The Good Doctor (2017–…): Season 3, Episode 8 - Moonshot - full transcript

Okay.

Okay.

This is terrifying.

And very fun.

Are you ready to try lying down?

Because I am ready, Shaun.
I am very ready.

Carly.

Six hundred thread count,
microfiber sheets.

A shredded memory foam pillow.

A 40-watt A19 incandescent bulb.

I'm sorry.



You didn't return
my calls this weekend.

After a ride
up Skyline Boulevard,

60 minutes of Muay Thai
and a 15-year reserve Scotch,

I had a moment of clarity.

What you said about my
objectivity in the Fields case

wasn't about me.

You were in pain.

I was taking responsibility.

And asking you
to take your share.

It was a good surgical plan.

You need to accept that,
despite being a gifted surgeon,

you are fallible.

I think I should run
my procedures by Glassman

from now on.



Audrey, we need some
checks and balances.

I am checked and balanced.

And I'm the chief
of this department.

You will continue to run your
medical decisions past me.

Browne,
you're with Melendez today.

Murphy and Park,
meet me in the ER observation unit in 20.

I thought I was on ER
consults with Park today.

If I'm being bumped because
I took off the other day,

Dr. Browne was every bit...
First lead surgery.

Thank you.
Scheduled for tomorrow.

Study the images
and prep your patient.

Yes.
I rock. I rock.

The surgery gods know it.
I know it.

And apparently, so do
es Andrews.

Boasting doesn't have the same
impact when you're picked last.

He was obviously waiting for
the right case to come along.

No.

You're kidding me.

This is much better
than my first surgery.

Damn right.
A med student could do an appy.

The carotid endarterectomy
takes serious finesse.

Fair to say it's really
a fifth-year procedure,

but I don't have time to sit
around debating semantics.

I have the Holy Grail of
resident surgeries to prep for.

The tumor was found on my left
lung at my medical fitness exam.

Tricky spot.

Curable,

but tough to remove without
taking the entire lung.

That's what they said.

And you didn't like that answer.

I need my lung.

I'm going to the moon.

When did the chest pain start?
Around 9:00 this morning.

I'm gonna look at your heart.
This gel may be a little cold.

You see a cardiologist.
Did you use the nitro he prescribed?

It usually relieves the
angina, but not this time.

Are you the same Rosalind Elion
who just published a study

on IDH2 inhibitors
in myeloid leukemia

in the Journal
of Pediatric Oncology?

Yeah.

Wow.

You're famous.

I used an IDH2
on a kid with AML.

He's doing great.
Oh.

Your study has revolutionized
leukemia treatment.

It's an honor to meet you.

That's kind of you to say.

Noticing anteroapical wall
motion abnormalities.

Is your chest pain worsening?
Yes.

How did you...

She's having a heart attack.

Contact her family,
then meet us in surgery.

She needs a triple bypass.

- The moon?
- The moon.

In 2020.

It's a private venture
partnership with NASA.

Floating in an expanse
of uninhabitable emptiness,

200,000 miles
from the nearest Starbucks.

Not for me.

You never wanted to be an
astronaut when you were a kid?

Had enough challenges
here on Earth.

Did you?

I was a Trekker.

All my friends had Spock ears.

I was all about McCoy.

There's our tumor.

It's embedded in the hilum.

NASA doctor was right.

We'd have to take the
entire lung to get it out.

Not necessarily.

The tumor's growing
into the upper lobe.

If we can remove it
from the main bronchus,

we can get a clean margin.

The rest of the lung can stay.

No go.

You'd have 80% of...

If treatment reduces
my lung volume at all,

I'll be unfit for space travel.

The mass is too deep.

Major blood vessels,
your airway, esophagus

and heart are right there.

The next opinion you get
will be the same.

Or worse.

Thank you for your time.

What do you see at the apex?

I see profusion, abnormalities.

Her LAD and PD
are completely occluded.

She listed her
husband as her medical proxy.

You'll need to update
him as soon as he gets here.

The entire left side
of her heart is compromised.

