The Good Doctor (2017–…): Season 4, Episode 12 - Teeny Blue Eyes - full transcript

I couldn't sleep.

You should start taking your
blood pressure every day.

That's very sweet
and responsible.

Yes. I am going to try to
be extra responsible now.

Yeah.

We have to talk about
what we... want to do.

I love you. I want a
child, so I want this child.

I love you too.

And I do want kids,
but it's complicated.

Is this the right time in my
career? In our relationship?

Am I too young?
Can we afford this?



Am I willing to make this
commitment right now?

We can start depositing money
into a shared account for expenses,

and I can talk to Dr. Glassman
about hiring you an assistant

- to help with your workload.
- Shaun, just slow down.

I... I don't need you to
answer these questions now,

I just need to...

think, to figure out what to do.

And you do too.

Dr. Chambers, I'd like you
to meet our residents. This...

I know that I'm old, but I
can still read name tags.

Dr. Chambers, you started experiencing
aches in your right hand a month ago?

Then tremors, weakness, spasms.

Had to drop out in the middle
of a bowel resection last Friday.

I sent you a video
of the surgery.



Given your symptoms,
it seems carpal tunnel...

Oh, it "seems"? Well, then...

problem solved.

I'll be on my way.

Sir, can I just say that the documentary
on your work in Haiti changed my life.

It's the reason why I went to...

If you want to suck up to
me, call me "Doctor" not "sir."

And this is a hospital,
not Coachella.

If you can't wear something appropriate,
at least try something that fits.

Rule out autoimmune disorder,
hypothyroidism, diabetes,

amyloidosis, MS,
and multiple myeloma.

Then we'll get back
to carpal tunnel.

All right. If you have any
other questions or concerns,

- please don't hesitate to...
- Twelve.

First: I prefer blankets
not made of sandpaper.

Second: dim these damn lights.

This isn't some San Fernando
Valley porn shoot. Third...

If you made a list, you
don't need to tell us.

- He's had the pain for nine months now.
- And it's on both sides?

Sometimes his forehead.
Other times his cheeks, his nose.

It's persisting through very
high doses of hydrocodone?

Yeah, obviously the drugs
don't work. It's why I'm here.

[woman] Oscar.

It's a fair question.

Look, I'm sorry.

Okay? I've been to six
doctors now. I can't work.

I mean, I... I can't even kiss
my wife. I can hardly smile.

I'm going to lightly
brush your cheek.

[grunts]

Okay.

[gasps]

Please, help me.

Been on the phone for an
hour with the cable company.

Lea's pregnant.

You want to have...

Yes.

Wow. [chuckles]

Okay. I'm glad
you're happy. Um...

- Do you have any concerns?
- Yes.

Sleep deprivation.

But I have started looking
into an affordable night nurse.

Well, there's going to
be some bigger issues.

I mean, this is a...

This is a gigantic moment
for anyone, especially...

Especially for you.

You mean...

because of my ASD?

Yeah, because of your
ASD, because of your family...

Your job. I mean... [chuckles]

a million things.

I don't want to tell
you what... What to...

I mean, I don't
even know what I...

Having a child...

changes everything.

[theme music playing]

Nasal cavity's clear.

There's no abscess,
facial tumor, or sinusitis.

It could be acoustic neuroma.

- Without any hearing loss?
- Let's do an MRI to check.

We ran eight negative
tests. We don't need it.

We do the tests till
we know what he has.

It's fibromyalgia.

So your diagnosis for his pain is pain
that no one can explain? Well done.

[Alex] Some pain's unavoidable.

When I was competing
in Taekwondo,

they taught us to adjust
our relationship to it,

learn to tolerate it. It
can make you stronger.

Wow. That statement
has the absolute ideal ratio

of heartlessness, humble-bragging,
and machismo. Bravo.

Seriously? You're
pleased with that?

"Machismo" is Spanish,
"bravo" is Italian,

and "humble-brag" is 2011.
We can do better, don't you think?

Maybe we're not finding anything
because it's psychological?

Some kind of
conversion disorder?

You do the MRI.
I'll talk to the wife.

Negative for endocrine issues.

He's got a history of
moderate carotid stenosis.

If enough plaque builds up,
starves the brain of oxygen,

it could cause the
hand problems?

[Claire] If it got that bad, we'd
have already seen signs of a stroke.

[Enrique] Anyone else annoyed
that we're wasting these resources

to confirm what's
clearly carpal tunnel?

He may be a jerk,
but he's a great doctor.

