The Good Doctor (2017–…): Season 2, Episode 2 - Middle Ground - full transcript
As Shaun pushes back against Dr. Melendez in order to treat a gravely ill hospital janitor and deal with the return of Lea, Dr. Lim risks a lawsuit and her career to help a teenage girl ...
_
You're here early. Trouble sleeping?
No. Just wanted to get out
of my apartment and to work.
We work you plenty hard enough. Go home.
Making sure you're rested
is also part of the job.
I understand.
What should I tell a patient
if they don't think they're sick
but I think they have pancreatic cancer?
You think one of our patients
has pancreatic cancer?
Seventeen.
He's burped 17 times
in 10 minutes.
It's a frequent symptom
of pancreatic cancer.
Shaun, it's acid reflux.
He's also jaundiced.
No, he isn't.
Paul's skin is definitely not
the same color it was six months ago.
- Paul?
- I looked at his mouth
when he was telling me
about his daughter.
- She just...
- Walk with me.
Say nothing.
Hey, Shaun.
Do a CVC, CMP,
amylase, lipase, CA-19 levels,
and CT abdomen,
pelvis pancreatic protocol,
and do not tell him why.
You want me to lie?
I don't want you to tell the truth.
The discoloration, if there
is any, is very minor.
I don't want you scaring the crap
out of the man over nothing.
Excellent. I've been practicing lying.
I lied to you before when I said
I just wanted to get out
of my apartment and to work.
Take Claire.
Hello. I'm Dr. Lim.
How can I help you today...
Asha?
I want plastic surgery.
Sweetheart, this is the Emergency Room.
If you want, I can make
an appointment for you...
Well, you do vaginal rejuvenation, right?
Yes...
On much older, much vainer women,
generally after having many children.
I don't know what the
boys have told you...
Examine me.
Please.
Please take off your underwear.
Were you in an accident?
No.
Can you help me?
- Did your father do this to you?
- No.
- Please just...
- Did your mother...
- I need to know who did this to you.
- No, you don't!
It doesn't matter who...
When I was 2 years old...
I was... Tied down,
and I was circumcised.
Please.
I'm hideous.
Will you help me?
Yes.
Why do you need to confirm
a diagnosis of acid reflux?
Because we're doctors. It's what we do.
We just like to be sure of everything.
There are a few remote possibilities...
I've got this!
Are you familiar with
the hospital employee manual
section 17, subsection C, triple I?
- No.
- Good.
- Good?
- Yes.
It requires that all employees
shall be subject to,
and I quote,
"Any and all possible necessary tests
"to confirm any and all diagnoses,
"no matter how mundane,
the cost of which tests
"shall be borne by
the hospital," end quote.
The Board wants to make sure
that no one is exposed to patients
if there is any chance that they have
any communicable condition.
I had the flu last week.
Why didn't anybody
do anything for me then?
- It's a new policy.
- You might have pancreatic cancer.
What?
What'd he say?
Female genital mutilation
is the ritual cutting
or removal of some, or all,
of the external female genitalia.
Over 200 million victims worldwide.
It is almost universally practiced
in a number of African
and Asian countries.
Where was she born?
Wisconsin.
Yeah, it's way more common
here than you think.
- What religion is she?
- I didn't ask.
This isn't about religion.
No legit religious organization
endorses this stuff.
We're gonna do the labiaplasty
first thing in the morning.
The damage done to her nerves
is not going to get undone,
nor is the psych damage,
but at least she'll
look like other girls.
We should be able to have her out of here
by 6:00 in the evening.
Outpatient? Why the hurry?
So her mother will simply
think she's in school,
then out studying with her friends.
She loves her parents
and doesn't want to tell them
that she's rejecting one
of their cultural traditions.
They won't stay in the dark for long,
since we're legally obligated
to report them.
That "cultural tradition" also fits
- the definition of abuse.
- And they'll also find out when we ask
for their permission to do this surgery.
She's a minor.
Her ID says she's 18.
Yes, her fake ID
says she's 18.
Her number starts with an "H," which
means she was born in the '50s.
Also, the photo background
is green instead of blue.
Also six other things.
Maybe we can get Legal
to get a court order...
If I believe that ID is real,
then I am entitled
to perform this surgery
without seeking consent of
anyone other than the patient.
And, as legally required within 36 hours,
I will report the evidence of abuse
under the name and address
listed on that ID.
If the investigation of that report
doesn't begin until the girl is long gone
and happens to lead nowhere
because the name wasn't real,
that's no fault of mine.
Are you sure you want
to risk your medical license
to protect an abusive mother?
If we do this by the book,
we never see that girl again
and no one gets help.
If we do this by the book, maybe
the cops lock the parents up.
We shine a light on this thing,
her community gets scared,
and maybe the next girl
doesn't need our help.
Or maybe the testimony of the girl
about what happened to her when she was 2
doesn't help the cops at all.
Maybe the parents just
take their daughter home,
and maybe we scare the next girl
into not even asking for help.
I'm doing the surgery to this girl
under this name
tomorrow morning at 7:00 a.m.
I can't believe people ever lie.
There are so many questions
people might ask you,
but if you tell the truth,
you already know the answers.
And, also, it's wrong.
But sometimes,
you shouldn't tell the whole truth?
No. Of course not.
Because that lets you be honorable
and tell the truth and be a good person,
but at the same time,
you get to completely deceive the person.
- No, I don't think that...
- Lea came back.
Wow, Shaun, that's great.
She's staying with me
until she finds her own place.
You must be so excited.
Yes.
You're not excited?
I said, "Yes."
Paul has one year to live.
He has pancreatic cancer.
Stage III.
There are no metastatic
lesions, but there are
- local nodes involved.
- And there's partial encasement
of the superior mesenteric artery.
