The Good Doctor (2017–…): Season 4, Episode 17 - Letting Go - full transcript

Don't put any food down the
sink. Garbage disposal's broken.

- I'll call the landlord.
- All right.

He took a week to call the
plumber when we lost the hot water,

but I guess this
doesn't matter as much.

- We'll just use the regular trash.
- Yes.

Ten to 15 percent of known
pregnancies end in miscarriage.

This wasn't unusual.

No, you're right, we're not the
only people to go through this.

The best thing to do is
to just get back to normal.

Hmm.

I'm glad you're
going back into work.



A couple more days of
rest, and I'll be doing that too.

Are you sure you're all right?

"All right" is
stretching it, but yeah.

We just need some time.

- How you feeling?
- All right.

- How's Lea doing?
- She thinks we need time. I agree.

Hey, Shaun. How are you feeling?

All right. And Lea
thinks we need time.

Well, I didn't expect to see you
here. You have a few days leave,

- I thought you'd be home.
- I prefer to work.

Well, we respect your
judgment. Bon appétit.

Gastric reflux causing
projectile vomiting.

I'm clearing your schedule
for the next... how many days?

Oh. Well, that is up to my
lovely and talented doctors.



Welcome to St.
Bonaventure, Senator Clark.

- Please. Marian.
- Oh, Marian. I am a huge supporter.

You had my vote in the
presidential primaries.

- Thank you, Dr. Browne.
- Oh, Claire.

Claire. If only if there'd been
another couple million like you...

Yeah.

It's okay, nothing wrong
with a balanced ticket.

I was in my hotel this
morning, going over my speech,

when this started
happening to my face.

Whole left side went rogue,
blinking and twitching like crazy.

Has it happened before?

This was the third time.
Fortunately, all in private.

Needless to say, I had
to cancel my appearance.

Can I see that again?

Oh, I'm sorry, just deleted it.

The only thing worse than people
seeing my twitchy face in person

is them seeing my twitchy
face on a hacked video.

So, how do we go about
deleting it from my body?

It's a hemifacial spasm.

We should do an MRI to rule out
the more serious possible causes.

- Which are?
- Aneurysm, MS,

possibly a brain tumor.

What are the less
serious causes?

Stress, exhaustion,
too much coffee.

Well, that's my job description.

Which can be treated
with Botox injections

- and Ativan.
- Ah. Sold.

We still need to do the MRI.

Do both.

Oh. As Claire knows, I always
have to control the agenda.

Hi. Artie Hill. I have
mild heart failure.

I'm Dr. Park. How do you
know you have mild heart failure?

I'm tired and I've been
having palpitations.

We'll run tests, but if it
makes you feel better,

a lot of people have palpitations, and
it doesn't usually mean heart failure.

Yeah, but I was talking
to my doctor on the phone,

and he told me I
have heart failure.

- The doctor who did my bypass.
- Your bypass?

He told me I should go to
the nearest emergency room.

I was in the park,
looking at the cherry trees,

and I started feeling
funny, so I called...

- When was this bypass?
- A month ago.

Paul Nakano. I performed his
surgery at San Jose General.

Mr. Hill, I hope you took
a taxi, as I asked you to.

It was only three blocks.

If you don't mind, I'd
like to get a 12-lead EKG,

cardiac CT, and blood work.

Ordinarily, I'd be thinking about
volume overload as the cause...

But in this case, sodium
and BUN are normal.

The next thing I'd look at is a
post-op myocardial infarction.

But in this case the
troponins are normal.

- So you know what I'm thinking?
- Yes. You did your job too damn well.

The heart's been so
strengthened from the bypass

that it's revealed a
weakness in the valve.

It can't handle the
pump pressure.

Dr. Nakano was my chief of
surgery when I was a resident.

- So when do you want to open him up?
- I'm hoping never.

Have either of you ever done a
transcatheter aortic valve replacement?

Well, I've read about it.

It's minimally invasive, and
way preferable to opening up

the patient for the
second time in a month.

I look forward to
learning from you again.

Hmm.

Oh. Excuse me. Sir.

Person in the hall.

