The Good Doctor (2017–…): Season 3, Episode 1 - Disaster - full transcript
Shaun feels his first date with Carly is a disaster. A new bride's life is endangered when Shaun proposes a radical surgery. Dr. Morgan and Dr. Park compete for the chance to lead the operation on an elderly patient.
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Previously on The Good Doctor:
You work together
and you're sleeping together.
You don't see any way
that can go wrong?
You went out on a limb for me.
Fire me now, you'll look like a fool.
Doctor Andrews,
you don't have the votes to carry it.
I don't need the votes.
Just as you have
the power to fire someone,
- so do I.
- Hear about Han?
Can't imagine Andrews will survive.
They're gonna need
a new chief of surgery.
Aoki should be calling you any minute.
Here are flowers and chocolates.
- Are you asking me out?
- Yes.
I would love to.
Why are you smiling?
I don't know.
I just...
I wanted you to know that...
things are okay.
Good.
I saw a movie last weekend.
Which one?
What kind of movies do you like?
Oh. This looks delicious. Thank you.
- I said, no pickles.
- Pardon me?
- It's okay, they can just...
- I said, no pickles.
- I am so sorry.
- I said, no pickles!
It was a disaster.
What happened?
Don't you all have work to do?
- Sorry, we...
- Shaun was on a date.
- Mm.
- Congratulations.
You're our first female chief of surgery.
That's nice... Thank you, yes.
And you're still not working.
Not you.
We need to go to HR and break up.
We need a head CT and a trauma panel.
Please! Help my wife!
We've been married for 45 years.
- Two children.
- So far.
- Oh! Stop it!
- Ricky and Tammy.
Ricky's got two kids of his own.
When did you first notice the pain?
- This morning.
- Saturday.
He has a history of kidney stones.
- I try to get him to drink water...
- You try? When did I ever say no to you?
Probably another stone,
but we'll rule out anything more serious.
Thank you.
Did you tell them about the kids?
We have two, you know.
So far.
That's nice.
- Not it.
- What?
He's got dementia, it's boring.
Probably stones. Best-case scenario,
kidney tumor.
We've assisted on eight nephrectomies.
Your case, your chart, you're primary.
Kellan's coming,
I need to be out of here,
and we are not children,
we don't decide things by who called it.
- You touched the chart first. Did so.
- Did not.
We walked up together,
Petringa handed the chart to you.
- Did not.
- Did so.
- Did not.
- Did so.
Why?
It just wasn't working out.
Oh. Well, I hope it's not because of
Doctor Lim's promotion to
chief of surgery,
that she's your supervisor?
We knew that arrangement
would be unacceptable,
and since we only recently started...
You were seeing each other secretly
before you reported it, correct?
So maybe you've just gone back
to seeing each other in secret?
No. We made the decision that this
opportunity for Doctor Lim is just...
What are you writing?
I have accepted your explanation
and report.
- Thank you.
- But I don't believe it.
You're going to keep seeing each other,
and I can't do anything to stop that,
nor do I want to.
But know this,
love doesn't conquer all,
lust doesn't either,
and like doesn't even come close.
This is gonna be more
complicated than you think.
Looks like you have a large
uterine fibroid that's bled.
It has to be removed surgically.
Yes, routine surgery. You should be fine.
Uterine? Am I gonna be able to have...
The surgery won't affect
your ability to have children.
I didn't let her finish,
because I anticipated
what she was going to ask,
because the uterus
has very few functions.
Nicely done.
To improve OR access,
we're going to automatic block release
and implement staggered starts
for anesthesia. Questions?
Doctor Andrews and Han
wouldn't authorize staff overtime.
- Now, our nurses...
- Good point, thank you.
Yes, authorized.
One other thing, and this is for
third-years, but affects all of you.
Traditionally, you don't lead surgeries
until fourth year. That will be changing.
The earlier you take responsibility,
the more you learn.
When the right surgery comes along,
something simple, basic,
it'll be yours. Start prepping.
Maybe I did touch the chart first.
Relax, it's okay. I can stay late
now and again, this is my job.
Stop it.
You don't want the case, it's boring,
I get it.
I know you get it.
Boring is now exciting.
Boring means it's a routine surgery,
which means it's a surgery
Lim just said one of us may lead.
This is probably no surgery at all.
Just kidney stones with
a man with dementia.
I'll take that chance.
- You hate people.
- People don't know that.
People like me.
You need to be with your family.
- Kellan barely talks to me...
- It's who touched the chart first, me.
- And as you said...
- Excuse me?
- Yes, Harvey. Is everything okay?
- Why am I in here?
Nothing to worry about.
Likely a kidney stone,
- you just have to...
- Yes! It's cancer.
Nicely isolated, simple surgery.
Perfect for a resident.
Traction on the uterus
to expose the ligament.
I'll slide the pelvic retractor
under the fundus.
Did wine spill all over you?
- Did it spill all over Carly?
- Stop!
Look above the posterior cul-de-sac.
- Cancer.
- Yes.
Very extensive, I think.
It appears to have metastasized
everywhere.
Liver, kidney, abdominal wall.
Close her up.
I rang the doorbell.
Yes, you did.
Are you gonna spend the rest of your life
in this backyard?
That and lying next to my future wife.
Congratulations. I heard.
What are you going to do professionally?
When people think they're going to die,
like you did,
they assess their life,
reevaluate what's important.
You need to make a difference.
- You have a puppy for me to adopt?
- I have a vacancy at president.
