All language subtitles for The.Good.Doctor.S06E13.39.Differences.720p.AMZN.WEBRip.DDP5.1.x264-NTb.[eng]

Morning. Admissions percentage is out.
Top colleges have dropped to record lows.

- Thinking about going back to school?
- No, I'm thinking about our son's future.

As in starting a college fund
for the peanut?

No, I put the peanut on a wait list
for prekindergarten at McClellan Hall.

Isn't that a snobby private school
in Menlo Park?

It is one of the top three feeder schools
for Stanford University.

So you've decided he's going to college,
and picked out which one.

Given our son's genetic makeup,
he will probably be very intelligent

and will require
a challenging academic curriculum.

Or he may not even enjoy academics.

What he ends up doing will be his call.

Whatever prekindergarten he ends up
attending will be our call, not his.

No coffee. Glassy's still in his room?

- I heard him leave at 6:14.
- He's been so sad about losing his house.

How can you tell?

- Have you noticed how quiet he's been?
- Yes, it's been nice.

I guess he's just
throwing himself into his work.

Dr. Murphy, little help here.

Give tetanus booster, clean with betadine.

- Administer--
- We got that. It's...

We wanted a second opinion.

Victor did.

Yeah, before these young pups
take a saw to our son's foot,

I'd like to talk to a supervisor.

The nail's bent.

I am their supervisor,

and we need the saw
to cut the nail, not his foot.

Are you good, Ricky?

You all know my angel
for the past 11 years, Dr. Lim.

Hey, Roses.
And this is my resident, Dr. Jordan Allen.

Hi.

-"Roses"?
- My website's called "More Than 65 Roses."

It's what I called it
when I was diagnosed at five.

Sixty-five roses. Cystic fibrosis.

- Okay.
- And welcome to vlog number 458.

Going out all around the world.

- And what does DLT stand for?
- That would be double lung transplant.

Your new lungs just arrived.

I never should've agreed to let him go.

You didn't. You just stopped
fighting with me about it.

He's running a mild fever. 100.4.
Go where?

Church camping trip,
less than an hour away.

Camping can be very dangerous.

Thank you, Dr. Murphy.

I had my first fire-roasted s'more
last summer,

so it can also be very fun.

Thank you, Dr. Wolke.

Be careful, please.

Victor, he's a doctor.

- Just try to trust--
- Trust that things will work out.

Yep. I know.

You're a Warriors fan?
You like Steph Curry?

- I like Draymond.
- A rebel. I like it.

Look at this beast.

Nice job, Ricky.

His temperature just jumped two degrees.

Get a CBC, blood cultures
and CT of his foot

to check for damage
to the bones and muscles.

Dr. Park. How kind of you to join me.

You paged me.

Have a seat.
And, yes, they're Herman Miller.

The cappuccino, mochaccino,
expresso, latte...

None of those are for you.

Okay, I was wrong.

This is the perfect job for you.

Your first study has what, 800 patients?

But since you've had four whole days
to hire all the clinical trial nurses,

it should be easy.

I may be a little behind,
may have 13 patients waiting,

but I will handle it.

With a lot of cappuccinos.

Thanks for your support.

Do you want me to give you a hand?

I have 90 minutes before my next surgery.

In exchange for unlimited use
of your espresso machine.

We'll see.

Poor Ricky.

He probably just has a minor infection.

I meant the parents.

Two very different schools of thought
on child-rearing.

It's hard on the marriage,
but harder on the kid.

Everyone has different opinions,
Dr. Wolke.

Which they need to sort out
before having kids.

My college roommate, Jewish,
married a Catholic woman.

They had three children quickly.

Started fighting about parenting nonstop.

My parents never fought about us.
My dad didn't care.

As long as Mom got me and my brother
dressed and out in time for chores.

No hematoma or abscess.
No explanation for the fever.

My neck.

It really hurts.

Okay.

Hey, I got you.

He has tick bites on his back.

Pink, plump and spongy.

What's that?

Pneumonia?

In both lungs.

She's lucky if she has another week.

Ex vivo lung profusion.

Maybe we can make the lungs
heal themselves.

That's usually used in cases
involving pulmonary edema.

Get the lungs.
Meet me in the procedure room.

Tick bites?

His fever, vomiting and sore neck
could be neurological.

It's in his brain?

Possibly. The blood tests
were inconclusive,

so we'd like to do a lumbar puncture
to check Ricky's CSF.

This camp just keeps
getting better and better.

Can we not do this right now?

- I want this to never happen again.
- And I don't?

I care about our son as much as you.

And yet you keep prioritizing fun
over safety.

Yes, I care about fun.

And socialization, self-esteem,
self-expression--

None of which are as important
as his safety.

I can't do this anymore.

After six, only one with a minor reaction.

- You?
- Me too.

So we are 12 down, one to go.

