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These are the user uploaded subtitles that are being translated: 1 00:00:10,241 --> 00:00:12,341 Morning, Doc! 2 00:00:12,366 --> 00:00:14,549 Good morning, Kenny. 3 00:00:17,671 --> 00:00:19,237 Hey, hey, hey. 4 00:00:22,493 --> 00:00:25,226 Brosef, your cable's out. 5 00:00:25,251 --> 00:00:27,096 I don't have cable. 6 00:00:27,098 --> 00:00:29,331 I have a digital antenna. 7 00:00:29,333 --> 00:00:31,767 - Why? - Digital antennae 8 00:00:31,769 --> 00:00:35,938 receive superior picture and sound quality, 9 00:00:35,940 --> 00:00:37,473 and the channels are free. 10 00:00:37,475 --> 00:00:39,375 Yeah, but you get, like, 10 channels that way. 11 00:00:39,377 --> 00:00:40,676 I only watch three. 12 00:00:40,678 --> 00:00:42,445 You mind if I run a line to your tube? 13 00:00:43,980 --> 00:00:45,381 Cable guy can't fit me in till next week. 14 00:00:45,383 --> 00:00:47,883 Mm. 15 00:00:47,885 --> 00:00:49,185 Come on, 10 channels are better than none. 16 00:00:49,187 --> 00:00:51,487 Yes, they are. 17 00:00:51,489 --> 00:00:52,788 All right. 18 00:00:52,790 --> 00:00:54,457 Gracias, amigo. 19 00:00:54,459 --> 00:00:55,958 No hay na que agradecer. 20 00:00:55,960 --> 00:00:57,299 What? 21 00:01:00,698 --> 00:01:02,331 Dr. Reznick was orphaned 22 00:01:02,333 --> 00:01:03,866 once Dr. Coyle was transferred, 23 00:01:03,868 --> 00:01:05,501 so she'll be joining our team. 24 00:01:05,503 --> 00:01:06,502 Hi. I'm Claire. 25 00:01:06,504 --> 00:01:07,670 Nice to meet you. 26 00:01:09,740 --> 00:01:11,373 Are you the autistic one? 27 00:01:11,375 --> 00:01:13,008 No. 28 00:01:13,010 --> 00:01:14,210 That's me. 29 00:01:14,212 --> 00:01:15,778 Dr. Shaun Murphy. 30 00:01:15,780 --> 00:01:17,546 Hi. 31 00:01:17,548 --> 00:01:19,915 We've got two pretty straightforward cases, 32 00:01:19,917 --> 00:01:23,185 nice level playing field for an eager group. 33 00:01:23,187 --> 00:01:24,320 Not interested. 34 00:01:24,322 --> 00:01:26,188 Competition can foster teamwork, 35 00:01:26,190 --> 00:01:27,990 which can lead to a greater understanding 36 00:01:27,992 --> 00:01:29,458 and appreciation 37 00:01:29,460 --> 00:01:31,060 of residents' strengths and weaknesses 38 00:01:31,062 --> 00:01:32,495 and improve patient care. 39 00:01:32,497 --> 00:01:34,130 You're playing the same game Glassman had us do 40 00:01:34,132 --> 00:01:35,131 when we were interns. 41 00:01:35,133 --> 00:01:36,132 Not interested. 42 00:01:36,134 --> 00:01:38,412 Winning team gets first dibs 43 00:01:38,413 --> 00:01:40,379 on assisting on all surgeries next week. 44 00:01:40,404 --> 00:01:41,277 - In. - In. 45 00:01:41,302 --> 00:01:42,400 Out. 46 00:01:43,573 --> 00:01:45,141 Mm. 47 00:01:48,212 --> 00:01:49,879 I pick the boy genius. 48 00:01:52,617 --> 00:01:53,883 That's you. 49 00:01:55,000 --> 00:02:01,074 50 00:02:04,896 --> 00:02:06,095 Dr. Browne. 51 00:02:07,765 --> 00:02:10,099 - Kalu. - Dr. Reznick. 52 00:02:10,667 --> 00:02:13,235 Thank you. I'm looking forward to it. 53 00:02:15,300 --> 00:02:16,534 Thank you. 54 00:02:18,910 --> 00:02:20,943 Same stakes as last time? 55 00:02:20,945 --> 00:02:22,411 Absolutely. 56 00:02:26,751 --> 00:02:27,817 Hi, Quinn. 57 00:02:27,819 --> 00:02:29,084 We hear you've had some stomach pain. 58 00:02:29,086 --> 00:02:30,085 Do you mind if we take a look? 59 00:02:30,087 --> 00:02:31,620 It doesn't hurt that bad. 60 00:02:31,622 --> 00:02:33,589 Poor thing says everything is okay, 61 00:02:33,591 --> 00:02:36,192 but when Quinnie didn't want to go swimming today, 62 00:02:36,194 --> 00:02:38,294 I knew that something must be wrong. 63 00:02:39,930 --> 00:02:42,097 We'll be as gentle with her as possible. 64 00:02:43,968 --> 00:02:45,401 Quinn's parents are out of town, 65 00:02:45,403 --> 00:02:48,103 so I'm... I flew in to babysit. 66 00:02:48,105 --> 00:02:49,205 Mm-hmm. 67 00:02:52,710 --> 00:02:54,410 Okay. 68 00:02:54,412 --> 00:02:56,011 Let's see. 69 00:02:59,550 --> 00:03:00,783 - That's a... - Penis. 70 00:03:02,352 --> 00:03:03,919 She's not a girl. 71 00:03:03,921 --> 00:03:05,120 He's a boy. 72 00:03:06,117 --> 00:03:11,397 Synced & corrected by kinglouisxx www.addic7ed.com 73 00:03:16,070 --> 00:03:17,036 It's just a phase. 74 00:03:17,038 --> 00:03:18,504 Stop saying that. 75 00:03:18,506 --> 00:03:20,006 I'm not a boy. I'm a girl. 76 00:03:20,008 --> 00:03:21,674 - You're transgender? - Yes. 77 00:03:21,676 --> 00:03:22,875 No. 78 00:03:22,877 --> 00:03:25,978 Quinn has XY chromosomes like Jared and me, 79 00:03:25,980 --> 00:03:27,446 not XX like you. 80 00:03:27,448 --> 00:03:29,415 Science says he's male. 81 00:03:29,417 --> 00:03:31,651 No, Quinn has gender dysphoria. 82 00:03:31,653 --> 00:03:33,986 Her assigned gender is not the one she identifies with. 83 00:03:33,988 --> 00:03:35,922 She's mismatched, Dr. Murphy. 84 00:03:35,924 --> 00:03:37,189 But biologically... 85 00:03:37,191 --> 00:03:38,524 Other than biologically, 86 00:03:38,526 --> 00:03:40,359 how do you know you're supposed to be a boy? 87 00:03:42,829 --> 00:03:44,830 Your question doesn't make sense. 88 00:03:44,832 --> 00:03:46,766 I'm not supposed to be anything. 89 00:03:46,768 --> 00:03:47,900 I am a boy. 90 00:03:47,902 --> 00:03:49,402 Biologically, that's it. 91 00:03:53,374 --> 00:03:55,174 Okay, deep tenderness at McBurney's point. 92 00:03:55,176 --> 00:03:56,509 Could be acute appendicitis. 93 00:03:56,511 --> 00:03:59,345 Murphy, get imaging to confirm. 94 00:03:59,347 --> 00:04:00,546 Mm. 95 00:04:06,454 --> 00:04:08,321 Mr. Shaw, your chart says 96 00:04:08,323 --> 00:04:10,389 that you passed out in class. 97 00:04:10,391 --> 00:04:12,521 - What do you teach? - History. 98 00:04:12,546 --> 00:04:14,660 I got a little dizzy because I skipped breakfast. 99 00:04:14,662 --> 00:04:15,962 I-It's nothing. 100 00:04:15,964 --> 00:04:18,397 The school insisted on calling an ambulance. 101 00:04:18,399 --> 00:04:20,333 Taken any medications in the last few months? 102 00:04:21,401 --> 00:04:23,069 Uh, I took some Vicodin 103 00:04:23,071 --> 00:04:25,805 after I threw out my back six weeks ago, 104 00:04:25,807 --> 00:04:27,773 and then I had a stomach flu, 105 00:04:27,775 --> 00:04:29,342 so I took Ofloxacin. 106 00:04:29,344 --> 00:04:32,111 But the flu part didn't totally go away, 107 00:04:32,113 --> 00:04:34,714 so I took Azithromycin and Prednisone 108 00:04:34,716 --> 00:04:36,782 because my glands were swollen. 109 00:04:36,784 --> 00:04:39,685 But I still had a sore throat, so I took some Cipro. 110 00:04:41,788 --> 00:04:43,422 What doctor prescribed you all that? 111 00:04:43,424 --> 00:04:45,391 Uh, they were leftovers 112 00:04:45,393 --> 00:04:47,960 I had in my medicine cabinet. 113 00:04:47,962 --> 00:04:50,563 - Uh... - All right, lay back for me. 114 00:04:52,500 --> 00:04:54,667 Look, I'm a single dad with twins 115 00:04:54,669 --> 00:04:57,003 who bring home every disgusting germ 116 00:04:57,005 --> 00:04:59,271 they touch at preschool. 117 00:04:59,273 --> 00:05:01,173 I can't afford to miss work. 118 00:05:02,377 --> 00:05:04,310 You've got a fever 119 00:05:04,312 --> 00:05:05,611 and you've gone through two IVs 120 00:05:05,613 --> 00:05:07,446 which tells me that you're severely dehydrated. 