The Good Doctor (2017–…): Season 4, Episode 16 - Dr. Ted - full transcript

[monitor beeping]

- You said the pain was intense?
- Yeah, it was sharp on both sides.

And it didn't last long?

Just a few minutes.

- And nothing in the 24 hours since then?
- Mm-mm.

My OB said it was probably
round ligament pain.

Yeah, that's basically
growing pains.

Your uterus is expanding,
so do your ligaments.

Normal fetal heart
rate and movement,

your BP is perfect, and
everything seems normal.

Complications and
miscarriage are also normal.



Lea's OB did not
consider every possibility.

Which is why we're
here. Shaun made a list.

I'm pretty sure he's not going to
sleep until every possibility is ruled out.

I categorized every
medical complication

that could negatively
impact Lea or the baby,

then sorted by
Case Fatality Risk.

I'll get started on the tests.

[Asher] Shortness of breath, pulse
ox and respiratory rate are dropping.

She needs oxygen.
Maxine Stanley,

87 years young. Passed
out on the dance floor

at a cocktail fundraiser
for the Art Deco Society.

[Maxine breathing heavily]

Art Nouveau.

- Oh.
- [monitor alarm beeping]



- She's in V-fib.
- Getting the crash cart.

Have a look at her bracelet.

The vintage
Lalique? It's stunning.

Other wrist. Her medical
bracelet. She signed a DNR.

If we don't do anything,
she'll go asystolic.

I know.

- Can't we just...
- No.

Epinephrine? Epinephrine doesn't qualify
as extraordinary life saving measures.

She has a DNR for a reason.

[EKG flatlining]

Time of death, 2...

[monitor beeping]

She has no heartbeat,
but her pressure is rising.

- Could machines be screwing up?
- All of them?

Her oxygen levels
are climbing to over 90.

I'm hearing blood flow.

[gasps]

Wow.

I'm alive?

Which one of you bozos did this?

[theme music playing]

[knock on door]

Debbie ask me to
bring this for the baby.

Stuffed toys aren't safe for
infants under 12 months old.

They increase the
risk of suffocation.

I'll tell her you
said, "Thank you."

- You should be at work.
- Yeah.

But you're not. So you
must be here for a reason?

Claire must have called
you? She's worried about Lea.

You got some of that right.

Except that Lea
is fine. You're not.

Shaun, you gotta relax.

No... No one expecting
a baby should relax.

There are many things
that could go wrong.

Okay, so after the baby's
born, then you can relax?

N... No. The baby will be
helpless, need us for everything.

So once the baby learns
how to feed itself and dress,

- then you can relax?
- No.

Is my point becoming
at all obvious?

That I'm never going
to relax ever again?

Kind of. Yeah.

Shaun, this should be the most
amazing moment of your life.

Every parent will tell
you the same thing.

If you blink, you're gonna
miss it, and you're blinking.

You're nervous and you're
scared when you should be excited.

No signs of preterm
labor, and tests on your liver

ruled out obstetric cholestasis,

and it's not
twin-twin transfusion

because you're
officially not having twins.

Turns out having a baby with a
medical genius has a downside.

If there is a problem, I'd rather
be here than anywhere else.

Gotta take care
of this little girl.

Is the transducer secure?

I just checked it, why?

The baby's heart
rate's mildly bradycardic.

Heart rate fluctuates with activity,
and you've been off your feet for a while.

But if Shaun were here, he would
check a transvaginal ultrasound.

Let's get it set up.

Good news. The arrhythmia
didn't do a lot of damage...

Three things I can't
tolerate: lactose, cargo pants,

and my wishes being ignored.

I can assure you, we did
not disregard your DNR.

Then who did?

It wasn't a "who." You were
treated for lung cancer recently?

Didn't work. All chemo did was make
me puke up any decent meal I ate.

You also had a lobectomy
to remove the tumors.

They implanted a cardiac device.

A pacemaker. So I
wouldn't die on the table.

It's not a pacemaker, it's basically
a miniature pump inside your heart.

If your heart
stops, it takes over.

Can you turn it off?

Then take it out.

Mm. I love it.

It's too big for an
infant to swallow,

which means it's only
moderately hazardous.

Most good things in life are.

Someday we'll tell our
daughter how Dr. Ted

and Dr. Dad both kept her safe.

We have found something.

You have Type 2 Vasa previa.

It's when the fetal blood
vessels run across the cervix,

making them
extremely vulnerable.

Now, they could
rupture at any time,

definitely when your water breaks,
but also under other added stress.

