what?
Endoscopic Retrograde
CholangioPancreatography.
ERCP? Why?
You've done those before, Shaun.
You're good with people who have autism.
Okay, Glen, let's get this, star... ted
Glen, you almost finished?
It's Dr. Kalu.
Glen?
Yeah, we have a code green.
Patient is Caucasian, male, 185 pounds.
Shaun, can you talk to him or something?
I can't push the Midazolam.
Four lights... four doors.
Yes. Lots of things.
32 and 8. 32, 8.
32 is the number of cabinet windows,
and 8 is the number of handles.
The end title's CO2 is rising.
He needs oxygen.
He has respiratory depression.
It's a common reaction to Midazolam.
CO2 is coming down.
- You can proceed, Claire.
- Thank you.
Have you been around
a lot of other autistic people?
I've never met someone with autism.
So, it must be nice to spend
some time around Liam, then.
Why?
Why would that be nice?
Okay.
There are no stones.
Where are the stones?
And there is scarring.
This has nothing to do with gallstones.
The entire biliary tree is so
thick with scarring
we can't even get the camera through.
The differential diagnosis for
biliary tree scarring includes
primary sclerosing cholangitis,
liver failure,
secondary to primary biliary cirrhosis...
Yeah, Shaun, we can add a few
cancers to that list as well...
It's a long and ugly one.
Find another way
to figure out what it is.
We could do an MRI.
No, we couldn't.
It's not possible.
That's the first time
I've ever heard you say that.
- Liam is stimming.
- Stimming?
The tics and spasms are a
neurological response to stress.
If he's doing an MRI, there is stress...
if there is stress, he won't keep still,
if he wont' keep still,
we can't do an MRI.
Therefore, it is impossible.
Maybe if you just keep talking
to him like that,
he'll doze off and it'll all be simple.
Give him a mild sedative.
He didn't respond well
to Midazolam during ERCP...
depresses his breathing.
His respiratory saturation can't
be properly monitored inside...
I get it.
He could die in the MRI
and we wouldn't know.
You're just gonna have to find
a different way to calm him.
Okay. We'll do it.
Guess he has an idea.
We have a code green.
Patient is a Caucasian male,
73 years of age.
Shaun, what are you doing?
Counting.
- Counting what?
- Distance.
Why?
I want $1,643.
You can get that by counting?
That's why you're alone
and pacing in this room?
What do you want the money for?
- I want to buy a television.
- $1,600 for a television?
And 43. I am a surgeon. I get paychecks.
You're not a surgeon yet.
You're a surgical resident.
There's a big difference
in the paycheck there, pal.
I'm not a child, pal.
How 'bout $1,000 for a television?
No. The one I want is $1,643, okay?
I know, but you have a budget.
- A budget.
- You... Rent, food, bills to pay.
I should do my own budget.
I have an MRI to do.
These are live feeds...
entrances, E.R., receiving dock.
If your patient had left,
we would've seen it.
Then where'd he go?
A freight elevator, but we don't
have cams in the freights,
and he doesn't pop back up.
So, we're dealing with
an alien abduction here?
Sorry.
We don't have cams
on the freight elevators
on levels one, four
and five, and the basement.
And you got people
looking on those floors?
We've covered four and five,
and we're moving on to one.
Hey.
What's in the basement?
Pediatric patient lost a blanket...
I'm just gonna check lost and found.
That's nice of you.
While you're there,
you might want to check
if they found your code green.
This is Doctor...
This is Shaun.
I an hear you when you speak.
I was thinking about something.
There are 24 steps
from the ambulance to the E.R.
Please turn down the lights.
That helps calm him.
There are 24 steps
from the ambulance to the E.R.
There are 22 steps from
the ambulance to the E.R.
He has very long strides.
Yes.
There are 22 steps
from the ambulance to the E.R.
There are 37 steps
from the elevator to room 405.
There are 37 steps
from the elevator to room 405.
In room 405,
there are 6 steps to the sink...
6 steps to the sink.
We're getting good images.
It's amazing how accomplished
you are for someone with ASD.
Three steps to the window.
Three steps to...
Three...
It's seven steps...
It's seven steps to the door.
Liam, there are seven steps to the door.
You need to get him out.
Just a little more time.
- He's scared.
- It's okay to be scared.
We need to finish this.
Seven... You're doing wonderfully, honey.
Just breathe. Just breathe.
No, it's seven steps to the door.
Glen?
Glen?
Glen?
Glen?
It's Dr. Kalu.
Let's get you upstairs.
Go away.
We're gonna get your new pacer in.
Don't you get it?
I broke my pacer on purpose.
I want to die.
With a new pacemaker,
maybe you'll feel better.
So, I'll be cured?
Good as new?
Heh.
Well, it'll reduce your pain,
and then hopefully...
You think this is
the first time I've heard that?
It's always the "next best thing."
The truth is
I'll just keep getting worse.
I know it, you know it.
Do you have any family you can talk to?