121 00:05:07,448 --> 00:05:09,315 You can't stand me touching your stomach 122 00:05:09,317 --> 00:05:10,483 without wincing in pain. 123 00:05:10,485 --> 00:05:13,185 Dr. Reznick, let's get Mr. Shaw here an ultrasound. 124 00:05:15,397 --> 00:05:17,577 - We've been trying for a while. - Five months. 125 00:05:17,602 --> 00:05:19,736 I realize my prime egg days were two decades ago, 126 00:05:19,761 --> 00:05:21,093 but I've been vigilant. 127 00:05:21,095 --> 00:05:23,429 Ovulation kits, LH and FSH testing, 128 00:05:23,431 --> 00:05:24,530 basal body temp. 129 00:05:24,532 --> 00:05:27,199 I've checked my estradiol and AMH levels. 130 00:05:27,201 --> 00:05:29,168 The old-fashioned way wasn't working. 131 00:05:29,170 --> 00:05:32,338 Okay, well, there are a lot of possibilities to consider. 132 00:05:32,340 --> 00:05:34,874 Many benign, many easily corrected. 133 00:05:34,876 --> 00:05:37,176 So I will take some samples from you both, 134 00:05:37,178 --> 00:05:38,644 run some tests, we go from there. 135 00:05:38,646 --> 00:05:39,845 There's a clock. 136 00:05:39,847 --> 00:05:42,214 We need to know if we start with IUI or IVF... 137 00:05:42,216 --> 00:05:44,884 Both of you... You need to stop worrying. 138 00:05:44,886 --> 00:05:47,586 Isabel, you are not the first 40-something woman 139 00:05:47,588 --> 00:05:49,822 to come here and ask these questions. 140 00:05:49,824 --> 00:05:52,491 Myself included. 141 00:05:52,493 --> 00:05:54,326 You came to me because you trust me, yes? 142 00:05:54,328 --> 00:05:56,062 Right. 143 00:05:56,064 --> 00:05:57,630 So let me do what I do, 144 00:05:57,632 --> 00:05:59,131 and you two focus on each other. 145 00:06:00,935 --> 00:06:02,601 Hey. 146 00:06:02,603 --> 00:06:04,203 We're a team, babe. 147 00:06:04,205 --> 00:06:06,539 In this together, all right? 148 00:06:06,541 --> 00:06:07,973 Okay. 149 00:06:17,518 --> 00:06:18,684 I'm afraid, Howard, 150 00:06:18,686 --> 00:06:20,753 your appendix has already ruptured. 151 00:06:20,755 --> 00:06:23,106 Book an OR stat and page Melendez. 152 00:06:23,131 --> 00:06:24,489 Wait. I need to figure out 153 00:06:24,514 --> 00:06:25,707 who's gonna take care of my kids, 154 00:06:25,732 --> 00:06:28,036 call the school so they can get subs for my classes. 155 00:06:28,061 --> 00:06:30,129 Mr. Shaw, if we don't get you into surgery now, 156 00:06:30,131 --> 00:06:32,465 your infection could spread and you could become septic. 157 00:06:32,467 --> 00:06:34,467 Dr. Browne will make all the necessary phone calls 158 00:06:34,469 --> 00:06:36,035 I prep you for surgery. 159 00:06:36,037 --> 00:06:37,703 Isn't that so, Dr. Browne? 160 00:06:40,073 --> 00:06:41,440 You're in good hands, Mr. Shaw. 161 00:06:41,442 --> 00:06:42,541 We've got you covered. 162 00:06:42,543 --> 00:06:43,709 Let's go. 163 00:06:51,686 --> 00:06:53,552 Hello. 164 00:06:53,554 --> 00:06:54,520 Do you wear dresses? 165 00:06:54,522 --> 00:06:56,789 Murphy, don't. 166 00:06:56,791 --> 00:06:59,492 Quinn is a boy who thinks he's a girl. 167 00:06:59,494 --> 00:07:01,994 I want to know why he thinks that. 168 00:07:01,996 --> 00:07:04,130 Sometimes I wear dresses, but sometimes I wear leggings. 169 00:07:04,132 --> 00:07:07,433 Do you like the color pink? 170 00:07:08,469 --> 00:07:10,035 I'm more of a purple girl. 171 00:07:10,037 --> 00:07:12,238 - Do you play with dolls? - Since I was 5, 172 00:07:12,240 --> 00:07:13,939 but I'm super into mermaids. 173 00:07:13,941 --> 00:07:14,974 Do you take dance... 174 00:07:14,976 --> 00:07:16,642 Murphy, 20 questions are up. 175 00:07:16,644 --> 00:07:18,177 I only asked four. 176 00:07:18,179 --> 00:07:19,678 - Do you wear perfume? - It doesn't matter. 177 00:07:19,680 --> 00:07:20,728 The CT's ready. Let's go. 178 00:07:20,753 --> 00:07:22,448 - Do you always paint your nails? - Let's go. 179 00:07:32,360 --> 00:07:34,493 Perforated appendix is out. 180 00:07:34,495 --> 00:07:36,362 Lavage or no lavage. 181 00:07:36,364 --> 00:07:37,630 Dr. Browne. 182 00:07:37,632 --> 00:07:39,365 Lavage before closing the wound 183 00:07:39,367 --> 00:07:41,367 decreases residual fluid accumulation 184 00:07:41,369 --> 00:07:44,570 - and minimizes residual contamination. - Claire's right. 185 00:07:44,572 --> 00:07:45,704 Although, a recent study 186 00:07:45,706 --> 00:07:47,339 documented a higher abscess rate 187 00:07:47,341 --> 00:07:49,775 when irrigation was used for perforated appendicitis. 188 00:07:49,777 --> 00:07:51,844 Well, someone did their homework. 189 00:07:51,846 --> 00:07:53,846 I'm partial to AMSURG since they published me. 190 00:07:53,848 --> 00:07:55,915 As a medical student? 191 00:07:55,917 --> 00:07:58,284 It was about the cost and stabilization of disease 192 00:07:58,286 --> 00:08:00,085 in patients undergoing transcatheter 193 00:08:00,087 --> 00:08:01,854 and surgical aortic valve replacement. 194 00:08:01,856 --> 00:08:03,989 Are you thinking of specializing in cardio-thoracic? 195 00:08:03,991 --> 00:08:05,824 A girl can dream. 196 00:08:06,927 --> 00:08:08,260 Staple up and close up. 197 00:08:11,464 --> 00:08:12,531 It's, uh... 198 00:08:12,533 --> 00:08:14,466 it's good to have you on board, Morgan. 199 00:08:14,468 --> 00:08:18,170 It's great to have another female surgeon. 200 00:08:18,172 --> 00:08:21,340 Oh, uh, I'm sorry, 201 00:08:21,342 --> 00:08:23,075 you and I are not gonna be friends, 202 00:08:23,077 --> 00:08:25,144 hanging out, having sleepovers, 203 00:08:25,146 --> 00:08:26,912 braiding each other's hair. 204 00:08:26,914 --> 00:08:30,182 That's not exactly where I was going with it. 205 00:08:30,184 --> 00:08:31,417 When residency's over, 206 00:08:31,419 --> 00:08:32,685 the hospital's likely only keeping two of us. 207 00:08:32,687 --> 00:08:35,387 Shaun is Glassman's pet project, so he's in. 208 00:08:35,389 --> 00:08:37,990 Jared is persona non grata, so he's out. 209 00:08:37,992 --> 00:08:40,192 Which means every time you win, I lose. 210 00:08:40,194 --> 00:08:42,094 And vice versa. 211 00:08:45,466 --> 00:08:47,032 Thanks for the heads up. 212 00:08:57,545 --> 00:09:01,714 Do you think he's complicated or confused? 213 00:09:03,084 --> 00:09:05,384 Dude, you've got to quit calling her a "he." 214 00:09:05,386 --> 00:09:06,986 We're never going to win this competition 215 00:09:06,988 --> 00:09:08,207 with you disrespecting our patient. 216 00:09:08,232 --> 00:09:09,745 Don't they have transgender people in Wyoming? 217 00:09:09,770 --> 00:09:12,725 Okay. Transgender patient care 218 00:09:12,727 --> 00:09:16,061 was not part of my medical school curriculum. 219 00:09:16,063 --> 00:09:18,397 Was it part of yours? 220 00:09:18,399 --> 00:09:19,732 No. 221 00:09:24,504 --> 00:09:27,973 Quinn doesn't have appendicitis. 222 00:09:27,975 --> 00:09:31,010 He has testicular cancer. 223 00:09:33,781 --> 00:09:34,813 She. 224 00:09:37,734 --> 00:09:40,951 We found a mass on Quinn's left testicle. 225 00:09:40,976 --> 00:09:42,509 She has cancer, but... 226 00:09:42,511 --> 00:09:44,025 - Am I gonna die? - No, no. 227 00:09:44,079 --> 00:09:45,412 Prognosis is very good. 228 00:09:45,414 --> 00:09:46,619 We've caught it before it spread, 229 00:09:46,651 --> 00:09:48,550 and we'll do surgery on the mass to remove it. 230 00:09:48,552 --> 00:09:51,787 The CT also showed he has osteopenia. 231 00:09:51,789 --> 00:09:53,956 Murphy, stop with the "he." 232 00:09:55,393 --> 00:09:57,960 Um, Quinnie, it's your mom. 233 00:09:57,962 --> 00:10:00,062 - I... I have to... - Of course. 