The Good Doctor (2017–…): Season 3, Episode 3 - Claire - full transcript
Dr. Claire Browne faces complications at home and work as she prepares to lead her first surgery; the staff must treat a fisherman's injuries without damaging his prize catch.
I'll be performing
your surgery today.
I'm Dr. Browne.
I'll be performing your surgery today.
I'll be performing
your surgery today.
It's a very simple procedure.
It's a straightforward
procedure.
It was a successful surgery.
The surgery was a success.
We expect a full recovery.
I expect a full recovery.
Baby.
Where do you want this?
Uh, thanks, Mom.
Uh, put it by my bag.
I'll have the hospital lab
run it.
Nausea and severe
abdominal pain after eating.
This patient could need
a lap chole.
That would be
an ideal first surgery.
Let's not get
ahead of ourselves.
She may just need an antacid.
Hi, Michelle.
I understand your mother
is on her way in.
I'm Dr. Browne.
And I'm Dr. Shaun Murphy.
You need to fix my sister.
What's your name?
Tisha. Hi, Tisha.
Well, that is exactly
why we're here...
To help your sister.
Fostersister.
When did the pain start?
About an hour ago.
It was on the bus.
My sister rides with me
every day to school and back.
My brother and I
used to live on a bus.
Cool.
Have you felt like this before?
A few times.
Ow.
She has extreme upper-right
quadrant tenderness.
That's consistent
with cholecystitis.
As is her fever
and elevated white count.
Your gallbladder probably
needs to be removed.
You must be excited, Claire.
This is going to be
your first surgery.
Has your urine changed color?
Gotten darker?
I hear Dr. Browne might have
landed her first lap chole.
It's not exactly
a straightforward case.
The duct is massively dilated,
the wall's inflamed,
this scarring...
It's gonna limit visibility.
Well, the thickness
of the gallbladder wall
does pose a challenge.
What do you think?
It's not her decision.
It's mine, as the attending.
Doesn't mean she shouldn't
offer her opinion.
I think that, um,
Dr. Melendez is right.
With the limited visibility,
I shouldn't be...
Only with a laparoscopic
cholecystectomy.
Which I don't think
we should do.
An open procedure
would provide a clearer view
of the gallbladder
and the surrounding anatomy
despite the inflammation.
Carly and I went on
another date last night.
Mm. What did you do?
Dinner, movie...
We walked 12 minutes to a deli
and had some food and talked.
Where are we going?
Andrews is starting
an open chole.
Sounds like it's going
well with you and Carly.
Oh, yes.
She answered
all of my questions.
How many did you ask?
83, although some had
multiple parts.
"Do you want to have children?
If yes, how many and when?"
"Where do you plan
to raise them?
In what religious tradition?"
Those are pretty intense.
They're good questions,
Claire, about important topics.
Early on, people usually
stick with lighter stuff...
Favorite movies, bands,
hometowns.
Small talk.
Put some LAPs
in the upper-right quadrant.
Here's the Bovie, Dr. Andrews.
Isn't the point of dating
to gather information
to determine compatibility?
Retract the omentum.
Sure.
Isn't that best achieved
by finding out what's
important to the other person?
Hemostats.
It's a... It's a process, Shaun,
like peeling an onion.
People are more comfortable
revealing their layers
gradually,
as opposed to getting sliced
right down the middle.
I heard Dr. Lim selected you
for the first lead.
I'm guessing you drew
a cholecystectomy.
Sponge on a stick.
What's your approach
to dissecting...
Retrograde or antegrade?
Antegrade.
Once I've located
the porta hepatis.
I think Carly was comfortable.
Why does it matter
what kind of questions
are asked when?
Aren't the answers
what's important?
I'm sure you're right.Yes.
What is the plan
for the next date?
Hmm.
We didn't make another date.
Then I grasp gallbladder fundus
and elevate it which way? S-Superiorly.
Is that significant?
No follow-up date?
Not necessarily.
How did the night end?
Good-night kiss?
I've exposed
the triangle of Calot
and ligated the cystic duct
and artery.
What is the risk
at this juncture?
Lacerating the liver
during dissection. Correct.
We didn't kiss.
Ironically, a complication
which I've inadvertently
just demonstrated.
Hold direct pressure.
I need better exposure.
I sliced instead of peeled.
You are familiar
with the Pringle procedure,
Dr. Browne?
Yes, although I've never...
Clamp down the portal triad
with an atraumatic
hemostat clamp,
then use a number 2
catgut suture.
Shaun, just go to her
and explain.
If what I said
made her uncomfortable,
then saying more could make
her more uncomfortable.
I sliced instead of peeled.
After Michelle's surgery,
I will go and talk to Carly.
Good.
You can talk to her soon.
OR 2 had a cancellation.
Your surgery is in 45 minutes.
Hi, I'm Dr. Browne.
I will be performing
Michelle's surgery.
I will be removing
her gallbladder.
It is a simple procedure.
We're gonna make sure
your daughter
is well taken care of.
Ow!
Sir, we need to decapitate it.
No, don't. I'm begging you.
Don't.
Please.
I can't get an image.
How did that...
I-Is that a swordfish?
With that dorsal fin?
It's a marlin.
I hooked him
with a naked ballyhoo.
Battled me for over an hour.
Suddenly, he just leapt out of the water.
He came right at me.
Save the story
for the bar, Quint.
Right now, we need to cut
the damn thing in half.
No. 40-plus years
I've been
chasing a fish like this.
You can't just behead him!
Can't leave his nose
in your leg, either.
His bill.
Can't you just
pull him out gently?
I'll sign a waiver.
The pull-out method never works.
