All language subtitles for The.Good.Doctor.S06E19.WEB

Previously on The
Good Doctor ...

I want to do another
embryo transfer ASAP.

You have some lettuce.

- Oh.
- No, no, no. Here.

Dr. Glassman, it would
be hard to lose my father

just as I am about
to become one.

Do the scan for me.

Please hold still.

I'm breathing.

You moved your head.

Shaun, go away and let
the technician do his job.

I sent him out for coffee.

I am now scanning the
location of your prior tumor.

Did you decline
maintenance chemotherapy?

It's hard to hold still
while I'm talking.

Dr. Blaize recommended six
cycles of temozolomide.

The slight benefit of that stuff

wasn't worth the
constant nausea.

The benefit is statistically...

Shaun, I made my choice.

You chose wrong.

There's a spot on your brain.

There's the right ovary.
And that looks like the...

Corpus luteum.

The endometrium is smooth
and around 13 millimeters,

which means my uterine
infection is cleared.

Carrying the pregnancy to term
should be a lot easier this time.

Your transfer is on my
schedule for tomorrow evening.

Fantastic.

And you have two high-grade
embryos available.

Do you want a boy or a girl?

You don't have to decide now.

Just let me know before
the embryo transfer.

Seven and a half hours.

Uninterrupted?

Didn't even have to wake
up to use the bathroom.

So?

Six hours, 45 minutes.

Oh, winner, winner,
pancakes for dinner.

I really thought I
had it in the bag.

How'd you do, Danny?

How much sleep you
get? Over or under?

No clue.

Hold up.

- Morning, all.
- Morning.

Dr. Allen.

Good morning, Dr. Kalu.

Park is doing a hip
arthroscopy today.

I'd like to scrub in.

Sorry, I'm already
assigned to Park.

I'm thinking about
specializing in ortho,

so how about a trade?

How about no?

Sorry I asked.

Go, team.

Brady Sullivan. Oil rig
worker. Metal sheet hit him.

Severe chest and
pelvic injuries.

O2 sats are critical.

Brady, I'm Dr. Andrews.

He's non-responsive.
Sluggish pupils.

There's major hemorrhage.

GCS six, no head trauma.

Three-inch right-sided sucking
chest wound. Collapsed lung.

That's from the support hook.

The metal sheet he was
welding caused another injury.

How deep does this go?

Down to the spinal column.

He's nearly cut in half.

It's scar tissue
from the radiation.

Could be, but the FA value...

Is more consistent with a
glioblastoma recurrence.

That's right, and the path

of the radiation
they blasted me with,

that Swiss cheese look,
textbook necrosis.

The irregular shape implies a
multifocal cancerous lesion.

I've been looking at brain scans

since before electricity.

I think I know what
scar tissue looks like.

You are not objective here.

Oh, right, and you are?

Neither of you are.

If that lesion is cancer,

a DNA spinal fluid
analysis will confirm it.

Yes.

That is objective.

I'll do a spinal tap
and send it to the lab.

Should have results in 24 hours.

Fine.

I'll set it up.

O2 sat's 68.

Chest tube's in,
draining a lot of blood.

Every time I clamp a
bleeder, another one pops up.

Dr. Lim? Where do you want us?

We're busy with
the chest trauma.

I need you guys on
the pelvic injury.

How do we remove it?

You don't. It's the only
reason he didn't bleed out.

I need you four to
figure out a plan

to reattach his lower half.

Read every journal.
Study every case report.

Check all the international
surgery registries.

Look everywhere.

PA ruptured. Gotta move him.

OR one, now.

- Give me the baby.
- No, no, no, no, no, no.

I'm here for Jazz.

- Just hand her to me.
- I don't know you.

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

- Sir, please.
- Hold on, let me talk to him.

I'm a doctor here.
I can help you.

I don't need a
doctor. I need Jazz.

Jazz. Is Jazz the mother?

Yes.

You're trying to help the baby?

Jazz... Jazz passed out

and then the, uh... the
flashing lights took her.