That puts it past the point
where we can cure with local resection.
We could do Whipple surgery.
That's not advised for
stage III pancreatic cancer.
Not quite. It's not advised for stage IV.
For stage III, it's discretionary.
In my discretion,
he's better off with
12 semi-comfortable months,
rather than running the risk of
dying on the table tomorrow.
If he doesn't die on the table,
he could have many years.
It isn't our call to make.
I'll talk to Paul,
advise him of the parameters,
let him make his own decision.
No.
Shaun should do it.
Claire can do it.
Yes, she can,
which is why you should do it.
This is a teaching hospital.
Andrews is right...
Being a surgeon isn't just about cutting.
Would it be okay
if we spoke someplace more quiet?
You need someplace quiet
to tell me I have acid reflux?
I think we should be someplace quiet
because people sometimes get very upset
when they find out
they probably only have
less than a year to live.
Okay, uh...
Can I call my family?
They should probably hear
what you have to say, too.
I'd rather just talk to...
Of course you can.
I'll elevate it with
a 6-inch Ambler tissue hook.
You separate the underlying
tissue with iris forceps.
I got it. Tenotomy scissors.
I think we're actually
a little ahead of schedule.
Might be able to get her home
in time to do her homework.
Back to the bosom of her loving family.
We'd remove as much
of the cancer as possible
by removing the head of the pancreas
and other attached organs,
but then, we'd have to
reconstruct the anatomy.
The easiest way to do that
is to bring up a loop of jejunum...
Shaun.
Sorry.
The jejunum is part
of the small intestine
between the duodenum and ileum.
It's complicated, very dangerous surgery.
And even if it's successful,
post-operative complications
are frequent and serious.
And recovery can be very painful.
But if it works, he's better?
He'll be healthy?
He would still need chemotherapy
and a lifetime of monitoring.
But hopefully, a long lifetime.
Let's do it, Dad.
What do you say?
What should I do?
It's your decision.
All we can do
is present you with the facts.
Yeah, here are the facts, Dad...
The surgery may kill you.
Not doing the surgery will kill you.
Can you give us a few minutes?
Of course.
It was very nice of Dr. Andrews
to give you an office,
even though, you're on medical leave.
Yeah, he is a prince.
Who's your surgeon going to be?
I haven't d...
I haven't decided yet.
You should definitely go with
Dr. Joshua Atkinson
at Stanford Medical Center.
His mortality index is .3.
It's too low.
Not enough of his patients are dying?
No, Shaun, sometimes patients die.
Doesn't matter how good the doctor is.
But when your mortality rate
is as low as Atkinson's,
it means you're turning away patients.
You turn away patients,
it means you lack confidence.
You lack confidence, I don't
want you inside my head.
And I'd like to be able to dress myself
when I'm all done.
Shaun, what are you doing here?
You showed up at work early this morning.
Go home. Get some rest.
I won't rest if I go home.
The surgery went great.
Once everything's healed, I think
you'll be very happy with the results.
- What time is it?
- Not quite 5:45.
We just need you to pee, and...
I need to go home.
And you will... very soon.
- It hurts.
- I told you it would.
We did a lot of cutting and scraping.
You had a lot of scar tissue.
It hurts a lot.
We'll give you some Tylenol,
and you can tell your mother
you're cramping.
Ow!
Hang ketamine... 130 micrograms
per kilogram per hour.
Why does it hurt this much?
I don't know.
But you're not going home.
Ow!
She's heavily sedated.
What did we do to her?
What if this is good news?
I know you haven't been
a doctor all that long,
but pain is rarely a sign of good news.
It is if you're talking about
a part of the body
you thought was dead.
What if this means there's still
viable nerve endings in there?
What if this means we can
actually reconstruct her clitoris
and that it's capable of sensation?
Maybe. All we know for sure
is she's not gonna be home
anywhere near 6:00,
which means we're about to have
a missing child on our hands.
We have to bring Andrews up to speed.
I did a bad job of telling you
that you're dying.
Is there a good way?
I can't figure out
when I'm supposed to lie,
when I'm supposed to tell
part of the truth.
And it doesn't really matter,
because I can't figure out
how to do it anyway.
You did fine with me.
You never need to lie.
Lies don't protect you from the truth.
I don't like your haircut.
Okay.
Maybe sometimes, when the
truth can't help someone...
...you should definitely just lie.
Do you think praying will
help you reach a decision?
I've already reached a decision.
I'm praying to help me find
comfort with that decision.
My family wants the surgery.
And what do you want?
I want what my family wants.
I love them.
But they love you, too, right?
Don't they want what you want?
Long ago, I made a decision
to be there for them
no matter what.
And if the last choice I make in my life
is consistent with that,
I'm comfortable with that.
I'm surprised by you.
I, arguably, made errors in judgment,
but it was all in an effort
to help a patient.
Yes, and that would make sense
if you thought
you'd never have
another patient ever again.
And if there wasn't currently an
opening for Chief of Surgery.
I didn't know that was on the table.
See, that's the difference
between you and Melendez.
I have no doubt that as soon
as I got this promotion,
Melendez had done the math
and reacted accordingly.
But I suspect that even
if you had done the math,
it wouldn't have changed
how you handled this patient.
I don't view that as a weakness.
I'll handle the administrative fallout.
You...
...notify the parents immediately.
I can't.
We don't know the girl's real name,
and we have to keep her sedated,
so there's no way we can track...
She's a teenager. She's got a phone.
Next time it rings, answer it.
- You feel the mesenteric artery pulsing?
- Yes.
You shouldn't.
You're too close to the vein.
Great. Dr. Browne,
pass a penrose drain through.
Bovie.
Suction.
Got it all.
I see leaking pancreatic fluid.
That'll eat holes
in everything it touches.
Our duct tie didn't hold.