Brother's dead. I don't have a wife.
So, no, there's no one around to
nag me into doing what you want.
We have great counseling services here.
I'm in pain, 28...
all the time.
Talk therapy gonna talk that away?
Let's get you upstairs.
You color's not good,
and your lungs are crackling,
which means there's fluid building in...
I know my...
I know my rights.
I don't have to get treatment
if I don't want it.
The minute I catch my breath,
I'm gonna walk out of here,
so you can just leave.
I'm not leaving.
We can't treat it until
we find the underlying cause.
How do you do that?
Surgically... It's called
"exploratory laparoscopy."
We use a camera to navigate
Liam's midsection.
There are significant risks...
perforation of an organ,
accidental spread seeding malignancy.
And you have to do this
because he can't stay still
during an MRI?
You obviously know your son
better than I do.
Do you think we should try again?
So, Shaun told me he's getting a TV...
70 inches, all the works.
Is he now?
It's just a TV.
It's not about a TV.
Why are you so worried about him?
He showed up late for work
half a dozen times,
he calls me 2:00 in the morning
'cause he can't find a screwdriver,
and his superintendent wants to
kick him out of his building.
- Did you show up?
- What?
At 2:00 in the morning when he called you
about a lost screwdriver,
did you show up?
He was frantic.
I didn't know what he was gonna do.
There are 47 residents here,
and all of them show up late sometimes,
all of them make mistakes,
and hopefully, all of them learn.
If you want to worry about Shaun, fine.
But you fought to hire him
because you know he can learn.
The question is,
are you willing to let him?
Shaun?
I can see the pixelation.
- That's great. Listen...
- It's not great.
It's not good.
On a highquality display,
the human eye at 20/20
cannot detect the pixels.
You disappeared after the failed MRI.
I failed.
Yeah, see, I don't think it's about that.
You were hesitant with this kid
even before that.
You asked me to the ERCP.
Doctors don't have to like their
patients, Claire.
- You don't like him?
- I don't know him.
Shaun, there's something else
going on here.
- I know you know that.
- No. Nu... Nu-
He has the same condition you have.
You have never met anyone with...
Do you like all people with psoriasis?
I don't have...
Yes, you do.
And you can never get rid of it.
Okay.
It's too bad you don't like him,
because I think he likes you.
Not only that,
I think he looks up to you.
So you know how he thinks?
Well, not as much as you probably do.
What are you waiting for?
For you to pass out.
Judging by the size your ankles...
that shouldn't be too long from now.
Then hopefully I can get you
upstairs before you die.
Why do you give such a damn
about what I do with my life?
I don't know, Glen.
Why'd you want to die so bad?
I've lived.
I've had decent jobs,
and I've had jobs that went nowhere.
Had a good roof over my head,
and I've had that good roof
taken away from me.
I loved a girl, and I got married.
The 20 happiest years of my life...
then she died.
And now I'm alone
and in pain.
Feels like the end of the story.
I understand.
Yeah?
You've had some tough times, too, 28?
Nobody understands what it's like
to be so goodlooking and successful?
I was raised by nannies and housekeepers.
My God.
You're an ass.
Your point is you didn't suffer
because you were goodlooking
and smart...
you suffered because you were rich?
The only time I ever saw
my parents was Christmas.
Seriously, the story continues?
They had this big party every year,
and wherever they were traveling
they'd always fly home for it.
And I'd have to come home, too,
from whatever school they sent me off to.
When I was 18,
I decided that I was fed up.
I was a man, done being their son.
And I was gonna tell them publicly,
tell all their friends what
horrible people they were.
So I came home from school,
and I knocked on the door,
and someone answered.
But it wasn't my parents.
It was a stranger.
Turns out they'd sold the house
months ago.
They were gone.
I guess they were done with me, too.
To prep Liam for the laparoscopy,
we need to make four small
incisions in his stomach.
I don't need to do it.
II don't need to do it.
- Liam, you do need to.
- I don't need to!
If you could just hold still
for a second, Liam.
The... the bus driver lets me off.
II get lost...
You're safe now.
I get lost. I'm hungry.
I can't make food.
CCCan't do bath... Don't need to do it!
CCCan't do food...
CCan't put on clothes.
Can't do bus.
I took the bus.
I got off at the wrong stop,
and I got scared,
but then I found my way.
I did an MRI, and a man got hurt.
I made a mistake.
I make a lot of mistakes.
You tried to walk.
You made a mistake.
But mistakes are good.
You should make more.
You're like me.
You have red eyes... uveitis.
Liam takes vitamins... Does Liam
also take herbal supplements?
Kava root. Why?
He doesn't need the laparoscopic surgery.
I know what's wrong with him.
The red eyes... they're
caused by an immune flareup,
which can create the scarring
that we're seeing
in his digestive system.
The solution requires us to go in
and remove damaged segments
of the bowel piece by piece.
Us?
Yes, myself and my team.
Is Dr. Murphy on your team?