If any of your blood vessels
are damaged, it gets messy.
Congrats. I hear your surgery
is on the schedule.
How's his distal pulse?
A little thready,
but still there.
We need to get him to an MRI.
I'm not going anywhere
without Franklin.
I named him after my father.
You and Franklin both won't fit.
Aah! Oh! Oh!
How? You said he was dead!
I didn't take a pulse.
Go get something to kill it.
No, it's dead! It's moving!
It's a postmortem response.
You guys are doctors.
Don't people do this?
No! No!
I'll help you review at lunch.
Surgery's in 20 minutes.
Good luck. You, too.
I want to...
No, no, I haven't looked.
I want to be... Great...
great... Okay.
Got it. I'll be back
as soon as I can.
Hi. You must be
Michelle's mother.
I'm Dr. Browne. I'll be...
Yeah. How long will
she have to stay in here?
Hospitals make me nervous.
Three days to a week,
depending on...
Well, she's gonna miss
a lot of school.
And she watches Tisha and her
brothers in the afternoon.
Your daughter has a serious
infection in her gallbladder.
She's been experiencing symptoms
on and off for a while now.
She never told me that.
Why didn't you tell me that?
Mama... My point is,
she's been ill for a while,
- so her recovery may take...
- Mom.
Mom?
P-Please, my... my chest hurts.
What's wrong?
Her oxygen levels are dropping.
She's tachycardic.
I need a chest CT, stat.
You had a blood clot
in the artery
that feeds your lungs.
It's called
a pulmonary embolism.
This medicine broke it up.
How could that happen?
According to our scan,
it was part of a larger clot
in your leg
that broke off
and traveled there.
As for why
the larger one formed,
when I asked you if you were
taking birth control pills,
you said no.
Was that the truth?
You asked me in front of Tisha.
I'm doing it with my boyfriend,
and I don't want babies,
so I'm taking
birth control pills.
How long have you been
taking them?
I don't know. A year?
I'm prescribing condoms
for your boyfriend.
You need to go off the pill
to prevent further clots.
Dr. Browne is gonna place an IVC
filter via your femoral vein,
in case other parts
of the clot break off.
Your gallbladder surgery's gonna
have to wait till tomorrow.
What are you doing?
This is where
the catheter goes in.
How did you get these scars?
I cut myself climbing a fence.
Those scars...
They're straight, in a row,
all the same length.
I don't believe you
got them from a fence.
I don't care what you believe.
Kids who cut,
most of them are really sad,
in a lot of pain,
and they say cutting
makes them feel better.
Is that how it is with you?
I don't want to talk about it.
Okay.
My life sucks, okay?
Tell me how.
Why?
It won't change anything.
Talking might
make you feel better,
and maybe I can help.
I live in a foster home,
but I'm not a foster kid.
I'm a whole mother,
but I've never had a baby.
My mom brought three kids
in our home,
and now it's my job
to take care of them...
Make breakfast,
get the kids dressed,
take them to school,
go to school,
pick them up,
dinner, homework, laundry.
Repeat.
I barely ever leave the house
without a kid attached to me.
Can you help me with that?
Michelle wouldn't
hurt herself on purpose.
Michelle is unhappy.
She feels pressure
to look after
her foster siblings,
help out at home...
Yeah, her home life is fine.
I'll talk to her.
It might be helpful to have
her speak with a psychiatrist.
My daughter is not crazy.
We... We don't do psychiatrists.
You know that.
That needs to change.
When are you doing her surgery?
Tomorrow. Thank you.
I will speak to my daughter.
Don't.
It's your job to fix her
gallbladder, not her life.
It's your first surgery.
Don't get distracted.
Have you talked to Carly?
No.
Blood pressure is 62/31.
Your patient
is in cardiac arrest.
I know.
You're practicing
the Pringle maneuver
in the event of a liver bleed?
Yes.
That was better. Thanks.
Now you can talk to Carly.
I need to practice.
Dr. Lim says
getting away from things
every now and again,
having balance in our lives
can be just as important to
our performance as practice.
Maybe you should get some
balance by talking to Carly.
I don't know.
I'm nervous about
my surgery, Shaun.
Practice will make me
less nervous.
That will improve
my performance.
Okay.
Okay.
You should also practice
not causing a liver bleed.
Planning on it.
Also, how you will recover
if you cut the portal vein.
That's potentially fatal.
Or if you perforate
the small bowel,
which could cause sepsis,
leading to death.
Or if you cut
the common bile duct,
which would cause...
I'm gonna go talk to Carly.
Right now? Right now.
Aren't you still nervous? Nope, all better.
What blade for the Kocher?
What?
Incision for the chole...
what blade?
Uh...
10. Mm-hmm.
No, they won't both
fit in the MRI.
Fish Boy doesn't buy it.
Location of the incision.
Why are you trying to help me?
Lim picked you
for the first surgery.
Everyone knows that makes you
the front-runner
for Chief Resident.
This is me sucking up.
I've never been big
on pretense...
Are you okay?
What the hell just happened?
The marlin must have had
metal in his body...
Lures and stuff.
I think a license plate
flew by me.
Franklin!
Oh, no!
Franklin!
Oh, it's okay.
Franklin's okay.
It all came out one side.
It won't show when I mount him.
Well, thank goodness
for small miracles.
Ooh. Oh!
Ow!
Oh! Ah!
I've got his femoral.
Call the OR. We're coming.
Hang on, Dr. Browne.
Just need to make an incision
above and below
the arterial injury site.
We need to clamp the femoral
proximal to the bleed
without clipping
the femoral nerve.
Got it. I feel the nerve
right above my index finger.
One down.
My hand is starting to cramp.