Suction. Needle driver.
Excellent.
You have approved a scrub nurse
and a circulating nurse
and seven other personnel.
Everyone and everything is covered,
except for an actual surgeon.
Yeah. I think we may have to postpone.
Have you notified your tumor to
stop growing in the interim?
I think any possible damage from a delay
may be more than offset
by having somebody competent
digging around in my brain.
"Competent"?
- What's wrong with Sanders?
- 6% mortality rate.
- Taylor?
- I don't like the way he's planning on
dealing with a carotid tear.
- That's nowhere near your tumor.
- It's the principle.
- Unger?
- He doesn't like me.
- No one likes you.
- No! You don't like me.
He doesn't like me. That's two.
Just pick a name. I don't care who.
I don't care if they're a doctor.
Just pick a name.
Because in 48 hours, you're
either getting your surgery
or you're getting a new oncologist.
She's in pain.
That's why she's asleep right now,
because of what you did to her?
What I did to her
I believe revealed
that what you did to her
didn't do as much damage
as we initially feared.
We want to do a second surgery...
How can you stop her pain?
It's called clitoral reconstruction.
The nerves of her clitoris are exposed.
We can sheath them using...
Our daughter wants this?
Asha wants to be like other girls.
She wants to be able to...
Mara told you that?
That's our daughter's name.
Not Asha.
You don't know her at all.
We need to do this surgery
to relieve her pain.
No. There must be another way.
We want a second opinion.
Not at this hospital.
How soon can our daughter be moved?
Excuse me, Dr. Lim.
I am Ellen Vahtra from
Child Protective Services.
Until I complete my review,
I'm afraid you're not going to be
moving your daughter anywhere.
How did it go? Is Dad okay? No, I'm good.
There were complications,
but we found solutions.
It went very well. We got it all.
Oh, my...
There's still...
I don't think I did that well.
They're too happy.
Post-surgical complications are
still a major concern that they...
Let them enjoy the good news.
Is deceiving someone in a
way that makes them happy
better than deceiving someone
in a way that makes them sad?
Shaun. I think there's
someone here to see you.
Hey.
I had some time, so I thought
you might want to have
some lunch with me?
I do not have time.
What's wrong?
What did she do?
Shaun. Sha...
You don't want to talk to Lea.
I don't understand.
I don't understand.
I don't understand!
You're not being fair to her or yourself.
- She's always been nice to you.
- No, she hasn't.
She's your friend.
Whatever's happened, you have
to talk to her about it.
Be honest about what you're feeling...
I can't be.
- Of course you can.
- I don't know...
I don't know how I feel!
I can't be honest
if I don't know how I feel!
Our 16-year-old daughter
is lying in a hospital bed unconscious
to protect her from overwhelming pain
because of what this place did
to her without our permission.
And you are investigating us?
Your daughter is suffering
because you butchered her
when she was 2 years old.
Dr. Lim, please refrain from
unsubstantiated allegations.
Either they're the butchers or
they're protecting the butchers.
If you didn't do it, tell us who did.
It was an aunt
and a grandmother from Kenya.
They were watching Mara
while we were on vacation.
Well, you must've been horrified.
Did you take her to a doctor?
That girl's sex organs
were covered with scar tissue.
She had no medical attention
to treat any of her wounds.
She was fine.
She was happy, laughing.
It's not that big a deal.
I was cut.
My mother was cut. Her mother was cut.
It is a rite of passage connecting
our women to their ancestors.
She will not find a husband
in our culture if she's...
So she'll find someone else.
It's not that big a deal.
These parents forfeited
the right to make any calls
about their daughter a long time ago.
Our daughter is an honor student,
taking three AP classes
in her junior year,
went on a mission to Haiti
to build a school.
We have raised her well.
She is a good person.
We're proud of her.
I'm sure she is a good person.
But you are not gonna convince me
that what happened to Mara
when she was 2 years old
is anything short of an abomination.
But that's not the issue today.
The issue is, how do we
best help this girl now?
The clitoral reconstruction
should protect the exposed nerve.
"Should"?
That is the surgery that,
in my medical opinion,
is called for.
But it's not the only option?
We could oblate the peripheral nerves
and remove the remaining clitoral tissue.
And is that surgery safer
or more dangerous?
It's simpler, but that's not
the only factor here.
It's the only factor to us.
We want to know that our daughter
won't spend the rest of her life in pain.
Please.
For a moment,
can we think about something
other than Mara's pain?
Can we think about her pleasure?
We have a chance to give her
a healthy, meaningful sex life.
That is what she came here looking for.
Wake her up.
She's in pain, and she's already
told me what she wanted.
Yesterday, she was requesting
cosmetic surgery.
Today, you're asking her
to risk a lifetime of pain
for a chance at pleasure.
From everything I've heard,
she's mature enough
to make the call herself,
even if it means suffering
for a few minutes to do so.
Dr. Unger has a mortality index
that is not too high and not too low.
It's not gonna be Unger.
You have not eliminated Dr. Ko.
Not yet.
I may have to go out of state
to find a neurosurgeon.
Plus, I may have to find
myself a new oncologist.
You've used Dr. Ko many times.
Did you think
she might kill your patients?
No.
Do you think you're better than them?
Yes, a little.
That was a joke.
You don't want to talk about this.
No, I don't want
to talk about this, Shaun.
That, in fact, is the point
of the alcohol.
Okay, I understand.
Good.
Why can't we talk about it?
Because it's upsetting.
Is that why you're stalling?
Because you're afraid of dying?
I'm not afraid of dying.
Really?
Why not?
You should be. Dying is terrible.
Yes, dying is terrible.
But there are worse things.
What's worse than dying?
Not dying.
That doesn't make sense.
Makes sense to me.
That doesn't make sense.
That's the middle ground, Shaun.