An ambulance?

There's an encampment
over on Elm.

Is that where you and Jazz were?

Then she's a patient here.

They didn't see the
baby in her tent.

She didn't sound good.
She... she needs her mama.

You did the right thing
bringing her here.

Can I examine her?

Uh...

and you'll... you'll
find... you'll find Jazz?

I promise.

We have a code pink. The
baby's in heart failure.

You may have saved her life.

Found another tear in
the pulmonary artery.

A big one.

Every major artery in
this lung is damaged.

His body needs to divert
every resource it has

to his vital organs.

We should amputate
his lower half.

- We're not there yet.
- It's barely hanging on.

But it is. We're
gonna try to save it.

It's a big job to
hand the residents.

Good thing I hire the best.

This vessel's too
damaged to repair.

I need to clamp the trunk.

Start the clock
on lung ischemia.

I think we should sack

the upper segmental
pulmonary artery.

That would mean he'd
lose his upper lung lobe.

He has a physical job.

If we end up amputating,

he's not gonna be
working oil rigs.

But he could be playing
wheelchair basketball.

PTFE graft on his artery
could save his lung.

Okay.

Central line is in.

Pushing milrinone to
increase cardiac output.

Severely decreased
heart function,

but her chambers look normal.

Increasing high flow oxygen.

- BP is improving a little.
- Found it.

In her posterior chest,
there's a critical...

Narrowing of her aorta.

Her eye spacing is approximately

six millimeters wider than
the upper limit of normal.

She also has
slightly low-set ears

and her hands are swollen.

She has Turner syndrome.

If we don't get that narrowing
fixed in the next few days,

she'll die.

It won't be easy to
access, but I need an angio

for a better view.

I'll locate the mother
and get consent.

Brady's pelvis is broken

and separated from
the spinal column.

So to reattach his lower half,

we need to repair the pelvis,
plus all the damaged organs,

plus the major
vascular injuries,

and then find a way to
ensure it all heals.

Are we even doing the right
thing by trying to fix this?

You want to give up
before we even start?

I've just never read anything

supporting reattaching
this kind of injury.

Could kill him.

Amputation is the
safest thing to do.

Lim already knows
about that option.

- Our job is to find a better one.
- No, our job...

Danny's right. We need
to divide and conquer.

I will work on organ damage.

I'll focus on public fractures.

I need intraoperative
imaging to build a 3D model.

Oh, well, I'll go with you.

I need to see the full extent
of the vascular injuries.

That leaves you to figure
out how these repairs heal.

I'll see what I can find.

- This is the baby's mom?
- We think so.

She was brought
in a few hours ago

from a homeless encampment

with a delayed
postpartum infection.

She's septic.

They're optimistic
she'll pull through.

Soon, let's hope.

We've got some big decisions
to make for her baby.

Her name's Jasmine West.

She's homeless and
has bipolar disorder.

County records show the baby
was born seven weeks ago.

No dad in the picture,
no other family.

And this was all she had on
her when EMS brought her in.

We need your consent

for the baby's
diagnostic angiogram.

Sure.

The baby's Turner syndrome
makes every procedure,

even a diagnostic
test, a little riskier.

Well, this is your
area of expertise.

Her baby's name is Eden.

Pretty close to the
upper lung bifurcation.

I reinforced it with sealant.

With a synthetic wrap?

Are you questioning
my surgical skills?

Are you getting defensive?

Okay. We're done.

Let's test it.

Good job.

Cardiac function stable.
You're good to go.

Inserting the catheter.

What a cute little girl.
Little girls are cute.

- Mine would be really cute.
- Yeah, she'd be adorable.

A boy could be adorable too.

Are you trying to
pick your embryo?

I'm leaning towards a girl.

I have a playbook to work from.

My playbook didn't help me much.

A lot of my issues
with Kellan came

from me trying to stop him

from making the mistakes I made.

If I'd had a daughter,
maybe I wouldn't have

dumped all my baggage on her.