Again?
You're interested.
But you think things have to change,
they don't.
You led a meaningful life before cancer,
and you'll lead a meaningful life after.
Well, thank you. I'm very inspired.
Think about it.
Also, sunscreen.
What's going on behind the pancreas at
the root of the
superior mesenteric artery?
- We need a better angle.
- We're not gonna get one.
Not when we're actually operating.
So, what's the solution?
There isn't one, not surgically.
We should refer them to an oncologist.
Chemo might help, but I'm not hopeful.
What are you gonna tell them?
You guys are third year.
You want to learn by doing?
How about sympathetic communication?
Shaun,
let the bride know she's dying.
This morning,
who'd you give the Calderon chart to?
- You guys.
- You handed it to one of us.
One of us actually took it. Me, right?
- What does it matter?
You just came up and...
From the right.
I came up on Morgan's left,
you're left-handed?
- It makes sense I would be closer...
- Excuse me?
Any news about my husband?
Harvey,
you remember
Doctors Park and Reznick?
They did your scan.
- Right...
- They were looking for kidney stones.
Unfortunately, we found some cancer.
It's on your left kidney.
- Cancer?
- The good news is,
it's isolated
and in a very operable location.
Cancer? I have cancer?
- We have to tell the children.
- We'll do a biopsy,
but I'm confident we caught it early.
This is terrible. I can't die, I...
You need me.
I know.
With surgery, radiation and
immunotherapy, prognosis is excellent.
- You're supposed to talk to our patient.
- They can wait until we're sure.
We are sure. Doctor Melendez is sure.
Doctor Lim told us
we're ready for more responsibility,
so I can make a decision on my own.
I decided to do more research.
Shaun, you need to learn to do this,
and stalling makes it worse.
I think maybe
you're feeling bad about your date,
and you're in here burying yourself
in things you subconsciously think
you can control.
How do people know what's going on
in their subconscious?
What happened, Shaun?
When you jumped up?
Your phone is...
ringing.
It can wait.
- It's your mother.
- It can wait.
What went wrong?
What was the disaster?
She called earlier, too.
If stalling is bad,
then why are you avoiding
your mother's calls?
Did you ever forgive your mother
for not protecting you?
Is that what your mother
wants to know?
My mother was terrible.
It wasn't all her fault, she was bipolar.
That doesn't change the fact
that she was terrible.
I... I don't think
it's good for her to be in my life.
Are you looking for guidance?
From me?
Am I a role model to you?
On some issues, absolutely.
I don't usually think about the past.
It doesn't help.
- But the date?
- Mm.
Yesterday is part of the past,
and the past matters.
What happened?
I... told a joke.
- No.
- Yes. Lea said I should.
No! That is not what I said.
- Does this tie look good?
- Yes, but not with those pants.
And what I was saying was
jokes are the types of things
people do on dates.
They talk about the weather, hobbies,
where they went to college...
I'm a person. Should I change
my pants with you in the room?
No. And yes, I know you're a person,
but we have strengths and weaknesses.
Telling jokes is easy.
There are books full of them.
I said, no.
Yes, there are a lot of jokes,
but you have to know how to tell them,
you have to know when to tell them.
So I took a gap year before college,
which I think might have been a mistake.
Staying at home...
My relationship with my dad...
Caesar walked into a bar and asked
the bartender for a martinus.
The bartender said,
"Do you mean a martini?"
And Caesar says, "If I wanted two,
I would have ordered two."
Did she laugh?
- I'm not sure.
- What did she say?
She made a sound.
A chuckle, I think. That's good.
No, it's not. I read six joke books,
and all I got was a "ha-ha."
- It was a disaster.
- Because of a joke?
Something bigger
must have gone wrong.
What happened?
A young woman may be dying.
I have a lot of research to do.
- Boom. My chart, my case, my surgery.
- You took it from me.
It touched my fingers, and you took it.
I'm the one holding the chart.
That's evidence we've got.
- If you could prove...
- Angles? We need more angles.
How many cameras do we have?
Doctor Lim, I'm glad you made
that decision on the overtime.
- You're welcome.
- But you'd want to know
the real issue isn't overtime,
it's being understaffed.
We need two more nurses
on this floor, one in ICU...
I'm sorry. I'm sure you're right,
but we just don't have the budget.
- Excuse me?
- Nothing, ma'am.
- I gave you OT, you're not being fair.
- Aren't I?
You told me I was right, then told me
you're not gonna do it.
Who's being unfair?
Nobody said this job...
Shaun.
Come with me.
Is everything okay? The nurse told us
you didn't finish the surgery...
Suzanne...
you have very extensive cancer
throughout your abdomen.
It appears to be malignant.
And it appears to have metastasized
around every organ.
But there's hope with surgery.
We can't see the retrohepatic part
of the cancer because of the liver.
We can't see the retroperitoneal part
because of the kidney.
Yes, I know. That's why we
should take out the organs.
You wanna remove her liver
and right kidney?
Yes, and also her left kidney,
and her pancreas,
and the intestinal tract,
and the stomach.
- Several of those organs are essential.
- We'll put them back.
We remove them, clean up
the cancer, then put them back.
- Ex vivo surgery.
- It's been done for pancreatic cancer.
- Without much success.
- No.
Think it'd work better here?
Not really, but the alternative is death.
- Hi.
- Hi. How are you?
Good.
Not working?
Yeah. It's been 72 hours
and I still haven't found a job.
Relax, I'll be fine. I got some irons
in the fire. What do you need?