If Silas Chambers
has a medical opinion,

- we'd better check it out.
- I didn't think he was a jerk.

Dr. Andrews and Dr. Lim also
criticize us and have particular demands.

Yeah. They want us to improve.

How do you know
Dr. Chambers doesn't?

He did improve Enrique.

Not kidding. You look snazzy.

I know what Dr. Chambers has.

We're having trouble finding a
physical basis for your husband's pain.

And you defended me when I
asked him about pain killers earlier.

A few years ago,
Oscar was on a job site.

Working crazy hours,
he was exhausted.

He shot himself with a nail
gun. Right through his palm.

We didn't have insurance, so
we went to this clinic, and, um...

Opioids?

Really bad. Took a
year for him to kick.

But now, um...

He's taking more
pills than ever.

Whenever I talk to
him about getting help,

he just gets mad. I, uh...

I had to move out last week.

I'm only here because
he asked me to.

I think he's faking.

[sighs]

You threw 113 sutures
in your last day of surgery.

In at least half, I detected
a very subtle tremor.

Congratulations on discovering
a symptom I told you about.

It occurs during
the part of your stitch

when the wrist is
straight, not when it's bent.

That's not carpal tunnel,
it is Musician's Dystonia.

My wrist flexes on every suture.

You're talking about a
difference of milliseconds.

Yes, he is.

Your condition was probably
caused by your repetitive technique.

Even Dr. Andrews throws sutures
in varied ways. You never do.

This kind of obsessive behavior
is common for those with autism.

- So I can refer...
- What did you just say?

I'm not autistic.

Dr. Murphy didn't
mean any offense.

- He himself is on the spectrum.
- Oh, is he?

I thought his robotic
voice and hand-clasping

were just charming affectations.

Do you really think I
am anything like him?

- I am not saying that...
- I am. You're extremely organized,

you hardly make eye contact,
and given your problems with food,

blankets, and lighting,

plus the fact you wear
headphones even in surgery,

you clearly have sensory issues.

I'm organized.

Would you rather I show up
in the O.R. and just wing it?

I have good taste in food and
music. Now that's a mental disorder?

And as for eye contact...

Okay.

I didn't come here
for a psych consult.

It was just an observation about
a possible reason for the behavior

that led to your hand symptoms,
which is what we should be talking about.

Physical therapy is the
recommended course for dystonia.

I'm not wasting months on
a treatment that won't work.

I want an MRI-guided ultrasound
ablation of the VO nucleus of the thalamus.

You want to jump
to brain surgery?

I would jump right to amputating
a toe if it got me my career back.

What were you thinking?

You just supported me.

Yes, because part of my job is not
yelling at residents in front of patients.

What you did is equivalent
to looking at a fuzzy MRI

- and blurting out a patient has cancer.
- Cancer can kill you.

Neither diagnosis is one
a patient is excited to hear.

Prep him for the ablation, and do
not talk to him again about autism.

He's seen six doctors
in the last month,

gotten three opioid prescriptions,
and he had a previous opioid problem.

It's textbook drug-seeking.

It's also textbook
a bunch of dingbats

missing a Trigeminal
Neuralgia diagnosis.

His wife agrees with
me. She knows him.

Would explain
why yours left you.

Snap. Except my
wife didn't leave me,

so neither a good point,
nor even a clever one.

FIESTA imaging would take hours to
set up, cost the patient serious money,

and still come out negative
because... it's textbook drug-seeking.

We have other patients who need
us. I'm sending the discharge order.

Hey.

[Lea retching and gagging]

I hate poop.

Like, what if I suck
at changing diapers?

Maybe we should start
with the bigger issues

and work our way down?

This isn't at the top of my
list, but since you are a doctor...

- Shaun's ASD, is it...?
- Inheritable?

Probably. But it's
unclear how much.

So even that... what am I
supposed to do with that?

Think it through.

Let's say you have
a little baby Shaun.

Like...

Tiny, honest, brilliant
guy who adores me...

Mini button-down...

teeny blue eyes...

And me?

A mom?

I mean, I'm not saying
my life would be worse,

but it would just be so different
from what I was planning.

Not that I was really planning,
but I am enjoying just...

being.

And so what if you wait?

I just want to make sure
I'm making the right decision.

[sighs]

I guess you'll
never really know.

I had to make a lot of hard
choices about my mom...

and I still wake up wondering
which of them went the wrong way.

But...

you still gotta choose.

[Asher] No abnormal
signal in the mid pons.

So are you and Dr. Park
like this at home too?