Lean over this way a little bit.
Rotate your wrist.
Just a little bit more.
Let's see if that holds.
Go get cleaned up.
We'll take it from here.
I wanted to check
the patient's bloodwork.
He's negative for
HIV, Hep B and C.
You don't need
prophylactic meds.
I'm nervous about my surgery.
You'll be fine.
And don't ever say that again.
Why?
Weren't you nervous
before your first lead?
If I was,
I didn't volunteer that
to the Chief of Surgery...
Or anyone.
We're women, we're not white,
and we're surgeons.
Unicorns consider us
a fabled species.
We don't get the luxury
of public insecurity.
I will aspire to repressed
stoicism in the future.
We don't need to be insecure,
because every step of the way,
we've had to be twice as
good as everybody else.
Suck it up.
You got this.
Don't forget we have our
session with Dr. Donovan today.
I won't.
Your patient. Mm-hmm.
What are they like?
Man, woman, young, old?
Woman.
Girl, actually.
She's tough, smart...
really sad.
Her mom has her taking care
of three foster kids.
At least you were only stuck
looking after me.
How old?
14.
Although she acts a lot older.
She's been having sex
for almost a year.
Well, you were about that age
when you were with Wayne.
I didn't have sex
with Wayne. What?
He was in love with you,
always sniffing
around our place.
Maybe. He didn't get any.
So, who?
Junior prom guy... Derek.
Der... No.
I didn't lose my virginity
until sophomore year of college.
What were you hoping for,
a proposal?
No.
I wanted it to be special.
Oh, good for you.
I mean, I wouldn't
have held out...
No... but good for you.
I thought for sure
you and Wayne were doing it.
You were okay with that?
You were so serious.
So restrained.
We talked about birth control.
I figured, "Good for her."
She's finally relaxing,
having some fun."
Well, I was so restrained
and serious
'cause I never knew when
you were gonna fall apart.
Got to get to work.
I'll be back before
Michelle goes into surgery.
Have you had a chance
to talk to her
about her cutting?
Oh, yeah, some fool friend
of hers gave her the idea.
She's not unhappy.
It's just peer pressure.
She sounded unhappy to me.
She's upset I didn't let her
go hang out with her friends.
It's typical teen drama.
She promised me
she's done cutting.
Self-harming behavior
doesn't just stop.
Michelle might need... Dr. Browne.
My daughter
needs to have surgery
and get out of this hospital.
You didn't tell your mom
the truth
about why you cut yourself,
about how unhappy you are.
I tried.
She didn't want to hear it,
just said that things aren't
always gonna go my way
and I need to be
more responsible.
Like I'm not already.
Growing up, I had
to take care of my mom.
What was wrong with her?
She's mentally ill.
Bipolar disorder
and a drinking problem, pills.
When things were bad,
she'd forget to buy groceries
or clean the trailer
or pick me up.
Or she'd spend all our rent
on something stupid.
And I thought
if I could make her life
easy enough...
If I cooked and cleaned
and got good grades...
Then she'd get better.
But she never did.
And for the longest time,
I thought it was my fault
she was sick.
And I probably still would
if a psychiatrist
hadn't refused to believe me
when I said I was fine.
You've been to a psychiatrist?
But you're, like,
a fancy surgeon.
I could have a therapist
come by and see you
before your surgery.
Okay.
He should be getting better.
It's got to be an infection
from the marlin.
Aeromonas
or mycobacterium marinum.
Would've responded
to the antibiotics.
Guys, I'm trying to focus.
What if he has an underlying
autoimmune disorder?
It could've been triggered
by the surgery
or even the initial
fish stabbing.
It would explain why the leg
ulcerations are progressing
despite good arterial flow.
We could see
if he responds to steroids.
Which could kill him
if it is an infection.
But we could run an ANA,
see if he's positive.
What about a parasite?
Rhinosporidium seeberi
or a gill worm.
Have you talked to Carly?
Sorry.
I got sidetracked by a marlin.
Come in.
You wanted to see me?
Ms. Reynolds tells me that
you went against her wishes
and had her daughter
speak with a psychiatrist.
Uh, Michelle asked
to see a therapist.
Only after
you talked her into it.
I'm gonna report you
to the medical board.
You had no right...
Dr. Browne, were you concerned
that Michelle might be
a serious danger to herself?
Yes.
In that case,
the consult was required.
That said,
Dr. Browne's failure to
inform you was inappropriate.
You're off the case.
Dr. Melendez
will perform the surgery.
How are you doing?
Claire?
I understand today's
a big day for you.
Your first surgery.
We don't need
to talk about that.
Hmm, I think we do.
You've been taking care of
your mother for a long time.
That's a pattern you both
need to break out of.
I know I haven't always
been there for you,
and I just... I...
I'm trying to change that.
I know, Mom.
I'm good. Everything is fine.
And your first surgery?
Is that this afternoon?
It's...
Actually, it's not.
Um... I arranged a psych consult
without the mother's permission,
so I got thrown off the case.
How could the hospital
allow that?
What is wrong with them?
After how hard
you've worked, I just...
It's okay, Mom.
They kind of had to.
That must be
a big disappointment...
It is.
Anything else, Claire?
I'm upset, humiliated,
so, so mad
at my patient's mother
for not taking care
of her daughter.
And I... I'm relieved.
I'm so, so relieved
to have that weight off of me,
and that makes me
feel like a fraud.
Don't you say that.
How can I be so scared
to do something
I've wanted for so long?
Because things that matter
are scary.
That's how I feel
about coming here,
talking about my life
and our relationship.
What if I can't fix it?
What if I can't make up
for all the times
I've let you down?
And then I think...