- Oh, sorry.
- Hello. I am Dr. Shaun Murphy.

I am a surgeon.

I... I can't find my socks. I can't
find the button to call someone.

Oh, right. Now, why would they
put it there? You can't even see it.

What about the socks?

I have mild heart failure.

I was in the park, looking
at the cherry trees...

Cherry trees aren't in
bloom at this time of year.

I can still look
at them, though.

They don't disappear just
because the blossoms fall.

I can get you socks from
the pre-op supplies area.

Oh, yes, I remember those crappy
socks they give you. I'll take them.

Why do you guys keep it so
cold in here? My feet are freezing.

It's beautiful to look at

if you're inside and don't
have to go anywhere.

And you might not want to
go anywhere if you don't...

supposed to take care of ours,

but he lost his silly
head and shot Broome.

And that's what was so
funny about it, is that we...

We'll use a pigtail catheter
to place the guide wire,

then run a delivery catheter
through an 18 French sheath

to ferry the new valve through
the femoral artery to the heart.

Then we inflate a balloon
that expands the new valve

and installs it right
inside his current one.

That would kill him.

He has cold feet.

Who are you?

I'm Dr. Shaun Murphy.

He's one of my residents.

Oh. Artie has cold feet?
He's afraid of the procedure?

No, I think Dr. Murphy means it
literally, the patient has cold feet.

Is his body
temperature dropping?

No, his core body
temperature is stable at 98.5.

He rarely has cold
feet. I got him socks.

You're gonna need to draw
some dotted lines here for me.

Okay. Cold feet means
impaired circulation,

which means constricted
blood flow from the heart,

which means a damaged vessel.

If we try to push the new
valve through the damaged area,

it will rip open, killing him.

- Damaged vessel?
- Yes, you made a mistake during bypass.

Most likely a tear in the aorta.

- I didn't make a mistake.
- You caused an aortic dissection.

Shaun, this man has
more cardiac experience

than everyone in
this room, times ten.

A lot of people have cold
feet. My wife has cold feet.

Everyone has cold
feet in a hospital.

Yes. We should perform
an angio on Mr. Hill.

That will show the
aortic dissection.

This man recently
underwent open-heart surgery.

He's gonna have
valve replacement.

We don't need to load him
up with yet another procedure

when there was no mistake.

Studies show that old people
are less likely to admit mistakes

because they are less
aware when they've made one.

Okay, Dr. Murphy. You've told
us your thoughts on this case.

It's my understanding that
you have a few days of leave.

I suggest you take them.

I'd prefer to continue working.

Then do it somewhere else.

You... will kill him.

- You think my surgeon is wrong?
- Yes.

And you're, like, a
real doctor, right?

I am a real doctor.

No offense, but
best heart guy around

versus the guy who happened to be
passing my room when I needed socks.

Why shouldn't I let Dr. Nakano
do what he thinks I need?

If anything goes
wrong, he can fix it.

It could be difficult.

The tip of the catheter
would be likely to rupture

your weakened aorta, ripping it
open and causing you to hemorrhage

into your chest and bleed
out in a matter of minutes.

If you survived, you'd have
severe anoxic brain damage.

But it's unlikely you'd survive.

Go home.

Is Mr. Hill
requesting the angio?

He's not just requesting,
he's demanding.

This is why you take a leave
of absence when you need one.

You're not thinking clearly,

or you never would have
pulled a stunt like this.

I prefer to stay at work. I
could assist with ER consults.

Dr. Murphy, because
I'm being professional,

you may not understand
how angry I am right now.

Will you do what Mr. Hill wants?

What you want, you mean.

Yes, we'll do it.
You've forced our hand.

Good.

I would have fired him.

Honey, when Freya brings you a
dead rat, she's offering you a gift.

I know, I waited until she was gone
so she wouldn't see me toss it away.

Wish you were here, you
could strike the right balance

between enthusiasm
and discouragement.

Oh. Honey, I gotta go.
My doctors are here.

You sure everything is okay?

Absolutely. These shots are
working like a charm. Love you!

Love you. Mwah.

The shots are not doing the
job. What else do you have?