Mr. Riggs?

Mr. Riggs?

Sorry.

I just drifted off.

My fault for keeping you waiting so long.

So, how are you feeling, aside from tired?

Just a bit achy,

especially my knees and elbows, hips.

And some mild jaundice.

Other than that, I feel pretty good.

Hello. We should sort out our differences
about child-raising.

If this is about McClellan Hall,
not a big deal.

I've made a list
of 37 other potential differences.

I'd love to discuss them,
but Andrews just approved new EMR software

and wants me to run a beta test on it
in the next 24 hours.

- Have you talked to Glassy?
- No.

He didn't come to work today,
but I got a text. He says that he is okay.

Where is he?

It is not over yet.

Lungs are remarkably resilient organs

when they are in a body.

Which is why we have to convince them
they still are.

We give them a blood supply
by hooking them up to a profusion machine,

an air supply
by hooking them up to a ventilator,

IV drips to feed them antibiotics,

and we might be able
to con them back into viability.

The next six hours are crucial.

How will you know if they're viable?

Our main indicator
is a calculation called the P/F ratio.

When that reaches
at least 400 mm of mercury...

those lungs are good to go.

Mom, relax.

It's Dr. L.

Palpate to find the L3-4 interspace.

Maybe Lea and I won't be able
to sort out our differences

about child-raising and become angry
like Victor and Shelly.

You and Lea
are nothing like Victor and Shelly.

They're from completely different worlds,
have vastly different outlooks.

Lea and I are very different too.
Insert the spinal needle.

Who knows if they love each other.

You and Lea, I know you do, a lot,
and that's all that matters.

At least according
to the Hallmark Channel.

I'm in.

The infection has elevated
his intracranial pressure.

Intubate and load him with levetiracetam

and dexamethasone
before his brain herniates.

CSF confirming a very rare infection
called naegleria fowleri.

It's a brain-eating amoeba
that's caused cerebral swelling.

We need to put Ricky
in a barbiturate-induced coma

and surgically place a port
into the center of his brain.

Then we will flood it with antibiotics,
which should reduce the edema.

And he contracted this from a tick?

No, it's contracted via contaminated water
through the nose.

So he got it from
the swimming hole at camp.

That's a good guess.

Ricky's too anxious around water
to put his head under,

let alone get water up his nose.

Naegleria fowleri has also been found
in untreated swimming pools,

- nasal rinses, water heaters--
- Nasal rinses?

If unboiled tap water is used.

I gave him a nasal rinse
the morning he left for camp.

He had a runny nose.

That is a better guess.

Excuse me.

Riggs has fatigue, joint pain,
impaired mental acuity,

tachycardia and mild liver failure.

- Thanks.
- Maybe he has a pre-existing condition.

He should have been eliminated

by any remotely competent
screening process.

Those protocols were in place
before you came on board.

I'll remind the CRO of that
when I tell them, on my first day,

that their $4 million trial
needs to be trashed.

Save the doomsday predictions
until after the blood panel results.

Lab's on the way to the OR.

- It hasn't been six hours yet, has it?
- Six and a quarter.

You want company?

Thanks.

Hello. Where is Victor?

Beating himself up somewhere.

I just...

wish that made a difference.

Do you love each other?

Yeah.

Of course.

We've always been oil and water.
That's how my dad describes us.

Victor grew up in Belgrade.
I grew up in Berkeley.

Different religions and politics,
socio-economic status.

But when I got pregnant,

we knew we had
a lot of issues to work out.

And we did.

Then Ricky was born and...

we suddenly started arguing over...

When can he safely eat tree nuts?

How high should he climb
on the jungle gym?

When can he stay with a babysitter?

Those little things were the ones
we could never work out.

But, yes, we still love each other.

It's just that...

I'm not sure love is enough anymore.

Still waiting.

Still hoping.

That's kind of what we do,
isn't it, Roses?

And the wait is over.

I'm sorry.

We've put you back on the list.

You're at the very top.

I deserved this.

I wanted those lungs.

I wanted someone to die.

Brecca.

Honey, should we finish?

No.

Hello, Dr. Glassman.

Shaun.

You might try knocking next time,

although, you know,
it might be a little tough.

- What are you looking for?
- You know...

My life.

Just my life.

Not yet.

I think I'm gonna keep at it for a bit.

- Okay.
- No, this is on me. You can head home.

Thanks.

I will miss your big screen LED TV.

It was old
and had a pixel line down the right side.

Did you love Alana?

What?

Did I love Alana? Yeah, of course.

Did you love Debbie?

Yeah. I loved Debbie.
Where is this going, Shaun?

That wasn't enough
for you to get over your differences.

How do I know if love will be enough

for me and Lea
to get over our differences?

You won't know.

I mean, how can you know? You can't know.

I do not like worrying about this.

