All language subtitles for The.Good_.Doctor.S06E18.WEB_

Previously on The Good Doctor...

You go going to
the club or work?

Yeah, these early calls are
gonna take some getting used to.

Browne retractor.

No Browne retractor.

I thought I put it on your
tray from the supply room.

Dr. Kalu is not your peer.

He's your employee,
and you are his boss.

I do not plan to give
Jared special treatment.

And if I see it, it won't
be good for either of you.

I'm not expecting
special treatment, Shaun,

but I don't appreciate being
treated like an intern either.

Dr. Andrews said he is judging my
performance off of your performance,

and your performance
is not good.

You come in with your fancy car
and your old tricks and think,

"Ta-da, I'm a surgeon,"
but you're not.

I just want to prove
that I belong here.

When I checked on
Yara post-operatively,

I noticed you only used eight
sutures when you closed,

and she had a small bleed.
You should have used ten.

Dr. Glassman closed
the galea and skin.

- Dr. Glassman skipped two sutures?
- Guess so.

At what time did you wake
up yesterday morning?

The usual, 5:30. Why?

At lunch, you had a Cobb salad
with balsamic vinaigrette,

so that's 450 calories ingested,
assuming you kept it down.

Yes, I kept it down.

Did you use a sauna, engage in rigorous
exercise, and/or experience diarrhea?

No, I didn't do any
of those things.

What's with the
questions, Shaun?

You made an error in
yesterday's craniotomy.

I'm trying to evaluate
various factors

that would negatively
impact focus.

I made an error?

You closed with
only eight sutures.

The size of the
wound required ten.

We need to figure out why.

Why do we need to
figure out why?

Two sutures, it's a
blip. It's not a thing.

It could be part of a more
troubling pattern needing attention.

- Shaun, the surgery was a success, right?
- Yes.

The patient had a great outcome.

There is no pattern.

Goodbye.

I'm a surgeon,
and I belong here.

I'm a surgeon,
and I belong here.

You are a surgeon,
and you belong here.

I just keep imagining
you in the mirror

like, "You have the hair of Tracee
Ellis Ross and the swag of Beyonce."

Do not shame my self-care.

Affirmations are
backed by research.

FMRI evidence
shows a correlation

with positive
changes in the brain.

I've just put the finishing
touches on a surprise.

Drum roll please.

Or not.

Well, get your song lists ready

because you are all
officially invited to...

Star Karaoke, 7:00 p.m. until
question mark, question mark.

You know it's gonna be a party when
there's double punctuation involved.

Yeah, just the chance to unwind and
get to know you all a little better.

Sounds fun. Thanks
for the invite.

Prepare to be destroyed. My
"Someone Like You" slays.

Need a surgical consult for a clinic
patient with a dislocated patella.

Mm, sorry, ER.

You two are it. Room one.

When did the chest pain start?

I first noticed
it Tuesday morning

along with shortness of breath.

Are you taking any medications?

I started with one, then
switched a few times.

These are used to treat ADHD.

And brain fog.

I'm a COVID long-hauler.

Um, and I just started
guanfacine and N-acetylcysteine,

which may actually
be helping finally.

- When was your initial infection?
- Eight months ago.

It just felt like a mild
flu, but then it got worse,

like someone poured
molasses on my brain.

I've done cognitive therapy,

memory exercises,

still am,

whatever I can do to
get back in the field.

- Which one?
- Clover.

I'm an evolutionary biologist.

- Oh.
- Wow.

I have been studying how white clover
adapts to environmental changes...

And I'm on indefinite leave.

Please stop talking now.

Bluish skin, low O2
levels, rapid heart rate.

And increasingly
labored breathing.

Possible pulmonary embolism.

Order a chest CTA
and echo, stat.

I have to go.

Oh.

You will need this.

I sent one half of a high
volume order to your printer.

These are Glassman's op reports?

For the last three
months. January to March.

October to December is printing
in Park's and my office.

So you sent reports for, like,
100 surgeries to my printer?

No, 176 surgeries.

473 pages.

I've emailed Operations
to replace your toner.

