All language subtitles for The.Good.Doctor.S04E12.1080p.WEB.H264-STRONTiUM

I couldn't sleep.

We should start taking
your blood pressure every day.

This is very sweet
and responsible.

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

Yeah.

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

I love you.

I want a child.

So I want this child.

I love you, too.

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

Is this the right time
in my career?

In our relationship?

Am I too young?

Can we afford this?

Am I willing to make
this commitment right now?

We can start
depositing money

into a shared account
for expenses,

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

to help
with your workload --

Shaun, just slow down.

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

I just need to...think.

To figure out what to do.

And you do, too.

Dr. Chambers,
I'd like you to meet
a few of our residents.

This is Doctor --
I know that I'm old,

but I can still read
name tags.

Dr. Chambers, you started
experiencing aches

in your right hand
a month ago?

Then tremors, weakness,
spasms.

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

I sent you a video
of the surgery.

Given your symptoms, it seems
that carpal tunnel --

It "seems."

Well, then, problem solved.

I'll be on my way.

Sir, can I just say
that the documentary

on your work in Haiti
changed my life.

It's the reason
why I went into --

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

And this is a hospital,
not Coachella.

If you can't wear
something appropriate,

at least try something
that fits.

Rule out autoimmune disorders,
hypothyroidism,

diabetes, amyloidosis, MS,
and multiple myeloma.

Then we'll get back
to carpal tunnel.

Alright.

If you have
any other questions
or concerns,

please don't hesitate --

Twelve.

First, I prefer blankets
not made of sandpaper.

Second,
dim these damn lights.

This isn't some
San Fernando Valley
porn shoot.

Third --
SHAUN: If you made a list,

you don't need
to tell us.

He's had the pain
for nine months now.

And it's on both sides?

Sometimes his forehead,

other times his cheeks,
his nose.

And it's persisting through
very high doses
of hydrocodone.

Yeah, obviously,
the drugs don't work.

It's why I'm here.

Oscar.

It's a fair question.

Look, I'm sorry.

Okay, I've been
to six doctors now.

I can't work.

I mean, I-I c--
I can't even kiss my wife.

I can hardly smile.

I'm just gonna lightly brush
your cheek.

Okay.

Please...help me.

I've been on the phone
for like an hour

with the cable company --

Lea's pregnant.

You want to have...

Yes.

Wow.

I'm glad you're happy.

Um, do you have
any concerns?

Yes.

Sleep deprivation.

But I have started
looking into
an affordable night nurse.

Well, there's gonna be
some bigger issues.

I mean, this is a...

This is a gigantic moment
for anyone,

especially --
especially for you.

You mean

because of my ASD?

Yeah,
because of your ASD.

Because of your family.

Your job.

I mean...

A million things.

I don't want to tell you
what -- what to --

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

Having a child

changes everything.

Nasal cavity's clear.

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

It could be
acoustic neuroma.

Without
any hearing loss?

Let's do an MRI
to check.

We've run eight negative tests
already.

We don't need a ninth.

We do the tests
till we know what he has.

It's fibromyalgia.

So, your diagnosis
for his pain

is "pain that no one
can explain"?

Well done.
Some pain's unavoidable.

When I was competing
in Tae Kwon Do,

they taught us to adjust
our relationship to it,

learn to tolerate it.

It can make you stronger.

Wow. That statement has
the absolute ideal ratio

of heartlessness,
humble-bragging, and machismo.

Bravo.

Seriously?
You're pleased with that?

"Machismo," Spanish,
"bravo"'s Italian.

And "humble-bragging"'s 2011.

We can do better,
don't you think?

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

Some kind of
conversion disorder?

You do the MRI.

I'll talk to the wife.

Negative
for endocrine issues.

He's got a history
of moderate carotid stenosis.

If enough plaque
builds up,

starves the brain
of oxygen,

maybe could cause
the hand problems.

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

Anyone else annoyed
that we're wasting

all these resources to confirm
what's clearly carpal tunnel?