Brain surgeries have a tendency
to end in the middle ground.
Brain surgeries can be
considered a success
even when the patient
ends up compromised.
He can't walk. He can't talk.
His hand can't stop shaking.
I've been terrible
at a lot of things in my life,
but I am damn smart.
And I am a damn good surgeon.
And if I can't be those things,
then I don't know who I'd be.
You'd be my friend.
Well, thank you, Shaun.
I have to go. My patient just crashed.
It's not enough. Is it?
No.
I'm sorry it isn't.
Mom. Dad.
We're here.
We love you.
We just don't understand
why you would turn your back.
Uh...
Hello, Mara.
I'm Ellen Vahtra. I'm a social worker.
Your parents know what happened,
and Dr. Lim gave you a nerve block.
It hurts. It still hurts.
I understand that, and we are
going to try to get you
back to sleep as quickly as possible.
But something happened during
your surgery, and we need you
to make a decision
about what is done next.
We believe that, despite what
was done to you as a child,
the reason you're in so much
pain because you still have
functioning nerves in your clitoris,
nerves that had been covered
with scar tissue.
I'd like to repair that.
We can make you physiologically complete.
But there's no guarantee
that it would work.
I'm confident.
There is a safer choice.
We could... remove your entire clitoris.
This is your choice.
You will be protected no matter what.
Take it out.
Mara, we can make you whole...
I made a mistake. Take it out.
She's on medication. She's in pain...
Dr. Lim, please let her go back to sleep.
And prepare to operate
to remove the damaged tissue.
Hang fresh, frozen plasma, too.
Looks like he's going into DIC.
Give me another hemostat.
BP's 71 over 53.
We should have warned the family.
Can't see anything in here.
There's too much blood.
- More suction.
- I think you got the hepatic artery.
The warning wouldn't
have made any difference.
The bleeding is not slowing down.
We need to send the aorta to the celiac.
- I need to see it to clamp it.
- They would have been prepared.
A-line systolic's 54. He's bottoming out.
No, they wouldn't.
You two, shut up and
pack his abdomen with laps
while I sort through this mess.
I won't do it.
Can we appeal this? Do you know?
I've spoken with our legal department.
Unless we can prove
the social worker was biased,
we are stuck with this ruling.
Well, then you're also
stuck with "I won't do it."
You're a good doctor.
This hospital will miss you.
You're gonna fire me because I
won't butcher a teenage girl?
Of course I am.
This hospital will face
lawsuits, suspensions,
perhaps criminal charges,
and this little girl will still
get the surgery you hate.
Could Dr. Lim at least
talk to Mara again?
You want to wake her up again in pain?
Every woman deserves the right
to make decisions about her sexuality
without her parents hanging over her.
Okay.
When I was 15 years old,
my father caught me with a boy.
I mean, we weren't doing it,
but my top was off and
Well, it doesn't matter.
My father hit me.
I still have a small scar.
Our relationship was never the same.
But that's what growing up is.
Not everyone gets called a slut.
Not everyone gets butchered.
But everyone becomes a man or a woman
and stops being a child.
I want to take a piece of
tissue from inside your cheek
and I want to graft it to your clitoris.
We can make you feel... love.
I can't turn my back on my
family, on my traditions.
Traditions
connect us to the past.
What about the future?
Please.
No. I'm in pain.
Cross-clamping his aorta.
He's in ventricular fibrillation.
Starting chest compressions.
Okay. Everybody clear.
Prep the cheek, as well.
She's taking the graft?
The paperwork doesn't say...
She consented verbally.
We didn't want to keep her
awake any longer
than absolutely necessary.
I wanted to help her as much as you...
When she wanted help.
- But if she doesn't want this...
- She wants this.
Dr. Lim just told us.
Prep the cheek.
I'll tell the family.
No.
Claire, you do it.
This isn't the time for learning.
I'm sorry.
Paul died during surgery.
He had a gastroduodenal artery rupture.
It's a common complication
of a Whipple surgery,
especially when someone's cancer was...
As advanced as his was.
We... did everything we could
for as long as we could.
He didn't suffer.
You did this to him.
Dad didn't want this.
You saw that look on his face.
He was scared.
In my experience,
it does no good to dwell...
Of course he was scared.
That doesn't mean...
He just wanted to live
his last few months.
Stop it.
Nobody made your father do anything.
He knew the risks.
It's your fault, too, Mom.
All of us.
He would do anything for us.
We killed our father.
It's not true.
Paul wanted this surgery.
He told me he wanted this surgery.
Was that true?
Paul told me...
When the truth can't help someone,
we should lie.
Mom?
How are you? Does anything hurt?
Not much. I'm better.
Looks like she's doing well.
Thank you, Doctor.
There should still be some
discomfort at the surgical site.
A nurse will bring you some...
Sorry.
A nurse will bring you some Tylenol,
which should really be all you need.
Thank you.
You're gonna be great.
You're here.
Yes. I live here.
You know that.
Well, I was starting to doubt
it the last couple of days.
You come home after I'm asleep.
You leave before I can even get up.
Wow.
Thank you.
Please take this.
No, this is yours, Shaun.
I gave it to you to remember me by.
It hurt.
I didn't want to tell you the truth
because I didn't know it,
but I have to tell you the
truth because it will help.
Every night, I would come home,
and I would look at that baseball,
and I would think of you.
The baseball was here,
but you weren't.
That's sweet.
No, it isn't.
It hurt.
You hurt me.
Okay, Shaun, you know...
You went away, and it hurt,
and it kept hurting, and now you're back.
If you stay, you will go away again,
and it will hurt again.
So I want you to go back to Hershey.
I know you don't mean that, and I know...
Please go back to Hershey
or anywhere other than here!
Feeling okay?
Yeah, sure, superduper.