You should choose a girl.

But you're having a boy.

We didn't get to choose.

In all long-term health metrics,

females are more likely
to outperform males,

although they'll
probably make less money.

The narrowing is longer
than it measured on echo.

We should resect
the narrowed segment

and do an aortic anastomosis.

Huge surgery for a baby.

It's the only
definitive treatment.

Very definitive if
she dies on the table.

Balloon dilation is safer.

We can do a bigger procedure in a
few years when Eden can tolerate it.

Her heart failure could
relapse between surgeries.

Your two-step approach is safer,

but only if the baby
gets daily medication

and regular follow-up care.

That's a lot to ask
of a homeless mom.

I'll page CPS and get consent.

You two practice the surgery.

A lot.

His pelvis looks like a jigsaw
puzzle with a 100 missing pieces.

Jared may be right.

You're taking his side.

I'm not taking anyone's side.

- Scans don't lie.
- Okay.

I'm not sure if you're
mad at him or me,

but we all need to get along.

Well, you two seemed
to be getting along

pretty well at the taco
truck the other night.

That was nothing.

Mm-hmm.

You're spying on me?

I was getting a taco.

This green-eyed monster thing
is not a good look for you.

I'm not jealous.

But you're right.

We're supposed to be a team.
He's just not a good fit.

Let's just focus on the patient.

Fine.

Can't see how we're gonna repair

all of that arterial damage.

What if we don't?

They could bypass it.

All of it.

This paper by
Dr. Alice Chen features

interesting data on
tumor treating fields

for GBM tumors.

I'm trying to
enjoy my tuna melt.

Dr. Chen is starting
a new study soon.

You should call her.

I'm not gonna spend the day
chasing down cancer treatments

because I don't have cancer.

Okay, there is a higher
probability of cancer relapse

because you refused
maintenance chemotherapy.

I'm not gonna talk about this.

Recurrent GBM causes
much worse symptoms

than temozolomide.

That's the decision I made.

I'm going crazy. There are
three crib sets I like.

I just can't decide.

Could you guys go to the
store after work tonight

and pick your fave?

Okay.

I have to go practice
the baby's surgery.

I will see you after work.

Oh, my God!

Should I be worried?

About me? No.

We're going to kill him

trying to save the
lobe of his lung.

Removing it still leaves
him with 4/5ths capacity.

When there's a chance you
might lose half your body,

everything you
have left matters.

I need lobectomy instruments.

This is my OR, my department.

My hospital.

And when a doctor's
judgment is compromised,

it's my responsibility to step
in and protect our patients.

In what possible way
am I compromised?

Are you implying that my time in a
wheelchair is affecting my objectivity?

How could it not?

This is my patient.

And I'm your boss.

You can either do this with me,
or I'll find someone who will.

Deaver retractor.

After they fix the
colon, Lim can use

some preserved bowel
to create a new bladder

like these Korean surgeons did.

That would work perfectly
with what I found.

We can bypass all of
the artery injuries

through two Dacron conduits

directly to his
lower extremities.

And the improved blood flow
would help with my idea

with his pelvis.

So skin flaps,

Dacron artery
bypass, neo-bladder,

bowel repair with
biomaterials, and...

a badass, Wolverine-like
adamantium skeleton.

It's experimental, but
it's pretty damn cool.

Now, how do we make
sure all this heals?

There's one study in Canada.

A cocktail of recumbent
growth hormones

and pentoxifylline showed
a threefold increase

in traumatic wound
healing rates.

That's great.

There's only four patients,

and none of them had the
same injuries as Brady.

So no one got cut in half

with a metal sheet
on an oil rig?

Great, I guess we just
toss that study out.

I'm just saying, I wish
we had something better.

I'll happily take a
threefold increase.

This is a workable plan.

Good, because Lim
wants an update.

Some promising ideas,

but there's a lot of
frail tissue to heal.

I found a study
using growth hormones

to accelerate the healing.

Interesting. Would
that work here?