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

If Silas Chambers has
a medical opinion,

we better check it out.

I didn't think
he was a jerk.

Dr. Andrews and Dr. Lim
also criticize us

and have
particular demands.

Yeah.
They want us to improve.

How do you know
Dr. Chambers doesn't?

He did improve Enrique.

Not kidding.

You look snazzy.

I know
what Dr. Chambers has.

We're having trouble finding
a physical basis

for your husband's pain.

And you defended me
when I asked him

about painkillers earlier.

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

Working crazy hours.

He was exhausted.

He shot himself with a --
with a nail gun.

Right through his palm.

We didn't have insurance,

so we went to this clinic,
and, um...

Opioids?

Really bad.

Took a year
for him to kick.

Now, um...he's taking
more pills than ever.

Whenever I talk to him
about getting help,

he just gets mad.

I...

I had to move out
last week.

I'm only here
because he asked me to.

I think he's faking.

You threw 113 sutures
in your last day of surgery.

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

Congratulations on discovering
a symptom I told you about.

It occurs during the part
of your stitch

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

That is not carpal tunnel.

It is musician's dystonia.

My wrist flexes
on every suture.

You're talking about
a difference of milliseconds.

Yes, he is.

Your condition
was probably caused

by your repetitive technique.

Even Dr. Andrews
throws sutures
in varied ways.

You never do.
This kind of
obsessive behavior

is common
for those with autism.

So, I can refer --

What did you just say?

I'm not autistic.

Dr. Murphy
didn't mean any offense.

He himself
is on the spectrum.

Is he?

I thought his robotic voice
and hand clasping

were just
charming affectations.

Do you really think
I am anything like him?

I'm not saying that --

I am.

You're extremely organized.

You hardly make eye contact.

And given your problems
with food, blankets,

and lighting, plus the fact
you wear headphones
even in surgery,

you clearly have
sensory issues.

I'm organized.

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

I have good taste
in food and music.

Now that's
a mental disorder?

And as
for eye contact...

Okay.

I didn't come here
for a psych consult.

It was just an observation
about a possible reason

for the behavior that led
to your hand symptoms,

which is what we should
be talking about.

Physical therapy is
the recommended course
for dystonia.

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

I want an MRI-guided
ultrasound ablation

of the VO nucleus
of the thalamus.

You want to jump
to brain surgery?

I would jump
right to amputating a toe

if it got me
my career back.

What were you thinking?

You just supported me.

Yes, because part of my job
is not yelling at residents

in front of patients.

What you did is equivalent
to looking at a fuzzy MRI

and blurting out
a patient has cancer.

Cancer can kill you.

Neither diagnosis is one
a patient is excited to hear.

Prep him
for the ablation.

And do not talk to him again
about autism.

He's seen six doctors
in the last month,

gotten three
opioid prescriptions,

and he had
a previous opioid problem.

It's textbook
drug-seeking.

It's also textbook
"a bunch of dingbats

missing a trigeminal neuralgia
diagnosis."

His wife agrees with me.
She knows him.

Would explain why yours
left you.

Snap. Except my wife
didn't leave me,

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

FIESTA imaging would
take hours to set up,

cost the patient
serious money,

and still come out
negative.

Because...it's
textbook drug-seeking.

We have other patients
who need us.

I'm sending
the discharge order.

Hey.

I hate poop.

Like, what if I suck
at changing diapers?

Maybe we should start
with the bigger issues

and work our way down.

This isn't
at the top of my list,

but since
you are a doctor...

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

Inheritable?

Probably.

But it's unclear
how much.

So, even that.

W-What am I supposed to do
with that?

Think it through.

Let's say you have
a little baby Shaun.

Like...tiny, honest,

brilliant guy
who adores me...

Mini button-down,

teeny blue eyes...

And me?

A mom?

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

but it would just be
so different

from what I was planning.

Not that
I was really planning,

but I am enjoying
just...being.

And so what if you wait?

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

I guess
you'll never really know.