How do you say no to a person?
I'm not doing it right.
Okay. Watch closely.
Really?
If you're gonna give up that easily,
quit now.
The biopsy confirmed the cancer
is a renal cell carcinoma.
Cancer? I have cancer?
Yes.
Why didn't you tell me?
We did.
The good news is
it's treatable with surgery,
immunotherapy, and radiation.
- We have to tell the children.
- They know.
How do they know?
What's going on?
Am I dying?
- The cancer is serious, but...
- Ruby,
we'd like to talk outside.
I'll be right back.
The problem isn't how you said no,
the problem is how you said yes.
- She seemed happy with the yes.
- It came too quickly.
You made her think she was helping
instead of the other way around,
so she asked for more,
feeling she was entitled.
So I should have said no
when I wanted to say yes?
You shouldn't tell her what you want,
tell her what she needs to hear.
It's your job to figure out
what you can give them,
convince them that's what they need,
and then make them feel they owe you.
None of that sounds like me.
And you wanna do the job your way
without changing?
Is that amusing to you? Yes, I do.
Yesterday you were an attending,
today you're chief.
You are a different person.
Want an espresso?
Without surgery, your husband would
probably live another two to five years.
He would have little discomfort,
until close to the end,
and that can be managed.
- You said it was treatable.
- It is, but fighting cancer is never easy.
We have to weigh the benefits
against the suffering.
And the surgery itself is...
usually the easiest part.
- He's strong, he's healthy!
- He's not healthy, not mentally.
And the burden on you...
I am not letting my husband die
because caring for him is inconvenient,
because I'm gonna have
to repeat a conversation.
Just go to hell.
This surgery has never been
done for this condition.
We'd be dealing with
every one of your abdominal organs,
and something could go wrong
with any of them.
You could be on dialysis
for the rest of your life.
You could have a very
compromised digestive tract,
lifelong diabetes,
you could have liver failure.
- That's not a complete list.
- You could die.
And, uh... if we don't do the surgery?
Chemotherapy and radiation,
although the likelihood of success
is slim. About 25 percent.
You may prefer hospice care.
You'd probably live maybe a year,
but it'd be a good year.
Could you give us time to think about it?
Of course.
We're supposed to be at lunch.
- We're gonna be late.
- Why?
Why?
Because I need meaning in my life.
Your heart seems fine,
liver seems to be in the right place.
You're a brain surgeon.
You don't think you can get meaning
being a brain surgeon?
This is a boring patient
with boring symptoms.
Shaun, meet Marco Higgins,
he's a mechanic in between jobs.
Three sons, two of whom he hasn't
spoken to in quite some time,
but he's working on that. Open.
Wide.
It's good to get to know people,
Shaun, it makes you a better doctor.
- Say, "Aah."
- Aah.
You have boring symptoms,
that's a good thing.
You do not want exciting symptoms.
You had a date last night,
didn't you?
- Mm.
- I wanna hear about this.
Marco, you wanna hear about this?
- Yes, please.
- Yes, please.
Open.
It was a disaster.
- Thank you, but it's not...
- No, it's polite and chivalrous.
Even though chivalry
is a problematic notion,
- politeness is a good thing no matter...
- Shaun!
Are you okay?
- Oh, my.
- I'm okay.
She might not be okay.
- No, I am okay.
- Okay, don't get up.
I'm pretty sure she's okay.
Take off his...
Boots.
What?
Do you think Marco's diabetic?
Based on the color of his skin
in the crease of his neck, I do.
Based on his chart, I do too.
He could have an infection in his feet
and the pain is masked
by diabetic neuropathy.
That infection could be causing
the abdominal symptoms.
Marco, mind taking off your boots?
I was wrong, it's not boring.
I can do it myself.
I'm sure,
but our job here
is to help each other, and...
today, I didn't do that.
I'm trying to make up for that
with a jar of pickles.
I overstepped and...
undercut you
in front of the patient's wife.
I accept your apology.
What I should have done...
was privately tell you
you're wrong.
- Give me the jar.
- And let you, as lead,
tell them that this
surgery's a bad idea.
Because we should let a 70-year-old man
die of a treatable condition?
Because we shouldn't condemn
a man to years of confusion and fear.
His life still has value.
Seriously?
He has memory issues,
he's not a vegetable.
He's funny, he's charming,
they've lived a life together.
He brings happiness to his wife,
to his children.
- He's happy.
- Exactly.
Let him stay happy
for whatever time he has left.
Nurse Petringa?
- I'm sorry if I overstepped.
- I didn't track you down for an apology.
You're gonna get additional staff?
No.
If I get you additional staff,
you lose hours, overtime.
So you're doing us a favor
by making sure
we never see our families?
Your problem isn't the staff,
your problem is the actual work.
The crap part of work that takes
too long and too many of you.
I authorized purchase
of two Hoyer patient lifts
and a mechatronic ICU bed.
A smart bed?
- Ha. Those are supposed to be fun.
- Gotta promise to let me try it.
You got it.
Doctor Lim?
Thank you.
You owe me.
I'm well aware
of what he'll be going through.
My sister had cancer.
The chemo, the radiation...
They beat the crap out of her,
didn't they?
Yeah.
Now imagine going through that
and not understanding, every day.
The throwing up
and not knowing why.
Losing your hair and not knowing why.
Learning he has cancer,
and being devastated by it,
day after day.
- But at the end...
- There are no guarantees.
He's old
and his body's breaking down.