Of course.
Thank you for diagnosing our son.
Dr. Melendez, you have our
permission to do the surgery,
but in no way will Dr. Murphy be in it.
Well, the parents... they won't budge.
They don't believe
that anyone who has autism
is capable do doing surgery.
Well, clearly they're irrational...
I don't know... shallowminded people.
Who cares? What's the difference?
You agree with them, right?
Do you agree with them?
It's my team... I don't want
anybody telling me
who's supposed to be on my team,
including the Board.
You're not answering my question.
- The question's moot.
- Moot? No, it's not.
If you agree with them,
then the only issue
is somebody stepping on
your poor, little toes.
Get over it and go save the kid.
If you don't agree,
if you think Shaun can handle
surgery, then tell them that.
Tell them to go screw themselves.
Either they agree that Dr. Murphy belongs
in that room with you,
or you can go find them
someplace else to do the surgery.
I was an 18yearold
with no one and no money.
So I worked three jobs
and took out loans.
Still alive.
That's not a bad story, 28.
What happened with the parents?
I talk to them now, but...
they're not the people who got me here.
It was the people I didn't expect...
the exMarine at the shelter
who got me my first job,
and this crazy artist girl
who convinced me to go after
what I really wanted.
When you think you're alone,
Glen, you're not.
All right.
All right?
Ready?
Two, three!
- No disturbing dreams?
- After a 36hour shift?
From the moment my head hits the pillow
to the moment wake up,
all I see is black.
How's your level of concentration?
Have you had any difficulty focusing?
I mean, I can do
the New York Times crossword
puzzle in one sitting.
Sure, sometimes
I wish I was more focused.
It's pretty normal, right?
Shaun's different.
He also has savant syndrome.
He has a remarkable memory.
He has autism, same as
our son... same limitations.
You saw what happened
to our son in the MRI...
he knew he needed to lie still,
but he couldn't.
Now, what happens if Dr. Murphy
breaks down like that
while he's standing over my son
at an operating table?
You know your son.
I know surgeons.
And after working with Dr. Murphy,
after challenging him in surgery
and everywhere else...
probably more than he deserved...
I can tell you
he has my compete confidence.
I'm sorry.
He doesn't have ours.
So, what do we do now?
I've contacted my colleague
at St. Joseph's,
updated her on Liam's condition.
They have good people.
We can arrange for transportation
as soon as possible.
Where's my phone? Have you seen my phone?
Where's his second bag,
the one with his medications?
I want...
I want...
What, honey?
He said I could do it.
I want Dr. Shaun.
Your pacemaker's here.
The techs are programming it as we speak.
The moment they're ready,
we're gonna put it in.
I told you my wife died.
The truth is sshe left me.
But I gave her good reason for that,
so I got what I deserved.
We all make... But you didn't
get what you deserved...
good parents who loved you.
They were lucky to have you, Jared.
You appear remarkably welladjusted.
Thank you.
That's not a compliment.
That's my concern.
Well, I assume
everyone responds differently.
The thing is everyone responds.
Strictly speaking,
you don't meet the criteria to
be required to go into treatment
or take a leave of absence,
so I'm not gonna ground you.
You're a strong woman, Claire,
and that strength has
undoubtedly played a major role
in getting you where you are.
But if you have suppressed
feelings about this incident,
you need to find someone
to share them with.
Because if not, they will eat you up
no matter how strong you are.
All right, Glen. Second ti...
Come on.
Thank you.
It should be a very interesting surgery.
I'm glad I'm participating.
His pressure is bottoming out.
What's happening?
His bowel must have perforated.
He's going into septic shock.
This perforation could be anywhere.
What's the best way to access
the entire bowel
as quickly as possible?
Fulllength midline incision.
Good. Mark it.
And what do we do once we get in there?
Eviscerate the entire bowel
so we can check every inch
for necrotic segments.
Okay, let's make the cut.
You gonna take it or not?
This is the Number 3 L.
It's made of high carbon steel.
It doesn't break.
That's correct, Dr. Murphy.
Time of incision... 2:05 P.M.
We have a code green...
patient is a Caucasian male,
73 years of age.
Where'd he go?
Yeah, on my way.
I have a fivecentimeter segment
of proximal jejunum.
It's... sclerotic, but not perforated.
All right, mark it and move on.
Shaun, why are you just standing there?
We have 25 feet of bowel to run.
Shaun, you need to get moving...
unless you've found something.
I have...
- the perforation.
- Clamp it off...
I'll get in there
with the enterotomy scissors
and remove the damaged segment.
I can't.
You can't? Why not?
It's a phlegmon.
You found a walledoff abscess?
It's large.
- Don't touch it.
- I already am.
If you move and that thing ruptures,
the pus will spread to his
entire abdominal cavity...
this boy dies.
I know, that's why I'm not moving.
Claire, I need you to open it up gently.
I'm gonna evacuate the septic contents,
flush the cavity with antibiotics,
and then I'm gonna have you
remove the capsule.