234 00:10:03,133 --> 00:10:04,366 Osteopenia. 235 00:10:04,368 --> 00:10:06,201 - That's low bone density, right? - Yeah. 236 00:10:06,203 --> 00:10:07,469 How'd you know that? 237 00:10:07,471 --> 00:10:10,039 Do you know how I got cancer? 238 00:10:10,041 --> 00:10:12,207 There are several possible causes, but I... 239 00:10:12,209 --> 00:10:14,610 - Microlithiasis, mumps, hypospadias... - Murphy. 240 00:10:14,612 --> 00:10:16,478 Intraepithelial germ cell neoplasia, 241 00:10:16,480 --> 00:10:17,646 inguinal hernia, HIV... 242 00:10:17,648 --> 00:10:20,149 Murphy. Enough. 243 00:10:20,151 --> 00:10:22,785 Your parents are on their way here. 244 00:10:22,787 --> 00:10:25,220 Um, they just told me... 245 00:10:25,222 --> 00:10:27,089 Quinn, are you on puberty blockers? 246 00:10:28,658 --> 00:10:31,794 That's the likely cause of the osteopenia. 247 00:10:31,796 --> 00:10:33,996 Are you taking leuprorelin or histrelin? 248 00:10:33,998 --> 00:10:36,632 I've been leuprorelin for nine months. 249 00:10:36,634 --> 00:10:38,267 Why didn't you say anything earlier? 250 00:10:38,269 --> 00:10:41,503 Because my parents didn't want my grandma to know. 251 00:10:46,010 --> 00:10:47,976 Looks like he has an abscess. 252 00:10:47,978 --> 00:10:49,278 You have an infection. 253 00:10:49,280 --> 00:10:51,613 We'll drain it, put you on antibiotics. 254 00:10:51,615 --> 00:10:52,648 It's nothing to worry about. 255 00:10:52,650 --> 00:10:53,749 It just means you might be in the hospital 256 00:10:53,751 --> 00:10:54,750 a couple of extra nights. 257 00:10:54,752 --> 00:10:55,784 I... I can't spend 258 00:10:55,786 --> 00:10:56,885 a couple of extra nights. 259 00:10:56,887 --> 00:10:58,253 I need to get out of here. 260 00:10:58,255 --> 00:11:00,255 Are you worried about your kids? 261 00:11:00,257 --> 00:11:02,458 Well, they're with my sister, they're safe, 262 00:11:02,460 --> 00:11:04,259 but they've never spent a night without me 263 00:11:04,261 --> 00:11:05,327 since they were born. 264 00:11:05,329 --> 00:11:06,995 Well, then consider this a blessing. 265 00:11:06,997 --> 00:11:08,464 A free vacation from your kids. 266 00:11:08,466 --> 00:11:10,099 They're my life. 267 00:11:14,105 --> 00:11:17,439 My wife died of ovarian cancer last year. 268 00:11:20,177 --> 00:11:22,211 I... 269 00:11:22,213 --> 00:11:23,679 I hate hospitals. 270 00:11:23,681 --> 00:11:25,781 I'm so sorry. 271 00:11:25,783 --> 00:11:28,383 Why don't I find a laptop 272 00:11:28,385 --> 00:11:29,718 so you can Skype with them? 273 00:11:30,954 --> 00:11:33,689 And I'll rustle up a couple of toy bears from Peds 274 00:11:33,691 --> 00:11:35,424 for you to take home. 275 00:11:35,426 --> 00:11:36,692 Thank you. 276 00:11:39,296 --> 00:11:40,796 I want to reassure you 277 00:11:40,798 --> 00:11:42,231 that the puberty blockers 278 00:11:42,233 --> 00:11:44,733 are in no way responsible for causing cancer. 279 00:11:44,735 --> 00:11:47,569 The leuprorelin did cause your osteopenia. 280 00:11:47,571 --> 00:11:49,872 Does this mean I have to stop taking puberty blockers? 281 00:11:49,874 --> 00:11:50,973 Yes. 282 00:11:50,975 --> 00:11:52,307 We'll get you on dietary supplements 283 00:11:52,309 --> 00:11:53,542 to help regain your bone strength, 284 00:11:53,544 --> 00:11:54,843 but the puberty blockers are hurting you. 285 00:11:54,845 --> 00:11:55,878 You'll be fine without them. 286 00:11:57,080 --> 00:11:59,248 Fine? 287 00:11:59,250 --> 00:12:01,283 I... I don't want an Adam's apple 288 00:12:01,285 --> 00:12:03,852 or a deep voice or hair all over my body. 289 00:12:03,854 --> 00:12:05,888 You can't reverse that, can you? 290 00:12:05,890 --> 00:12:08,857 No, I'm afraid not. 291 00:12:16,901 --> 00:12:19,768 Girls have body hair, too. 292 00:12:27,811 --> 00:12:30,379 Toy bears, Skype with kids... 293 00:12:30,381 --> 00:12:31,814 you've got game. 294 00:12:31,816 --> 00:12:34,283 "Game"? 295 00:12:34,285 --> 00:12:35,751 I believe the name for what I did 296 00:12:35,753 --> 00:12:38,687 is "basic human decency." 297 00:12:38,689 --> 00:12:40,389 Everyone has an agenda. 298 00:12:40,391 --> 00:12:42,658 Sometimes it's conscious, sometimes it's not, 299 00:12:42,660 --> 00:12:43,725 but it's always there. 300 00:12:43,727 --> 00:12:44,960 And you've got this whole 301 00:12:44,962 --> 00:12:46,728 "queen of kindness" thing down pat. 302 00:12:46,730 --> 00:12:49,131 Awfully cynical for someone so young. 303 00:12:49,133 --> 00:12:50,299 Mm, not cynical. 304 00:12:50,301 --> 00:12:51,466 Just the reality of how the world works. 305 00:12:53,437 --> 00:12:54,469 It's Howard. 306 00:12:55,840 --> 00:12:57,973 He spiked a fever, temp's 105. 307 00:12:57,975 --> 00:12:59,408 BP's tanking, 80 over 40. 308 00:12:59,410 --> 00:13:01,176 - He's soiled his sheets. - Site's clean. 309 00:13:01,178 --> 00:13:02,644 Infection should be clearing by now. 310 00:13:02,646 --> 00:13:04,046 - What's going on? - I don't know. 311 00:13:04,048 --> 00:13:05,113 Page Melendez. 312 00:13:05,115 --> 00:13:06,715 Give me 500 milligrams acetaminophen, 313 00:13:06,717 --> 00:13:08,584 2 grams of meropenem IV infusion empirically. 314 00:13:08,586 --> 00:13:11,420 Run a chem panel, CBC, and get cultures ASAP. 315 00:13:12,155 --> 00:13:13,655 Hang in there, Howard. 316 00:13:13,657 --> 00:13:15,023 We're gonna figure this out. 317 00:13:22,230 --> 00:13:23,931 Any word on Quinn Darby's labs? 318 00:13:23,974 --> 00:13:25,848 Big backup today. Nothing much I can do. 319 00:13:25,880 --> 00:13:27,279 Text you when they're ready. 320 00:13:27,281 --> 00:13:28,347 Yeah. 321 00:13:29,816 --> 00:13:30,883 Hey, Gus. 322 00:13:30,885 --> 00:13:33,085 I saw raspberry and rose petal doughnuts 323 00:13:33,087 --> 00:13:34,487 in the cafeteria today. 324 00:13:34,489 --> 00:13:36,218 Got you the last one. 325 00:13:36,280 --> 00:13:37,790 You remembered. 326 00:13:37,792 --> 00:13:39,458 Thank you. 327 00:13:39,460 --> 00:13:41,594 Howard Shaw's labs. 328 00:13:41,596 --> 00:13:44,063 - I put a rush on them for you. - You're the best. 329 00:13:45,133 --> 00:13:49,001 Why did you give Gus a doughnut? 330 00:13:49,003 --> 00:13:50,202 I was being nice. 331 00:13:50,204 --> 00:13:52,705 I needed my patient's labs expedited. 332 00:13:52,707 --> 00:13:55,141 - Gus likes doughnuts. - It's called bribery. 333 00:13:55,143 --> 00:13:56,876 I call it "basic human decency." 334 00:13:58,678 --> 00:13:59,812 See you later. 335 00:14:04,985 --> 00:14:06,786 Howard has a superbug. 336 00:14:08,321 --> 00:14:09,555 A C. Diff infection? 337 00:14:09,557 --> 00:14:12,825 It's resistant to all medication. 338 00:14:15,163 --> 00:14:16,729 Quinn's pre-op labs are normal, 339 00:14:16,731 --> 00:14:18,731 so we can do the surgery first thing in the morning. 340 00:14:18,733 --> 00:14:19,765 The procedure is called 341 00:14:19,767 --> 00:14:21,734 a radical inguinal orchiectomy. 342 00:14:21,736 --> 00:14:24,503 It's radical in that 343 00:14:24,505 --> 00:14:26,705 the entire cancerous testicle is removed. 344 00:14:26,707 --> 00:14:28,874 All functionality will remain the same. 345 00:14:28,876 --> 00:14:30,843 Quinn should be able to resume her normal activities 346 00:14:30,845 --> 00:14:31,844 in one or two weeks. 347 00:14:31,846 --> 00:14:33,846 See? Baby, that's good news. 348 00:14:33,848 --> 00:14:35,181 No, not really. 