His mind is breaking down...
and it's gonna end,
no matter what we do.
In 45 years, I have never once lied to him.
When memory goes,
all that's left is emotion.
What we've learned doesn't matter,
what we had for lunch,
where we went for vacation,
none of it matters.
But how we feel...
who we're close to...
He's the same man I've always loved.
The same sense of humor,
same everything.
He hasn't changed.
And what I owe him...
hasn't changed.
- Have you decided?
- Not yet.
Take your time,
there is no urgency...
What are you waiting for?
Doctor Murphy, they are facing
an impossible choice.
But they have to make it.
What additional information
are you waiting for?
- Shaun...
- I'll be a better doctor
- if I understand the patient.
- True, but right now,
- your skills are secondary...
- Are you debating whether
you should find somebody else
to fall in love with?
- Someone healthy?
- No. No, of course not.
You should be.
We're kids.
You shouldn't have to spend the rest
of your life taking care of an invalid.
You think that's the issue?
Me? A burden on me?
- This is so much easier on me than you.
- No, it's not.
Whatever happens to me
is gonna happen...
and I have to live with it.
You...
You have a choice.
In sickness and in health.
That was the commitment I made...
this morning.
Now, if this had
happened yesterday...
So it's not that difficult
a decision, then, right?
I guess not.
I can feel her humeral head
outside the glenoid fossa.
It's an anterior dislocation.
I can reduce that.
- Here?
- Yes, with traction and external rotation.
Oh. Oh.
Oh, my, that feels better.
- I bumped you.
- No, don't worry.
It happens.
I wasn't watching either.
Come on.
That's it?
You bumped into
a very understanding woman,
you amazingly caught
a bottle of wine...
Where was the disaster?
Unclamp the superior mesenteric
to perfuse the organs.
The small intestines
look dusky and cyanotic.
We need to resect
all the necrotic segments.
Claire, find the first viable part
of the ilium and clamp proximal to it.
I don't think your
irons in the fire are very hot.
Any job interviews you get,
you're gonna spend
a large chunk of time trying to explain
why you lasted less than a year
as president at Saint Bonaventure.
I mean, how do you put a positive spin
on why you spent a fortune
on a chief of surgery
you fired weeks later
to protect a second-year resident?
- You think I made a mistake?
- No, I think you did the right thing.
I admire you.
Which is why I wanna do you a favor.
You need to prove
you haven't burned bridges.
Which means you have to come back
to work at Saint Bonaventure.
As what?
As a surgeon, working for you?
And the fact that you're in need
of a surgical attending
to replace yourself is a coincidence?
It's what you need.
I admire the effort...
but don't con a conman.
Your greatest strength
and greatest weakness
as a leader was your stubbornness.
Don't let it be a weakness today.
My back hurts, on the left side.
That's where you had your biopsy.
It's gonna hurt.
What biopsy?
Harvey, you came in because
you thought you had kidney stones.
We did some imaging
and you don't...
What is it? What... what's wrong?
What's going on, Ruby?
Why isn't anybody saying anything?
Am I dying?
Ruby?
I... I can't die,
I need to take care of you.
I can't...
They didn't find stones.
Everything is okay.
The pain will go away.
We're gonna go home tonight.
- Okay? Okay.
- Mm-hm.
I had a nice time.
That's it?
- It's over?
- Where's the disaster?
I've listened to an hour of this,
I was promised a disaster.
Where's the disaster?
It was exhausting.
Everything was always out of control.
Anything could happen at any time.
Anything did.
There was too much to remember to do,
too much to remember not to do,
and none of it made sense.
It was hard,
uncomfortable, unpleasant.
I spent the whole evening
doing unnatural things
to make her happy,
and I have no idea if she was happy,
and I know I wasn't happy!
It was all a disaster.
I want you to meet our new attending,
Doctor Marcus Andrews.
Pleasure to meet you.
How long have you been working here?
- Ms. McDougal?
- She didn't ask for ID.
It's policy.
We take a lot of immigrants here.
She also didn't look at me.
Check the symptom I told her I had.
"Cut over the left eye."
You heal very nicely, Ms. McDougal.
You hate it here.
Hate is a strong word.
What would you do differently?
Give me five things.
Diabetes clinical educator,
on-site lab and X-ray,
mental health advisor, multidisciplinary
care team, electronic medical records.
We had the clinic at the hospital,
and had to shut it down
because it was a money pit.
Come back as president,
and we'll reopen it.
Your office can be in the clinic.
Do I have to wear a tie?
Hey.
Welcome back.
- Am I okay?
- The surgery went very well.
We're confident
that we got all of the cancer.
There's a bag by her side.
- Is that just to drain stuff post-surgery?
- There were complications.
We had to remove
a large portion of your bowel
and divert the waste
through a stoma in your skin.
That's an ileostomy bag.
How long will I have that?
Forever.
So I have to go to the bathroom
in this thing for the rest of my life?
Yes.
We'll teach you how to change it,
how to dispose of it.
They'll teach both of us.
You know,
this is why we do it, Shaun.
Every date is a disaster,
every relationship is out of control.
But if you stick with it,
you wind up with someone
in your life
who will help you
when you need to be helped,
love you when you do not feel lovable,
be with you no matter what.
It's not worth it.
Hi, Mom.
My son's coming to town.
Think I'll pick him up at the airport.
♪ And when I see ♪
♪ And if I walk ♪
♪ And when I run away ♪
Hi, Grandpa.