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

And I still wake up
wondering

which of them went
the wrong way.

But...you still
gotta choose.

No abnormal signal
in the mid pons.

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

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

Hey, we're almost --

Come on.

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

Don't bother asking
for consults
if you're gonna --

Wait.

What's that on the right
superior cerebellar artery?

An abnormal loop
causing compression.

He has
trigeminal neuralgia.

The pain's real.

We have
good visualization

of the target area.

Connect
the ultrasound
to the stereotactic frame.

Ablation won't work.

You changed your mind?

You don't think
he has dystonia?

He does,
but it's a symptom.

His vertebral artery takes
an aberrant course.

It is pressing against
his spinal cord.

He needs vascular surgery
or he'll die.

It's a disorder of the nerve
that carries sensation

from the face
to the brain.

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

And very hard
to diagnose.

Thank God Dr. Park approved
all those tests.

Y-You were in agony.

And I...

I told him
I thought you were lying.

You thought I was lying?

You thought
I was just being an addict.

And still
you came here with me.

Sat at my side.

We'd like to do
a microvascular decompression.

We'd go in through the back
of your skull

and put in a Teflon patch
to cushion the affected nerve.

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

It's relatively safe.
And other options

are unlikely to relieve
the pain.

Look, I-I'll do it.

Thank you so much.

We want to run
a vertebral artery BTO.

If you tolerate it,
then we would sacrifice the --

Sacrifice the vessel
with onyx embolization.

We recognize you might
not love this proposal.

The one in which
my hand weakness remains,

destroying my career?

Did you consider
vertebral-to-vertebral
artery bypass

with physical removal
of the aberrant artery?

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

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

With your history
of carotid stenosis,

it would be a coin flip
whether you survive.

I can live
with those numbers.

Or, for that matter,
die with them.

Corridor
to the trigeminal nerve origin
is open.

I freed up
the offending vessel.

Teflon sponge.

The sponge is too big.

It'll compress
the brain stem.

I have at least 4 millimeters
of room.

You have half that.

Yes, you have a better view
50 feet away.

How long have they been
like this?

A while.
It's getting worse, though.

Sorry, Park,
you're right.

Just like you were
when you decided

to discharge the sick guy.

Wow,
you invented sarcasm.

Really impressive.

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

Park,
you missed the diagnosis.

Reznick,
you ignored protocol.

How about you both show
some humility and shut up?

Sorry.

Teflon's placed.

What if we used the saphenous
vein for the bypass?

Not enough flow.
He'll stroke out.

Carotid
to distal vert, then?

Stenosis is too severe.

Dude's loaded.

He's at retirement age.

He could teach, travel,
screw around all day.

Why is he demanding
that we do this?

When you dedicate your life
to something

that gives you meaning,

it starts to define you.

His decision
may be irrational,
but I get it.

I don't think
it is irrational.

Dr. Chambers has no friends,
no children,

no family,
no outside interests.

If he can't be a surgeon,
he'll have nothing.

I think our best bet
is a radial graft.

Highest flow
I can think of.

Any other ideas?

Okay.
We go with the radial graft.

I'm impressed.

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

But then I had
a dark afternoon of the soul

and suddenly I knew it

those were
totally solid burns.

Maybe not A+,
but A-, B+ at the worst.

So it hit me -- your plan was
to throw me off my game,

make me doubt myself --

I'm attracted to you.

I've been fighting
this stupid feeling,

trying to find reasons
to not...feel.

Are you kidding me?

Yes.

Your jokes were lame.

And that's how
you screw with someone.

No.

You're not
that good of a liar.

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

Since when
can't you take a joke?

Since my roommate
hit on me.

You have to move out.

As soon as possible.

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

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

Good call.
I agree.

You should risk your life
for this surgery.

Are you being facetious?

No.

It just boggles
the mind.

You can't understand
what anyone means.

You can't express yourself
like an adult.

You're a child
playing dress-up.

And everyone here
just plays along.

Let's go, Shaun.

Y-You're agitated.