I had another episode. It
was shorter, but still there.

The MRI shows a branch
off the basilar artery

that's compressing
the facial nerve.

Unfortunately, you
have a tortuous artery.

Where it should be
straight, it bends and twists.

Bad news is, it'd be a nightmare
to try and address this surgically.

- Good news...
- Is, other than some twitching,

which is minimized by the Botox,

- it's not causing any other problems.
- Exactly.

Aside from the complete destruction
of all I want to achieve in life.

Melodramatic, yet true.

These episodes keep happening,

eventually one of them
will get caught on video.

Ten minutes later, it'll
be all over social media.

My opponents will
mock me relentlessly.

I think a lot of people
would have sympathy for you.

We don't vote for people
we feel sympathy for.

We want strong leaders. We want
the symbol more than the reality.

Please, help me.

- Unfortunately, there's nothing we can do.
- We'll see what we can come up with.

♪ Last night I came out
I was so damn manic ♪

♪ I don't even know
Where I went wrong ♪

♪ But I went wrong ♪

♪ And it's times like
these That I swear to God ♪

♪ Oh, that my mother
can't see me And if she did ♪

♪ I don't know how I
would keep it together ♪

♪ I don't know how
I would keep it... ♪

Shaun?

You shouldn't be here.

Andrews is pissed at
you, with good reason.

There's no need to
make him more angry.

That's why I'm hiding.

I couldn't wait in the lounge
because the walls are glass

and people could see me.

Wait? What are you waiting for?

When they see that I was
right, they'll let me come back.

I want to be prepared. I'm reading
about options in aortic dissection.

- Shaun, no.
- Yes.

Once they do the angio,
they'll see the evidence.

Dr. Andrews won't
be angry anymore.

They did the angio.

Mm.

Oh.

No. No, they... They couldn't.

They did it. I was
there. You were wrong.

But...

- Cold feet...
- It was a focused angio.

I saw the ascending
aorta and the aortic root.

There was no sign of dissection.

They're giving the patient a chance
to rest before scheduling the TAVR.

We all make mistakes.

I think you should leave the
building while you're still forgivable.

♪ There's a hole in the
drywall Still not fixed ♪

♪ I just haven't
gotten around to it ♪

♪ And besides ♪

♪ I'm starting to get
used to the gaps ♪

♪ Say you wish you could
find Some way to help ♪

♪ To be so hard on myself ♪

♪ So why is it easy
for everyone else? ♪

♪ I'm not always like this ♪

♪ There's always
tomorrow, I guess ♪

- Lea?
- Yeah.

- How are you?
- I'm good.

It happened to me too.

Twice.

We could bypass
the basilar artery.

A 25-percent
mortality rate? Sure.

How about stereotactic
radiosurgery?

Oh, she wouldn't like it.

It takes months to see
any kind of improvement.

It's interesting. The fact
that you like this person

makes you willing to make
stupid decisions that could kill her.

We could meet in the middle.

Tortuous or not, the main
basilar isn't causing the spasms.

So we leave it alone and just
sling up the branch of the artery

that's applying the pressure.

Nice.

I have two predictions to make.

One, she'll come up with
a rationalization to justify

not telling her husband
about this surgery.

And two, you'll come
up with a rationalization

to justify forgiving
her for that.

You wouldn't have fired him.

He's dealing with
some personal issues.

And I remember you giving me
some slack once when I screwed up.

Well, you were facing
a challenging surgery.

And your girlfriend, who I never
liked, by the way, dumped you, so...

You knew about the dumping?

Oh, yeah. I just
didn't know why.

She wanted a commitment,
said I didn't love her enough.

And I told her I loved her, but
I didn't have time to get into it

because I had an
esophagus to reconstruct.

Why did you help me? I
mean, why me, and not Penzer?

He was always number one in
our class, I was always second.

Where's Penzer now?

You think I've been following the
guy's career for the past 20 years?

He's at the NIH, making policy.

That's Penzer. Great
mind, great hands.

But I knew he'd
never be a surgeon.

He didn't love it enough.

- I can wait.
- Oh, this can too.