♪ And when I run away ♪
♪ Hold me in your arms ♪
♪ Don't let go ♪
♪ Don't let go ♪
♪ And when I see ♪♪
---
Previously on The Good Doctor:
You work together
and you're sleeping together.
You don't see any way
that can go wrong?
You went out on a limb for me.
Fire me now, you'll look like a fool.
Doctor Andrews,
you don't have the votes to carry it.
I don't need the votes.
Just as you have
the power to fire someone,
- so do I.
- Hear about Han?
Can't imagine Andrews will survive.
They're gonna need
a new chief of surgery.
Aoki should be calling you any minute.
Here are flowers and chocolates.
- Are you asking me out?
- Yes.
I would love to.
Why are you smiling?
I don't know.
I just...
I wanted you to know that...
things are okay.
Good.
I saw a movie last weekend.
Which one?
What kind of movies do you like?
Oh. This looks delicious. Thank you.
- I said, no pickles.
- Pardon me?
- It's okay, they can just...
- I said, no pickles.
- I am so sorry.
- I said, no pickles!
It was a disaster.
What happened?
Don't you all have work to do?
- Sorry, we...
- Shaun was on a date.
- Mm.
- Congratulations.
You're our first female chief of surgery.
That's nice... Thank you, yes.
And you're still not working.
Not you.
We need to go to HR and break up.
We need a head CT and a trauma panel.
Please! Help my wife!
We've been married for 45 years.
- Two children.
- So far.
- Oh! Stop it!
- Ricky and Tammy.
Ricky's got two kids of his own.
When did you first notice the pain?
- This morning.
- Saturday.
He has a history of kidney stones.
- I try to get him to drink water...
- You try? When did I ever say no to you?
Probably another stone,
but we'll rule out anything more serious.
Thank you.
Did you tell them about the kids?
We have two, you know.
So far.
That's nice.
- Not it.
- What?
He's got dementia, it's boring.
Probably stones. Best-case scenario,
kidney tumor.
We've assisted on eight nephrectomies.
Your case, your chart, you're primary.
Kellan's coming,
I need to be out of here,
and we are not children,
we don't decide things by who called it.
- You touched the chart first. Did so.
- Did not.
We walked up together,
Petringa handed the chart to you.
- Did not.
- Did so.
- Did not.
- Did so.
Why?
It just wasn't working out.
Oh. Well, I hope it's not because of
Doctor Lim's promotion to
chief of surgery,
that she's your supervisor?
We knew that arrangement
would be unacceptable,
and since we only recently started...
You were seeing each other secretly
before you reported it, correct?
So maybe you've just gone back
to seeing each other in secret?
No. We made the decision that this
opportunity for Doctor Lim is just...
What are you writing?
I have accepted your explanation
and report.
- Thank you.
- But I don't believe it.
You're going to keep seeing each other,
and I can't do anything to stop that,
nor do I want to.
But know this,
love doesn't conquer all,
lust doesn't either,
and like doesn't even come close.
This is gonna be more
complicated than you think.
Looks like you have a large
uterine fibroid that's bled.
It has to be removed surgically.
Yes, routine surgery. You should be fine.
Uterine? Am I gonna be able to have...
The surgery won't affect
your ability to have children.
I didn't let her finish,
because I anticipated
what she was going to ask,
because the uterus
has very few functions.
Nicely done.
To improve OR access,
we're going to automatic block release
and implement staggered starts
for anesthesia. Questions?
Doctor Andrews and Han
wouldn't authorize staff overtime.
- Now, our nurses...
- Good point, thank you.
Yes, authorized.
One other thing, and this is for
third-years, but affects all of you.
Traditionally, you don't lead surgeries
until fourth year. That will be changing.
The earlier you take responsibility,
the more you learn.
When the right surgery comes along,
something simple, basic,
it'll be yours. Start prepping.
Maybe I did touch the chart first.
Relax, it's okay. I can stay late
now and again, this is my job.
Stop it.
You don't want the case, it's boring,
I get it.
I know you get it.
Boring is now exciting.
Boring means it's a routine surgery,
which means it's a surgery
Lim just said one of us may lead.
This is probably no surgery at all.
Just kidney stones with
a man with dementia.
I'll take that chance.
- You hate people.
- People don't know that.
People like me.
You need to be with your family.
- Kellan barely talks to me...
- It's who touched the chart first, me.
- And as you said...
- Excuse me?
- Yes, Harvey. Is everything okay?
- Why am I in here?
Nothing to worry about.
Likely a kidney stone,
- you just have to...
- Yes! It's cancer.
Nicely isolated, simple surgery.
Perfect for a resident.
Traction on the uterus
to expose the ligament.
I'll slide the pelvic retractor
under the fundus.
Did wine spill all over you?
- Did it spill all over Carly?
- Stop!
Look above the posterior cul-de-sac.
- Cancer.
- Yes.
Very extensive, I think.
It appears to have metastasized
everywhere.
Liver, kidney, abdominal wall.
Close her up.
I rang the doorbell.
Yes, you did.
Are you gonna spend the rest of your life
in this backyard?
That and lying next to my future wife.
Congratulations. I heard.
What are you going to do professionally?
When people think they're going to die,
like you did,
they assess their life,
reevaluate what's important.
You need to make a difference.
- You have a puppy for me to adopt?
- I have a vacancy at president.
Again?
You're interested.
But you think things have to change,
they don't.
You led a meaningful life before cancer,
and you'll lead a meaningful life after.