Many elements are in color.

And why, exactly, do
you need all of this?

To find out if his
mistake was a blip.

Second time I've
dislocated my knee.

Uh, first was a few
months ago, I think.

- That was the sprained ankle.
- Ah.

The dislocation was last year.

Your MRI shows no associated
damage to bones or ligaments.

She's also been complaining
about dizziness,

swollen ankles, maybe
menopause-related.

Dr. Reznick is looking to get her
on hormone replacement therapy.

Orion insisted I come in and
get everything checked out

before she leaves and
moves 6,000 miles away

to live alone.

I'm moving to Prague
next week for a new job,

and you can come visit
me anytime you want, Mom.

Not with a busted knee.

To move forward with HRT,

I need to confirm
all the medications

you've used over
the last five years.

Oh, uh, there was a
purple triangle one,

but they took me
off that last year

and an orange-shaped one.

I'll review it with you.

We need to see how
your knee is moving.

Lay back, please.

Go ahead with the
exam, Dr. Kalu.

I thought I'd observe.

It's a knee exam,

not a multi-ligament
reconstruction.

You told me last time not
to assume I know everything.

This is just making
me do your job.

That sounded like an apneic
spell. Check her tonsils.

Ms. Garcia.

Mm?

Oh, did I fall asleep again?

Yes.

Can I take a quick
look in your mouth?

Mm-hmm.

Kissing tonsils.

They're so enlarged,
they're touching

and obstructing your airway,
causing severe apnea.

You need a tonsillectomy
right away.

No pulmonary embolism, but
multiple cardiac issues.

Severe narrowing of
the pulmonic valve,

hypertrophied right ventricle

and opening between
the lower chambers.

This set of defects
almost looks like

- tetralogy of Fallot, but...
- It is.

She has the fourth malformation,

overriding aorta.

I've never seen tet
in an adult before.

How is she still alive?

Hang on a sec.

I have to write
everything down now.

Tet is almost always
diagnosed in infancy.

Doctors somehow missed
it in your case.

Oh, you have a
rare presentation.

The right ventricle
obstruction has been balanced

by an increased flow
into the left ventricle.

Damage from COVID
disrupted the balance.

The virus may have
saved your life.

Very few undiagnosed
tet patients

survive past childhood.

A mere 2% make it to 40.

You're saying

I would have just dropped
dead at some point?

It's very likely.

We can remove that risk with
two separate procedures.

First, we'll close
the extra vessels

that have formed to compensate
for your heart defects.

Then we'll do a surgery
to repair those defects.

Is it possible the
tet is connected

to my long COVID symptoms?

Could fixing my heart
clear up my head,

the brain?

No. I'm sorry.

You snagged our table.

Beat Hawks and Nunez to it.

You're a champion.

One Splenda, half Sugar in
the Raw, light almond milk.

Now who's the champion?

Mm.

I have something for you.

- Really?
- Mm-hmm.

An agreement acknowledging
a consensual relationship.

I, Marcus Andrews,
would like to take you,

Dalisay Villanueva, on a date.

And as hospital president,
you know, I already signed it.

This is so romantic.

Give me the pen.

- Dinner this weekend?
- Let me see.

Oh, I'm needed on the ward.

Sorry. Lock it down later?

Sure.

Iced coffee?

I'm good.

How about a hot coffee?

In honor of Daphne's
successful tonsillectomy,

I got a few options.

Is that a latte?

Mm.

It was a routine tonsillectomy.

Those were unusually
large tonsils.

A good thing her
daughter brought her in.

You think Daphne was
better off not breathing?

I don't think it's
a daughter's job

to make sure Mom
goes to the doctor.

It's Daphne.

Heart rate spiked.
She's hypoxic.

Turn up oxygen to max flow.

Loud murmur from the right
ventricle and atrium.

Chronic damage from apnea
could have increased

the pressure in her lungs,
causing right heart failure.

BP's dropping.

We need to get her
to the cath lab.

Positioning coiling system.

Two vessels left to close.

Deploying the coil.

O2 sats are dropping.