349 00:14:35,183 --> 00:14:36,549 Without the puberty blockers, 350 00:14:36,551 --> 00:14:38,651 I'll be the freak in ballet with a mustache. 351 00:14:38,653 --> 00:14:40,953 Aren't there any other options? 352 00:14:40,955 --> 00:14:41,954 I wish there were... 353 00:14:41,956 --> 00:14:43,789 If we do a bilateral orchiectomy, 354 00:14:43,791 --> 00:14:44,824 Quinn will have 355 00:14:44,826 --> 00:14:46,458 the testosterone level of a girl. 356 00:14:46,460 --> 00:14:48,961 We are not removing both testicles. 357 00:14:48,963 --> 00:14:50,972 You want to castrate my grandson? 358 00:14:50,997 --> 00:14:52,064 - No. - No. 359 00:14:53,234 --> 00:14:55,434 I'm so sorry for Dr. Murphy's outburst. 360 00:14:55,436 --> 00:14:58,103 I'm gonna have gender confirmation surgery 361 00:14:58,105 --> 00:14:59,805 when I'm 18 anyway. 362 00:14:59,807 --> 00:15:00,873 Why not just do it now. 363 00:15:04,312 --> 00:15:05,978 Quinn is a child 364 00:15:05,980 --> 00:15:09,982 who still plays dress-up and make-believe. 365 00:15:09,984 --> 00:15:12,255 He may want to have children of his own some day. 366 00:15:12,280 --> 00:15:13,219 Ew. 367 00:15:14,088 --> 00:15:15,588 We'll give you some privacy. 368 00:15:15,590 --> 00:15:16,755 Thank you. 369 00:15:21,529 --> 00:15:23,762 - I will not allow you... - It's not up to you. 370 00:15:26,410 --> 00:15:28,886 You are making me doubt the wisdom of drafting you, Murphy. 371 00:15:28,911 --> 00:15:31,003 If you go around saying inflammatory things to people, 372 00:15:31,005 --> 00:15:32,705 it will only upset them. 373 00:15:32,707 --> 00:15:35,007 How will I know if I said something inflammatory 374 00:15:35,009 --> 00:15:36,375 until I say it? 375 00:15:36,377 --> 00:15:38,878 Test it on Kalu first. 376 00:15:38,880 --> 00:15:40,746 Which you can do 377 00:15:40,748 --> 00:15:43,349 the two of you prep an SDA for this case. 378 00:15:43,351 --> 00:15:45,251 An SDA? 379 00:15:45,253 --> 00:15:46,652 A Shared Decision Aid 380 00:15:46,654 --> 00:15:48,888 is a paper presenting the pros and cons 381 00:15:48,890 --> 00:15:50,689 - of making a difficult... - I know what it is, Murphy. 382 00:15:50,691 --> 00:15:52,057 But why am I being punished? 383 00:15:52,059 --> 00:15:53,525 It's not a punishment, it's necessary. 384 00:15:53,527 --> 00:15:54,660 It'll help Quinn's family 385 00:15:54,662 --> 00:15:57,596 understand all the options available to them for her care. 386 00:15:57,598 --> 00:16:00,232 - Understood? - Understood. 387 00:16:03,971 --> 00:16:05,437 The stool culture and sensitivity test 388 00:16:05,439 --> 00:16:06,605 indicate that you're resistant 389 00:16:06,607 --> 00:16:07,706 to every antibiotic. 390 00:16:07,708 --> 00:16:09,575 Which only happens when you've been exposed 391 00:16:09,577 --> 00:16:10,542 to every antibiotic. 392 00:16:10,544 --> 00:16:15,247 I... I did this to myself? 393 00:16:15,249 --> 00:16:16,749 But I've used those medications before 394 00:16:16,751 --> 00:16:17,750 without a problem. 395 00:16:17,752 --> 00:16:18,817 Why did this happen now? 396 00:16:20,921 --> 00:16:22,755 You weren't under a doctor's care, 397 00:16:22,757 --> 00:16:24,790 so you were likely taking the wrong medication 398 00:16:24,792 --> 00:16:25,958 for the wrong symptoms. 399 00:16:25,960 --> 00:16:27,860 But you can fix this, right? 400 00:16:27,862 --> 00:16:29,929 We're gonna have to perform a colostomy 401 00:16:29,931 --> 00:16:31,597 where we attach an ostomy pouching system 402 00:16:31,599 --> 00:16:32,798 to your abdomen 403 00:16:32,800 --> 00:16:34,300 to collect waste from your body. 404 00:16:34,302 --> 00:16:35,901 For how long? 405 00:16:35,903 --> 00:16:37,036 Well, with the level of damage 406 00:16:37,038 --> 00:16:38,304 we're seeing throughout the colon, 407 00:16:38,306 --> 00:16:39,371 indefinitely. 408 00:16:42,043 --> 00:16:44,043 I'm so sorry, Howard. 409 00:16:52,653 --> 00:16:53,786 I don't understand 410 00:16:53,788 --> 00:16:55,187 why you'd suggest the bilateral orchiectomy 411 00:16:55,189 --> 00:16:56,956 when you don't even believe Quinn's a girl. 412 00:16:56,958 --> 00:16:59,725 I was answering Dr. Lim's question. 413 00:16:59,727 --> 00:17:01,760 She said there were no other options, 414 00:17:01,762 --> 00:17:02,828 but I found one. 415 00:17:02,830 --> 00:17:05,064 And now we're here. 416 00:17:05,066 --> 00:17:07,499 Yes. 417 00:17:07,501 --> 00:17:09,201 You're actually enjoying this scut work, aren't you? 418 00:17:09,203 --> 00:17:11,270 Yes. We are being helpful. 419 00:17:13,073 --> 00:17:15,474 We're not doing this to be helpful, Murphy. 420 00:17:15,476 --> 00:17:17,443 We're doing this because you pissed off Lim, 421 00:17:17,445 --> 00:17:20,579 and I'm collateral damage. 422 00:17:20,581 --> 00:17:22,848 We're still being helpful. 423 00:17:26,386 --> 00:17:28,053 Doesn't matter. 424 00:17:28,055 --> 00:17:30,756 Doesn't matter, competition's over. 425 00:17:30,758 --> 00:17:32,424 Is it? 426 00:17:32,426 --> 00:17:34,059 We're in here and not with the patient. 427 00:17:34,061 --> 00:17:35,728 No face time plus you calling her a "he" 428 00:17:35,730 --> 00:17:37,930 equals crappy survey scores. 429 00:17:37,932 --> 00:17:39,365 It's okay. It's a game. 430 00:17:39,367 --> 00:17:41,600 - It's not important. - It is to me. 431 00:17:45,505 --> 00:17:47,740 I'm a pariah. 432 00:17:47,742 --> 00:17:50,242 These scores are part of our resident evaluation. 433 00:17:50,244 --> 00:17:52,344 Our jobs depend on them. 434 00:17:52,346 --> 00:17:54,380 Mine does, at least. 435 00:17:59,120 --> 00:18:03,122 Then we should do this scut work very well. 436 00:18:14,100 --> 00:18:15,634 Finola called. 437 00:18:15,636 --> 00:18:17,736 She found an irregularity with one of the tests 438 00:18:17,738 --> 00:18:19,338 but wants to re-run it to be sure. 439 00:18:19,340 --> 00:18:24,076 Okay, so we wait until she re-runs it. 440 00:18:24,078 --> 00:18:27,246 Marcus, we're both doctors. 441 00:18:27,248 --> 00:18:28,781 The results aren't gonna change. 442 00:18:32,852 --> 00:18:36,088 I waited too long. 443 00:18:36,090 --> 00:18:37,456 It's all my fault. 444 00:18:41,327 --> 00:18:42,828 This is the part where you say, 445 00:18:42,830 --> 00:18:43,896 "No, babe, it isn't." 446 00:18:43,898 --> 00:18:48,033 You had goals, other priorities. 447 00:18:48,035 --> 00:18:50,736 You said you supported my career choices, 448 00:18:50,738 --> 00:18:52,404 just like I supported yours. 449 00:18:52,406 --> 00:18:54,840 I do support you. Always. 450 00:18:54,842 --> 00:18:56,375 And I am so proud of you. 451 00:18:56,377 --> 00:18:58,277 But it came at a cost 452 00:18:58,279 --> 00:19:00,279 that we both knew was possible. 453 00:19:00,304 --> 00:19:03,015 - We should have started trying sooner. - When? 454 00:19:03,017 --> 00:19:05,350 When you were 3,000 miles away teaching at Dartmouth? 455 00:19:05,352 --> 00:19:07,419 Or, what, when you were chasing down head of surgery? 456 00:19:07,421 --> 00:19:09,922 - We would have figured it out. - "Figuring it out" 457 00:19:09,924 --> 00:19:11,590 would have meant me and a nanny raising a baby. 458 00:19:11,592 --> 00:19:12,658 I didn't want that. 459 00:19:12,660 --> 00:19:13,859 I tried to bring it up four years ago, 460 00:19:13,861 --> 00:19:15,394 but you wanted to get your practice up and running. 