"Just be like Claire."
Because nothing
stops you... ever.
You see what you want,
and you go after it
with everything you've got.
You are an inspiration.
You're myinspiration.
Carly?
Hi. Do you have a second?
OR 2 is waiting to learn
the patient's mass wasn't
cancerous so they can close.
I can come back after.
I'll be at the cafe?
Mm-hmm. Okay.
Anesthesiology, line 271.
Anesthesiology, call line 271.
Cancer.
The marlin guy has cancer.
CT chest, abdomen,
and pelvis showed no masses.
It's in his leg.
It explains
progressive ulcerations
despite good arterial flow.
And why the antibiotics
aren't working.
We'll send a tissue sample
from the ulcerated area.
And when I'mChief Resident,
I'll remember this.
There's a problem with Michelle.
I'm not doing it!
You need to calm down.
You don't get
to tell me what to do!
I want Dr. Browne!
Michelle? What's going on?
I want you to do my surgery.
I want her, Mama,
not somebody else.
Dr. Melendez
is gonna do your surgery.
He is a great doctor.
He's not you.
Y-You care about me.
Everybody here cares
about you, Michelle.
Now, please sit down.
You could rupture your gallbladder.
I-I-I don't want to get better.
Don't say that. It's the truth!
Michelle, you need this surgery.
That is all that matters...
not whether I do it.
I'm gonna be there.
I will be watching
from the gallery
the whole time.
You just... You need...
You need to sit down.
The kid okay?
I had to pull you off.
If you made even the tiniest
misstep during surgery,
that mom would go
from threat to lawsuit.
Is Patricia okay with me
watching from the gallery?
No.
You can't remove her
gallbladder from the gallery.
What?
You're doing Michelle's surgery.
How'd you get the mom
to change her mind?
I explained that, given Dr. Browne's
commitment to her daughter,
she's the perfect choice
to lead the surgery.
Especially with me over her
shoulder the whole time.
Thank you for fighting for me.
That's what bosses do.
Let's go.
You stood me up.
Sorry about that.
What's up?
Shaun's a little worried
he may have freaked you out
with his... questionnaire
the other night.
Oh, I thought it was cool.
Small talk
bores the hell out of me.
Well, then, great.
I'll tell him.
Shaun got worried about that
all on his own?
That doesn't seem like him.
I may have mentioned
that people don't usually ask
deeply personal questions
on an early date.
Claire, I like you,
but we don't really know
each other.
And yet you decided
how I was going to react
to Shaun's questions,
which isn't your business.
And you were wrong...
Totally, totally wrong.
Shaun and I don't need you
or anyone else
to run interference
on our relationship.
Butt out.
Is everybody ready
for a Time Out?
Dr. Claire Browne, lead surgeon.
Dr. Neil Melendez,
attending surgeon.
Dr. Shaun Murphy, assisting.
Dr. Jan Lancaster, anesthesia.
Donna Petringa, scrub nurse.
Shani Walden, circulating nurse.
Patient is Michelle Reynolds.
We will be performing
an open cholecystectomy.
All tools I need
are confirmed to be present.
Estimated blood loss, 100 cc.
Patient will go to the ICU
after surgery.
Is everybody in agreement?
Dr. Murphy, have you
ChloraPrepped the site?
I have.
10 blade.
Sponge.
Top layer of abdominal muscle
is exposed.
I'll need a Bovie
to cut through.
Nice work, Dr. Browne.
Bookwalter Retractor.
I see the liver,
and I need to better expose
the inferior surface.
Retract the duodenum
inferiorly, please.
Gallbladder exposed.
Dr. Browne?
There is more scarring
than the imaging suggested.
True.
Talk through your approach.
I... grasp
the gallbladder fundus forward
and use a right-angle clamp
in my suction
to develop a plane
around the gallbladder.
Kelly clamp,
a right-angle clamp,
and suction.
That was elegant use
of the Kelly clamp.
I see the cystic duct
and, behind it,
the cystic artery.
I need my first assist
to confirm
that I have identified
the common bile duct
and it is out of the way.
Yes.
Cutting the duct would be...
Very, very bad.
Move the gallbladder
cranially a little bit.
Titanium clip applier.
You sure you have a clear view?
Making the cut.
She's hemorrhaging.
I can't see
the source of the bleeding.
MAP is 45 and dropping.
What do you think is happening?
Most likely,
my scissors' tip nicked
the right hepatic artery.
It happens.
It's happened to me.
I need to clamp
the common hepatic artery,
repair the arterial wall
with running
6-0 Prolene sutures.
That's what I would do.
Hey, hey, hey.
Slow down. Slow down.
No running. No running.
Dr. Browne, how's my daughter?
The surgery was a success,
and we expect a full recovery.
I wanna see her!
Is that okay?
Yay! Okay.
Michelle says
she wants to be a doctor.
She would be a great one.
Uh, that therapist
Michelle talked to...
could I get her card?
Hi, baby.Hey.
Okay.
Three, two, one.
You were right.
He had angiosarcoma of the leg.
Had to amputate,
but the margins were clean.
Hmm. What happened to the...
Franklin!
Oh!
Franklin, you amazing fish!
You saved my life.
Come on, bring him...
bring him here.
Bring him... Bring him in.
Oh.
Thank you, guys.
Group hug.
Do you prefer to work in a team
or do you prefer to lead
or follow command?
Team... and to lead.
What machine
or appliance in your house
aggravates you the most?
The dishwasher.
Hey, I'm just leaving.
Who is this?
Message received at 5:30 p.m.
from Mom.
Hey, baby, I got your text.
See, I knew it was just
a temporary setback.
We're gonna celebrate.