Well, thank you. I'm very inspired.
Think about it.
Also, sunscreen.
What's going on behind the pancreas at
the root of the
superior mesenteric artery?
- We need a better angle.
- We're not gonna get one.
Not when we're actually operating.
So, what's the solution?
There isn't one, not surgically.
We should refer them to an oncologist.
Chemo might help, but I'm not hopeful.
What are you gonna tell them?
You guys are third year.
You want to learn by doing?
How about sympathetic communication?
Shaun,
let the bride know she's dying.
This morning,
who'd you give the Calderon chart to?
- You guys.
- You handed it to one of us.
One of us actually took it. Me, right?
- What does it matter?
You just came up and...
From the right.
I came up on Morgan's left,
you're left-handed?
- It makes sense I would be closer...
- Excuse me?
Any news about my husband?
Harvey,
you remember
Doctors Park and Reznick?
They did your scan.
- Right...
- They were looking for kidney stones.
Unfortunately, we found some cancer.
It's on your left kidney.
- Cancer?
- The good news is,
it's isolated
and in a very operable location.
Cancer? I have cancer?
- We have to tell the children.
- We'll do a biopsy,
but I'm confident we caught it early.
This is terrible. I can't die, I...
You need me.
I know.
With surgery, radiation and
immunotherapy, prognosis is excellent.
- You're supposed to talk to our patient.
- They can wait until we're sure.
We are sure. Doctor Melendez is sure.
Doctor Lim told us
we're ready for more responsibility,
so I can make a decision on my own.
I decided to do more research.
Shaun, you need to learn to do this,
and stalling makes it worse.
I think maybe
you're feeling bad about your date,
and you're in here burying yourself
in things you subconsciously think
you can control.
How do people know what's going on
in their subconscious?
What happened, Shaun?
When you jumped up?
Your phone is...
ringing.
It can wait.
- It's your mother.
- It can wait.
What went wrong?
What was the disaster?
She called earlier, too.
If stalling is bad,
then why are you avoiding
your mother's calls?
Did you ever forgive your mother
for not protecting you?
Is that what your mother
wants to know?
My mother was terrible.
It wasn't all her fault, she was bipolar.
That doesn't change the fact
that she was terrible.
I... I don't think
it's good for her to be in my life.
Are you looking for guidance?
From me?
Am I a role model to you?
On some issues, absolutely.
I don't usually think about the past.
It doesn't help.
- But the date?
- Mm.
Yesterday is part of the past,
and the past matters.
What happened?
I... told a joke.
- No.
- Yes. Lea said I should.
No! That is not what I said.
- Does this tie look good?
- Yes, but not with those pants.
And what I was saying was
jokes are the types of things
people do on dates.
They talk about the weather, hobbies,
where they went to college...
I'm a person. Should I change
my pants with you in the room?
No. And yes, I know you're a person,
but we have strengths and weaknesses.
Telling jokes is easy.
There are books full of them.
I said, no.
Yes, there are a lot of jokes,
but you have to know how to tell them,
you have to know when to tell them.
So I took a gap year before college,
which I think might have been a mistake.
Staying at home...
My relationship with my dad...
Caesar walked into a bar and asked
the bartender for a martinus.
The bartender said,
"Do you mean a martini?"
And Caesar says, "If I wanted two,
I would have ordered two."
Did she laugh?
- I'm not sure.
- What did she say?
She made a sound.
A chuckle, I think. That's good.
No, it's not. I read six joke books,
and all I got was a "ha-ha."
- It was a disaster.
- Because of a joke?
Something bigger
must have gone wrong.
What happened?
A young woman may be dying.
I have a lot of research to do.
- Boom. My chart, my case, my surgery.
- You took it from me.
It touched my fingers, and you took it.
I'm the one holding the chart.
That's evidence we've got.
- If you could prove...
- Angles? We need more angles.
How many cameras do we have?
Doctor Lim, I'm glad you made
that decision on the overtime.
- You're welcome.
- But you'd want to know
the real issue isn't overtime,
it's being understaffed.
We need two more nurses
on this floor, one in ICU...
I'm sorry. I'm sure you're right,
but we just don't have the budget.
- Excuse me?
- Nothing, ma'am.
- I gave you OT, you're not being fair.
- Aren't I?
You told me I was right, then told me
you're not gonna do it.
Who's being unfair?
Nobody said this job...
Shaun.
Come with me.
Is everything okay? The nurse told us
you didn't finish the surgery...
Suzanne...
you have very extensive cancer
throughout your abdomen.
It appears to be malignant.
And it appears to have metastasized
around every organ.
But there's hope with surgery.
We can't see the retrohepatic part
of the cancer because of the liver.
We can't see the retroperitoneal part
because of the kidney.
Yes, I know. That's why we
should take out the organs.
You wanna remove her liver
and right kidney?
Yes, and also her left kidney,
and her pancreas,
and the intestinal tract,
and the stomach.
- Several of those organs are essential.
- We'll put them back.
We remove them, clean up
the cancer, then put them back.
- Ex vivo surgery.
- It's been done for pancreatic cancer.
- Without much success.
- No.
Think it'd work better here?
Not really, but the alternative is death.
- Hi.
- Hi. How are you?
Good.
Not working?
Yeah. It's been 72 hours
and I still haven't found a job.
Relax, I'll be fine. I got some irons
in the fire. What do you need?
How do you say no to a person?
I'm not doing it right.
Okay. Watch closely.
Really?
If you're gonna give up that easily,
quit now.