I want to thank you for your trust.
I'll do my best to deserve it.
Well, that's all I can ask.
You know the drill.
10...
9...
8...
7...
You're here early. Trouble sleeping?
No. Just wanted to get out
of my apartment and to work.
We work you plenty hard enough. Go home.
Making sure you're rested
is also part of the job.
I understand.
What should I tell a patient
if they don't think they're sick
but I think they have pancreatic cancer?
You think one of our patients
has pancreatic cancer?
Seventeen.
He's burped 17 times
in 10 minutes.
It's a frequent symptom
of pancreatic cancer.
Shaun, it's acid reflux.
He's also jaundiced.
No, he isn't.
Paul's skin is definitely not
the same color it was six months ago.
- Paul?
- I looked at his mouth
when he was telling me
about his daughter.
- She just...
- Walk with me.
Say nothing.
Hey, Shaun.
Do a CVC, CMP,
amylase, lipase, CA-19 levels,
and CT abdomen,
pelvis pancreatic protocol,
and do not tell him why.
You want me to lie?
I don't want you to tell the truth.
The discoloration, if there
is any, is very minor.
I don't want you scaring the crap
out of the man over nothing.
Excellent. I've been practicing lying.
I lied to you before when I said
I just wanted to get out
of my apartment and to work.
Take Claire.
Hello. I'm Dr. Lim.
How can I help you today...
Asha?
I want plastic surgery.
Sweetheart, this is the Emergency Room.
If you want, I can make
an appointment for you...
Well, you do vaginal rejuvenation, right?
Yes...
On much older, much vainer women,
generally after having many children.
I don't know what the
boys have told you...
Examine me.
Please.
Please take off your underwear.
Were you in an accident?
No.
Can you help me?
- Did your father do this to you?
- No.
- Please just...
- Did your mother...
- I need to know who did this to you.
- No, you don't!
It doesn't matter who...
When I was 2 years old...
I was... Tied down,
and I was circumcised.
Please.
I'm hideous.
Will you help me?
Yes.
Why do you need to confirm
a diagnosis of acid reflux?
Because we're doctors. It's what we do.
We just like to be sure of everything.
There are a few remote possibilities...
I've got this!
Are you familiar with
the hospital employee manual
section 17, subsection C, triple I?
- No.
- Good.
- Good?
- Yes.
It requires that all employees
shall be subject to,
and I quote,
"Any and all possible necessary tests
"to confirm any and all diagnoses,
"no matter how mundane,
the cost of which tests
"shall be borne by
the hospital," end quote.
The Board wants to make sure
that no one is exposed to patients
if there is any chance that they have
any communicable condition.
I had the flu last week.
Why didn't anybody
do anything for me then?
- It's a new policy.
- You might have pancreatic cancer.
What?
What'd he say?
Female genital mutilation
is the ritual cutting
or removal of some, or all,
of the external female genitalia.
Over 200 million victims worldwide.
It is almost universally practiced
in a number of African
and Asian countries.
Where was she born?
Wisconsin.
Yeah, it's way more common
here than you think.
- What religion is she?
- I didn't ask.
This isn't about religion.
No legit religious organization
endorses this stuff.
We're gonna do the labiaplasty
first thing in the morning.
The damage done to her nerves
is not going to get undone,
nor is the psych damage,
but at least she'll
look like other girls.
We should be able to have her out of here
by 6:00 in the evening.
Outpatient? Why the hurry?
So her mother will simply
think she's in school,
then out studying with her friends.
She loves her parents
and doesn't want to tell them
that she's rejecting one
of their cultural traditions.
They won't stay in the dark for long,
since we're legally obligated
to report them.
That "cultural tradition" also fits
- the definition of abuse.
- And they'll also find out when we ask
for their permission to do this surgery.
She's a minor.
Her ID says she's 18.
Yes, her fake ID
says she's 18.
Her number starts with an "H," which
means she was born in the '50s.
Also, the photo background
is green instead of blue.
Also six other things.
Maybe we can get Legal
to get a court order...
If I believe that ID is real,
then I am entitled
to perform this surgery
without seeking consent of
anyone other than the patient.
And, as legally required within 36 hours,
I will report the evidence of abuse
under the name and address
listed on that ID.
If the investigation of that report
doesn't begin until the girl is long gone
and happens to lead nowhere
because the name wasn't real,
that's no fault of mine.
Are you sure you want
to risk your medical license
to protect an abusive mother?
If we do this by the book,
we never see that girl again
and no one gets help.
If we do this by the book, maybe
the cops lock the parents up.
We shine a light on this thing,
her community gets scared,
and maybe the next girl
doesn't need our help.
Or maybe the testimony of the girl
about what happened to her when she was 2
doesn't help the cops at all.
Maybe the parents just
take their daughter home,
and maybe we scare the next girl
into not even asking for help.
I'm doing the surgery to this girl
under this name
tomorrow morning at 7:00 a.m.
I can't believe people ever lie.
There are so many questions
people might ask you,
but if you tell the truth,
you already know the answers.
And, also, it's wrong.
But sometimes,
you shouldn't tell the whole truth?
No. Of course not.
Because that lets you be honorable
and tell the truth and be a good person,
but at the same time,
you get to completely deceive the person.
- No, I don't think that...
- Lea came back.
Wow, Shaun, that's great.
She's staying with me
until she finds her own place.
You must be so excited.
Yes.
You're not excited?
I said, "Yes."
Paul has one year to live.
He has pancreatic cancer.
Stage III.
There are no metastatic
lesions, but there are
- local nodes involved.
- And there's partial encasement
of the superior mesenteric artery.
That puts it past the point
where we can cure with local resection.
We could do Whipple surgery.
That's not advised for
stage III pancreatic cancer.
Not quite. It's not advised for stage IV.