I made dinner.
And I'm gonna
go get some dessert.
I'll see you soon.
I'm so proud of you, baby.
your surgery today.
I'm Dr. Browne.
I'll be performing your surgery today.
I'll be performing
your surgery today.
It's a very simple procedure.
It's a straightforward
procedure.
It was a successful surgery.
The surgery was a success.
We expect a full recovery.
I expect a full recovery.
Baby.
Where do you want this?
Uh, thanks, Mom.
Uh, put it by my bag.
I'll have the hospital lab
run it.
Nausea and severe
abdominal pain after eating.
This patient could need
a lap chole.
That would be
an ideal first surgery.
Let's not get
ahead of ourselves.
She may just need an antacid.
Hi, Michelle.
I understand your mother
is on her way in.
I'm Dr. Browne.
And I'm Dr. Shaun Murphy.
You need to fix my sister.
What's your name?
Tisha. Hi, Tisha.
Well, that is exactly
why we're here...
To help your sister.
Fostersister.
When did the pain start?
About an hour ago.
It was on the bus.
My sister rides with me
every day to school and back.
My brother and I
used to live on a bus.
Cool.
Have you felt like this before?
A few times.
Ow.
She has extreme upper-right
quadrant tenderness.
That's consistent
with cholecystitis.
As is her fever
and elevated white count.
Your gallbladder probably
needs to be removed.
You must be excited, Claire.
This is going to be
your first surgery.
Has your urine changed color?
Gotten darker?
I hear Dr. Browne might have
landed her first lap chole.
It's not exactly
a straightforward case.
The duct is massively dilated,
the wall's inflamed,
this scarring...
It's gonna limit visibility.
Well, the thickness
of the gallbladder wall
does pose a challenge.
What do you think?
It's not her decision.
It's mine, as the attending.
Doesn't mean she shouldn't
offer her opinion.
I think that, um,
Dr. Melendez is right.
With the limited visibility,
I shouldn't be...
Only with a laparoscopic
cholecystectomy.
Which I don't think
we should do.
An open procedure
would provide a clearer view
of the gallbladder
and the surrounding anatomy
despite the inflammation.
Carly and I went on
another date last night.
Mm. What did you do?
Dinner, movie...
We walked 12 minutes to a deli
and had some food and talked.
Where are we going?
Andrews is starting
an open chole.
Sounds like it's going
well with you and Carly.
Oh, yes.
She answered
all of my questions.
How many did you ask?
83, although some had
multiple parts.
"Do you want to have children?
If yes, how many and when?"
"Where do you plan
to raise them?
In what religious tradition?"
Those are pretty intense.
They're good questions,
Claire, about important topics.
Early on, people usually
stick with lighter stuff...
Favorite movies, bands,
hometowns.
Small talk.
Put some LAPs
in the upper-right quadrant.
Here's the Bovie, Dr. Andrews.
Isn't the point of dating
to gather information
to determine compatibility?
Retract the omentum.
Sure.
Isn't that best achieved
by finding out what's
important to the other person?
Hemostats.
It's a... It's a process, Shaun,
like peeling an onion.
People are more comfortable
revealing their layers
gradually,
as opposed to getting sliced
right down the middle.
I heard Dr. Lim selected you
for the first lead.
I'm guessing you drew
a cholecystectomy.
Sponge on a stick.
What's your approach
to dissecting...
Retrograde or antegrade?
Antegrade.
Once I've located
the porta hepatis.
I think Carly was comfortable.
Why does it matter
what kind of questions
are asked when?
Aren't the answers
what's important?
I'm sure you're right.Yes.
What is the plan
for the next date?
Hmm.
We didn't make another date.
Then I grasp gallbladder fundus
and elevate it which way? S-Superiorly.
Is that significant?
No follow-up date?
Not necessarily.
How did the night end?
Good-night kiss?
I've exposed
the triangle of Calot
and ligated the cystic duct
and artery.
What is the risk
at this juncture?
Lacerating the liver
during dissection. Correct.
We didn't kiss.
Ironically, a complication
which I've inadvertently
just demonstrated.
Hold direct pressure.
I need better exposure.
I sliced instead of peeled.
You are familiar
with the Pringle procedure,
Dr. Browne?
Yes, although I've never...
Clamp down the portal triad
with an atraumatic
hemostat clamp,
then use a number 2
catgut suture.
Shaun, just go to her
and explain.
If what I said
made her uncomfortable,
then saying more could make
her more uncomfortable.
I sliced instead of peeled.
After Michelle's surgery,
I will go and talk to Carly.
Good.
You can talk to her soon.
OR 2 had a cancellation.
Your surgery is in 45 minutes.
Hi, I'm Dr. Browne.
I will be performing
Michelle's surgery.
I will be removing
her gallbladder.
It is a simple procedure.
We're gonna make sure
your daughter
is well taken care of.
Ow!
Sir, we need to decapitate it.
No, don't. I'm begging you.
Don't.
Please.
I can't get an image.
How did that...
I-Is that a swordfish?
With that dorsal fin?
It's a marlin.
I hooked him
with a naked ballyhoo.
Battled me for over an hour.
Suddenly, he just leapt out of the water.
He came right at me.
Save the story
for the bar, Quint.
Right now, we need to cut
the damn thing in half.
No. 40-plus years
I've been
chasing a fish like this.
You can't just behead him!
Can't leave his nose
in your leg, either.
His bill.
Can't you just
pull him out gently?
I'll sign a waiver.
The pull-out method never works.
If any of your blood vessels
are damaged, it gets messy.
Congrats. I hear your surgery
is on the schedule.
How's his distal pulse?