The biopsy confirmed the cancer
is a renal cell carcinoma.
Cancer? I have cancer?
Yes.
Why didn't you tell me?
We did.
The good news is
it's treatable with surgery,
immunotherapy, and radiation.
- We have to tell the children.
- They know.
How do they know?
What's going on?
Am I dying?
- The cancer is serious, but...
- Ruby,
we'd like to talk outside.
I'll be right back.
The problem isn't how you said no,
the problem is how you said yes.
- She seemed happy with the yes.
- It came too quickly.
You made her think she was helping
instead of the other way around,
so she asked for more,
feeling she was entitled.
So I should have said no
when I wanted to say yes?
You shouldn't tell her what you want,
tell her what she needs to hear.
It's your job to figure out
what you can give them,
convince them that's what they need,
and then make them feel they owe you.
None of that sounds like me.
And you wanna do the job your way
without changing?
Is that amusing to you? Yes, I do.
Yesterday you were an attending,
today you're chief.
You are a different person.
Want an espresso?
Without surgery, your husband would
probably live another two to five years.
He would have little discomfort,
until close to the end,
and that can be managed.
- You said it was treatable.
- It is, but fighting cancer is never easy.
We have to weigh the benefits
against the suffering.
And the surgery itself is...
usually the easiest part.
- He's strong, he's healthy!
- He's not healthy, not mentally.
And the burden on you...
I am not letting my husband die
because caring for him is inconvenient,
because I'm gonna have
to repeat a conversation.
Just go to hell.
This surgery has never been
done for this condition.
We'd be dealing with
every one of your abdominal organs,
and something could go wrong
with any of them.
You could be on dialysis
for the rest of your life.
You could have a very
compromised digestive tract,
lifelong diabetes,
you could have liver failure.
- That's not a complete list.
- You could die.
And, uh... if we don't do the surgery?
Chemotherapy and radiation,
although the likelihood of success
is slim. About 25 percent.
You may prefer hospice care.
You'd probably live maybe a year,
but it'd be a good year.
Could you give us time to think about it?
Of course.
We're supposed to be at lunch.
- We're gonna be late.
- Why?
Why?
Because I need meaning in my life.
Your heart seems fine,
liver seems to be in the right place.
You're a brain surgeon.
You don't think you can get meaning
being a brain surgeon?
This is a boring patient
with boring symptoms.
Shaun, meet Marco Higgins,
he's a mechanic in between jobs.
Three sons, two of whom he hasn't
spoken to in quite some time,
but he's working on that. Open.
Wide.
It's good to get to know people,
Shaun, it makes you a better doctor.
- Say, "Aah."
- Aah.
You have boring symptoms,
that's a good thing.
You do not want exciting symptoms.
You had a date last night,
didn't you?
- Mm.
- I wanna hear about this.
Marco, you wanna hear about this?
- Yes, please.
- Yes, please.
Open.
It was a disaster.
- Thank you, but it's not...
- No, it's polite and chivalrous.
Even though chivalry
is a problematic notion,
- politeness is a good thing no matter...
- Shaun!
Are you okay?
- Oh, my.
- I'm okay.
She might not be okay.
- No, I am okay.
- Okay, don't get up.
I'm pretty sure she's okay.
Take off his...
Boots.
What?
Do you think Marco's diabetic?
Based on the color of his skin
in the crease of his neck, I do.
Based on his chart, I do too.
He could have an infection in his feet
and the pain is masked
by diabetic neuropathy.
That infection could be causing
the abdominal symptoms.
Marco, mind taking off your boots?
I was wrong, it's not boring.
I can do it myself.
I'm sure,
but our job here
is to help each other, and...
today, I didn't do that.
I'm trying to make up for that
with a jar of pickles.
I overstepped and...
undercut you
in front of the patient's wife.
I accept your apology.
What I should have done...
was privately tell you
you're wrong.
- Give me the jar.
- And let you, as lead,
tell them that this
surgery's a bad idea.
Because we should let a 70-year-old man
die of a treatable condition?
Because we shouldn't condemn
a man to years of confusion and fear.
His life still has value.
Seriously?
He has memory issues,
he's not a vegetable.
He's funny, he's charming,
they've lived a life together.
He brings happiness to his wife,
to his children.
- He's happy.
- Exactly.
Let him stay happy
for whatever time he has left.
Nurse Petringa?
- I'm sorry if I overstepped.
- I didn't track you down for an apology.
You're gonna get additional staff?
No.
If I get you additional staff,
you lose hours, overtime.
So you're doing us a favor
by making sure
we never see our families?
Your problem isn't the staff,
your problem is the actual work.
The crap part of work that takes
too long and too many of you.
I authorized purchase
of two Hoyer patient lifts
and a mechatronic ICU bed.
A smart bed?
- Ha. Those are supposed to be fun.
- Gotta promise to let me try it.
You got it.
Doctor Lim?
Thank you.
You owe me.
I'm well aware
of what he'll be going through.
My sister had cancer.
The chemo, the radiation...
They beat the crap out of her,
didn't they?
Yeah.
Now imagine going through that
and not understanding, every day.
The throwing up
and not knowing why.
Losing your hair and not knowing why.
Learning he has cancer,
and being devastated by it,
day after day.
- But at the end...
- There are no guarantees.
He's old
and his body's breaking down.
His mind is breaking down...
and it's gonna end,
no matter what we do.
In 45 years, I have never once lied to him.
When memory goes,
all that's left is emotion.