461 00:19:15,396 --> 00:19:16,695 A baby didn't fit in that picture, either. 462 00:19:16,697 --> 00:19:18,597 It is not the same. 463 00:19:18,599 --> 00:19:20,365 How many pregnant women get hired for anything? 464 00:19:20,367 --> 00:19:22,434 Or when they find out a woman's got a child at home, 465 00:19:22,436 --> 00:19:23,435 suddenly it's all 466 00:19:23,437 --> 00:19:24,870 "Who's gonna take care of the baby?" 467 00:19:24,872 --> 00:19:26,538 No one asks men that question. 468 00:19:26,540 --> 00:19:29,108 Yeah, well, none of it matters now. 469 00:19:29,110 --> 00:19:30,909 Right? Because it's probably too late. 470 00:19:30,911 --> 00:19:31,977 And I knew it. 471 00:19:31,979 --> 00:19:33,378 I knew this was gonna happen. 472 00:19:35,582 --> 00:19:37,983 You've been stewing over this. 473 00:19:37,985 --> 00:19:40,018 Resenting me. For how long? 474 00:19:40,020 --> 00:19:42,454 I don't resent you, Is. 475 00:19:42,456 --> 00:19:45,390 But, you know, if you want me to sit here 476 00:19:45,392 --> 00:19:47,926 and tell you that it's not your fault, 477 00:19:47,928 --> 00:19:51,196 I... I can't do that, I'm sorry. 478 00:20:08,882 --> 00:20:11,049 Hey. You like? 479 00:20:11,051 --> 00:20:13,519 That door was locked. 480 00:20:13,521 --> 00:20:15,220 Oh, I know. 481 00:20:15,222 --> 00:20:16,755 The cable guy had a cancellation, 482 00:20:16,757 --> 00:20:19,358 so he hooked me up, got us a two-for-one. 483 00:20:19,360 --> 00:20:20,959 Little thanks for being so chill earlier. 484 00:20:20,961 --> 00:20:23,395 Gracias, amigo. 485 00:20:30,404 --> 00:20:31,870 So, what kind of doctor are you? 486 00:20:34,707 --> 00:20:35,908 I'm a surgeon. 487 00:20:35,910 --> 00:20:37,543 A surgeon? 488 00:20:37,545 --> 00:20:40,546 Your stuff doesn't say surgeon, does it? 489 00:20:40,548 --> 00:20:42,714 It's like, uh, Selena and Justin. 490 00:20:44,450 --> 00:20:47,052 It doesn't really go together. 491 00:20:47,054 --> 00:20:48,554 Furniture's from, like, a dozen different places. 492 00:20:48,556 --> 00:20:50,422 14. 493 00:20:50,424 --> 00:20:51,857 14. 494 00:20:51,859 --> 00:20:54,960 The people in Casper knew I didn't have any money, 495 00:20:54,962 --> 00:20:57,062 so they gave me things to make a home. 496 00:20:57,064 --> 00:20:59,965 The bookshelf is from Jennifer, 497 00:20:59,967 --> 00:21:01,900 the town librarian. 498 00:21:01,902 --> 00:21:05,370 My table and chairs are from Mr. Grady's diner. 499 00:21:05,372 --> 00:21:06,972 The lamp is from Sheryl 500 00:21:06,974 --> 00:21:09,308 who teaches Sunday school at Highland Church. 501 00:21:09,310 --> 00:21:11,710 Dr. Glassman, he got me my bed. 502 00:21:11,712 --> 00:21:14,379 Well, you don't have to tell me the whole list, but... 503 00:21:15,915 --> 00:21:17,950 Okay. Yes. 504 00:21:17,952 --> 00:21:19,418 Everything I have works. 505 00:21:19,420 --> 00:21:21,353 There is no need to change it. 506 00:21:21,355 --> 00:21:22,921 Respect. 507 00:21:42,075 --> 00:21:43,875 Hi. 508 00:21:43,877 --> 00:21:45,577 - I'm Dr. Glassman. - Hi. 509 00:21:45,579 --> 00:21:46,945 I'm the president of the hospital. 510 00:21:46,947 --> 00:21:47,946 Is everything okay? 511 00:21:47,948 --> 00:21:48,981 Sit down. 512 00:21:51,351 --> 00:21:53,986 There has been no change in Quinn's condition. 513 00:21:53,988 --> 00:21:56,455 However, her grandmother 514 00:21:56,457 --> 00:21:58,824 has made a claim of child abuse 515 00:21:58,826 --> 00:22:01,827 against you and your husband. 516 00:22:01,829 --> 00:22:02,894 She's claiming that 517 00:22:02,896 --> 00:22:06,531 putting Quinn on puberty blockers... 518 00:22:06,533 --> 00:22:08,533 and these are her words, 519 00:22:08,535 --> 00:22:12,271 "making her think that being trans is okay"... 520 00:22:12,273 --> 00:22:16,208 is a form of emotional and physical abuse. 521 00:22:17,678 --> 00:22:20,045 Now, just to be clear, 522 00:22:20,047 --> 00:22:21,913 we don't believe any of these allegations 523 00:22:21,915 --> 00:22:23,448 have any merit whatsoever. 524 00:22:23,450 --> 00:22:24,683 I know my mom, okay? 525 00:22:24,685 --> 00:22:26,184 She's not gonna drop this. 526 00:22:26,186 --> 00:22:27,753 She'll go to court. 527 00:22:27,755 --> 00:22:29,087 Could she get custody? 528 00:22:29,089 --> 00:22:33,592 Well, she could try, but, uh, Dr. Lim would testify. 529 00:22:33,594 --> 00:22:36,662 - They could put her in a foster home. - Hey. 530 00:22:36,664 --> 00:22:38,363 Ty, she won't make it. 531 00:22:38,365 --> 00:22:40,899 If we let Quinn do the surgery she wants now, 532 00:22:40,901 --> 00:22:42,034 it'll all be over. 533 00:22:42,036 --> 00:22:44,970 There will be no reason for Ruth to fight us. 534 00:22:51,111 --> 00:22:52,827 Do what Quinn wants. 535 00:22:52,913 --> 00:22:54,561 Do the bilateral surgery. 536 00:23:03,043 --> 00:23:04,510 There is an issue. 537 00:23:05,121 --> 00:23:06,894 Your tests confirmed 538 00:23:06,933 --> 00:23:09,816 abnormalities in the semen parameters. 539 00:23:13,324 --> 00:23:14,524 I beg your pardon? 540 00:23:14,526 --> 00:23:16,581 The semen analysis. It showed that you have 541 00:23:16,606 --> 00:23:18,562 a low sperm count and low motility. 542 00:23:19,561 --> 00:23:21,325 - It's my fault? - No. 543 00:23:21,327 --> 00:23:23,661 We... we do not speak in terms of fault. 544 00:23:26,199 --> 00:23:28,866 15% of all couples struggle with infertility, 545 00:23:28,868 --> 00:23:31,769 and of those, 50% have a male factor component. 546 00:23:33,372 --> 00:23:35,778 It's not great news, but it's not a dead end. 547 00:23:35,808 --> 00:23:37,341 So what's the next step? 548 00:23:37,343 --> 00:23:39,744 I'm gonna refer you to Dr. Arjun Dhillon. 549 00:23:39,746 --> 00:23:41,479 He's an excellent urologist, 550 00:23:41,481 --> 00:23:43,748 and he'll give Marcus a... a full physical, 551 00:23:43,750 --> 00:23:46,159 do some blood work, and an ultrasound. 552 00:23:46,184 --> 00:23:47,583 That can't be right. 553 00:23:47,585 --> 00:23:49,085 - Marcus. - It can't be right. 554 00:23:49,087 --> 00:23:50,486 Marcus. We got this. 555 00:23:50,488 --> 00:23:51,687 Okay? 556 00:23:51,689 --> 00:23:52,955 We're gonna get through this together. 557 00:24:00,598 --> 00:24:02,264 Hey. Hey! 558 00:24:02,266 --> 00:24:03,899 Why didn't you tell me Howard's labs came back? 559 00:24:03,901 --> 00:24:06,268 I should have been there when you broke the bad news to him. 560 00:24:06,270 --> 00:24:09,271 So Melendez could see your touching bedside manner. 561 00:24:09,273 --> 00:24:10,706 It doesn't matter anyway. 562 00:24:10,708 --> 00:24:12,575 Oh, it doesn't? How the hell not? 563 00:24:13,610 --> 00:24:15,277 The poor guy's getting a colostomy. 564 00:24:15,279 --> 00:24:17,380 There's no way we're winning this competition. 565 00:24:19,116 --> 00:24:20,750 You really have no sympathy 566 00:24:20,752 --> 00:24:22,051 for what Howard's going through? 567 00:24:22,053 --> 00:24:23,919 It's a major bummer, no doubt. 568 00:24:23,921 --> 00:24:25,788 But we don't have time to get emotionally invested 569 00:24:25,790 --> 00:24:27,056 in every patient that we treat. 570 00:24:27,058 --> 00:24:29,625 Our job is to go in, do the surgery, 571 00:24:29,627 --> 00:24:30,893 and get out. 572 00:24:30,895 --> 00:24:34,130 Afterwards... his poop, someone else's poop... 573 00:24:34,132 --> 00:24:35,398 it's not our problem. 