A little thready,
but still there.
We need to get him to an MRI.
I'm not going anywhere
without Franklin.
I named him after my father.
You and Franklin both won't fit.
Aah! Oh! Oh!
How? You said he was dead!
I didn't take a pulse.
Go get something to kill it.
No, it's dead! It's moving!
It's a postmortem response.
You guys are doctors.
Don't people do this?
No! No!
I'll help you review at lunch.
Surgery's in 20 minutes.
Good luck. You, too.
I want to...
No, no, I haven't looked.
I want to be... Great...
great... Okay.
Got it. I'll be back
as soon as I can.
Hi. You must be
Michelle's mother.
I'm Dr. Browne. I'll be...
Yeah. How long will
she have to stay in here?
Hospitals make me nervous.
Three days to a week,
depending on...
Well, she's gonna miss
a lot of school.
And she watches Tisha and her
brothers in the afternoon.
Your daughter has a serious
infection in her gallbladder.
She's been experiencing symptoms
on and off for a while now.
She never told me that.
Why didn't you tell me that?
Mama... My point is,
she's been ill for a while,
- so her recovery may take...
- Mom.
Mom?
P-Please, my... my chest hurts.
What's wrong?
Her oxygen levels are dropping.
She's tachycardic.
I need a chest CT, stat.
You had a blood clot
in the artery
that feeds your lungs.
It's called
a pulmonary embolism.
This medicine broke it up.
How could that happen?
According to our scan,
it was part of a larger clot
in your leg
that broke off
and traveled there.
As for why
the larger one formed,
when I asked you if you were
taking birth control pills,
you said no.
Was that the truth?
You asked me in front of Tisha.
I'm doing it with my boyfriend,
and I don't want babies,
so I'm taking
birth control pills.
How long have you been
taking them?
I don't know. A year?
I'm prescribing condoms
for your boyfriend.
You need to go off the pill
to prevent further clots.
Dr. Browne is gonna place an IVC
filter via your femoral vein,
in case other parts
of the clot break off.
Your gallbladder surgery's gonna
have to wait till tomorrow.
What are you doing?
This is where
the catheter goes in.
How did you get these scars?
I cut myself climbing a fence.
Those scars...
They're straight, in a row,
all the same length.
I don't believe you
got them from a fence.
I don't care what you believe.
Kids who cut,
most of them are really sad,
in a lot of pain,
and they say cutting
makes them feel better.
Is that how it is with you?
I don't want to talk about it.
Okay.
My life sucks, okay?
Tell me how.
Why?
It won't change anything.
Talking might
make you feel better,
and maybe I can help.
I live in a foster home,
but I'm not a foster kid.
I'm a whole mother,
but I've never had a baby.
My mom brought three kids
in our home,
and now it's my job
to take care of them...
Make breakfast,
get the kids dressed,
take them to school,
go to school,
pick them up,
dinner, homework, laundry.
Repeat.
I barely ever leave the house
without a kid attached to me.
Can you help me with that?
Michelle wouldn't
hurt herself on purpose.
Michelle is unhappy.
She feels pressure
to look after
her foster siblings,
help out at home...
Yeah, her home life is fine.
I'll talk to her.
It might be helpful to have
her speak with a psychiatrist.
My daughter is not crazy.
We... We don't do psychiatrists.
You know that.
That needs to change.
When are you doing her surgery?
Tomorrow. Thank you.
I will speak to my daughter.
Don't.
It's your job to fix her
gallbladder, not her life.
It's your first surgery.
Don't get distracted.
Have you talked to Carly?
No.
Blood pressure is 62/31.
Your patient
is in cardiac arrest.
I know.
You're practicing
the Pringle maneuver
in the event of a liver bleed?
Yes.
That was better. Thanks.
Now you can talk to Carly.
I need to practice.
Dr. Lim says
getting away from things
every now and again,
having balance in our lives
can be just as important to
our performance as practice.
Maybe you should get some
balance by talking to Carly.
I don't know.
I'm nervous about
my surgery, Shaun.
Practice will make me
less nervous.
That will improve
my performance.
Okay.
Okay.
You should also practice
not causing a liver bleed.
Planning on it.
Also, how you will recover
if you cut the portal vein.
That's potentially fatal.
Or if you perforate
the small bowel,
which could cause sepsis,
leading to death.
Or if you cut
the common bile duct,
which would cause...
I'm gonna go talk to Carly.
Right now? Right now.
Aren't you still nervous? Nope, all better.
What blade for the Kocher?
What?
Incision for the chole...
what blade?
Uh...
10. Mm-hmm.
No, they won't both
fit in the MRI.
Fish Boy doesn't buy it.
Location of the incision.
Why are you trying to help me?
Lim picked you
for the first surgery.
Everyone knows that makes you
the front-runner
for Chief Resident.
This is me sucking up.
I've never been big
on pretense...
Are you okay?
What the hell just happened?
The marlin must have had
metal in his body...
Lures and stuff.
I think a license plate
flew by me.
Franklin!
Oh, no!
Franklin!
Oh, it's okay.
Franklin's okay.
It all came out one side.
It won't show when I mount him.
Well, thank goodness
for small miracles.
Ooh. Oh!
Ow!
Oh! Ah!
I've got his femoral.
Call the OR. We're coming.
Hang on, Dr. Browne.
Just need to make an incision
above and below
the arterial injury site.
We need to clamp the femoral
proximal to the bleed
without clipping
the femoral nerve.
Got it. I feel the nerve
right above my index finger.
One down.
My hand is starting to cramp.
Lean over this way a little bit.
Rotate your wrist.
Just a little bit more.
Let's see if that holds.
Go get cleaned up.