There was a threefold
plan that we had...

Well, hang on, I want to hear
from the guy who did the research.

I'm not confident it would.

You guys said you
had a workable plan.

It can work. Jared's
being overly cautious.

If you close the pelvis
without good vascular support,

all these repairs
will get necrotic.

We will have good support. The Dacron
conduit to restore blood flow...

Not normal flow and
not quick enough.

Oh, dude, you've been doom
and gloom from the start.

- I've been...
- Enough.

Find a way to heal him.

I don't care who it comes
from, but I need it soon.

The nurse said she's
responding to the medication.

How long will Eden be in the
hospital after the surgery?

Two weeks.

Jasmine's on the wait list
for long-term housing.

She might have a place by then.

Also, uh,

is this safe if she
keeps breastfeeding?

The police found
this in her tent.

This is a bipolar
mood stabilizer.

It's safe.

How long has she
been taking this?

She saw her psychiatrist
for the first time in years

about five weeks ago.

She responded to it in the past.

She had a follow-up
scheduled with him tomorrow.

There's another treatment
option for Eden.

I know, I know.
It's disgusting.

You're gonna think, "What
are the percentages?"

Trust me, you change his diapers

and you are gonna
bond with your son.

Okay, here is the
Angelic Dream Set.

And be attentive to
Lea. Be extra attentive.

She's gonna be sleep-deprived.

You are gonna be sleep-deprived.

You're both gonna want
to lose it. Don't.

This mattress is
very comfortable.

This dark wood is a
little bit funereal.

The baby won't care
about the color.

It's all about
first impressions.

It's a newborn, you
know? Clean slate.

You want to surround it
with beautiful things.

A stuffed, soft... No,
you don't want to do that.

That's a hazard.

But these spinny things...
What do you call these?

Mobiles, mobiles.

You know, everywhere he looks,

you want him to be
interested, stimulated.

Beautiful sounds.
Beautiful music.

Mozart. Joni Mitchell.

If you want to talk
about something

other than selecting a crib,

it should be brain
cancer treatments.

Oh my God! I don't want
to think about that.

I can't not think about it.

In 12 hours, we
will have results...

- Exactly.
- We should be prepared.

Okay, Shaun, stop. Just...
just stop for a second

Sit down.

Okay.

If I have cancer,

I'd be at stage four, right?

There's no miracle
cure for that.

You still haven't called
Dr. Chen in Cleveland.

I read her paper.

It doesn't work
with recurrent GBM.

How can you think about teddy
bears when you might be dying?

If you're right, Shaun,

then I won't be here
when your son is born.

I won't be here to help you.

We'll know when we know.

I like the lighter wood.

So do I.

What else should I
know about diapers?

Lung lobe is out.

These segmental
vessels are damaged.

Running 7-0 sutures
should fix them.

Why bother? The
upper lobe is out.

If we can get Perez's
Dacron graft to work,

we could use them to
save his lower half.

Very unlikely.

The residents are working on it.

And obviously not succeeding.

First, I'm compromised,

now you're slagging
on the residents?

Two are on probation,
you let another one go,

and her replacement
is someone I fired.

He's also the world's most
experienced first-year,

and he brings a new
perspective to the mix.

And training these
guys is my job.

Your job is to
make my job easier.

I thought it was to run a
great surgical department.

If you were doing that,
I wouldn't have to think

about that department as
much as I have recently.

Vessel loops.

You changed the baby's surgery?

We weren't giving
Jasmine enough credit.

She's done a lot to
turn her life around

since Eden was born.

For seven weeks.

And with this new
treatment plan,

she has to keep it
up for seven years.

A baby can change a person.

Code pink, NICU bed three.

That's Eden.

Code pink, NICU bed three.

Lim asked for my opinion.

I met so many rich, entitled
guys like you in college,

and I couldn't stand them...

Even the ones I slept with.

If you can't handle
the hard work,

just get in your
Lamborghini and go home.

Sherry Lewis.