574 00:24:36,466 --> 00:24:37,700 Hey, well, wait. 575 00:24:39,102 --> 00:24:40,236 What if we could get Howard 576 00:24:40,238 --> 00:24:41,470 a fecal microbiota transplant? 577 00:24:43,306 --> 00:24:45,041 FMT for a surgical case? 578 00:24:45,043 --> 00:24:47,543 Theoretically, we transfer healthy feces to him, 579 00:24:47,545 --> 00:24:49,211 it restores good flora to the body, 580 00:24:49,213 --> 00:24:50,179 kills off the CDI, 581 00:24:50,181 --> 00:24:52,048 and he avoids surgery all together. 582 00:24:53,483 --> 00:24:55,117 We could actually win this thing. 583 00:24:56,687 --> 00:24:57,920 I'm gonna pull all the research 584 00:24:57,922 --> 00:25:00,089 before pitching it to Melendez. 585 00:25:02,627 --> 00:25:04,427 So, this meeting is called 586 00:25:04,429 --> 00:25:07,463 a Challenging Patient Consultation Process. 587 00:25:07,465 --> 00:25:08,597 The name sucks, 588 00:25:08,599 --> 00:25:11,000 but there are things about it I do like. 589 00:25:11,002 --> 00:25:15,471 All you got to do is talk and listen 590 00:25:15,473 --> 00:25:17,273 and try to understand each other. 591 00:25:17,275 --> 00:25:18,407 What's to understand? 592 00:25:18,409 --> 00:25:20,543 Ruth accused us of being child abusers. 593 00:25:20,545 --> 00:25:21,877 And what's to discuss? 594 00:25:21,879 --> 00:25:23,145 We are Quinn's parents. 595 00:25:23,147 --> 00:25:24,880 We get to make her medical decisions. 596 00:25:24,882 --> 00:25:26,816 What if Quinnie's better off as a boy? 597 00:25:26,818 --> 00:25:29,985 You have no idea what Quinn has been through. 598 00:25:29,987 --> 00:25:32,888 Every kid goes through rough patches. 599 00:25:32,890 --> 00:25:34,723 Every kid is confused. 600 00:25:34,725 --> 00:25:36,625 Quinn has always told us exactly who she was, 601 00:25:36,627 --> 00:25:37,827 ever since she was 3. 602 00:25:37,829 --> 00:25:39,295 So you let Quinn play with dolls. 603 00:25:39,297 --> 00:25:40,596 Big deal. 604 00:25:40,598 --> 00:25:42,665 You don't make life-altering decisions 605 00:25:42,667 --> 00:25:45,167 because a child wants to be a princess. 606 00:25:49,773 --> 00:25:52,741 We used to let Quinn do whatever she wanted at home. 607 00:25:52,743 --> 00:25:55,511 But when she went out in public, 608 00:25:55,513 --> 00:25:57,580 we made her present as a boy. 609 00:25:59,049 --> 00:26:01,083 It felt false to her. 610 00:26:01,085 --> 00:26:03,419 She hated it. 611 00:26:03,421 --> 00:26:04,553 She hated herself. 612 00:26:04,555 --> 00:26:07,957 She became reclusive, depressed. 613 00:26:07,959 --> 00:26:10,726 And then a year ago, Quinn tried to kill herself. 614 00:26:17,101 --> 00:26:18,267 Sorry I'm late. 615 00:26:29,514 --> 00:26:31,380 Howard might not need the colostomy 616 00:26:31,382 --> 00:26:36,185 if we give him a fecal microbiota transplant. 617 00:26:36,187 --> 00:26:37,953 Hasn't the FDA gone back and forth on that? 618 00:26:37,955 --> 00:26:40,656 We could be introducing new bacteria into his system 619 00:26:40,658 --> 00:26:41,824 that could kill him. 620 00:26:41,826 --> 00:26:42,925 The likelihood of that is low. 621 00:26:42,927 --> 00:26:43,959 But not zero. 622 00:26:43,961 --> 00:26:45,327 But if we do the colostomy, 623 00:26:45,329 --> 00:26:46,695 we may not really be helping him. 624 00:26:46,697 --> 00:26:48,364 15% to 30% of patients 625 00:26:48,366 --> 00:26:50,757 get recurrent CDI after the initial bout. 626 00:26:50,782 --> 00:26:51,800 That's a good point. 627 00:26:51,802 --> 00:26:54,069 I believe 65% of that time, 628 00:26:54,071 --> 00:26:55,437 recurrent CDI becomes chronic, 629 00:26:55,439 --> 00:26:57,306 which can lead to repeated hospitalizations and death. 630 00:27:00,244 --> 00:27:01,744 Are my numbers right, Claire? 631 00:27:01,746 --> 00:27:03,279 Yes. 632 00:27:03,281 --> 00:27:05,548 But recent studies 633 00:27:05,550 --> 00:27:09,685 show better than a 95% success rate with FMTs. 634 00:27:09,687 --> 00:27:11,620 Howard is a good candidate. 635 00:27:11,622 --> 00:27:12,721 We should try it 636 00:27:12,723 --> 00:27:14,123 before he develops a toxic megacolon. 637 00:27:14,125 --> 00:27:16,258 Don't we owe it to him, to his twins, 638 00:27:16,260 --> 00:27:18,194 to at least try an experimental treatment 639 00:27:18,196 --> 00:27:19,795 before doing an invasive surgery 640 00:27:19,797 --> 00:27:21,463 which will alter his life forever? 641 00:27:21,465 --> 00:27:22,965 You're right. 642 00:27:22,967 --> 00:27:24,667 Prep him for the procedure. 643 00:27:24,669 --> 00:27:26,869 I appreciate your passionate advocacy 644 00:27:26,871 --> 00:27:27,903 for your patient. 645 00:27:27,905 --> 00:27:29,505 Good work, both of you. 646 00:27:32,909 --> 00:27:34,677 Oh, now you're a team player. 647 00:27:34,679 --> 00:27:35,911 When it benefits me, yes. 648 00:27:35,913 --> 00:27:37,680 Speaking of which, 649 00:27:37,682 --> 00:27:38,981 you were doing your research, 650 00:27:38,983 --> 00:27:40,482 I found Howard a match at the stool bank. 651 00:27:40,484 --> 00:27:41,817 Sample arrives in a couple of hours. 652 00:27:41,819 --> 00:27:42,918 Great. 653 00:27:42,920 --> 00:27:44,687 I let them know you'd be the designated doctor 654 00:27:44,689 --> 00:27:46,121 to handle the medical chain of custody 655 00:27:46,123 --> 00:27:47,356 when the sample arrives. 656 00:27:47,358 --> 00:27:49,091 So...? 657 00:27:49,093 --> 00:27:51,760 So you're the only person who can handle the sample. 658 00:27:51,762 --> 00:27:53,262 You'll have to dilute it, blend it, strain it 659 00:27:53,264 --> 00:27:54,530 all on your own. 660 00:27:54,532 --> 00:27:56,498 To safeguard against cross-contamination, of course. 661 00:27:56,500 --> 00:27:58,200 Of course. 662 00:28:06,776 --> 00:28:09,945 Your temperature and BP are normal. 663 00:28:09,947 --> 00:28:10,946 Normal. 664 00:28:10,948 --> 00:28:12,848 Whatever that means. 665 00:28:12,850 --> 00:28:15,618 Typical. Usual. 666 00:28:15,620 --> 00:28:17,419 Expected. 667 00:28:17,421 --> 00:28:20,389 Yeah, I don't feel like any of those things. 668 00:28:20,391 --> 00:28:22,758 What does it feel like to be a girl? 669 00:28:27,497 --> 00:28:28,831 Are you angry? 670 00:28:28,833 --> 00:28:31,400 Was that an inflammatory question? 671 00:28:31,402 --> 00:28:32,434 I'd rather people ask questions 672 00:28:32,436 --> 00:28:33,502 instead of pointing and staring. 673 00:28:35,739 --> 00:28:37,773 When I used to look like a boy, 674 00:28:37,775 --> 00:28:40,075 I felt... different. 675 00:28:40,077 --> 00:28:43,479 The kids at school didn't understand me, 676 00:28:43,481 --> 00:28:44,947 so they picked on me. 677 00:28:44,949 --> 00:28:46,915 I spent a lot of time alone. 678 00:28:48,886 --> 00:28:52,121 When my parents let me be me, 679 00:28:52,123 --> 00:28:53,956 I felt... 680 00:28:53,958 --> 00:28:55,658 like I didn't have to pretend anymore. 681 00:28:57,594 --> 00:28:58,494 I felt free, 682 00:28:58,496 --> 00:29:00,296 like when you're in a pool 683 00:29:00,298 --> 00:29:02,197 and you just let go and float. 684 00:29:06,570 --> 00:29:09,038 I'm not a very good swimmer. 685 00:29:18,582 --> 00:29:20,949 I don't know what it feels like 686 00:29:20,951 --> 00:29:23,185 to be anyone but me. 687 00:29:26,023 --> 00:29:27,956 Me, too. 688 00:29:29,493 --> 00:29:32,294 Is the bilateral more risky 689 00:29:32,296 --> 00:29:34,496 than the unilateral surgery? 