When I let him out of
his cage for meals, yes.

[door opens]

Hey. We're almost...

Oh, come on.

Did you not get the
text I didn't send?

Don't bother asking for
consults if you're going...

Wait, what's that on the right
superior cerebellar artery?

An abnormal loop
causing compression.

He has Trigeminal
Neuralgia. The pain's real.

We have good visualization
of the target area.

Connect the ultrasound
to the stereotactic frame.

Ablation won't work.

You changed your mind?
You don't think he has dystonia?

He does, but it's a symptom.

His vertebral artery
takes an aberrant course.

It is pressing against his spinal cord.
He needs vascular surgery or he'll die.

It's a disorder of the nerve

that carries sensation
from the face to the brain,

and it's one of the most
painful conditions that exists.

And very hard to diagnose.

Thank God Dr. Park
approved all those tests.

[sighs]

You... You were in agony...

And I...

I told them I thought
you were lying.

You thought I was lying?

You thought I was
just being an addict?

Still you came here with me.

Sat at my side...

We'd like to do a
microvascular decompression.

We'd go in through the back of
your skull and put in a Teflon patch

to cushion the affected nerve.

You're... You're
cutting into his brain?

It's relatively safe,

and other options are
unlikely to relieve the pain.

Look, I'll do it.
Thank you so much.

[Claire] We want to run
a vertebral artery BTO.

If you tolerate it, then
we would sacrifice...

Sacrifice the vessel
with onyx embolization.

We recognize you might
not love this proposal.

The one in which my
hand weakness remains,

destroying my career?

Did you consider
vertebral-to-vertebral artery bypass

with physical removal
of the aberrant artery?

Mm-hm. That would carry a
very high risk for a stroke or bleed.

It would fix the dystonia
and let me get back to work.

[Marcus] With your
history of carotid stenosis,

it would be a coin flip
whether you survive.

I can live with those numbers.
Or for that matter, die with them.

Corridor to the trigeminal
nerve origin is open.

I freed up the offending
vessel. Teflon sponge.

The sponge is too big. It'll
compress the brain stem.

- I have at least four millimeters of room.
- You have half that.

- You have a better view 50 feet away.
- How long have they been like this?

A while. It's getting
worse, though.

[Morgan] Sorry, Park,
you're right. Just like you were

when you decided to
discharge the sick guy.

Wow, you invented
sarcasm. Really impressive.

- Hey, look at me, I'm using it too.
- Park,

you missed the diagnosis.
Reznick, you ignored protocol.

How about you both show
some humility and shut up?

Sorry. Teflon's placed.

What if we use the
saphenous vein for the bypass?

- Not enough flow, he'll stroke out.
- Carotid to distal vert, then?

Stenosis is too severe.

Dude's loaded. He's
at retirement age.

He could teach, travel,
screw around all day.

Why is he demanding
that we do this?

When you dedicate your life to
something that gives you meaning...

Starts to define you. His
decision may be irrational,

but I get it.

I don't think it is irrational.

Dr. Chambers has no
friends, no children, no family,

no outside interests. If
he can't be a surgeon,

he'll have nothing.

I think our best
bet is a radial graft.

Highest flow I can think of.

Any other ideas?

Okay. We go with
the radial graft.

I'm impressed.

I was actually starting to
wonder if I was losing my touch.

But then I had a dark afternoon
of the soul and suddenly I knew it.

Those were totally solid burns.

Maybe not A plus, but A
minus, B plus at the worst.

So it hit me,

your plan was to throw me off
my game, make me doubt myself.

I'm attracted to you.

I have been fighting this stupid
feeling, trying to find reasons to not...

feel...

Are you kidding me?

Yes.

Your jokes were lame. And
that's how you screw with someone.

No.

You're not that good of a liar.

I can't have a roommate
who has feelings for me.

- Since when can't you take a joke?
- Since my roommate hit on me.

You have to move out...
as soon as possible.

We've decided to use your
radial artery for the graft.

We've scheduled an
O.R. for tomorrow morning.

- Good call.
- I agree.

You should risk your
life for this surgery.

- Are you being facetious?
- No.

It just boggles the mind.

You can't understand
what anyone means.

You can't express
yourself like an adult.

You're a child playing dress-up,
and everyone here just plays along.

Let's go, Shaun.

- You're agitated.
- I'm fine.

You are rubbing your mug.

People with ASD often
have comfort objects

for when they become agitated.
I can order you propranolol.

You're going to give me
the Ruseckas-Freedman

ASD Diagnostic Questionnaire,

and that's going to
shut your damn mouth.