I mean, Lea had some doubts
just a little while ago.

- You both got over that.
- Yes.

- Because I was very supportive.
- There you go.

But differences about child-raising
seem to be bigger than normal differences.

Yeah. Having a child,
I mean, that's big, that's huge.

It's a shift. It shifts everything.
Marriage, everything.

I do not want a shift in our marriage.

Maybe it'll shift for the better.

Ardie's eye.

First thing I ever bought Maddie
was a stuffed aardvark.

Back in the day,
I performed a 21-hour surgery.

I removed an astrocytoma
from the medulla of the brain stem.

It was heroic, it put me on the map.

My elective surgeries
were booked out for a year.

I was in a zone,
like playing scratch golf.

And then Ilana got pregnant.

She didn't want to stop work.
Had a real estate thing, doing well.

I didn't want to stop.
I wanted to stay on the map.

And then we brought Maddie home
that first night.

Everything changed.

Go talk to Lea.

I tried.

She had to run a beta test
on new EMR software.

Then you'll have to wait until she's done.

All I had on my DVR was
a marathon of Shark Tank.

Can't say I was in the mood to be staring
at Mr. Wonderful's bald head.

So why not entertain myself by watching
some hot line perfusion action?

I'm not one to kink shame.

Coffee and cronuts, from Chaz's bakery.

I'm happy for the company.

Pneumi is not much of a conversationalist.

- Pneumi?
- My pet name for them.

From the Greek word for lungs, pneumonas.

I thought it was better than "Lungy."

Yeah, I may be losing it.

Cronut.

- Any progress?
- Negligible.

I keep doing the same thing over and over,
hoping for a different outcome.

Yeah, I'm definitely losing it.

Then do something different.

Okay.

Doubling up on antibiotics,
and we can add steroids.

This will either hammer out
the infection or the lungs.

- How's Glassy?
- Very sore and very sooty.

- We need to talk--
- About our 37 differences?

I thought of two more.

Shaun, as you know,
I'm kind of busy right now,

so you'll have to settle for me
agreeing that, yes,

we'll have many differences.

But in time,
we'll be able to work them out.

That's what Victor and Shelly thought.

And now they are talking about separating.

I don't know who Victor and Shelly are.

In any event, I have at least
two more hours of work to do.

Okay.

You're waiting, aren't you?

Yes, I am very patient.

You are very patient
and very understanding.

And you were so good with me
on our babymoon.

If you could just channel some of that...

On our babymoon,
I thought love was enough.

That's kind of a big thing
to drop on me this late at night.

You were too busy
to discuss it in the morning.

So I talked to Dr. Glassman about it,

and he said having a child
will shift our dynamics.

If it does, we can talk about it then.

If we can't talk about our dynamics now,
how about our differences?

Really? We have 39,

so we need serious time,
and I'm sure they'll keep

because we're kind of committed
to having a kid together,

whether love is enough or not.

Shaun, I'm way too tired

to have a productive conversation
about this right now.

- Okay?
- Okay.

It's time to call it.

I had half an hour left on my call
when she first came into the ER.

Coughing blood, vitals on the floor.

When we opened her up,

her lungs looked like a 70-year-old's.

Didn't think she'd make it
through the night.

She was eight.

I couldn't go home.
And stayed with her that night.

And then the next morning,
she just opened her eyes,

looked at me and told me
she liked my French braid.

Once I call it,

I have to go up there and tell her
I failed her.

Got Riggs' latest test results.

Turns out he did have
a pre-existing condition.

Hemochromatosis.

So the jerk lied about it
to get into the study?

- That's the assumption?
- He got 3,500 bucks to participate.

I think it's a pretty sound assumption,
but whether he lied or not,

it means the screeners are incompetent.

That's got to take a toll.

Expecting the worst of everybody.

I'd rather be pleasantly surprised
than bitterly disappointed.

And that's the world view you want
to impart to your future child?

Assume the worst of everyone?

Help. We need help in here.

- What's happening?
- Add a milligram of lorazepam.

- He's seizing.
- Because his ICPs are in the 40s.

Cerebral edema's gotten worse.

If we don't open Ricky's skull
immediately, he will die.

Removing hemicranial skull flap.

Performing wide dural opening.

Look at the monitor.
EEG's all over the place.

He's still seizing.

Place an additional EVD and increase
propofol to burst suppress.

But he's maxed out.

Giving more propofol could kill him.

If we don't,
the seizures will definitely kill him.

Okay.

We can remove the damaged cortex
in the left anterior temporal lobe,

using pre-op imaging to guide us.

Cut out part of his brain? That's extreme.

That is the area
that's causing the seizures.

- Might be a tough sell to his parents.
- Which is why you will help.

Okay. Please keep him stabilized
with eyes to the cortical surface.

"The country flew past,

as if they were seeing it
from the windows of an express train.