And if that were to happen,
how bad would it be?

[Shaun] We...

would lose the baby.

There's a small secondary placental
lobe and multiple vessels at risk.

Gestational age?

Twenty-two weeks, two
weeks short of viability.

C-section is not an option.

I suggest fetoscopic laser
ablation to stabilize the vessels

and avoid fetal exsanguination.

It's very risky but has
the highest potential

to avoid elective prematurity.

I wrote a preliminary surgical
plan. Should we review it?

- Well, I'm familiar with the procedure.
- Good.

Since you're the head of
surgery, you can take the lead.

I will assist, and Claire
showed excellent judgment

ordering the ultrasound,
so I would like her to join us.

Also, Jordan has a
calming bedside manner.

This is a good team.

I don't disagree.

Except you can't be on it.

Yes, I can. I
reviewed the rules.

It is a conflict of interest for doctors
to operate on family members.

Lea and I are not
married, so is no conflict.

Shaun, Lea is
carrying your child.

- We aren't operating on the child.
- You're citing technicalities?

- I am citing the rules.
- And why are those rules in place?

So that people with
emotional conflicts don't get in...

Then the rule should have
said that. It doesn't. It just says...

Shaun. I care about you and Lea
too much to put your baby's life at risk

just to make you feel useful.

You are the president of the
hospital, you can overrule Dr. Lim.

I agree with Lim.

Everyone, including you, is always
telling me I'm not emotional enough,

and now you are saying
that I am too emotional?

Are you not angry
right now, Shaun?

Are you not scared?

You're as emotional as anyone.
Maybe you don't have access to it.

Maybe you don't understand.
Well, nobody understands it.

It's just that that's
not the issue.

If I hadn't been scared,
we wouldn't be here,

I wouldn't have ordered the tests,
and Lea would have lost the baby.

My emotion helped.

Dr. Lim made the right call.

Considering Maxine's age,

stopping her heart and placing
her on bypass is way too risky.

What about robotic
assisted surgery?

Adapt the approach used in
cardiac tumors to remove the device

while her heart's still beating.

I'm sorry, but should we really
be operating on this woman at all?

A DNR is one thing,

but now we're considering an
experimental elective surgery

for the sole purpose of
facilitating the patient's death.

The patient agreed to
the device to save her life,

not prolong her death.

Is that what we're doing when
we treat terminally ill patients?

- She's making a mistake.
- She's making a choice.

- Which is hers to make.
- But it doesn't make sense.

She's more full of life than any
patient I've treated this month.

So talk to her. Make
her change her mind,

or maybe she'll change yours.

[upbeat music playing]

I love you too.

Pong. I've been waiting
for that Red Dragon.

You're ready for your
close-up, Ms. Stanley.

A Sunset Boulevard reference.
And you were born, what,

- ten years ago?
- Mm.

I've never seen it, but my
Bubbe... Uh, grandmother,

used to say it all the time.

She's the one who
taught me Mahjong.

Well, was she as
naive as you think I am?

You have better things
to do, young man.

And at this point in my life, I
don't need any new friends.

Do you want to die?

Something only the young would
ask, thinking there's actually an option.

Well, sometimes, if you're
lucky, there's a choice about when.

And sometimes, if you're really
lucky, there's a choice about how.

I want to die on
the dance floor...

with a song in my
heart, a drink in my hand.

You want me to die a
few months later, in pain,

not knowing who I
am or where I am.

Forgive me for not saying
thanks for the opportunity.

Ah.

Mahjong.

[monitor beeping]

[Morgan] Feels weird, right?

Watching other
people do your job

is like being the understudy
in a Broadway show.

Or a couple college musicals.
Basically the same thing.

I should be part of
the surgical team.

I have studied every aspect
of this surgery extensively.

You know, I never expected to
take you seriously as a surgeon.

I never saw you as competition until
that aortic dissection our second year.

There was surprise
clotting in the false lumen.

Which you performed flawlessly.

That's when I realized
I'd underestimated you.

Just like Dr. Lim is
underestimating me now.

No, Shaun. You didn't
become a better doctor

because of that
surgery with Melendez.

I became less of an
idiot, and finally realized

I wasn't the only person here
capable of doing great work.

Lea's in good hands, even
if they're not your hands.

The baby is fine.

Dr. Lim did an excellent job.
So did Claire and Dr. Allen.

The vessel is healing,
but still vulnerable.

Also, the baby needs steroids
to speed lung development.

We will recheck the
ultrasound in 24 and 48 hours.