Okay, the "Rafad-Q"
is just a tool.

An official diagnosis needs
to come from a psychiatrist.

Well, since I might be dead
tomorrow, this is your next best option.

I'll... get the test.

Why can't you treat people
with an ounce of respect?

Respect has to be earned,
not doled out like candy.

No, that's an excuse people like you
use to justify your garbage behavior.

That's just an excuse people
like you use to avoid facing reality.

No one was respectful to
me when I was a resident.

They were dismissive and cruel,

but it lit a fire and it made
me the man I am today,

the man that you came
into my room idolizing.

- Not anymore.
- I'm devastated.

Surgeons deal in human
lives, not childish fantasies.

If you want to succeed,

you're going to have
to be a lot more like me.

- Everything okay?
- Yep.

Surgery went very smoothly.

No pain right now.

Want to take it
for a test drive?

[grunts]

It's worse.

Collateral circulation
is not ideal.

How are we going
to harvest the artery?

What's going on?

How much am I going to have to
change who I am to be a surgeon?

Well, to be great, or even good at
anything, we have to compromise.

I used to get too emotionally
involved in my work,

with patients, everyone.

I had to learn to
distance myself.

Yeah, you've really
grown cold and heartless.

I have changed. We
all end up changing.

You gotta try and
make it a good change.

Well, I don't want to change.

I want to change
what's around me.

- I'll... I'll figure it out.
- I'm sure you will.

Hey, you're the guy who
makes living in a van look cool.

[chuckling]

So the circulation...

The right side looks
like it has better length.

Yeah. Better collateral too.

Given the poor outcome,

we can't recommend
further surgery right now.

We suggest six months
of pain medication

and referrals to neurology and
pain management specialists.

What surgery aren't
you recommending?

A DREZ lesioning.

We'd cut the signal
from the trigeminal nerve

to the sensory
areas of your brain,

but there's a real possibility of
paralysis on one side of your body.

I want the surgery.

Baby, I'll help you
manage the pain. I...

I'll move back in.

I'll take care of you.

You know how I
treated you before.

I'm only going to get worse.

I would never leave you again.

That's what scares me.

I'd start cutting you
down, being cruel.

And you'd just put up with it.

I won't let that happen.

We'll prep an O.R.

"I frequently point out
other people's mistakes."

Duh. That's a yes.

"People tell me I
overthink things."

Only people who underthink
things. But fine, another yes.

"I sometimes speak
in an abnormal tone."

Who thinks they speak
in an abnormal tone?

Just mark no.

- How many more of these?
- None.

Your answers are fully congruent
with someone on the spectrum.

No. You keyed it wrong.

- No. Look. No, I... Look, I didn't.
- Or something. Here, no.

- Give it to me. Don't!
- See... No.

You idiot! Stupid, careless...

- I... I stepped back...
- Get out of my room!

- Get out!
- Okay.

[Audrey] Make sure we're not
impacting normal spinal cord pathways.

[Asher] Somatosensories
are at baseline.

BP's steady.

[monitor beeping]

Leg and arm SSEPs at 50
percent decreased amplitude.

Check the cord above and below
for hematoma or bony compression.

Cord's fine. Push IV
fluids and start pressors.

So, what is it?

I don't know.

[beeping continues]

- Any issues with motor potentials?
- Unilateral amplitude down 70 percent.

We're about to get total
neurological collapse.

[Morgan] A clot
from a branch artery.

We checked the
spinal blood vessels.

The outside. But the electrode
could have injured a sulcal artery.

We need to follow the DREZ pathway
inward and search for a small clot.

Start at the site of last
ablation with the electrodes.

It's gotta be deep.

This'll be easier
if she's in here.

Scrub in, Dr. Reznick.

We're setting up the
neuromonitoring for Silas' surgery.

- He's angry with me.
- Silas?

He's angry with everyone.

Dr. Andrews said to stop
talking to him about ASD,

but I brought it up
anyway, gave him a test.

His mug broke, and I
don't know what to do now.

I don't know what
to feel. And Lea...

Lea told me about the pregnancy.

Is this hard for me because I'm
dealing with both things at once?

I think both things are related.

What if my child...

has no friends?

What if they're picked on?

This is not small-town Wyoming.
The world has changed, Shaun.

I haven't changed. How can I...

know what they're feeling?
How can I comfort them?

How can I be a good father?

Remember when we first met?

Right over there?

You were mad at me.

Yeah, but you were
right about the patient.