We'll take it from here.
I wanted to check
the patient's bloodwork.
He's negative for
HIV, Hep B and C.
You don't need
prophylactic meds.
I'm nervous about my surgery.
You'll be fine.
And don't ever say that again.
Why?
Weren't you nervous
before your first lead?
If I was,
I didn't volunteer that
to the Chief of Surgery...
Or anyone.
We're women, we're not white,
and we're surgeons.
Unicorns consider us
a fabled species.
We don't get the luxury
of public insecurity.
I will aspire to repressed
stoicism in the future.
We don't need to be insecure,
because every step of the way,
we've had to be twice as
good as everybody else.
Suck it up.
You got this.
Don't forget we have our
session with Dr. Donovan today.
I won't.
Your patient. Mm-hmm.
What are they like?
Man, woman, young, old?
Woman.
Girl, actually.
She's tough, smart...
really sad.
Her mom has her taking care
of three foster kids.
At least you were only stuck
looking after me.
How old?
14.
Although she acts a lot older.
She's been having sex
for almost a year.
Well, you were about that age
when you were with Wayne.
I didn't have sex
with Wayne. What?
He was in love with you,
always sniffing
around our place.
Maybe. He didn't get any.
So, who?
Junior prom guy... Derek.
Der... No.
I didn't lose my virginity
until sophomore year of college.
What were you hoping for,
a proposal?
No.
I wanted it to be special.
Oh, good for you.
I mean, I wouldn't
have held out...
No... but good for you.
I thought for sure
you and Wayne were doing it.
You were okay with that?
You were so serious.
So restrained.
We talked about birth control.
I figured, "Good for her."
She's finally relaxing,
having some fun."
Well, I was so restrained
and serious
'cause I never knew when
you were gonna fall apart.
Got to get to work.
I'll be back before
Michelle goes into surgery.
Have you had a chance
to talk to her
about her cutting?
Oh, yeah, some fool friend
of hers gave her the idea.
She's not unhappy.
It's just peer pressure.
She sounded unhappy to me.
She's upset I didn't let her
go hang out with her friends.
It's typical teen drama.
She promised me
she's done cutting.
Self-harming behavior
doesn't just stop.
Michelle might need... Dr. Browne.
My daughter
needs to have surgery
and get out of this hospital.
You didn't tell your mom
the truth
about why you cut yourself,
about how unhappy you are.
I tried.
She didn't want to hear it,
just said that things aren't
always gonna go my way
and I need to be
more responsible.
Like I'm not already.
Growing up, I had
to take care of my mom.
What was wrong with her?
She's mentally ill.
Bipolar disorder
and a drinking problem, pills.
When things were bad,
she'd forget to buy groceries
or clean the trailer
or pick me up.
Or she'd spend all our rent
on something stupid.
And I thought
if I could make her life
easy enough...
If I cooked and cleaned
and got good grades...
Then she'd get better.
But she never did.
And for the longest time,
I thought it was my fault
she was sick.
And I probably still would
if a psychiatrist
hadn't refused to believe me
when I said I was fine.
You've been to a psychiatrist?
But you're, like,
a fancy surgeon.
I could have a therapist
come by and see you
before your surgery.
Okay.
He should be getting better.
It's got to be an infection
from the marlin.
Aeromonas
or mycobacterium marinum.
Would've responded
to the antibiotics.
Guys, I'm trying to focus.
What if he has an underlying
autoimmune disorder?
It could've been triggered
by the surgery
or even the initial
fish stabbing.
It would explain why the leg
ulcerations are progressing
despite good arterial flow.
We could see
if he responds to steroids.
Which could kill him
if it is an infection.
But we could run an ANA,
see if he's positive.
What about a parasite?
Rhinosporidium seeberi
or a gill worm.
Have you talked to Carly?
Sorry.
I got sidetracked by a marlin.
Come in.
You wanted to see me?
Ms. Reynolds tells me that
you went against her wishes
and had her daughter
speak with a psychiatrist.
Uh, Michelle asked
to see a therapist.
Only after
you talked her into it.
I'm gonna report you
to the medical board.
You had no right...
Dr. Browne, were you concerned
that Michelle might be
a serious danger to herself?
Yes.
In that case,
the consult was required.
That said,
Dr. Browne's failure to
inform you was inappropriate.
You're off the case.
Dr. Melendez
will perform the surgery.
How are you doing?
Claire?
I understand today's
a big day for you.
Your first surgery.
We don't need
to talk about that.
Hmm, I think we do.
You've been taking care of
your mother for a long time.
That's a pattern you both
need to break out of.
I know I haven't always
been there for you,
and I just... I...
I'm trying to change that.
I know, Mom.
I'm good. Everything is fine.
And your first surgery?
Is that this afternoon?
It's...
Actually, it's not.
Um... I arranged a psych consult
without the mother's permission,
so I got thrown off the case.
How could the hospital
allow that?
What is wrong with them?
After how hard
you've worked, I just...
It's okay, Mom.
They kind of had to.
That must be
a big disappointment...
It is.
Anything else, Claire?
I'm upset, humiliated,
so, so mad
at my patient's mother
for not taking care
of her daughter.
And I... I'm relieved.
I'm so, so relieved
to have that weight off of me,
and that makes me
feel like a fraud.
Don't you say that.
How can I be so scared
to do something
I've wanted for so long?
Because things that matter
are scary.
That's how I feel
about coming here,
talking about my life
and our relationship.
What if I can't fix it?
What if I can't make up
for all the times
I've let you down?
And then I think...
"Just be like Claire."
Because nothing
stops you... ever.
You see what you want,
and you go after it
with everything you've got.