I didn't do anything.
That's the pressure tanking.
You need to finish
what you're doing right now.
Let's go, Claire. Come on.
Clamp.
You guys check left.
Hey. Hey. Come on.
Stop.
Come on, Glen.
We can do this.
I don't want to...
I just don't want to.
Please leave me alone.
Once I get my strength back,
I'll climb up and jump.
I can't let you do that.
When this temporary pacer fails,
which it will,
your heart may stop and you die suddenly.
But more likely, Glen,
you slip back into that slow rhythm,
your chest is racked
with excruciating pain
and your lungs start to fill with fluid,
and slowly you suffocate.
Give it a rest, 28.
Just get me a DNR and a cab.
You can't help me.
Yes, I can.
It was a difficult procedure.
We removed a total of two feet of...
Is he okay?
He will be okay.
Thank you.
Thank you, thank you.
II'm sorry. We're... We just...
He's our son.
You shouldn't feel bad.
You did what you thought
was best for Liam.
You love Liam.
I didn't have that from my parents.
It also means I didn't have
to take kava root,
so I didn't get
hypereosinophilic gastroenteritis.
Are you gonna get in trouble for this?
You're worried about me now?
You signed the DNR.
All I'm doing is sitting with you.
Are you feeling any anxiety?
No.
Pain?
Some.
Would you like a dose
of morphine to help with that?
Thank you.
Find your guy?
I did.
Put in the biventricular?
How long did it take to get
access to the coronary sinus?
I didn't do the surgery.
I didn't put the pacer in. He, um...
he didn't want it.
He was a good guy.
I lost a patient, too.
Want to talk about it?
I do.
Your surgery went well.
You should be able to get up
and move around in two weeks
once we're sure the antibiotics
have cleared your infection.
Hear that?
It won't be too long
until we can go home.
You did great, honey.
The lights.
Are the lights okay?
Do you want them dimmed?
They're... okay.
You'll love the software.
It makes it very easy to budget.
And the best part,
it links directly to the bank,
and... get rid of the ball!
He was the first quarterback
picked in 2013,
but his stats outside the pocket
are only 27% competed passes.
Their backup QB is at 65% under pressure.
Absolutely.
- He's wasted potential on the bench.
- Yes.
Anyway, the link to the bank
will help make automatic...
Did you see that?
He pinned it against
his helmet... even with the PI!
I want to go to the Super Bowl.
Okay, see,
that's exactly the kind of thing
you have to think about before you buy.
Tickets are very expensive.
Hoohoohoo!
You know... You know what? You should go.
I should go. We should go.
Okay.
Excuse me.
It's almost closing time, so...
I'd like to buy this TV.
Stay as long as you like.
Worked fine for me.
I don't have time for this.
How you doing?
The computer is not working.
That's not what I'm talking about.
I know. I'm fine.
A patient died
because of something you did.
I think it's safe to say the
one thing you are not is "fine."
I'm dealing.
How exactly are you dealing?
I'm getting back to work,
I have a diabetic toe to debride,
and I'm putting it behind me.
How do you do that... put it behind you?
By moving forward.
- I appreciate your concern.
- You're welcome.
I'm gonna make an appointment
for you for grief counseling.
Dr. Mohan... She's an expert
in dealing with hospital staff
who have experienced stressful events.
That's not necessary.
You agree you had a "stressful event"?
And while I am comforted by your
commitment to move forward
by not looking back,
I still want you to see Dr. Mohan.
If she says that you are fine,
then... and only then...
can you go back to surgery.
It's working now.
You just have to be patient.
Heart rate 36.
Push another five milligrams of
morphine and prep a nitro drip.
We need atropine on board stat.
What do you got for me?
An MI with severe bradycardia.
He's had aspirin, nitro,
and now we're trying to give him
a real rate with atropine.
Cardiology see him?
He's got a broken pacemaker
and probably needs his coronary
arteries cleared...
feels like a triple bypass,
but you're the expert.
BNP is sky high.
What do you see?
His ventricles are barely pumping.
He's had two massive prior Mls.
End stage heart failure.
His heart's way beyond repair.
What are our options?
He's 73 years old.
His age is an absolute
contraindication for transplant.
- He's dying.
- Well, he's not dead yet.
What else?
How about cardiac resynchronization?
That will get what's left of
both ventricles
working together.
A biventricular pacer?
It should make him feel a little better
in the few months he's got left.
His rate drops any lower, he'll arrest.
Claire, prep his jugular to
float in a temporary pacemaker.
Shaun, call up to the cath lab
and have them get an estimate
on how long it'll take
to get the bipacer in house.
Something wrong?
Um, not at all.
Just a little bit too much
coffee this morning.
Let's go. Do it now.
Restraints, please!
I don't want to get stuck with a needle.
You're scaring him.
You're scaring him.
Haldol, five milligrams.
You're scaring him!
- Who are you?