690 00:29:34,498 --> 00:29:36,131 The big issue with the bilateral 691 00:29:36,133 --> 00:29:38,467 is Quinn will never be able to have biological children. 692 00:29:38,469 --> 00:29:40,602 If Quinn's parents think that Quinn's mature enough 693 00:29:40,604 --> 00:29:42,137 and strong enough in her beliefs, 694 00:29:42,139 --> 00:29:43,238 then they should do it now. 695 00:29:43,240 --> 00:29:45,774 It's an elective surgery on a child. 696 00:29:45,776 --> 00:29:47,943 There is no medical necessity. 697 00:29:47,945 --> 00:29:49,978 Except with a previous suicide attempt, 698 00:29:49,980 --> 00:29:51,046 she's still at risk. 699 00:29:51,048 --> 00:29:52,614 Her situation is different now. 700 00:29:52,616 --> 00:29:55,484 She's socially transitioned and living as a girl. 701 00:29:55,486 --> 00:29:57,786 But there just isn't enough good data 702 00:29:57,788 --> 00:29:59,488 on trans kids and their outcomes. 703 00:29:59,490 --> 00:30:01,623 On the other hand, there's very good reason 704 00:30:01,625 --> 00:30:02,991 to preserve future fertility. 705 00:30:02,993 --> 00:30:05,194 Dr. Lim and Dr. Andrews 706 00:30:05,196 --> 00:30:06,495 are both very excellent surgeons, 707 00:30:06,497 --> 00:30:08,030 and they very clearly have 708 00:30:08,032 --> 00:30:09,331 some passionate points of view, 709 00:30:09,333 --> 00:30:10,833 but their views are their own. 710 00:30:10,835 --> 00:30:14,069 You all need to decide what's best for Quinn. 711 00:30:15,572 --> 00:30:17,506 Whatever we decide, 712 00:30:17,508 --> 00:30:19,441 Quinn is still gonna be a girl. 713 00:30:22,612 --> 00:30:25,047 I don't know if I'll ever be able to accept that. 714 00:30:26,649 --> 00:30:29,118 I know that makes me sound horrible. 715 00:30:29,120 --> 00:30:33,622 I know what it's like to not put your family first, 716 00:30:33,624 --> 00:30:35,457 and it cost me. 717 00:30:35,459 --> 00:30:38,827 It cost me a great deal. 718 00:30:38,829 --> 00:30:41,730 And if I had to do it all over again, 719 00:30:41,732 --> 00:30:42,965 I'd ask myself... 720 00:30:42,967 --> 00:30:45,667 is it really worth sacrificing a life 721 00:30:45,669 --> 00:30:47,403 with someone I love 722 00:30:47,405 --> 00:30:51,607 over an idea that may never be? 723 00:30:57,214 --> 00:30:58,781 Why don't we give them the room? 724 00:31:07,291 --> 00:31:09,324 Hey. I got the page. What's going on. 725 00:31:09,326 --> 00:31:11,193 She started screaming in pain and vomiting. 726 00:31:11,195 --> 00:31:12,161 Temp's 104. 727 00:31:12,163 --> 00:31:13,529 Increased groin pain 728 00:31:13,531 --> 00:31:15,230 could be attributed to epididymitis, 729 00:31:15,232 --> 00:31:16,832 kidney stones, inguinal hernia... 730 00:31:16,834 --> 00:31:17,997 The extra weight of the tumor 731 00:31:18,022 --> 00:31:19,635 could be causing the testicle to twist on itself. 732 00:31:19,637 --> 00:31:22,204 There'd be no blood flow. 733 00:31:28,411 --> 00:31:31,313 She has a testicular torsion. She needs surgery now. 734 00:31:38,694 --> 00:31:40,461 Excuse me. Have you made a decision? 735 00:31:40,463 --> 00:31:42,730 Not yet. I mean, there's a lot to... 736 00:31:42,732 --> 00:31:43,998 We need one now. 737 00:31:44,000 --> 00:31:45,500 Quinn has testicular torsion. 738 00:31:45,524 --> 00:31:47,139 The spermatic cord is twisted 739 00:31:47,164 --> 00:31:48,676 and cutting off blood supply. 740 00:31:48,701 --> 00:31:50,069 We need to operate. 741 00:31:52,275 --> 00:31:56,420 If you want Quinn to live the way she wants, 742 00:31:56,579 --> 00:31:58,446 don't limit her future now. 743 00:32:00,990 --> 00:32:02,529 You heard her when my mom said 744 00:32:02,554 --> 00:32:04,252 she might want kids some day. 745 00:32:04,254 --> 00:32:05,820 She can't even fathom the thought 746 00:32:05,822 --> 00:32:07,855 because she's just a child. 747 00:32:13,738 --> 00:32:15,663 Just do what's medically necessary. 748 00:32:24,618 --> 00:32:27,986 Doesn't appear to be any palpable lymphadenopathy. 749 00:32:28,044 --> 00:32:30,507 It's likely a stromal tumor, 750 00:32:30,532 --> 00:32:32,907 - but get that to pathology right away. - Yes, sir. 751 00:32:37,787 --> 00:32:41,756 Quinn has tachycardia and hypotension. 752 00:32:41,758 --> 00:32:42,890 I'm not seeing any bleeding. 753 00:32:42,892 --> 00:32:44,425 EKG's normal. It's not coronary. 754 00:32:44,427 --> 00:32:46,894 CO2 and O2 are normal, so it's not a P.E. 755 00:32:46,896 --> 00:32:48,629 It must be a reaction to the anesthesia. 756 00:32:48,631 --> 00:32:50,898 I'm already pushing fluids and vasoconstrictors. 757 00:32:58,841 --> 00:33:02,110 Six syringes in, and no sign of leakage. 758 00:33:02,112 --> 00:33:03,544 Okay, we're wrapped up here. 759 00:33:03,546 --> 00:33:04,812 Let's get Howard into recovery. 760 00:33:04,814 --> 00:33:07,014 - Well done. - Thanks. 761 00:33:07,016 --> 00:33:09,851 I was thinking of writing up the procedure, 762 00:33:09,853 --> 00:33:11,552 possibly submit it for publication. 763 00:33:11,554 --> 00:33:13,254 I'd be happy to assist, 764 00:33:13,256 --> 00:33:15,423 seeing as I've done it before. 765 00:33:15,425 --> 00:33:17,425 Thanks, but I think I can... 766 00:33:17,427 --> 00:33:19,594 I read your paper in AMSURG, Dr. Reznick. 767 00:33:19,596 --> 00:33:20,895 You continue to impress. 768 00:33:20,897 --> 00:33:21,863 Coming from you, 769 00:33:21,865 --> 00:33:23,431 I take that as a huge compliment. 770 00:33:25,134 --> 00:33:26,959 When you get a chance, Dr. Browne, 771 00:33:27,030 --> 00:33:28,102 you should read it. 772 00:33:28,104 --> 00:33:29,637 Will do. 773 00:33:37,714 --> 00:33:39,247 I've given vasopressors 774 00:33:39,249 --> 00:33:41,182 and reduced her meds as much as I can. 775 00:33:41,184 --> 00:33:42,817 She's losing volume somewhere. 776 00:33:42,819 --> 00:33:44,952 It was dry when we ligated the spermatic cord. 777 00:33:44,954 --> 00:33:46,354 I'm still not seeing the bleed. 778 00:33:46,356 --> 00:33:49,123 Could be vagal stimulation from the severed nerve. 779 00:33:49,125 --> 00:33:50,391 But she's not responding to epi. 780 00:33:50,393 --> 00:33:52,493 - Sepsis? - It's too early for an infection. 781 00:33:54,263 --> 00:33:56,564 Her MAP is 20. She's barely profusing. 782 00:33:59,836 --> 00:34:01,169 Okay, excuse me, guys. 783 00:34:01,171 --> 00:34:02,804 - You're breaking scrub. - I'm so sorry. 784 00:34:03,639 --> 00:34:05,072 Grey-Turner sign. 785 00:34:05,074 --> 00:34:07,041 Could be a retroperitoneal hemorrhage. 786 00:34:19,122 --> 00:34:21,222 Jared could be right. 787 00:34:21,224 --> 00:34:24,525 It is possible that there's internal bleeding. 788 00:34:24,527 --> 00:34:26,360 The testicular artery 789 00:34:26,362 --> 00:34:28,596 can retract up into the pelvis. 790 00:34:28,598 --> 00:34:30,665 It's rare, but it can happen. 791 00:34:30,667 --> 00:34:32,600 Rare is an understatement. Dr. Andrews? 792 00:34:35,037 --> 00:34:36,804 I don't think we have any other choice. 793 00:34:36,806 --> 00:34:38,472 We need to do an ex-lap. 10 blade. 794 00:34:48,484 --> 00:34:49,784 Murphy, retract. 795 00:34:57,993 --> 00:34:59,627 Internal bleeding. 796 00:34:59,629 --> 00:35:00,928 Jared was right. 797 00:35:02,497 --> 00:35:04,298 Nice call, Dr. Kalu. 798 00:35:04,300 --> 00:35:05,466 Thank you, sir. 799 00:35:06,602 --> 00:35:08,769 Kalu, suction. We need a clear view of the field. 