What we've learned doesn't matter,
what we had for lunch,
where we went for vacation,
none of it matters.
But how we feel...
who we're close to...
He's the same man I've always loved.
The same sense of humor,
same everything.
He hasn't changed.
And what I owe him...
hasn't changed.
- Have you decided?
- Not yet.
Take your time,
there is no urgency...
What are you waiting for?
Doctor Murphy, they are facing
an impossible choice.
But they have to make it.
What additional information
are you waiting for?
- Shaun...
- I'll be a better doctor
- if I understand the patient.
- True, but right now,
- your skills are secondary...
- Are you debating whether
you should find somebody else
to fall in love with?
- Someone healthy?
- No. No, of course not.
You should be.
We're kids.
You shouldn't have to spend the rest
of your life taking care of an invalid.
You think that's the issue?
Me? A burden on me?
- This is so much easier on me than you.
- No, it's not.
Whatever happens to me
is gonna happen...
and I have to live with it.
You...
You have a choice.
In sickness and in health.
That was the commitment I made...
this morning.
Now, if this had
happened yesterday...
So it's not that difficult
a decision, then, right?
I guess not.
I can feel her humeral head
outside the glenoid fossa.
It's an anterior dislocation.
I can reduce that.
- Here?
- Yes, with traction and external rotation.
Oh. Oh.
Oh, my, that feels better.
- I bumped you.
- No, don't worry.
It happens.
I wasn't watching either.
Come on.
That's it?
You bumped into
a very understanding woman,
you amazingly caught
a bottle of wine...
Where was the disaster?
Unclamp the superior mesenteric
to perfuse the organs.
The small intestines
look dusky and cyanotic.
We need to resect
all the necrotic segments.
Claire, find the first viable part
of the ilium and clamp proximal to it.
I don't think your
irons in the fire are very hot.
Any job interviews you get,
you're gonna spend
a large chunk of time trying to explain
why you lasted less than a year
as president at Saint Bonaventure.
I mean, how do you put a positive spin
on why you spent a fortune
on a chief of surgery
you fired weeks later
to protect a second-year resident?
- You think I made a mistake?
- No, I think you did the right thing.
I admire you.
Which is why I wanna do you a favor.
You need to prove
you haven't burned bridges.
Which means you have to come back
to work at Saint Bonaventure.
As what?
As a surgeon, working for you?
And the fact that you're in need
of a surgical attending
to replace yourself is a coincidence?
It's what you need.
I admire the effort...
but don't con a conman.
Your greatest strength
and greatest weakness
as a leader was your stubbornness.
Don't let it be a weakness today.
My back hurts, on the left side.
That's where you had your biopsy.
It's gonna hurt.
What biopsy?
Harvey, you came in because
you thought you had kidney stones.
We did some imaging
and you don't...
What is it? What... what's wrong?
What's going on, Ruby?
Why isn't anybody saying anything?
Am I dying?
Ruby?
I... I can't die,
I need to take care of you.
I can't...
They didn't find stones.
Everything is okay.
The pain will go away.
We're gonna go home tonight.
- Okay? Okay.
- Mm-hm.
I had a nice time.
That's it?
- It's over?
- Where's the disaster?
I've listened to an hour of this,
I was promised a disaster.
Where's the disaster?
It was exhausting.
Everything was always out of control.
Anything could happen at any time.
Anything did.
There was too much to remember to do,
too much to remember not to do,
and none of it made sense.
It was hard,
uncomfortable, unpleasant.
I spent the whole evening
doing unnatural things
to make her happy,
and I have no idea if she was happy,
and I know I wasn't happy!
It was all a disaster.
I want you to meet our new attending,
Doctor Marcus Andrews.
Pleasure to meet you.
How long have you been working here?
- Ms. McDougal?
- She didn't ask for ID.
It's policy.
We take a lot of immigrants here.
She also didn't look at me.
Check the symptom I told her I had.
"Cut over the left eye."
You heal very nicely, Ms. McDougal.
You hate it here.
Hate is a strong word.
What would you do differently?
Give me five things.
Diabetes clinical educator,
on-site lab and X-ray,
mental health advisor, multidisciplinary
care team, electronic medical records.
We had the clinic at the hospital,
and had to shut it down
because it was a money pit.
Come back as president,
and we'll reopen it.
Your office can be in the clinic.
Do I have to wear a tie?
Hey.
Welcome back.
- Am I okay?
- The surgery went very well.
We're confident
that we got all of the cancer.
There's a bag by her side.
- Is that just to drain stuff post-surgery?
- There were complications.
We had to remove
a large portion of your bowel
and divert the waste
through a stoma in your skin.
That's an ileostomy bag.
How long will I have that?
Forever.
So I have to go to the bathroom
in this thing for the rest of my life?
Yes.
We'll teach you how to change it,
how to dispose of it.
They'll teach both of us.
You know,
this is why we do it, Shaun.
Every date is a disaster,
every relationship is out of control.
But if you stick with it,
you wind up with someone
in your life
who will help you
when you need to be helped,
love you when you do not feel lovable,
be with you no matter what.
It's not worth it.
Hi, Mom.
My son's coming to town.
Think I'll pick him up at the airport.
♪ And when I see ♪
♪ And if I walk ♪
♪ And when I run away ♪
Hi, Grandpa.
♪ And when I run away ♪
♪ Hold me in your arms ♪
♪ Don't let go ♪
♪ Don't let go ♪
♪ And when I see ♪♪