Until then, all we can
do is watch and wait.

At least I know the
password to the good Wi-Fi.

- You okay?
- If you're researching

- which steroid is most effective...
- I'm not.

I'm trying to take my mind off of
the baby and what can go wrong,

and all the other things
I can do nothing about

and focus on something
I can do well, my job.

[Lea sighs]

Is that helping?

It could be.

Go do your job.

[Marcus] Robotic-assisted
left anterior thoracoscopic

removal of a cardiac device.

Who wants to write
the paper with me?

[chuckles]

Assuming it works.

Shaun? I wasn't aware
you'd be joining us.

This surgery is interesting
and very complicated

and I don't care
about the patient.

It seems like an
excellent distraction.

We could use
another set of eyes.

I'm sorry about Lea. If
there's anything I can do...

No, you can't. As
a first-year resident,

you're one of the least
qualified doctors here.

There's more scarring around the
device than the imaging showed.

We're going to need to free
it before we can remove it.

Clamp is loaded, let's begin
with the outflow cannula.

We'll see if our
patient can tolerate it.

Vitals are stable. EKG is good.

EKG is good. This is excellent.

I am completely focused,
not thinking about Lea,

or how we could lose the baby.

Fetal heart rate is 125,
Mom's BP is 110 over 60,

vitals are normal.

There was some fluid leakage
so Dr. Allen checked for PROM.

Negative, and no contractions.

Let's confirm it's amniotic
fluid, then test for an L&S ratio

to see how the lungs are
responding to the steroids.

- How do you feel?
- I don't speak doctor,

but if I were a car, "fluid
leakage" would be a problem.

Amniotic fluid can leak
slightly after surgery,

it's just something for
us to keep an eye on.

Right. Wait and see.

Where is Dr. Ted?

- Who?
- The toy Shaun brought for the baby.

What mother loses her
baby's first teddy bear?

It's fine, one of the nurses...

- No, it's not. It just...
- He's right here.

Thank you.

Being in a hospital,
trying to protect your child,

is a terrifying,
awful, lonely feeling,

and there's nothing as a
doctor I can say to make it better.

But as your friend, I can let
you know you're not alone.

[Marcus] Isabel and I have
been trying to have a family.

I've almost lost track
of how many IVF cycles.

People come over
and ask how it's going.

We say, "Getting close,"
whatever that means.

Mostly it's just an answer designed
to get people to stop asking questions.

[Claire] I've been
scared since I was a kid.

If I could just be better,

a better... Better daughter, a
better student, a better doctor,

then I could stop bad
things from happening.

But when Melendez
died, I finally realized

that life is not something
you're supposed to control.

It's something you're
supposed to share.

[Alex] Eight months pregnant,
Mia and I had everything planned.

Bags packed, alternate
routes to the hospital.

Mia's water breaks at the mall.

Nothing like the way
it was supposed to go,

and it was the
best day of my life.

[Jordan] I thought I was
ready, but when I lost Junior...

It took a long time for
me to stop blaming myself.

A year later, I got
a cat. That helped.

You lost a child,
and you got a cat?

Junior was my tortoise.

- Oh.
- First pet I ever owned.

That should've been the
beginning of the story, Dr. Allen.

I wasn't the one who
left the gate open.

Your tortoise ran away?

[all laughing]

Your amniotic fluid
levels are stable.

That is good. We need a plan in
case your water breaks at the mall.

I take it that's a specific
concern you heard about from...

- Dr. Park says his wife...
- Stop talking to people.

Okay. There are three surgeries I'm
thinking of using to distract me next.

One is a gallbladder removal,
which sounds very boring,

- but it...
- [gasping] Shaun. What...

Lower extremity swelling
and shortness of breath

are symptoms of a
pulmonary embolism.

Page Dr. Browne!

Congratulations, Mrs. Stanley,
the surgery was a success.

Success feels like I've
been run over by a truck.

Surgery takes a toll.

You'll get a set of
instructions for post-op care.

Healthy food choices,
limiting activities.

And I can throw those
instructions in the trash for you,

- or you can do that.
- We'll give you something for the pain,

and some antibiotics for a small
infection around the surgical site.

[Alex] You'll be back to the
dance floor, blood pressure

and erratic heart
rhythm be damned.

Let me.

I don't turn over Rouge
Dior to just anyone.

Thank you for the
vote of confidence.

Hmm. Nice job.

Same Bubbe.

So, Dr. Wolke, what's
on your agenda this time?

This time, I just like you.

So, what are you going to do?