One of my last
patients in Denver.

Late-stage ovarian cancer.

Treatment's pelvic exenteration.

You remove everything.

The bladder, colon,
uterus, and vagina.

Now, in success,

the patient lives with
colostomy and urostomy bags,

severe menopause, and
absolutely no sex life.

Well, it's brutal but effective.

Would have been.

But I talked my
attending out of it,

in favor of an
experimental surgery.

A wide excision
of all the tumors,

then you reconstruct the entire
pelvic floor with TRAM flaps.

Incredibly advanced.

The type of stuff you're
talking about doing to Brady.

Sherry, um...

Sherry died on the table.

And I left Denver.

We take risks and people die.

But if we play it safe,

they die too.

I'd rather regret fighting
too hard for a patient

than not hard enough.

Why would your daughter
shave your cat?

Long story. Point
being, don't get a cat.

Kids are gonna tell you they're
gonna clean the litter box.

They're not gonna clean the litter
box. Don't fall for that trap.

You made a lot of mistakes.

Yeah.

It all boils down to

Maddy's mom basically raised her

while I focused on work.

You were a surgeon. She
was a real estate agent.

I love surgery.

I love poking around
in people's brains.

It's very exciting.

And I get to save some
lives while I'm at it.

Saving lives is very exciting.

So were Maddy's first
steps, her first words,

her first piano
recital, or so I heard.

Work over family, and
that's what you get.

You're not gonna make
the same mistakes.

I don't think I will.

We are very different people.

Are we?

I have learned some very
useful things from you.

Well, right back at you.

The baby needs surgery.

The crib needs to be assembled.

Go.

But you chose work
way too often.

When should I prioritize family?

When you have a sick baby

and a piece of furniture, the
sick baby wins every time. Go.

I got this.

Serial debridement.

Helps healing a little, but...

it increases
infection risk a lot.

Well, then I'm tapped out.

Me too.

I guess we should tell Lim.

Lamborghinis.

Lamborghinis.

Now, most sports cars use
pressurized combustion

to achieve that kind of
performance, but not Lambos.

No, no, no, no.

To reduce engine
wear, they use vacuums

to pour gas into the pistons.

Now, Brady's organs won't heal

because we can't get
enough flow to them,

but if you force more blood

into the area, well, then
we cause lethally high

abdominal compartment
pressure. So...

Let's pull in the blood
passively by creating a vacuum

using internal suction devices.

A low pressure system with low
tissue stress is better for healing.

That's...

That's a brilliant idea.

But it won't work.

Not without blood coming
into the right areas.

I need your help with that.

Where do you need the blood?

It's what we proposed earlier,

plus a healing
plan that Jared...

I can read.

Good work.

It's four experimental
techniques

rolled into an eight-hour surgery
with lousy odds of success.

Let's give it a try.

Dacron conduits are
connected to the aorta.

Do the anastomosis sites
look secure enough?

Any weak spots in there
will move that metal.

He'll bleed out.

They know.

On three.

One, two, three.

We have hemostasis.

And good blood flow
through the conduits.

Tissue's perfusing.

Yes! Yes!

Time to move on to
the pelvic fractures.

This is much more important
than assembling a crib.

But patients will
always need surgery,

and my family will
always need attention.

If there's no clear
choice between a patient

and your family, pick the
one that's related to you.

Hmm.

Obviously, choose
family when you can,

but sacrifice is
part of the job.

That's a good point.

But you are divorced.

That is more
sacrifice than I want.

Fair.

Eden's O2 sat just
dropped a bit.

I'm nowhere near her lungs.

Turner syndrome
causes leaky vessels.

The stress on Eden's body is
causing lymph fluid to build up.

We can drain it
with a chest tube.

Her chest is so small, you'd risk a
collapsed lung and pleural infection.

I could clear the
lung with diuretics.

The risks and benefits of both
treatments are nearly identical.

But that also means it doesn't
matter which one we choose,

which makes the choice easy.