- Dr. Shaun Murphy.
This patient is psychotic, Dr. Murphy.
He's not psychotic.
You don't like people touching you.
He's not psychotic. He's autistic.
You're being an excellent patient.
Okay. We're finished.
You're ssame as...
me.
Can we release his hands?
Dr. Murphy? His hands?
I'm here, son... Mom and Dad are here.
You can let go of his hands.
He won't hurt you.
Wrong stop. Wrong stop.
Can someone tell me what happened?
Liam has a 5.4 centimeter
laceration on his forehead,
probably from a fall.
The wound was infiltrated
with five milliliters of 1% lidocaine...
7... 7 singleinterrupted
50 Prolene sutures.
He will a small scar,
but no other longterm effects
from this injury.
You're my son's doctor.
I am. Dr. Shaun Murphy...
"Shaun" with a U.
Got lost... got lost, got lost,
got lost, got lost!
- Yes, yes. Yes. But you're okay.
- Got lost. Got lost, got lost.
You won't be taking that bus again.
This light is too bright.
These rooms make him anxious.
Can we take him home?
No.
Your son is jaundiced,
clenching his right abdominal
muscles when touched
and febrile.
He should not go home.
Why am I here?
Your pacemaker malfunctioned.
You had a heart attack.
I... I think I get that part.
Your neighbor's gardener
saw you on the ground
inside your house...
called 911, saved your life.
Well, I must remember to thank him.
How old are you?
Me?
I know how old I am.
I'm 28.
We have, a biventricular
pacer on its way,
and it's gonna make you feel
a lot better.
Is it?
I will be back to prep you for surgery.
Liam has elevated bilirubin
and liver enzymes,
a white cell count of 23.
Abdominal ultrasound shows
dilatation of the bile ducts.
Sounds like ascending cholangitis...
can lead to sepsis
if the bacteria gain access to his blood.
Is he stable now?
Yes, his vital signs are stable.
Cause could be anything
from cancer to diet, so...
Liam's parents have him
on a special ketogenic diet.
Highfat diets can cause
obstructive gallstones,
which could have set the whole thing off.
Do an ERCP to clear him.
After that, a few weeks
of broad spectrum antibiotics
should take care of things.
I want you help.
With what?
Endoscopic Retrograde
CholangioPancreatography.
ERCP? Why?
You've done those before, Shaun.
You're good with people who have autism.
Okay, Glen, let's get this, star... ted
Glen, you almost finished?
It's Dr. Kalu.
Glen?
Yeah, we have a code green.
Patient is Caucasian, male, 185 pounds.
Shaun, can you talk to him or something?
I can't push the Midazolam.
Four lights... four doors.
Yes. Lots of things.
32 and 8. 32, 8.
32 is the number of cabinet windows,
and 8 is the number of handles.
The end title's CO2 is rising.
He needs oxygen.
He has respiratory depression.
It's a common reaction to Midazolam.
CO2 is coming down.
- You can proceed, Claire.
- Thank you.
Have you been around
a lot of other autistic people?
I've never met someone with autism.
So, it must be nice to spend
some time around Liam, then.
Why?
Why would that be nice?
Okay.
There are no stones.
Where are the stones?
And there is scarring.
This has nothing to do with gallstones.
The entire biliary tree is so
thick with scarring
we can't even get the camera through.
The differential diagnosis for
biliary tree scarring includes
primary sclerosing cholangitis,
liver failure,
secondary to primary biliary cirrhosis...
Yeah, Shaun, we can add a few
cancers to that list as well...
It's a long and ugly one.
Find another way
to figure out what it is.
We could do an MRI.
No, we couldn't.
It's not possible.
That's the first time
I've ever heard you say that.
- Liam is stimming.
- Stimming?
The tics and spasms are a
neurological response to stress.
If he's doing an MRI, there is stress...
if there is stress, he won't keep still,
if he wont' keep still,
we can't do an MRI.
Therefore, it is impossible.
Maybe if you just keep talking
to him like that,
he'll doze off and it'll all be simple.
Give him a mild sedative.
He didn't respond well
to Midazolam during ERCP...
depresses his breathing.
His respiratory saturation can't
be properly monitored inside...
I get it.
He could die in the MRI
and we wouldn't know.
You're just gonna have to find
a different way to calm him.
Okay. We'll do it.
Guess he has an idea.
We have a code green.
Patient is a Caucasian male,
73 years of age.
Shaun, what are you doing?
Counting.
- Counting what?
- Distance.
Why?
I want $1,643.
You can get that by counting?
That's why you're alone
and pacing in this room?
What do you want the money for?
- I want to buy a television.
- $1,600 for a television?
And 43. I am a surgeon. I get paychecks.
You're not a surgeon yet.
You're a surgical resident.
There's a big difference
in the paycheck there, pal.
I'm not a child, pal.
How 'bout $1,000 for a television?
No. The one I want is $1,643, okay?
I know, but you have a budget.