800 00:35:13,547 --> 00:35:16,092 Fever's down, and the flora in your system 801 00:35:16,117 --> 00:35:17,449 seems to be returning to normal. 802 00:35:17,451 --> 00:35:20,166 - We expect a full recovery. - Thank you. 803 00:35:20,191 --> 00:35:21,824 For everything. 804 00:35:21,849 --> 00:35:23,515 Do you know when I can have visitors? 805 00:35:23,544 --> 00:35:25,536 I thought you might ask that question. 806 00:35:25,561 --> 00:35:27,394 There are a couple of eager preschoolers 807 00:35:27,419 --> 00:35:28,852 who'd like to say hi. 808 00:35:28,933 --> 00:35:29,899 Oh. 809 00:35:29,901 --> 00:35:31,323 - Daddy! - Keira! 810 00:35:31,348 --> 00:35:34,069 Sammy! Oh! 811 00:35:34,071 --> 00:35:36,372 Oh, I think you guys have grown! 812 00:35:36,374 --> 00:35:38,169 Hey. 813 00:35:38,194 --> 00:35:40,576 Hey, these are the doctors that saved Daddy. 814 00:35:40,578 --> 00:35:43,544 Dr. Reznick and this is, uh... 815 00:35:43,677 --> 00:35:45,560 Uh, I'm sorry, I forgot your name. 816 00:35:46,069 --> 00:35:48,348 Dr. Browne. 817 00:35:48,350 --> 00:35:50,050 - Thank you. - Thank you. 818 00:35:50,052 --> 00:35:51,585 You're welcome. 819 00:35:52,639 --> 00:35:53,854 Blah! 820 00:35:55,991 --> 00:35:57,291 Okay. 821 00:35:59,043 --> 00:36:00,227 Who's this guy? 822 00:36:00,229 --> 00:36:01,261 - Bear Bear. - Bear Bear? 823 00:36:10,638 --> 00:36:11,772 Did you do it? 824 00:36:11,774 --> 00:36:12,906 Did you remove both? 825 00:36:14,309 --> 00:36:15,409 No. 826 00:36:15,411 --> 00:36:16,543 Just the cancerous one. 827 00:36:16,545 --> 00:36:18,412 What? Why not? 828 00:36:19,697 --> 00:36:21,099 That's on me. 829 00:36:21,124 --> 00:36:23,317 I couldn't, in good conscience, remove a healthy organ. 830 00:36:28,404 --> 00:36:30,071 Quinnie. 831 00:36:30,096 --> 00:36:31,529 This was our decision. 832 00:36:31,569 --> 00:36:33,446 No! You said you were on my side! 833 00:36:33,471 --> 00:36:36,218 Hey, we are. Always. 834 00:36:36,243 --> 00:36:38,198 We haven't had enough time to talk, 835 00:36:38,200 --> 00:36:40,767 not with each other, with your therapist, 836 00:36:40,769 --> 00:36:42,208 with your doctors. 837 00:36:42,233 --> 00:36:43,837 So I'm gonna turn into a boy. 838 00:36:43,839 --> 00:36:45,772 Well, not right away. 839 00:36:45,774 --> 00:36:47,474 Your endocrinologist will talk to you 840 00:36:47,476 --> 00:36:48,475 about the right timeline 841 00:36:48,477 --> 00:36:50,444 for starting feminizing hormones. 842 00:36:53,582 --> 00:36:54,961 You know... 843 00:36:55,918 --> 00:36:58,352 the thought of having your own kids someday 844 00:36:58,354 --> 00:36:59,987 is a big decision, 845 00:36:59,989 --> 00:37:01,855 but you never know what you will or will not want 846 00:37:01,857 --> 00:37:03,023 once you get older. 847 00:37:03,025 --> 00:37:05,092 Cis people are always so worked up 848 00:37:05,094 --> 00:37:06,527 about having bio kids. 849 00:37:06,529 --> 00:37:08,362 If I really want a kid that bad, 850 00:37:08,364 --> 00:37:09,830 I can just adopt. 851 00:37:13,234 --> 00:37:14,701 You know, I'll be back when I'm 18 852 00:37:14,703 --> 00:37:16,603 for my gender confirmation surgery. 853 00:37:16,605 --> 00:37:20,541 And when you do, I'll be here to help you. 854 00:37:28,249 --> 00:37:30,450 Patient satisfaction survey scores are in, 855 00:37:30,452 --> 00:37:31,952 and it was very close. 856 00:37:31,954 --> 00:37:33,654 Not really. She's being kind. 857 00:37:33,656 --> 00:37:37,691 Congratulations go to Dr. Reznick and Dr. Browne. 858 00:37:37,693 --> 00:37:39,493 - Yes. - Thank you. 859 00:37:41,062 --> 00:37:43,063 Congratulations. 860 00:37:43,065 --> 00:37:44,131 Thank you, Shaun. 861 00:37:44,133 --> 00:37:46,066 Claire and I make a nice team. 862 00:37:49,370 --> 00:37:50,871 You should be psyched. 863 00:37:50,873 --> 00:37:52,639 Yeah. I should be. 864 00:37:55,253 --> 00:37:57,711 To the victor belong the spoils. 865 00:37:57,713 --> 00:37:59,212 Pay up. 866 00:37:59,214 --> 00:38:01,815 Oh, humility was never your strong suit. 867 00:38:03,751 --> 00:38:05,819 - Thank you, Mortimer. - Mm. 868 00:38:05,821 --> 00:38:07,988 Don't spend it all in one place. 869 00:38:07,990 --> 00:38:09,423 Spend it? 870 00:38:09,425 --> 00:38:11,024 I'm gonna frame it. 871 00:38:13,395 --> 00:38:15,896 What made you think of a retroperitoneal hemorrhage? 872 00:38:15,898 --> 00:38:16,863 Homework. 873 00:38:16,865 --> 00:38:17,931 You were right. 874 00:38:17,933 --> 00:38:19,700 Prepping for an SDA was important. 875 00:38:19,702 --> 00:38:21,435 We make a good team. 876 00:38:24,706 --> 00:38:26,873 Quinn doesn't like pink. 877 00:38:26,875 --> 00:38:28,141 Oh. 878 00:38:28,143 --> 00:38:30,877 Uh, I think she will like these. 879 00:38:30,879 --> 00:38:33,146 I hope so. 880 00:38:35,350 --> 00:38:38,151 She's more of a purple girl. 881 00:38:45,594 --> 00:38:47,661 Did you read Morgan's AMSURG article yet? 882 00:38:48,764 --> 00:38:51,331 It is on the top of my to-do list. 883 00:38:51,333 --> 00:38:53,600 I didn't tell you to read it to rub it in. 884 00:38:56,238 --> 00:38:58,271 I told you to read it so you knew what you'd be up against. 885 00:38:58,273 --> 00:39:00,340 You think I need to be more cutthroat? 886 00:39:00,342 --> 00:39:01,354 No. 887 00:39:01,379 --> 00:39:03,913 That's Morgan's M.O. You're different. 888 00:39:03,979 --> 00:39:05,812 You're smart, you're special. 889 00:39:05,814 --> 00:39:09,750 Rise up, play the game on your own terms. 890 00:39:09,752 --> 00:39:11,184 Don't wait for it. 891 00:39:39,348 --> 00:39:42,049 I heard you saved Quinn's life. 892 00:39:42,051 --> 00:39:44,785 Jared and I did. 893 00:39:44,787 --> 00:39:46,453 I like her. 894 00:39:46,455 --> 00:39:47,554 "Her." 895 00:39:49,191 --> 00:39:53,727 So you get that she is a "she." 896 00:39:53,729 --> 00:39:55,729 I have lots of questions. 897 00:39:55,731 --> 00:39:58,699 Yeah, well, questions are good. 898 00:39:58,701 --> 00:40:01,802 Leads to awareness and understanding. 899 00:40:01,804 --> 00:40:04,004 And, who knows, maybe even acceptance. 900 00:40:05,860 --> 00:40:07,235 Being a kid is tough enough, 901 00:40:07,260 --> 00:40:09,810 But being a trans kid? Oh, man, that's... 902 00:40:09,812 --> 00:40:11,111 that's off the chart. 903 00:40:13,549 --> 00:40:15,849 I can't imagine how it must feel 904 00:40:15,851 --> 00:40:19,119 to be so different on the outside 905 00:40:19,121 --> 00:40:20,320 than you are on the inside. 906 00:40:27,296 --> 00:40:29,229 Hey, Shaun. 907 00:40:29,231 --> 00:40:32,032 I can give you a lift. 908 00:40:32,034 --> 00:40:33,667 We could grab a bite. 909 00:40:36,138 --> 00:40:39,506 You said you can't be my friend. 910 00:40:39,508 --> 00:40:41,241 So, no, thank you. 911 00:40:46,248 --> 00:40:47,447 Okay. 912 00:40:55,858 --> 00:40:57,224 Hey, amigo. What's up? 913 00:40:57,226 --> 00:40:59,760 I need your help. 914 00:41:43,605 --> 00:41:47,474 You're not gonna do any laps or nothing? 915 00:41:47,476 --> 00:41:48,742 No. 916 00:41:51,413 --> 00:41:52,712 Then what are you doing? 917 00:41:55,183 --> 00:41:57,417 Understanding. 918 00:42:12,389 --> 00:42:17,189 Synced & corrected by kinglouisxx www.addic7ed.com 919 00:42:18,305 --> 00:42:24,545 Support us and become VIP member to remove all ads from www.OpenSubtitles.org 64134

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