He's not coming.

They've been divorced
for two years.

He hasn't spoken to her
in almost that long.

Murphy, anastomose the
internal mammary to the LAD.

Let's see if we can give her
heart a blood supply.

I tracked down
her sister in Santa Cruz,

she hasn't seen Rosalind
in years either.

That's a lot of legwork
for a surgeon.

No social worker available?

It's good that you
didn't find anyone.

Family members are the least
qualified people in the room

to make medical decisions.

Judging by the state
of her myocardium,

there's only one choice anyway.

She needs a new heart.

I think it's possible to spare her
upper lobe using a surgical robot.

Wren Braxton came to see me.

You're her second opinion?

Or fourth
or whatever she's up to?

I'm surprised you didn't
offer the robotic option.

It's the type of surgery
I usually send your way.

I didn't offer it
because with the robot,

if I'd nicked
her pulmonary artery,

she'd likely bleed out
before I get a chance

to open her up to control it.

She's just gonna keep looking
until someone gives her

the answer she wants.
And then what?

What do you think
her odds of survival are

if some hack
tries to cut the tumor out

leaving the lungs intact?

Roughly zero.
I agree.

And with you, with the robot?

Still lousy.

You can do this.

You're overestimating
the risk and I know why.

And you're doing exactly
what you did last time.

Assuming that I can do anything.

So everyone else is biased
except for you.

The one who just had
a patient die on him.

If it's had any effect,

it's to make my judgement
more acute.

I won't risk
having Wren leave here

the same way
that Patty Fields did.

People risk things to make
their dreams come true.

If you don't want to help
her, I'll do it myself.

The intra-aortic balloon pump

will support your heart
until we find a donor.

And when might that be?

A heart is the most
difficult organ to procure.

But since yours
is so badly damaged,

you are very high on the list.

I suppose that's a good thing?
Not really.

We're doing everything we can.

Thank you.

Is there anyone
you want us to call?

Yes.

My lab assistant.

The next few days are crucial
to my monoclonal antibody study.

Hannah needs to stay with
the cultures around the clock.

I don't want five years
of work to go to waste.

Can I ask why you listed your
ex-husband as your medical proxy?

I had to name someone.

Leo is the only person I ever
discussed my medical wishes with.

Now, if you don't mind,
I have a lot of work to do

which, as you've indicated,

I may not have
a lot of time to do it.

How are you, Shaun?

These are STAT cardiac labs.

I have to go.

I hope you're not
embarrassed about last night.

I want to have sex with you.

That's nice.

I think about it very often.

Even when I'm supposed to
focus on more pressing matters.

Like, 15 minutes ago,

when I was filling out
that lab requisition,

I almost forgot to add a BNP.

That's good.
No, it's not.

We need a BNP to monitor

her cardiac function
on the balloon pump.

I've been thinking
about you, too.

Sometimes when I shouldn't.
That's bad.

Not really.

I've been doing some research.

I came across this therapy
psychologists use to treat phobias.

And apparently,
it works in people with autism, too.

If you're game,
we could try tonight.

I'm game.

I need
a different first surgery.

Is there a problem
with your patient?

The plaque dissection is too
advanced for a third-year resident.

I was nervous as hell
for my first surgery.

And it was only a tonsillectomy.

I could take out a pair of tonsils
blindfolded, it's not nerves.

This is more like
a fifth-year procedure.

You're setting me up to fail.

This is why I picked you.

You come to me scared and
you couch it in arrogance.

It's rare that a resident
has what you have.

The aggressiveness,
the work ethic and talent

to be a leader.

I'm not setting you up to fail,

I'm setting you up to shine.

Or am I wrong about you?

No, sir.

I want you to do my surgery.
The one Dr. Lim suggested.

It was Dr. Lim's idea.
She's an excellent surgeon.

And my superior.
And you think I'm an idiot.

I am afraid of this surgery.

And I'm afraid
of going to the moon.

But it's not about the
moon, it's about the fear.

It's about getting beyond that.

That's how great things happen.

How they've always happened.