I'm just letting the
phone get to 10 percent,

then I'll run the gauntlet of
well-wishers and head out.

Yeah, I'm one of them.

When my grandma died,
I remember a whole relay

of the mothers of the church
bringing food to the house.

They all loved my grandma.

The older ladies got their best
hats and gloves out for the service.

Pastor made a special
prayer at the gravesite.

We all told stories about her.

There were rituals.

We said goodbye to the past.

You're saying
goodbye to the future.

I'm sorry for your loss.

And how soon could
I get out of here?

If all goes well, a day,
maybe two at most.

- Ugh. You hear that, Cal?
- Rebooking for Thursday.

- There was an "if" there.
- That's strange, I heard a "when."

Now, I will be appointing Cal

as my healthcare
surrogate while I'm under.

Most people
appoint their spouse.

Or at least notify them.

He'll just try to talk me out
of this because he loves me,

whereas Cal is using
me to find a better position

but knows exactly what I want.

So let's fix my broken brain.

I got your text.

I'm a good diagnostician.

Of course you are. Sit
down. You... You want to sit?

No.

I accounted for every symptom.
I listened to the patient's history.

Someone's feet were cold.

Okay? I just...

Sometimes that means
something, sometimes it doesn't.

This time it didn't.
So... So what?

What are you still
doing here, Shaun?

Do you not want to go home?

You gotta go home. You
suffered a loss. You gotta...

You gotta deal with
it. You gotta face it.

Hmm.

Why do I have to face it? What
does that mean? It happened.

Yeah, well...

It did happen.

It happened. Okay?

Go home...

and be with Lea.

Oh, Claire, I'm
happy to see you.

It seems the reporters
have discovered I'm here,

so poor Cal has gone off to
craft a believable explanation.

So, what's something a
person might be hospitalized for

that says, "I am an
unstoppable force"?

You want me to provide
you with a good lie?

Yeah.

But you must be scared.

I'm terrified.

You know, when I'm scared...

I think about Evvie Sinclair.

You were the commencement
speaker at my high school graduation.

Ah...

I was a bit of a mess
back then. I had no idea

what I was gonna do with my
life, or what I could do with my life.

And you told us
about Evvie Sinclair,

born with Turner Syndrome,

small in stature, facial
abnormalities, speech impairment.

But she just had... a
desperate need to learn.

And against her
parents' wishes...

she started high school.

And...

And I just remember thinking:

"If Evvie can go through those
doors and walk down those halls..."

I went home that day and
I applied to 11 colleges.

So I am a doctor...

because of you. And Evvie.

Mm.

That was a great story.

Rickie Demarest, he was my
campaign manager before Cal.

He made up some lovely stuff.

You're back early.

Dr. Andrews sent me home, and
Dr. Glassman thinks we should talk.

Dr. Glassman is not a
counselor. He's a neurosurgeon.

And a sometimes annoying
person. I'm gonna make some tea.

- Oh. It's your mother. Hello?
- No, no, no, no, no.

Hi, Shaun, how are you?

- I'm... well.
- I'm not here.

Lea can't talk to you now.

Oh, you're both home. I
wanted to ask about strollers.

The one Lea likes,
I read a review

that said the front
wheel keeps coming off.

I'm sure she won't listen,
so I'm gonna send a link.

You should read it too.

Yes. Thank you.

You don't want your little girl
pitching headfirst onto the sidewalk.

Oh, no, no, we wouldn't.

Just hang up. Just...

Okay. I should go.

And now that we know
it's a girl, I was wondering.

I already bought a onesie with little
dinosaurs on it, unbelievably cute.

Mm. Cute. Yes. Okay. That
sounds good. I am due at the hospital.

Just a quick question.
Since it's not a boy,

the dinosaurs will have to go.

- And...
- What would be nice for a girl?

I don't... I don't know.

There's one with ballet shoes.

That's stupid. Why would
you have to change it?

A girl would like dinosaurs
just as much as a boy,

dinosaurs are fascinating.
You need to shut up!

Um...

Shaun?

As you all know, Senator Clark
is a very competitive person.

She tore her meniscus while
charging the net to return a drop shot.