Faster and faster they raced,

but no one got tired or out of breath."

We can save the last chapter for later.

There is no later.

Where's Dr. L?

She wasn't ready to give up on your lungs.

There's still a chance?

Dr. Lim thinks so.

Let's finish.

Chapter 16.

"Farewell to the Shadowlands."

We'd cut out a small piece of his cortex.

It's already damaged by infection.

Removing it may be
the only way to keep him alive.

But how would that affect him?

There are areas of the brain that are
significantly less essential than others.

This part only impacts
his speech and memory.

Probably not long-term.

So he might not be able to talk
or know who we are?

We wouldn't be able to fully assess him
until he wakes up.

Ricky's skull is opened.

We should do it.

This is a very good hospital.

These are very smart doctors.

And someone very wise once told me that

sometimes you just have to trust
things will work out.

Okay.

Hemochromatosis?

You never noticed
these symptoms until now?

Joint pain, fatigue, mental fuzziness?

I turn 58 next week.

I haven't felt a day over 30 until now.

It's very unlikely your hemochromatosis

went from zero to 60 in a week.

Is it possible you gave the screener
someone else's blood?

You think I cheated? For the money?

No, Mr. Riggs. I'm just trying to--

You're a blood donor
in the 20 gallon club?

Yeah. Regular donor the last 30 years.

When was the last time you donated?

Two months ago,
just before I started this trial.

And you're not allowed to donate
while you're in the trial.

See, that's the downside.

I actually enjoy those cookies.

I'll make sure you get
all the cookies you want.

Don't you think it's time to come home?

No.

In that case, I wanted to make you
something delicious like you've made us,

but I'm not a very good cook
and everything's closed,

so I hope you like

hot-dog-flavored potato chips
and Nutty Buddys.

Yeah.

- Nail polish?
- Father-daughter time.

Maddie insisted that she paint
my fingernails a sparkly rainbow color.

And the next day, my first patient
was very uncomfortable.

That's when I realized I forgot
to remove the nail polish.

That's a nice memory.

Sit. No, sit, sit, sit.

So many memories.

That Halloween Maddie
wanted to go as a ham

because we had just seen
To Kill A Mockingbird.

But she wanted the ham

to be made out of an actual ham.

And then one night the wind was blowing
so hard it blew her bedroom door shut.

She was convinced that her grandmother's
ghost had come back to visit her.

Wanted to sleep in our bed
for the next two weeks.

You didn't come here
just to feed me junk food, did you?

I thought you might need
someone to talk to.

I'm fine.

I know someone you should talk to.

I know. But this was easier.

"Hot dog" should not be a flavor.

"All their life in this world
and all their adventures in Narnia

had only been the cover on the title page.

Now, at last,
they were beginning chapter one

of the great story
which no one on Earth has read,

which goes on forever,

in which every chapter

is better than the one before."

Checking in. Need me to up your morphine?

Couldn't hurt.

Hey, I changed my mind

about the vlog.

Wonderful.

Go for it.

Hey, Roses. I'm back.

The DLT didn't really work out,

so this is gonna be my last update.

I wasn't even going to do this,
I was gonna flip off Dylan Thomas

and go gently into that good night.

But...

I couldn't leave without saying goodbye.

And that it's okay to be hurt.

I am.

That my life's been cut short.

But the upside to all of this

is that I feel something
I never thought I would.

It's gratitude.

I'm grateful to my sweet mother.

And...

to the people who keep hope alive.

Like Dr. L, and...

Crash cart.

She's in full respiratory failure.

- We need to intubate her.
- No.

We need to let her go.

Pneumi hit 402. Get Brecca to the OR.

The lungs are good. We should intubate.

Yes.

- Ricky?
- Dr. Murphy.

Ricky? Can you hear us?

Hello.

Do you know where you are?

Do you know your name?

I'm Ricky Pavlovich.

I'm in the hospital

because I stepped
on a rusty nail at church camp.

But I would still like
to go back there next year.

Welcome home, Pneumi.

Riggs is a lifelong blood donor.

- Which totally eliminated his symptoms.
- Until he started this trial.

He's not allowed to donate till it's over.

So there was nothing wrong with
the protocols. Nobody was incompetent.

And Riggs isn't a big, fat liar.

In fact, he's a legit hero.

Maybe my world view
does need a little adjustment.

I prefer Italian roast.

Noted.

Ready to take Pneumi for a test run?

That's what she named your lungs.

It was a weird night.

Start small.

Thanks for coming.

We should talk.

Number 39, dietary restrictions.

Other than breast milk.

I felt a kick!

I felt...

This is very exciting.

Come here.

Think of all of the new memories

waiting to be made.

Hey. Let's go home.

Number 39, other than breast milk,

I don't think that peanut should have
any dairy products before six months.

Easy-peasy.

Number 38?