For stage III, it's discretionary.
In my discretion,
he's better off with
12 semi-comfortable months,
rather than running the risk of
dying on the table tomorrow.
If he doesn't die on the table,
he could have many years.
It isn't our call to make.
I'll talk to Paul,
advise him of the parameters,
let him make his own decision.
No.
Shaun should do it.
Claire can do it.
Yes, she can,
which is why you should do it.
This is a teaching hospital.
Andrews is right...
Being a surgeon isn't just about cutting.
Would it be okay
if we spoke someplace more quiet?
You need someplace quiet
to tell me I have acid reflux?
I think we should be someplace quiet
because people sometimes get very upset
when they find out
they probably only have
less than a year to live.
Okay, uh...
Can I call my family?
They should probably hear
what you have to say, too.
I'd rather just talk to...
Of course you can.
I'll elevate it with
a 6-inch Ambler tissue hook.
You separate the underlying
tissue with iris forceps.
I got it. Tenotomy scissors.
I think we're actually
a little ahead of schedule.
Might be able to get her home
in time to do her homework.
Back to the bosom of her loving family.
We'd remove as much
of the cancer as possible
by removing the head of the pancreas
and other attached organs,
but then, we'd have to
reconstruct the anatomy.
The easiest way to do that
is to bring up a loop of jejunum...
Shaun.
Sorry.
The jejunum is part
of the small intestine
between the duodenum and ileum.
It's complicated, very dangerous surgery.
And even if it's successful,
post-operative complications
are frequent and serious.
And recovery can be very painful.
But if it works, he's better?
He'll be healthy?
He would still need chemotherapy
and a lifetime of monitoring.
But hopefully, a long lifetime.
Let's do it, Dad.
What do you say?
What should I do?
It's your decision.
All we can do
is present you with the facts.
Yeah, here are the facts, Dad...
The surgery may kill you.
Not doing the surgery will kill you.
Can you give us a few minutes?
Of course.
It was very nice of Dr. Andrews
to give you an office,
even though, you're on medical leave.
Yeah, he is a prince.
Who's your surgeon going to be?
I haven't d...
I haven't decided yet.
You should definitely go with
Dr. Joshua Atkinson
at Stanford Medical Center.
His mortality index is .3.
It's too low.
Not enough of his patients are dying?
No, Shaun, sometimes patients die.
Doesn't matter how good the doctor is.
But when your mortality rate
is as low as Atkinson's,
it means you're turning away patients.
You turn away patients,
it means you lack confidence.
You lack confidence, I don't
want you inside my head.
And I'd like to be able to dress myself
when I'm all done.
Shaun, what are you doing here?
You showed up at work early this morning.
Go home. Get some rest.
I won't rest if I go home.
The surgery went great.
Once everything's healed, I think
you'll be very happy with the results.
- What time is it?
- Not quite 5:45.
We just need you to pee, and...
I need to go home.
And you will... very soon.
- It hurts.
- I told you it would.
We did a lot of cutting and scraping.
You had a lot of scar tissue.
It hurts a lot.
We'll give you some Tylenol,
and you can tell your mother
you're cramping.
Ow!
Hang ketamine... 130 micrograms
per kilogram per hour.
Why does it hurt this much?
I don't know.
But you're not going home.
Ow!
She's heavily sedated.
What did we do to her?
What if this is good news?
I know you haven't been
a doctor all that long,
but pain is rarely a sign of good news.
It is if you're talking about
a part of the body
you thought was dead.
What if this means there's still
viable nerve endings in there?
What if this means we can
actually reconstruct her clitoris
and that it's capable of sensation?
Maybe. All we know for sure
is she's not gonna be home
anywhere near 6:00,
which means we're about to have
a missing child on our hands.
We have to bring Andrews up to speed.
I did a bad job of telling you
that you're dying.
Is there a good way?
I can't figure out
when I'm supposed to lie,
when I'm supposed to tell
part of the truth.
And it doesn't really matter,
because I can't figure out
how to do it anyway.
You did fine with me.
You never need to lie.
Lies don't protect you from the truth.
I don't like your haircut.
Okay.
Maybe sometimes, when the
truth can't help someone...
...you should definitely just lie.
Do you think praying will
help you reach a decision?
I've already reached a decision.
I'm praying to help me find
comfort with that decision.
My family wants the surgery.
And what do you want?
I want what my family wants.
I love them.
But they love you, too, right?
Don't they want what you want?
Long ago, I made a decision
to be there for them
no matter what.
And if the last choice I make in my life
is consistent with that,
I'm comfortable with that.
I'm surprised by you.
I, arguably, made errors in judgment,
but it was all in an effort
to help a patient.
Yes, and that would make sense
if you thought
you'd never have
another patient ever again.
And if there wasn't currently an
opening for Chief of Surgery.
I didn't know that was on the table.
See, that's the difference
between you and Melendez.
I have no doubt that as soon
as I got this promotion,
Melendez had done the math
and reacted accordingly.
But I suspect that even
if you had done the math,
it wouldn't have changed
how you handled this patient.
I don't view that as a weakness.
I'll handle the administrative fallout.
You...
...notify the parents immediately.
I can't.
We don't know the girl's real name,
and we have to keep her sedated,
so there's no way we can track...
She's a teenager. She's got a phone.
Next time it rings, answer it.
- You feel the mesenteric artery pulsing?
- Yes.
You shouldn't.
You're too close to the vein.
Great. Dr. Browne,
pass a penrose drain through.
Bovie.
Suction.
Got it all.
I see leaking pancreatic fluid.
That'll eat holes
in everything it touches.
Our duct tie didn't hold.
Suction. Needle driver.
Excellent.
You have approved a scrub nurse
and a circulating nurse
and seven other personnel.