I'm fine.

You are rubbing your mug.

People with ASD
often have comfort objects

for when
they become agitated.

I can order you
propranolol.

You're gonna give me
the Ruseckas-Freedman

ASD Diagnostic
Questionnaire,

and that's gonna shut
your damn mouth.

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

An official diagnosis needs
to come from a psychiatrist.

Well, since I might be dead
tomorrow,

this is
your next-best option.

I'll get the test.

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

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

No, that's just an excuse
people like you use

to justify
your garbage behavior.

That's just an excuse people
like you use

to avoid facing reality.

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

They were dismissive
and cruel.

But it lit a fire
and it made me
the man I am today.

The man that you came
into my room idolizing.

Not anymore.

I'm devastated.

Surgeons deal
in human lives,

not childish fantasies.

If you want to succeed,

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

Everything okay?

Yep.
Surgery went very smoothly.

No pain right now.

Want to take it
for a test drive?

It's worse.

Collateral circulation
is not ideal.

How are we gonna harvest
the artery?

What's going on?

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

To be great --
or even good -- at anything,

we have to compromise.

I used to get too emotionally
involved in my work,

with patients,
everyone.

And I had to learn
to distance myself.

Yeah, you've really grown cold
and heartless.

I have changed.

We all end up changing.

You just got to try
and make it a good change.

I don't want to change.

I want to change
what's around me.

I'll figure it out.

I'm sure you will.

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

So, the circulation...

The right side looks like
it has better length.

Yeah.
Better collateral, too.

Given the poor outcome,

we can't recommend
further surgery right now.

We suggest six months
of pain medication

and referrals
to neurology and pain
management specialists.

W-What surgery
aren't you recommending?

A DREZ lesioning.

We'd cut the signal
from the trigeminal nerve

to the sensory areas
of your brain.

But there's a real possibility
of paralysis

on one side of your body.

I want the surgery.

Baby, I'll help you
manage the pain.

I-I'll move back in.

I'll take care of you.

You know
how I treated you before.

I'm only gonna get worse.

I would never
leave you again.

That's what scares me.

I'd start
cutting you down,

being cruel,

and you'd just put up
with it.

I won't let that happen.

We'll prep an O.R.

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

Duh.

That's a yes.

"People tell me
I overthink things."

Only people
who underthink things.

But, fine, another yes.

"I sometimes speak
in an abnormal tone."

Who thinks they speak
in an abnormal tone?

Just mark no.

How many more of these?

None.

Your answers
are fully congruent
with someone on the spectrum.

No.

You keyed it wrong.

No, look. No, I --
Or something.

Here. Look, I didn't.
No, give it to me.

No, I...
Don't!

You idiot!

S-Stupid, careless --

I-I stepped back --

Get out of my room.

Get out!
Okay.

Make sure
we're not impacting

normal spinal cord
pathways.

Somatosensories
are at baseline.

BP's steady.

Leg and arm SSEPs
at 50% decreased amplitude.

Check the cord above and below
for hematoma

or bony compression.

Cord's fine.

Push IV fluids
and start pressors.

So, what is it?

I don't know.

Any issues
with motor potentials?

Unilateral amplitude
down 70%.

We're about to get
total neurological collapse.

It's a clot
from a small branch artery.

We checked
the spinal blood vessels --

The outside.

But the electrode could have
injured a sulcal artery.

We need to follow
the DREZ pathway inward

and search
for a small clot.

Start at the site of last
ablation with the electrode.

It's gotta be deep.

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

Scrub in, Dr. Reznick.

We're setting up
the neuromonitoring

for Silas' surgery.

He's angry with me.

Silas?

He's angry
with everyone.

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

But I brought it up anyway,
gave him a test,

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

I don't know what to feel.

And Lea --

Lea told me
about the pregnancy.

Okay.

Is this hard for me
because I'm dealing

with both things
at once?

I think both things
are related.

What if my child

has no friends?

What if
they're picked on?

This is not
small-town Wyoming.