And you were stubborn, and crazy smart.
And you are still all of those things.

But...

if you were still just that guy that I
met running through those doors,

we would not be
sitting here right now.

You have changed.

You've adapted, you've grown.

Do you know how hard that
is? Most people don't even try.

And you are going to
grow into a great father.

Whenever it happens.

Slowly go perpendicular at the
angle of our ablation electrode.

Still not seeing the clot.

Amplitude loss at 80 percent.

[Morgan] Maybe it's not a clot.

Maybe it's something
higher up in the brain.

No. You were
right the first time.

Maybe it's hiding behind some
ultrasound-impervious segment.

Cut the dentate ligament.

It'll get more lateral access.

Completely section the ligament.

I see it.

Removing the clot.

[monitor beeping steadily]

Amplitude returning
to normal baseline.

Let me know if you need me.

We're good. Thank you.

Hey.

- We did good together.
- We did.

You still have to move
out though. Tonight.

On my first day here,
Dr. Melendez said

I would never do
anything besides suction,

but later he let me make
my first surgical incision.

He became my friend. I miss him.

Are you in the right room?

Did somebody tell you I
needed pointless stories?

I used to think being a doctor
was all I needed to make me happy.

It did make me happy.

But I realized I wanted more.

And that I could have more.

I changed.

You can change too,

but not if you're dead
from this surgery.

I've made up my mind.

Please leave.

My brother Steve, he gave me
a plastic scalpel before he died.

- It broke. I was very sad.
- I asked you to leave.

When I fixed my scalpel
it made me feel better.

I was 9 years old
when my father died.

I loved drinking hot chocolate
with him in the morning.

He'd bring me a mug
after every business trip.

He understood me.

My mother didn't. Nobody did.

I tried fitting in, but...

I got frustrated,
so... I gave up.

On relationships, on friends,

on all but the one
thing I was good at.

And now,
Dr. Murphy, I'm too old.

I've made too many
enemies, too many mistakes.

People tolerate me

because I save lives.

Without that...

why would anyone
ever care about me?

I care.

That smells good.

Bland.

Pasta with olive oil.
Kind of puke-proof.

Have you thought
any more about...

Yes.

I made a list.

I guess I learned from you.

What's the first
thing yours says?

That I think I would
be a good father.

But that I can't know for sure.

You'd make a great dad.

It's on my list.

You were right.

It is very complicated.

But...

I do know...

I want you to be happy, Lea.

I have so many
reasons to do this...

and so many doubts.

I'm just scared, Shaun.

But...

If we are both having
doubts, then maybe now...

isn't the right time.

Okay.

Mm.

I see that my hemoglobin's
stable and my white count is fine.

Yeah. We just wrote
your discharge orders.

This is a referral for
an ASD specialist.

I can look into that on my own.

Thank you, Dr. Murphy.

And thank you, Dr. Guerin.

Welcome back.

Did it work?

Let's find out.

[grunts]

Your hand's cold.

[chuckles]

I'm transferring out.

Last year I applied to a
program at Johns Hopkins.

They train doctors to travel the
world to help out in needy areas.

And they'll let me enroll late.

Sounds like a
good place for you.

Thanks for always being a
great boss. And a great friend.

Can't have been that
great. Sneaking out like this.

Uh, actually, for the first
time I can remember...

feels hard to say goodbye.

You're always doing so
much for other people.

Please don't forget to do something
for yourself every now and then.

Were you messing with me or not?

If I was, would you let me stay?

Yes.

I wasn't messing with you.

Then I guess it's good we're
not roommates anymore.

Because I couldn't do this.

This is a one-time thing.

Unless I change my mind,
so consider that an incentive.

♪ We get by ♪

♪ On love and faith ♪

♪ We'll get by ♪

♪ With a smile on our face ♪

♪ We get by With
help from our kin ♪

♪ We get by through
thick And through thin ♪

♪ We get by ♪

♪ We get by ♪

♪ No matter what happens
I'll be there for you ♪

♪ We get by ♪

Lea Dilallo?

[sighs]

She... called your name.

I spent all day reminding myself

of all the reasons why
this was a good idea.

But now that it's
actually happening, it...

doesn't make me feel any better.

It just makes me
feel really sad.

Maybe it's not the right
time, but will it ever be?

Feel the same.

Are we really doing this?

We...

are having a baby.

♪ We get by ♪

Yeah.

♪ No matter how long I'll
be waiting here for you ♪

♪ We'll get by ♪

Yeah?

Okay.

Okay.

[theme music playing]