You going to keep going
to Art Nouveau parties?

You say that like
it's a bad thing.

It's not a bad thing. It's
just not a meaningful thing.

My Bubbe died when
I was in med school.

I can't tell you what I'd give
for a little more time with her.

May her memories be a blessing.

Family's important.

I have a favorite nephew.

It'll be nice to spend
more time with him.

And a few others.

[Claire] There.

The clot is in the lower
right pulmonary artery.

It's small. Could we
use a tPA to dissolve it?

No, anticoagulants are
too risky during pregnancy.

Maybe we just keep an eye on the
clot and hope it breaks up on its own.

Bed rest increases the
likelihood of more clots.

I think we should
insert an IVC filter.

That would trap future clots
before they get to the lungs.

It's hard to know what the
stress of another procedure will do,

but I think we should risk it.

Shaun? What do you think?

Trust your judgment.

Hey. Have you seen Dr. Andrews?

I want to see if he'll talk
to our oncology group

about enrolling Mrs.
Stanley into a clinical trial.

What happened to dancing
and drinking until she dies?

Well, I think I sold her on a
little pain for a little more life.

That's... great.

Which one of your
patients rented the taco truck

that's blocking
the clinic entrance?

If they're serving
carnitas, I want in.

["I'm Gonna Live Till I
Die" playing over speakers]

♪ I'm gonna live till I die ♪

♪ I'm gonna laugh
'stead of cry ♪

♪ I'm gonna take the town
And turn it upside down... ♪

Doctors, welcome to
my going away soiree.

If you want some beads, you're
going to have to show a little...

Not happening, Maxine.

And as much as we understand
your desire to get back to partying,

- we have hospital rules about...
- Oh, sue me.

Or more accurately,
sue my estate.

I am sorry about your
grandmother, Asher.

But what you missed isn't more
time. It was a chance to say goodbye.

Thank you for giving
me that chance.

I've decided to
refuse the antibiotics.

Without antibiotics, you'll develop
sepsis and be in cardiogenic shock

in as little as 24 hours.

I don't understand.
Why are you doing this?

Because it's my life, all of it.

Including the ending.

[monitor beeping]

Placing an IVC filter
is a safe procedure

with a very low complication rate,
and Claire is an excellent doctor.

Shaun...

it's okay to be scared.

But it's not helpful.

I want to make things better.

I don't know how.

Look.

That's going to be us.

You don't need to
fix things, Shaun.

Just... believe with me that
we're going to get through this.

And that the three
of us are going home.

[baby cooing]

Somebody needs to check
your oxygen, young lady,

- because you're not making any sense.
- I told you.

I am not delirious, Dr. Glassman, I
just happen to have my own opinion.

It's not a matter of opinion,
it's a matter of absolute fact.

Ted Williams was the greatest
baseball player of all time.

- End of discussion. Full stop.
- Ted Williams was good.

Not exactly a hot take,

but John Paciorek beat
Ted Williams like a drum.

Only player to bat 1,000
in Major League Baseball.

- Now you'll say that...
- I am.

- John Paciorek only played one game.
- Played one game! Right.

And I'm going to say baseball
wasn't fully integrated until 1959,

a year before Williams retired.

Numbers aren't
everything, Dr. Glassman.

More does not mean better.
Not in life, not in baseball...

Maybe in tacos.

I'm sorry, why are we
talking baseball and tacos?

- Have you had one?
- I've had four, and they are wonderful.

And you would make
an excellent lawyer.

You know, I haven't
had this much tongue

in my mouth since Woodstock.

Well, some of us think that
you might be a little crazy.

A little.

Some people can't tell the
difference between crazy and happy.

Either way, you're perfectly
capable of making your own decision.

Now I'm going to
leave this lovely party.

Excuse me.

Just do me one favor, will
you? Keep the volume down.

It was a pleasure to meet you.

Pleasure to meet you. Thank you.

- Are those Maxine's new ABG results?
- No.

If you want to talk...

Why are you so upset about
Mrs. Stanley refusing treatment?

She has terminal cancer, she
is dying. Doctors can't fix that.

I know my family loved
me, but they didn't... see me.

Except my grandmother.

She'd catch my eye
at Shabbat dinner

and make some ridiculous face.

So I'd laugh and get sent to my
room, and that's where I'd find it...

a book or music or something...

verboten she thought I'd like.

She passed away a few years ago.

More time would have meant...

everything.

Time is hope.

ABG results for
Mrs. Maxine Stanley.