- A budget.
- You... Rent, food, bills to pay.
I should do my own budget.
I have an MRI to do.
These are live feeds...
entrances, E.R., receiving dock.
If your patient had left,
we would've seen it.
Then where'd he go?
A freight elevator, but we don't
have cams in the freights,
and he doesn't pop back up.
So, we're dealing with
an alien abduction here?
Sorry.
We don't have cams
on the freight elevators
on levels one, four
and five, and the basement.
And you got people
looking on those floors?
We've covered four and five,
and we're moving on to one.
Hey.
What's in the basement?
Pediatric patient lost a blanket...
I'm just gonna check lost and found.
That's nice of you.
While you're there,
you might want to check
if they found your code green.
This is Doctor...
This is Shaun.
I an hear you when you speak.
I was thinking about something.
There are 24 steps
from the ambulance to the E.R.
Please turn down the lights.
That helps calm him.
There are 24 steps
from the ambulance to the E.R.
There are 22 steps from
the ambulance to the E.R.
He has very long strides.
Yes.
There are 22 steps
from the ambulance to the E.R.
There are 37 steps
from the elevator to room 405.
There are 37 steps
from the elevator to room 405.
In room 405,
there are 6 steps to the sink...
6 steps to the sink.
We're getting good images.
It's amazing how accomplished
you are for someone with ASD.
Three steps to the window.
Three steps to...
Three...
It's seven steps...
It's seven steps to the door.
Liam, there are seven steps to the door.
You need to get him out.
Just a little more time.
- He's scared.
- It's okay to be scared.
We need to finish this.
Seven... You're doing wonderfully, honey.
Just breathe. Just breathe.
No, it's seven steps to the door.
Glen?
Glen?
Glen?
Glen?
It's Dr. Kalu.
Let's get you upstairs.
Go away.
We're gonna get your new pacer in.
Don't you get it?
I broke my pacer on purpose.
I want to die.
With a new pacemaker,
maybe you'll feel better.
So, I'll be cured?
Good as new?
Heh.
Well, it'll reduce your pain,
and then hopefully...
You think this is
the first time I've heard that?
It's always the "next best thing."
The truth is
I'll just keep getting worse.
I know it, you know it.
Do you have any family you can talk to?
Brother's dead. I don't have a wife.
So, no, there's no one around to
nag me into doing what you want.
We have great counseling services here.
I'm in pain, 28...
all the time.
Talk therapy gonna talk that away?
Let's get you upstairs.
You color's not good,
and your lungs are crackling,
which means there's fluid building in...
I know my...
I know my rights.
I don't have to get treatment
if I don't want it.
The minute I catch my breath,
I'm gonna walk out of here,
so you can just leave.
I'm not leaving.
We can't treat it until
we find the underlying cause.
How do you do that?
Surgically... It's called
"exploratory laparoscopy."
We use a camera to navigate
Liam's midsection.
There are significant risks...
perforation of an organ,
accidental spread seeding malignancy.
And you have to do this
because he can't stay still
during an MRI?
You obviously know your son
better than I do.
Do you think we should try again?
So, Shaun told me he's getting a TV...
70 inches, all the works.
Is he now?
It's just a TV.
It's not about a TV.
Why are you so worried about him?
He showed up late for work
half a dozen times,
he calls me 2:00 in the morning
'cause he can't find a screwdriver,
and his superintendent wants to
kick him out of his building.
- Did you show up?
- What?
At 2:00 in the morning when he called you
about a lost screwdriver,
did you show up?
He was frantic.
I didn't know what he was gonna do.
There are 47 residents here,
and all of them show up late sometimes,
all of them make mistakes,
and hopefully, all of them learn.
If you want to worry about Shaun, fine.
But you fought to hire him
because you know he can learn.
The question is,
are you willing to let him?
Shaun?
I can see the pixelation.
- That's great. Listen...
- It's not great.
It's not good.
On a highquality display,
the human eye at 20/20
cannot detect the pixels.
You disappeared after the failed MRI.
I failed.
Yeah, see, I don't think it's about that.
You were hesitant with this kid
even before that.
You asked me to the ERCP.
Doctors don't have to like their
patients, Claire.
- You don't like him?
- I don't know him.
Shaun, there's something else
going on here.
- I know you know that.
- No. Nu... Nu-
He has the same condition you have.
You have never met anyone with...
Do you like all people with psoriasis?
I don't have...
Yes, you do.
And you can never get rid of it.
Okay.
It's too bad you don't like him,
because I think he likes you.
Not only that,
I think he looks up to you.
So you know how he thinks?
Well, not as much as you probably do.
What are you waiting for?
For you to pass out.
Judging by the size your ankles...
that shouldn't be too long from now.
Then hopefully I can get you
upstairs before you die.
Why do you give such a damn
about what I do with my life?
I don't know, Glen.
Why'd you want to die so bad?
I've lived.
I've had decent jobs,
and I've had jobs that went nowhere.