Everyone and everything is covered,
except for an actual surgeon.
Yeah. I think we may have to postpone.
Have you notified your tumor to
stop growing in the interim?
I think any possible damage from a delay
may be more than offset
by having somebody competent
digging around in my brain.
"Competent"?
- What's wrong with Sanders?
- 6% mortality rate.
- Taylor?
- I don't like the way he's planning on
dealing with a carotid tear.
- That's nowhere near your tumor.
- It's the principle.
- Unger?
- He doesn't like me.
- No one likes you.
- No! You don't like me.
He doesn't like me. That's two.
Just pick a name. I don't care who.
I don't care if they're a doctor.
Just pick a name.
Because in 48 hours, you're
either getting your surgery
or you're getting a new oncologist.
She's in pain.
That's why she's asleep right now,
because of what you did to her?
What I did to her
I believe revealed
that what you did to her
didn't do as much damage
as we initially feared.
We want to do a second surgery...
How can you stop her pain?
It's called clitoral reconstruction.
The nerves of her clitoris are exposed.
We can sheath them using...
Our daughter wants this?
Asha wants to be like other girls.
She wants to be able to...
Mara told you that?
That's our daughter's name.
Not Asha.
You don't know her at all.
We need to do this surgery
to relieve her pain.
No. There must be another way.
We want a second opinion.
Not at this hospital.
How soon can our daughter be moved?
Excuse me, Dr. Lim.
I am Ellen Vahtra from
Child Protective Services.
Until I complete my review,
I'm afraid you're not going to be
moving your daughter anywhere.
How did it go? Is Dad okay? No, I'm good.
There were complications,
but we found solutions.
It went very well. We got it all.
Oh, my...
There's still...
I don't think I did that well.
They're too happy.
Post-surgical complications are
still a major concern that they...
Let them enjoy the good news.
Is deceiving someone in a
way that makes them happy
better than deceiving someone
in a way that makes them sad?
Shaun. I think there's
someone here to see you.
Hey.
I had some time, so I thought
you might want to have
some lunch with me?
I do not have time.
What's wrong?
What did she do?
Shaun. Sha...
You don't want to talk to Lea.
I don't understand.
I don't understand.
I don't understand!
You're not being fair to her or yourself.
- She's always been nice to you.
- No, she hasn't.
She's your friend.
Whatever's happened, you have
to talk to her about it.
Be honest about what you're feeling...
I can't be.
- Of course you can.
- I don't know...
I don't know how I feel!
I can't be honest
if I don't know how I feel!
Our 16-year-old daughter
is lying in a hospital bed unconscious
to protect her from overwhelming pain
because of what this place did
to her without our permission.
And you are investigating us?
Your daughter is suffering
because you butchered her
when she was 2 years old.
Dr. Lim, please refrain from
unsubstantiated allegations.
Either they're the butchers or
they're protecting the butchers.
If you didn't do it, tell us who did.
It was an aunt
and a grandmother from Kenya.
They were watching Mara
while we were on vacation.
Well, you must've been horrified.
Did you take her to a doctor?
That girl's sex organs
were covered with scar tissue.
She had no medical attention
to treat any of her wounds.
She was fine.
She was happy, laughing.
It's not that big a deal.
I was cut.
My mother was cut. Her mother was cut.
It is a rite of passage connecting
our women to their ancestors.
She will not find a husband
in our culture if she's...
So she'll find someone else.
It's not that big a deal.
These parents forfeited
the right to make any calls
about their daughter a long time ago.
Our daughter is an honor student,
taking three AP classes
in her junior year,
went on a mission to Haiti
to build a school.
We have raised her well.
She is a good person.
We're proud of her.
I'm sure she is a good person.
But you are not gonna convince me
that what happened to Mara
when she was 2 years old
is anything short of an abomination.
But that's not the issue today.
The issue is, how do we
best help this girl now?
The clitoral reconstruction
should protect the exposed nerve.
"Should"?
That is the surgery that,
in my medical opinion,
is called for.
But it's not the only option?
We could oblate the peripheral nerves
and remove the remaining clitoral tissue.
And is that surgery safer
or more dangerous?
It's simpler, but that's not
the only factor here.
It's the only factor to us.
We want to know that our daughter
won't spend the rest of her life in pain.
Please.
For a moment,
can we think about something
other than Mara's pain?
Can we think about her pleasure?
We have a chance to give her
a healthy, meaningful sex life.
That is what she came here looking for.
Wake her up.
She's in pain, and she's already
told me what she wanted.
Yesterday, she was requesting
cosmetic surgery.
Today, you're asking her
to risk a lifetime of pain
for a chance at pleasure.
From everything I've heard,
she's mature enough
to make the call herself,
even if it means suffering
for a few minutes to do so.
Dr. Unger has a mortality index
that is not too high and not too low.
It's not gonna be Unger.
You have not eliminated Dr. Ko.
Not yet.
I may have to go out of state
to find a neurosurgeon.
Plus, I may have to find
myself a new oncologist.
You've used Dr. Ko many times.
Did you think
she might kill your patients?
No.
Do you think you're better than them?
Yes, a little.
That was a joke.
You don't want to talk about this.
No, I don't want
to talk about this, Shaun.
That, in fact, is the point
of the alcohol.
Okay, I understand.
Good.
Why can't we talk about it?
Because it's upsetting.
Is that why you're stalling?
Because you're afraid of dying?
I'm not afraid of dying.
Really?
Why not?
You should be. Dying is terrible.
Yes, dying is terrible.
But there are worse things.
What's worse than dying?
Not dying.
That doesn't make sense.
Makes sense to me.
That doesn't make sense.
That's the middle ground, Shaun.
Brain surgeries have a tendency
to end in the middle ground.
Brain surgeries can be
considered a success
even when the patient
ends up compromised.