The world has changed,
Shaun.

I haven't changed.

How can I...

...know what
they're feeling?

How can I comfort them?

How can I be
a good father?

Remember
when we first met?

Right over there?

You were mad at me.

Yeah. But you were right
about the patient.

And you were stubborn.

And crazy smart.

And you are still
all of those things.

But if you were still
just that guy

that I met
running through those doors,

we would not be sitting here
right now.

You have changed.

You've adapted.
You've grown.

Do you know
how hard that is?

Most people
don't even try.

And you are going to grow
into a great father.

Whenever it happens.

Slowly go perpendicular

at the angle
of our ablation electrode.

Still not seeing
the clot.

Amplitude loss at 80%.

Maybe it's not a clot.

Maybe it's something
higher up,
in the brain.

No.
You were right the first time.

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

Cut the dentate ligament.

It'll get
more lateral access.

Completely section
the ligament.

I see it.

Removing the clot.

Amplitude returning
to normal baseline.

Let me know
if you need me.

We're good.

Thank you.

Hey.

We did good together.

We did.

You still have to move out,
though.

Tonight.

On my first day here,
Dr. Melendez said

I would never do anything
besides suction.

But later, he let me make
my first surgical incision.

He became my friend.

I miss him.

Are you
in the right room?

Did somebody tell you
I needed pointless stories?

I used to think

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

It did make me happy.

But I realized
I wanted more.

And that
I could have more.

I changed.

You can change, too.

But not if you're dead
from this surgery.

I've made up my mind.

Please leave.

My brother Steve,

he gave me a plastic scalpel
before he died.

It broke.
I was very sad.

I asked you to leave.

When I fixed my scalpel,
it made me feel better.

I was 9 years old
when my father died.

I loved drinking hot chocolate
with him in the morning.

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

He understood me.

My mother didn't.

Nobody did.

I tried fitting in,
but...

I got frustrated.

So I gave up.

On relationships.

On friends.

On all but the one thing
I was good at.

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

I've made
too many enemies.

Too many mistakes.

People tolerate me
because I save lives.

Without that

why would anyone ever care
about me?

I care.

That smells good.

Bland.

pasta with olive oil.

Kinda puke-proof.

Have you thought any more
about...

Yes.

I made a list.

I guess I've learned
from you.

What's the first thing
yours says?

That I think
I would be a good father

but that I can't know
for sure.

You'd make a great dad.

It's on my list.

You were right.

It is very complicated.

But I do know...

...I want you to be happy,
Lea.

I have so many reasons
to do this.

And so many doubts.

I'm just scared, Shaun.

But if we are both
having doubts,

then maybe now isn't
the right time.

Okay.

I see that
my hemoglobin's stable

and my white count
is fine.

Yeah. We just wrote
your discharge orders.

This is a referral
for an ASD specialist.

I can look into that
on my own.

Thank you, Dr. Murphy.

And thank you,
Dr. Guerin.

Welcome back.

Did it work?

Let's find out.

Your hand's cold.

I'm transferring out.

Last year, I applied to
a program at Johns Hopkins.

They train doctors
to travel the world,

help out needy areas.

They'll let me
enroll late.

Sounds like a good place
for you.

Thanks for always being
a great boss.

And a great friend.

Can't have been that great,
sneaking out like this.

Actually,
for the first time
I can remember,

it felt hard
to say goodbye.

You're always doing so much
for other people.

Please don't forget to do
something for yourself

every now and then.

Were you messing with me
or not?

If I was,
would you let me stay?

Yes.

I wasn't messing
with you.

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

'Cause
I couldn't do this.

This is
a one-time thing.

Unless I change my mind.

So consider that
an incentive.

Lea Dilallo?

She called your name.

I spent all day
reminding myself
of all the reasons

why this was a good idea.

But now that
it's actually happening,

it...doesn't make me feel
any better.

It just makes me feel
really sad.

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

I...

...feel the same.

Are we really
doing this?

...are having a baby.

Yes.

Okay.

Okay.