For the record, it was
match point, which she won...

I wonder if he negotiates
employment contracts.

And thanks to the terrific
doctors here at St. Bonaventure,

she will be back fighting
for you before you know it.

Senator Clark wanted
to thank all of you...

- Did you hear that? We're terrific.
- You must be.

You repaired her
meniscus through her head.

It's no one's business
why she's here.

And there's the rationalization
I've been waiting for.

If this was someone you
didn't like, these character flaws

would reveal some deep problem,
worthy of your eternal judgment.

- But since...
- You're head of department.

I'm sure you've had to
spin things sometimes.

Spin things, sure. Lie? No.

One more example of how
Senator Clark has been able...

- And that was an example of both.
- Reach across the aisle.

Marian isn't waking up.

And to that end, she's already
making calls and sending e-mails.

Oh, and texts. She just
told me to wrap it up.

I yelled at your mother.

Yeah.

I misdiagnosed a patient.
That's why they sent me home.

I'm not behaving normally.

Neither am I. But maybe this
is normal for where we're at.

Dr. Glassman talked
about facing my loss,

but I don't know what that
means, and even if we could face it,

won't we just hurt
ourselves for no reason?

I don't know. I don't think
grief has an actual solution.

It has to. I can't
stay this way.

Claire told me about
this support group.

I'm not sure we can just
force ourselves past this.

The cold feet are
not a coincidence.

If they do the TAVR
procedure, they'll kill the patient.

For a different reason.

The guide wire's in place. I'm
preparing to deliver the valve.

Okay. You... You have to
stop. If that valve goes through...

Get out of here.

No. If that valve
goes through, he'll die.

- Call security.
- I thought it was aortic dissection,

but I was wrong.

The cold feet are from a
coarctation... No. No! No!

No! It's too close. You're too
close! Stop! Stop! Stop, please! Stop!

BP's spiking. Two hundred over
100. Heart rate's up. He's gonna stroke.

Give him nitro and Cardene!

I'm pulling out.

BP's dropping.

He's starting to stabilize.

Okay.

Dr. Murphy?

Go on.

Dr. Nakano did not make a mistake
in the bypass, he did everything right.

But Mr. Hill has a congenital
narrowing of the abdominal aorta.

He's had that coarctation
for years, but never knew

because his body compensated
for the poor circulation

by raising his blood pressure,
which caused his heart to deteriorate,

requiring a bypass. The
stronger, repaired heart

put pressure on the valve,
and his blood pressure dropped.

No more compensation,
his feet got cold.

And I could get the guide wire up
there, but the valve delivery system

would be too big to fit
through the coarctation

- without damaging the vessel.
- Yes.

We'll have to open him up.

And the valve will have to be
replaced directly, through surgery.

I hope you'll join us for that.

How's Cal gonna spin this?

Her latest tennis match
went into extra sets?

Slinged branch looks good, no
conflict with the seventh nerve,

no bleeds, no strokes.

The basilar's dilated.

And compressing her brain stem.

- She stopped breathing.
- We need to intubate. Get the airway cart.

Tell them she's gonna
be at the conference.

And if they keep asking,
tell them the senator believes

anyone not ready to commit
on climate change action

is on the wrong side of history.

Just never use that phrase
more than once a month.

He has to run.

The sling procedure went
fine, but the basilar artery

was less stable than we'd
hoped. It's gotten even more dilated

and is causing progressive
neurological deficits.

We have no choice
but to bypass the artery.

The last surgery was
dangerous. This one way more so.

- What do you need me to sign?
- We should inform her husband.

There is a one in four
chance that she could die.

If I told Pete that, he'd be
at the airport in half an hour,

and everyone would know
that Marian is in this hospital

for something this serious.

She has a brain aneurysm.
That doesn't make her weak.

Even worse, it makes her mortal.

Her husband has
a right to be here.

A moral right. To destroy her career.
Which is what I'm protecting her from.

- This is just a game to you, isn't it?
- Yeah.

The game they make you play
before you can do anything real.

Valve placed, leaflets mobile.

The new valve is perfectly
seated in the annulus.

No regurgitation, flow
in both coronary arteries.