You are an inspiration.
You're myinspiration.
Carly?
Hi. Do you have a second?
OR 2 is waiting to learn
the patient's mass wasn't
cancerous so they can close.
I can come back after.
I'll be at the cafe?
Mm-hmm. Okay.
Anesthesiology, line 271.
Anesthesiology, call line 271.
Cancer.
The marlin guy has cancer.
CT chest, abdomen,
and pelvis showed no masses.
It's in his leg.
It explains
progressive ulcerations
despite good arterial flow.
And why the antibiotics
aren't working.
We'll send a tissue sample
from the ulcerated area.
And when I'mChief Resident,
I'll remember this.
There's a problem with Michelle.
I'm not doing it!
You need to calm down.
You don't get
to tell me what to do!
I want Dr. Browne!
Michelle? What's going on?
I want you to do my surgery.
I want her, Mama,
not somebody else.
Dr. Melendez
is gonna do your surgery.
He is a great doctor.
He's not you.
Y-You care about me.
Everybody here cares
about you, Michelle.
Now, please sit down.
You could rupture your gallbladder.
I-I-I don't want to get better.
Don't say that. It's the truth!
Michelle, you need this surgery.
That is all that matters...
not whether I do it.
I'm gonna be there.
I will be watching
from the gallery
the whole time.
You just... You need...
You need to sit down.
The kid okay?
I had to pull you off.
If you made even the tiniest
misstep during surgery,
that mom would go
from threat to lawsuit.
Is Patricia okay with me
watching from the gallery?
No.
You can't remove her
gallbladder from the gallery.
What?
You're doing Michelle's surgery.
How'd you get the mom
to change her mind?
I explained that, given Dr. Browne's
commitment to her daughter,
she's the perfect choice
to lead the surgery.
Especially with me over her
shoulder the whole time.
Thank you for fighting for me.
That's what bosses do.
Let's go.
You stood me up.
Sorry about that.
What's up?
Shaun's a little worried
he may have freaked you out
with his... questionnaire
the other night.
Oh, I thought it was cool.
Small talk
bores the hell out of me.
Well, then, great.
I'll tell him.
Shaun got worried about that
all on his own?
That doesn't seem like him.
I may have mentioned
that people don't usually ask
deeply personal questions
on an early date.
Claire, I like you,
but we don't really know
each other.
And yet you decided
how I was going to react
to Shaun's questions,
which isn't your business.
And you were wrong...
Totally, totally wrong.
Shaun and I don't need you
or anyone else
to run interference
on our relationship.
Butt out.
Is everybody ready
for a Time Out?
Dr. Claire Browne, lead surgeon.
Dr. Neil Melendez,
attending surgeon.
Dr. Shaun Murphy, assisting.
Dr. Jan Lancaster, anesthesia.
Donna Petringa, scrub nurse.
Shani Walden, circulating nurse.
Patient is Michelle Reynolds.
We will be performing
an open cholecystectomy.
All tools I need
are confirmed to be present.
Estimated blood loss, 100 cc.
Patient will go to the ICU
after surgery.
Is everybody in agreement?
Dr. Murphy, have you
ChloraPrepped the site?
I have.
10 blade.
Sponge.
Top layer of abdominal muscle
is exposed.
I'll need a Bovie
to cut through.
Nice work, Dr. Browne.
Bookwalter Retractor.
I see the liver,
and I need to better expose
the inferior surface.
Retract the duodenum
inferiorly, please.
Gallbladder exposed.
Dr. Browne?
There is more scarring
than the imaging suggested.
True.
Talk through your approach.
I... grasp
the gallbladder fundus forward
and use a right-angle clamp
in my suction
to develop a plane
around the gallbladder.
Kelly clamp,
a right-angle clamp,
and suction.
That was elegant use
of the Kelly clamp.
I see the cystic duct
and, behind it,
the cystic artery.
I need my first assist
to confirm
that I have identified
the common bile duct
and it is out of the way.
Yes.
Cutting the duct would be...
Very, very bad.
Move the gallbladder
cranially a little bit.
Titanium clip applier.
You sure you have a clear view?
Making the cut.
She's hemorrhaging.
I can't see
the source of the bleeding.
MAP is 45 and dropping.
What do you think is happening?
Most likely,
my scissors' tip nicked
the right hepatic artery.
It happens.
It's happened to me.
I need to clamp
the common hepatic artery,
repair the arterial wall
with running
6-0 Prolene sutures.
That's what I would do.
Hey, hey, hey.
Slow down. Slow down.
No running. No running.
Dr. Browne, how's my daughter?
The surgery was a success,
and we expect a full recovery.
I wanna see her!
Is that okay?
Yay! Okay.
Michelle says
she wants to be a doctor.
She would be a great one.
Uh, that therapist
Michelle talked to...
could I get her card?
Hi, baby.Hey.
Okay.
Three, two, one.
You were right.
He had angiosarcoma of the leg.
Had to amputate,
but the margins were clean.
Hmm. What happened to the...
Franklin!
Oh!
Franklin, you amazing fish!
You saved my life.
Come on, bring him...
bring him here.
Bring him... Bring him in.
Oh.
Thank you, guys.
Group hug.
Do you prefer to work in a team
or do you prefer to lead
or follow command?
Team... and to lead.
What machine
or appliance in your house
aggravates you the most?
The dishwasher.
Hey, I'm just leaving.
Who is this?
Message received at 5:30 p.m.
from Mom.
Hey, baby, I got your text.
See, I knew it was just
a temporary setback.
We're gonna celebrate.
I made dinner.
And I'm gonna
go get some dessert.
I'll see you soon.
I'm so proud of you, baby.