Because someone took a chance.

From what I read about you,

you're exactly the kind of
person I need in my corner.

Exactly the kind of person I would
have thought would understand.

Fear is also
what keeps us alive.

What do you think the odds are

of you not coming back
from the moon?

The reason it's heroic,
the reason it's exciting

is because you don't know
what to expect.

You can't anticipate everything.

One, two, maybe 5%.

60%. This surgery,
if I were doing it.

There is a 60% chance
that you die on the table.

It's called exposure therapy.

We'll lie down on the bed,
side-by-side, fully clothed

and not touching for 15 seconds.

When this timer goes off,
you'll go into the other room

for a three-minute break.

And then we'll go again
for 20 seconds.

Over time,
we will progress to longer intervals

and start to lie
closer together.

This seems like a good approach.

Whenever you're ready.

Are you okay?
What are you feeling?

I don't know!

I don't know.
I don't know why it didn't work.

It's okay, Shaun.
We'll try again.

No, no.

No, no, I can't.

We'll try for less time.

I can't do this!

Go.

What?
Go.

Get out of here.

We can watch the end...

I got the sheets, the
pillow, the dim lightbulb,

I read 18 psych journals.

And you give up
after eight seconds?

You're right,
this isn't going to work.

Go home.

How are things with Carly?

I lasted eight seconds.

She kicked me out of her house.

First time is difficult.
I'm sure she didn't...

We tried timed exposure therapy

to get physically closer,
but I...

Couldn't do it.

So try something else.

When I lie close to her,
I feel diaphoretic.

My heart rate is elevated
and mouth gets dry.

I don't know
how to not feel that way.

You want this, Shaun?

Yes.

Very much.

Then rely on your strengths.

Treat it like
a surgical problem.

Do your research.

Carly came up with a
solution, it didn't work.

But that doesn't mean
the next one won't.

Give me some good news.

I had a potential donor
in San Diego,

but the heart
was just too damaged.

I'm at the GE junction now.

Now she has complete
right-sided failure, too.

It's time to discuss a DNR.

She's got one day left
in this world.

Let's keep her comfortable.

60%? That number
is grossly exaggerated.

I spent an hour
convincing my patient

I'm not trying to kill her.

She came to me,
I gave her my surgical opinion.

I could fire you for this.

Because I contradicted
your opinion

after you contradicted
my opinion?

I gave her an option you
were too afraid to present.

No, you proposed
a potentially deadly surgery

to a woman who is desperate for any
option, no matter how crazy.

You don't have the authority.
Authority?

I thought we were talking
about the patient.

It was unprofessional,
disrespectful.

If anyone showed
a lack of respect...

Doctors, my office.

I wouldn't want to be kept
alive on life support.

Not if there was
no hope for recovery.

There wouldn't be.

As your heart failure worsens,

you may get short of breath
from fluid buildup.

We can use diuretics and
vasodilators to help control that.

I recommend both of those.

Of course, yes.

If that doesn't help,

we could insert a catheter in
your chest to drain the fluid.

The procedure does risk
a lung puncture

which would worsen
your symptoms.

You should give us every option
to keep you breathing easy.

And we'll be on call
all night to make sure

you're as comfortable
as possible.

Thank you.

I went through this with my mom
when she was dying of leukemia.

I'm so sorry.

Was it recent?

I was 10.

I remember feeling so helpless.

You should reach out to Leo.

It's too late.

I don't believe that.

There were things
between my wife and I

that I thought
we could never get past.

But last Christmas,

we almost lost our son.

And when I reached out,

Mia was there.

Leo

always made me feel pressured

to choose between
my research and him.

Eventually,
I realized he was right.

So I chose to go where
I was needed the most.

To call him now would be

hypocritical and...

Unfair.

It took a lot of time

and dedication to push
our understanding of leukemia

as far as you did.

I'm glad I have treatment
options for my patients.

You made a good choice.

Sorry to keep you waiting.

I assume that some of this
is professional,

the other 90% is personal.

Am I right?

It's a very difficult case.