He can't walk. He can't talk.
His hand can't stop shaking.
I've been terrible
at a lot of things in my life,
but I am damn smart.
And I am a damn good surgeon.
And if I can't be those things,
then I don't know who I'd be.
You'd be my friend.
Well, thank you, Shaun.
I have to go. My patient just crashed.
It's not enough. Is it?
No.
I'm sorry it isn't.
Mom. Dad.
We're here.
We love you.
We just don't understand
why you would turn your back.
Uh...
Hello, Mara.
I'm Ellen Vahtra. I'm a social worker.
Your parents know what happened,
and Dr. Lim gave you a nerve block.
It hurts. It still hurts.
I understand that, and we are
going to try to get you
back to sleep as quickly as possible.
But something happened during
your surgery, and we need you
to make a decision
about what is done next.
We believe that, despite what
was done to you as a child,
the reason you're in so much
pain because you still have
functioning nerves in your clitoris,
nerves that had been covered
with scar tissue.
I'd like to repair that.
We can make you physiologically complete.
But there's no guarantee
that it would work.
I'm confident.
There is a safer choice.
We could... remove your entire clitoris.
This is your choice.
You will be protected no matter what.
Take it out.
Mara, we can make you whole...
I made a mistake. Take it out.
She's on medication. She's in pain...
Dr. Lim, please let her go back to sleep.
And prepare to operate
to remove the damaged tissue.
Hang fresh, frozen plasma, too.
Looks like he's going into DIC.
Give me another hemostat.
BP's 71 over 53.
We should have warned the family.
Can't see anything in here.
There's too much blood.
- More suction.
- I think you got the hepatic artery.
The warning wouldn't
have made any difference.
The bleeding is not slowing down.
We need to send the aorta to the celiac.
- I need to see it to clamp it.
- They would have been prepared.
A-line systolic's 54. He's bottoming out.
No, they wouldn't.
You two, shut up and
pack his abdomen with laps
while I sort through this mess.
I won't do it.
Can we appeal this? Do you know?
I've spoken with our legal department.
Unless we can prove
the social worker was biased,
we are stuck with this ruling.
Well, then you're also
stuck with "I won't do it."
You're a good doctor.
This hospital will miss you.
You're gonna fire me because I
won't butcher a teenage girl?
Of course I am.
This hospital will face
lawsuits, suspensions,
perhaps criminal charges,
and this little girl will still
get the surgery you hate.
Could Dr. Lim at least
talk to Mara again?
You want to wake her up again in pain?
Every woman deserves the right
to make decisions about her sexuality
without her parents hanging over her.
Okay.
When I was 15 years old,
my father caught me with a boy.
I mean, we weren't doing it,
but my top was off and
Well, it doesn't matter.
My father hit me.
I still have a small scar.
Our relationship was never the same.
But that's what growing up is.
Not everyone gets called a slut.
Not everyone gets butchered.
But everyone becomes a man or a woman
and stops being a child.
I want to take a piece of
tissue from inside your cheek
and I want to graft it to your clitoris.
We can make you feel... love.
I can't turn my back on my
family, on my traditions.
Traditions
connect us to the past.
What about the future?
Please.
No. I'm in pain.
Cross-clamping his aorta.
He's in ventricular fibrillation.
Starting chest compressions.
Okay. Everybody clear.
Prep the cheek, as well.
She's taking the graft?
The paperwork doesn't say...
She consented verbally.
We didn't want to keep her
awake any longer
than absolutely necessary.
I wanted to help her as much as you...
When she wanted help.
- But if she doesn't want this...
- She wants this.
Dr. Lim just told us.
Prep the cheek.
I'll tell the family.
No.
Claire, you do it.
This isn't the time for learning.
I'm sorry.
Paul died during surgery.
He had a gastroduodenal artery rupture.
It's a common complication
of a Whipple surgery,
especially when someone's cancer was...
As advanced as his was.
We... did everything we could
for as long as we could.
He didn't suffer.
You did this to him.
Dad didn't want this.
You saw that look on his face.
He was scared.
In my experience,
it does no good to dwell...
Of course he was scared.
That doesn't mean...
He just wanted to live
his last few months.
Stop it.
Nobody made your father do anything.
He knew the risks.
It's your fault, too, Mom.
All of us.
He would do anything for us.
We killed our father.
It's not true.
Paul wanted this surgery.
He told me he wanted this surgery.
Was that true?
Paul told me...
When the truth can't help someone,
we should lie.
Mom?
How are you? Does anything hurt?
Not much. I'm better.
Looks like she's doing well.
Thank you, Doctor.
There should still be some
discomfort at the surgical site.
A nurse will bring you some...
Sorry.
A nurse will bring you some Tylenol,
which should really be all you need.
Thank you.
You're gonna be great.
You're here.
Yes. I live here.
You know that.
Well, I was starting to doubt
it the last couple of days.
You come home after I'm asleep.
You leave before I can even get up.
Wow.
Thank you.
Please take this.
No, this is yours, Shaun.
I gave it to you to remember me by.
It hurt.
I didn't want to tell you the truth
because I didn't know it,
but I have to tell you the
truth because it will help.
Every night, I would come home,
and I would look at that baseball,
and I would think of you.
The baseball was here,
but you weren't.
That's sweet.
No, it isn't.
It hurt.
You hurt me.
Okay, Shaun, you know...
You went away, and it hurt,
and it kept hurting, and now you're back.
If you stay, you will go away again,
and it will hurt again.
So I want you to go back to Hershey.
I know you don't mean that, and I know...
Please go back to Hershey
or anywhere other than here!
Feeling okay?
Yeah, sure, superduper.
I want to thank you for your trust.
I'll do my best to deserve it.
Well, that's all I can ask.
You know the drill.
10...
9...
8...
7...