- I'm about to close up.
- Looks like we've got a paravalvular leak.

- We need to go back and fix this.
- Irrigate and check the image.

No leak. Slight excess from the
washing jets in the mechanical valve.

Normal finding.

- Wow. You're very good.
- I think he knows that.

Still nice to hear.

Closing up now,
2-0 Vicryl suture.

Retracting temporal lobe
and cerebellum, very carefully.

Vascular anatomy is fully
exposed, avoiding the tortuous area.

Radial artery graft length
looks to be a perfect fit.

Anastomosing with 9-0 Prolene.

Temporal lobe's swelling.

BP and heart rate
are plummeting.

Drop her CO2, full
Propofol burst suppression.

- Widen the craniotomy.
- With the cerebellum herniating outward?

We do that, she may
never walk normally again.

- If she didn't want a twitch...
- Drill.

Open the arachnoid plane
and release C.S.F. collections.

Reduce the pressure from the
inside. For her, it's worth the risk.

Arachnoid dissector.

There was a patient admitted
this morning I think you should see.

Are you thinking of Mrs. Cavanaugh?
That's a good idea, Dr. Park.

We'd welcome another take as
to whether she's a good candidate

for inserting an ICD.

I'll consult just on that
question, if you'd like me to.

But I won't join in the
OR. I'm quitting surgery.

I don't understand.
When did you decide...

Fifteen minutes ago.

I nearly closed up without
doing a final antibiotic lavage.

But you didn't. Nurse Barker
prompted you with the syringe.

It was a tiny error. There was
no contamination of the field.

Many surgeons don't
even do a final lavage.

I always told myself once I
started making tiny errors,

I'd stop before I
made a big one.

Paul, we almost lost a patient
today. You were still rattled.

Thank you, Marcus.

But I made this plan years ago.

Because I knew that when the
time came, I'd look for reasons

why whatever I did wrong
was tiny, minor, didn't count.

That's when I made the
rule. Everything counts.

Dr. Murphy,

it was nice sewing with you.

You gave us a scare.
But it's all good now.

You're mad at me.

About Little Evvie.

No. Evvie inspired me.

I took strength
from her for years.

Now it's all fiction.

Fictional lives
can save real lives.

Four years ago, I used that
story on the Senate floor.

I got my bill
passed by one vote.

That lie helped millions
of people with disabilities.

I'm really proud of that lie.

I'm heading out to have
a drink with Dr. Nakano.

Are you going to try to talk
him out of leaving surgery?

No. I'm going because no one's
meant to shoulder loss alone.

And I'm the one who
should be with him tonight.

Why?

Because we love the same thing.

And he knows no one would understand
what he's lost more than I would.

I have been thinking. About all the
people you've helped, including me.

And about not sharing the danger
you were in with your husband.

Probably not sharing
a lot of other things.

And it struck me that...

being in a marriage
like that must be lonely.

You can't trust him to lie.

So you end up sharing more
of yourself with a guy like Cal,

who is a hired gun
and who's gonna end up

working for somebody
else two years from now.

The fact that Pete
and I don't talk shop

doesn't make our marriage
less than wonderful.

Another lie.

Hey, hey! How about
those Devils? Huh?

All right, before I go all
fangirl about last night's game,

let's talk about the upcoming
climate change conference.

I have to tell you guys
a story, about a little boy

who lives on the outer
banks of South Carolina,

whose home is about
to be washed away...

♪ I think if I fail again ♪

♪ That I know
you're still listening ♪

♪ Maybe it's all Gonna
turn out all right... ♪

I could get another mug, or I could
wash these. It's a tough decision.

Mm. And I should probably tell
you, I didn't get to calling the landlord.

And maybe ten minutes ago,

I saw a couple fruit
flies near the drain, so...

♪ I have to
believe that it is... ♪

So yeah.

Now it is my fault for...

If we get bugs.

♪ And when I
tell you that it is ♪

♪ Oh, it's more for my benefit ♪

♪ Maybe it's all Gonna
turn out all right ♪

♪ Oh, I know that it's not ♪

♪ But I have to
believe that it is ♪