I find inserting chest tubes
particularly satisfying,

so I will do that.

The risks and benefits of a boy and
a girl are nearly identical too.

But girls kick ass.

This implant's gonna be a tight
fit around the cauda equina.

The bioengineer's
mapping algorithm

was designed to
optimize stability.

Well, Brady's not an algorithm.

His nerves are gonna
run where they run.

I'll set it in position.

Nerve impingement.

I'll expand the
narrowing with a rod.

Wait, there's an alternate
algorithm that can fix that.

Settle down,
Dr. Allen. I got this.

That's $100,000 worth of
tech, and she's using a rod.

Nerve activity flattening.

One more minute.

The old cantilever maneuver.

Nice work.

Can't beat the classics.

Eden's surgery went well, so
I was hoping Jasmine might...

V-fib.

Ran a code for an hour, but...

she'd just been
through too much.

Vacuum devices are in position.

Let's see if they work.

Keep a close eye on his
intra-abdominal pressure.

We have vacuum.

IA pressure's okay.

Time for the tissue flaps.

Looking good, Lambo.

There's a small
spike in IA pressure.

- Increasing vacuum suction.

Still climbing.

Pressure's compressing
his organs.

He's getting ischemic.

I'm going up to 55.

He's in shock.

I did this.

You didn't do anything.
We're in this together.

We need to amputate.

Not yet.

Audrey, pressure's too high.

We're killing his organs.

I think he's wrong.

Then fight for your patient.

We need to amputate.

- Okay.
- All right.

We need a Liston
amputation knife,

a bone saw, and a set
of 5 1/2-inch hemostats.

He can handle 75.

With that kind of
pressure, he'll bleed out.

Normally, yes.

But the Dacron conduits
Dr. Perez chose

are more rigid than
typical vessels.

They'll hold up.

Let's do it.

I trust my residents, Marcus,
and I need you to trust me.

Let's go to 75.

Brady's family are here.

Is my husband...

The surgery was a success.

It will be a long
recovery, but...

Oh.

Thank you for saving my dad.

I'll take you to him.

I should be dead on my
feet, but I just feel...

- Awesome?
- Yeah.

It's been 24 hours.

Yeah.

I just need a minute.

A minute won't
change the results.

No, it won't.

No cancerous DNA detected.

I was wrong!

Yes, you were.

What?

I'm gonna keep up
this same energy

with some Whitney.

You were right.

You always are.

You're learning.

You know, before when I
was bitching about Jared,

it's because...

Well, I am a little jealous.

A little?

Okay.

What you saw between
Jared and I...

It's none of my business.

You deserve somebody who's
ready to fully commit.

Somebody who makes you happy.

Whoever that may be.

Danny!

We need your boy band
face for the chorus.

- Come here.
- Yeah, we need those abs.

Get up here, baby!

The new surgical
robot is operational,

and I just landed the
perfect nephrectomy

for its inaugural run.

Dibs.

Ah, you did the last cool case.

This one's going to Dr. Murphy.

This is cool.

Dr. Park should take it.

I have to finish
setting up our nursery.

Hey.

Good job today.

Thanks.

I've been under the microscope

with the board lately,
and I am stressed.

Things were said that
probably shouldn't have been.

Things weren't
said. You said them.

If you don't trust me, fire me.

And if you do, then
stay out of my way.

Hey.

Dalisay?

The baby's upset.

Her heart?

No, everything's fine there.

I just... I think she
needs some company.

I'll get to her when I
can, but I'm slammed.

I'm here, Eden.

You can open your eyes now.

It's so sweet.

The crib.

The dresser.

It's the Angelic Dream Set.

The dark walnut was funereal,

but it also came
in natural pine.

Oh, our little peanut
is gonna love it.

Oh.

Whatcha got there?

There are

two screws missing.

That is not good.

No Biggie, Shaun. It's
just a couple screws.

No, that means
Dr. Glassman missed a step.

Dr. Glassman doesn't
have brain cancer,

but there is something
wrong with his brain.