Had a good roof over my head,
and I've had that good roof
taken away from me.
I loved a girl, and I got married.
The 20 happiest years of my life...
then she died.
And now I'm alone
and in pain.
Feels like the end of the story.
I understand.
Yeah?
You've had some tough times, too, 28?
Nobody understands what it's like
to be so goodlooking and successful?
I was raised by nannies and housekeepers.
My God.
You're an ass.
Your point is you didn't suffer
because you were goodlooking
and smart...
you suffered because you were rich?
The only time I ever saw
my parents was Christmas.
Seriously, the story continues?
They had this big party every year,
and wherever they were traveling
they'd always fly home for it.
And I'd have to come home, too,
from whatever school they sent me off to.
When I was 18,
I decided that I was fed up.
I was a man, done being their son.
And I was gonna tell them publicly,
tell all their friends what
horrible people they were.
So I came home from school,
and I knocked on the door,
and someone answered.
But it wasn't my parents.
It was a stranger.
Turns out they'd sold the house
months ago.
They were gone.
I guess they were done with me, too.
To prep Liam for the laparoscopy,
we need to make four small
incisions in his stomach.
I don't need to do it.
II don't need to do it.
- Liam, you do need to.
- I don't need to!
If you could just hold still
for a second, Liam.
The... the bus driver lets me off.
II get lost...
You're safe now.
I get lost. I'm hungry.
I can't make food.
CCCan't do bath... Don't need to do it!
CCCan't do food...
CCan't put on clothes.
Can't do bus.
I took the bus.
I got off at the wrong stop,
and I got scared,
but then I found my way.
I did an MRI, and a man got hurt.
I made a mistake.
I make a lot of mistakes.
You tried to walk.
You made a mistake.
But mistakes are good.
You should make more.
You're like me.
You have red eyes... uveitis.
Liam takes vitamins... Does Liam
also take herbal supplements?
Kava root. Why?
He doesn't need the laparoscopic surgery.
I know what's wrong with him.
The red eyes... they're
caused by an immune flareup,
which can create the scarring
that we're seeing
in his digestive system.
The solution requires us to go in
and remove damaged segments
of the bowel piece by piece.
Us?
Yes, myself and my team.
Is Dr. Murphy on your team?
Of course.
Thank you for diagnosing our son.
Dr. Melendez, you have our
permission to do the surgery,
but in no way will Dr. Murphy be in it.
Well, the parents... they won't budge.
They don't believe
that anyone who has autism
is capable do doing surgery.
Well, clearly they're irrational...
I don't know... shallowminded people.
Who cares? What's the difference?
You agree with them, right?
Do you agree with them?
It's my team... I don't want
anybody telling me
who's supposed to be on my team,
including the Board.
You're not answering my question.
- The question's moot.
- Moot? No, it's not.
If you agree with them,
then the only issue
is somebody stepping on
your poor, little toes.
Get over it and go save the kid.
If you don't agree,
if you think Shaun can handle
surgery, then tell them that.
Tell them to go screw themselves.
Either they agree that Dr. Murphy belongs
in that room with you,
or you can go find them
someplace else to do the surgery.
I was an 18yearold
with no one and no money.
So I worked three jobs
and took out loans.
Still alive.
That's not a bad story, 28.
What happened with the parents?
I talk to them now, but...
they're not the people who got me here.
It was the people I didn't expect...
the exMarine at the shelter
who got me my first job,
and this crazy artist girl
who convinced me to go after
what I really wanted.
When you think you're alone,
Glen, you're not.
All right.
All right?
Ready?
Two, three!
- No disturbing dreams?
- After a 36hour shift?
From the moment my head hits the pillow
to the moment wake up,
all I see is black.
How's your level of concentration?
Have you had any difficulty focusing?
I mean, I can do
the New York Times crossword
puzzle in one sitting.
Sure, sometimes
I wish I was more focused.
It's pretty normal, right?
Shaun's different.
He also has savant syndrome.
He has a remarkable memory.
He has autism, same as
our son... same limitations.
You saw what happened
to our son in the MRI...
he knew he needed to lie still,
but he couldn't.
Now, what happens if Dr. Murphy
breaks down like that
while he's standing over my son
at an operating table?
You know your son.
I know surgeons.
And after working with Dr. Murphy,
after challenging him in surgery
and everywhere else...
probably more than he deserved...
I can tell you
he has my compete confidence.
I'm sorry.
He doesn't have ours.
So, what do we do now?
I've contacted my colleague
at St. Joseph's,
updated her on Liam's condition.
They have good people.
We can arrange for transportation
as soon as possible.
Where's my phone? Have you seen my phone?
Where's his second bag,
the one with his medications?
I want...
I want...
What, honey?
He said I could do it.
I want Dr. Shaun.
Your pacemaker's here.
The techs are programming it as we speak.
The moment they're ready,
we're gonna put it in.
I told you my wife died.
The truth is sshe left me.