We're both just overly invested.

Actually, I'd love for you
to weigh in on this one.

Dr. Lim, are you confident
in the surgical plan?

Good luck.
Thank you.

You didn't even
look at the case.

The pulmonary...

Dr. Lim is my Chief of Surgery.
I trust her judgement.

I'm sorry things
got out of hand.

It won't happen again.

It better not happen again.

If you two can't control your
interpersonal squabblings,

I'm gonna have to lose one of
you, at least.

We need an endoscopy suite to fetch
the spoon out of this guy's stomach.

Cool.

How's the intimacy
research going?

Dr. Elion has had
a very successful life

without a relationship.
So can I.

Success and happiness
aren't the same thing.

You need to decide what will
make you happy in the end.

I don't know if it's
being a great surgeon

or being close to Carly.

But I'm better at surgery
than I am with her.

Dr. Elion is wrong,
you don't have to choose.

I fly to Phoenix
every other weekend

to spend time
with Mia and Kellan.

Then you won't
be great at either.

I think Dr. Elion
is afraid.

I think it was never
about the journals

and the lives she could save.

I think she's always
been afraid.

Afraid she might lose Leo
just like she lost her mother.

And you,

you lost the person you loved
the most when your brother died.

Your elevated heart rate,
sweaty palms

are not about your sensory
issues, Shaun.

It's what we all feel.

Fear.

Why would anyone
want to feel afraid?

Because the thought of
ending up alone is scarier.

I don't think Dr. Elion
refuses to call Leo

because it is hypocritical.

I think she's afraid
he won't come.

Can you handle the spoon? Yes.

Okay.

Good morning, Dr. Glassman.
Morning.

Which shoulder would you like
to hurt for the next 24 hours?

I'm not here for a vaccine.

Okay.

Wrist and thumb joint pain.
I need cortisone shots.

Surgery is in two hours.

Can I ask you something?

If a patient, say, a violinist

who concertize
three or four times a week

were to come to you
with achy joints,

would you give him
a cortisone shot

or tell him to lay off
for a while?

Better question.

If he or she came to you
with achy joints

and pretended they
needed a vaccination,

what would you do then?

It's...

It's because I wanted
you to know and no one else.

I saw a rheumatologist
last month.

I have rheumatoid arthritis.

Wow.

I'm sorry to hear that.

My...
My mom had it, too.

It destroyed her wrist
and finger joints.

Maybe I should
leave Saint Bonaventure.

Berkeley's Chief
is retiring this year.

I could apply to replace him.

We are entitled to have
differing opinions.

We can argue...
Apparently we can't.

I love you.

I want our relationship to work.

And I want to be Chief.

If we can't find a way to work
together with me as your boss,

then something has to change.

Looks like you caught it early.

Without any noticeable erosion
of the joints. That's good.

What's your DMARD dose?

Twenty milligrams,

but Dr. Baxter just started it.

Okay.

You're gonna have to postpone

your first lead surgery
for awhile.

See how you respond.

I'd have to explain why
to Andrews and Lim.

As you should.

Cortisone shot
is just a temporary fix.

Do you know what the chances
are the DMARD can maintain

the dexterity you need to perform
an operation in the long run? 45%.

It'll change the way
they see me.

Yeah, you have a condition,
a medical condition.

They'll expect less from me.

They'll be looking
for me to fail.

Th-That's why I'm confiding
in you instead of them.

You advocated for Shaun
when everybody else

thought he couldn't be
a surgeon.

I'm sorry, you're comparing
arthritis to autism?

I'm comparing people's
assumptions, people's prejudices.

I'm asking for a chance
to prove myself.

In the surgery today,
you're gonna have to create

a plane as thin as paper

between two delicate
layers of tissue

without disrupting the major
blood flow to the brain.

If you miss by one-tenth,
one-tenth of a millimeter,

the patient will suffer
permanent brain damage or worse.

Right now, it's a matter of
pain, not function.

You think I would put
a patient's life at risk?

That's insulting.

I'm sorry.