Right before
inserting the IVC filter,

I ordered a non-stress test

to make sure the baby
could tolerate the procedure.

That's when I noticed the heart rate
had been getting progressively slower.

So after we implanted the filter,
I ordered a Doppler ultrasound.

The tracing of the umbilical artery
was dampened with flow reversal.

There wasn't just one
clot, Shaun, there were two.

One we couldn't see because it
was lodged in the umbilical artery.

Maybe I made a mistake...
or I missed something.

I really, really want to be
wrong about this, Shaun.

You aren't wrong.

I saw the test results
on the amniotic fluid.

The lungs aren't
responding to the steroids.

The baby can't survive.

I'm sorry.

Did you talk to Lea?

No.

I couldn't protect Lea.

The only thing I can do for
her now is give her more time...

to hope.

I don't think you're
doing this for Lea.

I think you're protecting yourself
from the pain of watching her pain.

Would you like me to be there?

No. Thank you.

[sobbing]

Crap.

There was nothing
anyone could have done

that would have
made any difference.

And nothing about this
affects your chances

of having a healthy baby later.

What do we do now?

Medically, you have two choices.
You can be sedated and have a D&C.

Or some people decide to induce
labor so they can hold their child.

Uh...

- Could you give us a minute?
- Of course.

Do you...

- want to discuss risks and benefits?
- No.

I don't need any
more information.

We've lost her.

We lost her, and this isn't about
medical questions anymore.

I can't go into labor and
not leave here with our baby.

[Alex] Remarkable. Swelling
is down, trends are improving...

your infection appears
to be clearing on its own.

Apparently, life isn't
done with you yet.

Yesterday was one of the...

the best days I've
had in a long time.

Not because of the party.

Because of the memories.

[chuckles] Midnight taco runs
with my college roommates.

My sister messing up the
words to my favorite song.

Arguing with my husband...

who served the best margaritas.

[sobbing] I... I've had
a wonderful life and...

with wonderful people.

Maxine, there's no reason
you can't have more of that.

They're gone.

And now, I, uh...

I have to go home alone.

Pretty incredible that a woman
of her age, ravaged by cancer,

could fight off an
infection overnight.

If I were a religious man, I'd say,
"Wow, that's... That's a miracle."

So either I should go join a
church or a temple or a mosque

or someone slipped antibiotics
into Maxine Stanley's IV,

antibiotics which she specifically
asked us not to give her.

Don't say anything. Not a word.

Say something stupid like a confession,
and I'm going to have to fire you

right on the spot.

Not to mention fending off
a lawsuit, which we would,

and most certainly should, lose.

More importantly, none of
this helps Maxine. Does it?

So, what happens now?

I don't know.

Let's just say for the sake
of it that you know this doctor.

Would they feel at all guilty?

Yes.

Why?

Because she's a
good woman and...

it was her decision.

You knew it was her decision.
You were told it was her decision.

You didn't listen. What makes you
think next time will be any different?

Because I saw her this morning.
And for the first time I saw...

her pain.

Okay.

You're going to have
to make this right.

[monitor beeping]

[pensive music playing]

Hey.

I'm sorry things didn't
turn out like you wanted.

It's okay.

Lots of great books
have... final lousy chapters.

This is an Aid-in-Dying request.

There are procedures that
allow you to end things...

when you want to end things.

It can be complicated,
quite a few regulatory hoops.

I'll get you through them.

["Ooh Child" playing]

♪ Ooh, child ♪

♪ Things are gonna get easier ♪

♪ Ooh, child,
things'll be brighter ♪

♪ Ooh, child ♪

♪ Things are gonna get easier ♪

♪ Ooh, child,
things'll get brighter ♪

♪ Someday, yeah ♪

♪ We'll put it together
And we'll get it undone ♪

♪ Someday When your
head is much lighter ♪

♪ Someday, yeah ♪

♪ We'll walk in the
rays Of a beautiful sun ♪

♪ Someday When the
world is much brighter... ♪

Did I ever tell you about
the day Kellen was...

You did.

But tell me again.

Hey, Deb.

No, I'm not going to be late.

I just, um...

I just...

wanted to hear your voice.

♪ Someday, yeah ♪

♪ We'll walk in the
rays Of a beautiful sun ♪

♪ Someday When the
world is much brighter ♪

[man on TV] As costs for
both imported petroleum

and non-petroleum products fell,

the government said...

♪ Ooh, child ♪

♪ Things are gonna get easier ♪

♪ Ooh, things'll get brighter ♪

[theme music playing]