But I gave her good reason for that,
so I got what I deserved.
We all make... But you didn't
get what you deserved...
good parents who loved you.
They were lucky to have you, Jared.
You appear remarkably welladjusted.
Thank you.
That's not a compliment.
That's my concern.
Well, I assume
everyone responds differently.
The thing is everyone responds.
Strictly speaking,
you don't meet the criteria to
be required to go into treatment
or take a leave of absence,
so I'm not gonna ground you.
You're a strong woman, Claire,
and that strength has
undoubtedly played a major role
in getting you where you are.
But if you have suppressed
feelings about this incident,
you need to find someone
to share them with.
Because if not, they will eat you up
no matter how strong you are.
All right, Glen. Second ti...
Come on.
Thank you.
It should be a very interesting surgery.
I'm glad I'm participating.
His pressure is bottoming out.
What's happening?
His bowel must have perforated.
He's going into septic shock.
This perforation could be anywhere.
What's the best way to access
the entire bowel
as quickly as possible?
Fulllength midline incision.
Good. Mark it.
And what do we do once we get in there?
Eviscerate the entire bowel
so we can check every inch
for necrotic segments.
Okay, let's make the cut.
You gonna take it or not?
This is the Number 3 L.
It's made of high carbon steel.
It doesn't break.
That's correct, Dr. Murphy.
Time of incision... 2:05 P.M.
We have a code green...
patient is a Caucasian male,
73 years of age.
Where'd he go?
Yeah, on my way.
I have a fivecentimeter segment
of proximal jejunum.
It's... sclerotic, but not perforated.
All right, mark it and move on.
Shaun, why are you just standing there?
We have 25 feet of bowel to run.
Shaun, you need to get moving...
unless you've found something.
I have...
- the perforation.
- Clamp it off...
I'll get in there
with the enterotomy scissors
and remove the damaged segment.
I can't.
You can't? Why not?
It's a phlegmon.
You found a walledoff abscess?
It's large.
- Don't touch it.
- I already am.
If you move and that thing ruptures,
the pus will spread to his
entire abdominal cavity...
this boy dies.
I know, that's why I'm not moving.
Claire, I need you to open it up gently.
I'm gonna evacuate the septic contents,
flush the cavity with antibiotics,
and then I'm gonna have you
remove the capsule.
I didn't do anything.
That's the pressure tanking.
You need to finish
what you're doing right now.
Let's go, Claire. Come on.
Clamp.
You guys check left.
Hey. Hey. Come on.
Stop.
Come on, Glen.
We can do this.
I don't want to...
I just don't want to.
Please leave me alone.
Once I get my strength back,
I'll climb up and jump.
I can't let you do that.
When this temporary pacer fails,
which it will,
your heart may stop and you die suddenly.
But more likely, Glen,
you slip back into that slow rhythm,
your chest is racked
with excruciating pain
and your lungs start to fill with fluid,
and slowly you suffocate.
Give it a rest, 28.
Just get me a DNR and a cab.
You can't help me.
Yes, I can.
It was a difficult procedure.
We removed a total of two feet of...
Is he okay?
He will be okay.
Thank you.
Thank you, thank you.
II'm sorry. We're... We just...
He's our son.
You shouldn't feel bad.
You did what you thought
was best for Liam.
You love Liam.
I didn't have that from my parents.
It also means I didn't have
to take kava root,
so I didn't get
hypereosinophilic gastroenteritis.
Are you gonna get in trouble for this?
You're worried about me now?
You signed the DNR.
All I'm doing is sitting with you.
Are you feeling any anxiety?
No.
Pain?
Some.
Would you like a dose
of morphine to help with that?
Thank you.
Find your guy?
I did.
Put in the biventricular?
How long did it take to get
access to the coronary sinus?
I didn't do the surgery.
I didn't put the pacer in. He, um...
he didn't want it.
He was a good guy.
I lost a patient, too.
Want to talk about it?
I do.
Your surgery went well.
You should be able to get up
and move around in two weeks
once we're sure the antibiotics
have cleared your infection.
Hear that?
It won't be too long
until we can go home.
You did great, honey.
The lights.
Are the lights okay?
Do you want them dimmed?
They're... okay.
You'll love the software.
It makes it very easy to budget.
And the best part,
it links directly to the bank,
and... get rid of the ball!
He was the first quarterback
picked in 2013,
but his stats outside the pocket
are only 27% competed passes.
Their backup QB is at 65% under pressure.
Absolutely.
- He's wasted potential on the bench.
- Yes.
Anyway, the link to the bank
will help make automatic...
Did you see that?
He pinned it against
his helmet... even with the PI!
I want to go to the Super Bowl.
Okay, see,
that's exactly the kind of thing
you have to think about before you buy.
Tickets are very expensive.
Hoohoohoo!
You know... You know what? You should go.
I should go. We should go.
Okay.
Excuse me.
It's almost closing time, so...
I'd like to buy this TV.
Stay as long as you like.