Without the pain, I can do this.

You believed in Shaun.

I need someone
to believe in me, too.

Okay.

Leo Adan?
That's me.

I'm Alex Park.

I'm Rosalind's doctor.

She's dying.

She wants to see you.

Then why didn't she call me?
Why did she send you?

She doesn't know I'm here.

Even when we were married,
I never topped her to-do list.

She wasn't cheating on you.

She wasn't doing anything
except saving lives.

She deserves to be
cut a little slack.

Yeah.

She was saving the whole
damn world. She's a saint.

I made partner, she wasn't
there, everybody understood.

My mother died, she wasn't
there, everybody understood.

Well, I didn't.

Look, maybe I was a selfish jerk
for wanting my wife to be around

but I did.

She didn't send you.

Good for her.

She's not a hypocrite.
At least that hasn't changed.

Assistant port is secured.

Load the forceps
and electrocautery.

My Chief's doing
a difficult surgery.

I'm here to help
in any way I can.

Instruments are ready.

Time of initial
incision, 11:32.

How is she?

She's really short of breath.

I gave her vasodilators and
diuretics, but she's not settling.

She has bilateral
pulmonary edema.

She needs 40 milligrams
of furosemide.

I'll push two lorazepam, too.

I can't catch my breath.

You've got fluid in your chest.

This medication should help
ease your breathing.

She should be improving,
but she's not.

Maybe we should insert a drain.

Shaun, this isn't about
the fluid, she's scared.

Rosalind, I know
this is frightening,

but you are not alone.

I'm here and I am
not going anywhere.

As long as you need me.

Leo...

I see the base of the tumor.

There's a lot of bleeding,
teasing off the pulmonary vein.

Put a bipolar electrocautery
instrument on the right arm.

It's way more friable
than it looks.

The tumor's invaded
the vessel wall.

We need to load
more hemostatic matrix.

If I keep going,
I'll end up with a bleed I can't control.

I need to take the lung.

Prep her for
an open thoracotomy.

I need a prostatectomy kit.

Now.

Prostate cancers tend to grow
along the surrounding nerves.

Equipment's designed
to dissect the tumor

without injuring the nerves.

Substitute arteries for nerves
and you've got our situation.

Load the hot shears.

Unclamp the
proximal and distal end.

You have good shunt flow.

Loupes.

Forceps and dissector.

Is there a problem,
Dr. Reznick?

Nice work, Dr. Reznick.

Did you...

We got it all.

And you'll still need
that flight suit.

Thanks, Doc.

He might have
helped out a little, too.

The tumor was more entangled in
your arteries than it appeared

but Dr. Melendez pulled off
a remarkable win for us.

This is the reason you still
have two complete lungs.

Sign it.

Both of you.

I'm going to
leave it on the moon.

She's very close.

I'll pronounce her.

I'd like to do it.

Thank you.

I hope it's not too late.

It's fine. Come in.

You were right.

It was a crazy surgery.

Not as crazy as I thought.

It wouldn't have even
happened if it wasn't for you.

You were right, too.

I'm not objective
when it comes to you.

I blew off your concerns
about the risks

'cause I thought
you'd lost your mojo.

Great.

We're both right.

And we found a way
to work together.

And our patient's
better off for it.

Today. What about
the next time?

We won't make the same mistakes.

I'm not sure they were mistakes.

I think they might have
just been our nature.

I don't think I can give you

the unconditional support
you deserve from a partner

and the objectivity
you need from a Chief.

And...

I don't want to give up
on my dream.

I love you.

But it's not enough.

Good night, Neil.

Dr. Reznick.

Dr. Glassman.

Thank you for your support.

My pain is 90% better
than it was.

The shots helped.

Well, you did a remarkable job.

I'm fine.

Congratulations.

I did extensive further research

on intimacy treatment
for autism.

And?

And I found nothing.

You were right.

Exposure therapy is the
most effective option.

You're very smart and thorough.

Thank you.

I'd like to try again.

It's time to take a break.

I know.

This is terrifying.

And

very nice.