Her infundibular muscle
is clamping down.

She is having a tet spell.

Give phenylephrine
and 100% oxygen.

I have never seen
one in-person before.

We need to move blood
up to the lungs.

Give her a bolus
and up the opiates.

If we don't stop the spasm,

she could have
permanent brain damage.

The chance of a future
infundibular spasm is very high.

Her tet repair surgery
will be much more risky.

Pressure in Daphne's lungs
is still critically high.

Not a routine
tonsillectomy at all.

Puncturing the atrial septum.

Right heart is decompressing.

Give nitric oxide to relax
and dilate the vasculature.

Her apnea really did a number
on her pulmonary vessels.

No wonder she's
clumsy and forgetful.

She's been sleep- and
oxygen-deprived for decades.

It still doesn't make her her
daughter's responsibility.

Would you want Kellan to put his
life on hold to take care of you?

Not his whole life, no,

but I don't think being overly
devoted is the worst quality in a kid.

Remove the catheters.

I was one of six
growing up, only girl.

Mom and dad worked a lot,

so I was basically second
mom since kindergarten.

I love my brothers, but...

there's a lot you miss out on

if you're all about taking
care of someone else.

She's throwing a lot of PVCs.

Maybe an electrolyte issue.

BP's dropping. Heart rate 172.

We're barely getting a pulse.
She's in V-tach. Defib pads.

BP and heart rate stabilizing.

Get a new chemistry,
chest X-ray, EKG.

We need to figure out what else
is going on with her heart.

Oh, please don't
disturb my materials.

Which are what, exactly?

Dr. Glassman made an
uncharacteristic surgical error.

I am determining if
it was an anomaly

or part of a pattern.

Glassman must be really
pleased about that.

He is not.

You are being sarcastic.

Performance review is
a standard practice

and benefits both
doctors and patients.

I have identified three additional
errors made in the last four months.

I don't see a pattern.

A dural tear on scarred tissue,

closing with a running
nylon instead of Monocryl...

Is that even a mistake?

Dr. Glassman has always
used subcutaneous Monocryl.

These are variations,
minor missteps.

You pore through four months
of any surgeon's op reports,

and you'll find
discrepancies like this.

- No.
- Yes.

Not in mine.

That's probably true.

Eh, if you're not
finding a pattern,

maybe it's because
there isn't one.

My patient is awake.

Does this mean you can't move
forward with the tet repair?

There's a medication
called propranolol

that will significantly
reduce the risk

of having another
spasm during surgery,

but because of your long COVID,

you're at risk for some
very rare side effects.

- Are they serious?
- Yes.

Well, some of them are
not, like nausea, vomiting,

muscle aches, and
dizziness, but others,

such as hypoglycemia
or visual changes...

We'll start you on
the propranolol.

There's a good chance you won't
experience the rare side effects,

but we'll need to keep
a close eye on you.

And are those
patients ahead of her

also seniors with diabetes?

Do not hang up on me, Phillip,

or I'll head down to
do this in person.

I'll wait.

Hey.

There is a great new
Portuguese spot I read about.

I can make reservations for
us Friday or Saturday at 7:00?

Uh, I'm working a
double both days.

It's been a nonstop scramble
since Baker and Linh left.

Well, you have two new
travelers starting on Monday.

We need staff nurses.

These nurses are
highly skilled. We...

It doesn't matter
how skilled they are.

Travel nurses disrupt workflow,

don't build long-term
relationships.

Right now, we just don't have the
resources for permanent replacements.

You just hired a new
full-time surgical resident

to replace someone who
left way more recently.

That was Lim's department. I...

Yes, great. I'm
sending her down.

Sorry. We'll talk later?

Of course.

So you're watching
to see if I throw up?

Or faint, seize, or
have muscle spasms.

You know, before
COVID, my brain was...

I did evolutionary patterns,

genetic, uh...

how genes go together.

The sequence.

Now my brain can't handle the
sequence of brushing my teeth.

My focus, my working
memory, all of the...

The executive function.

It's not always happening.

Please page Dr. Wolke to monitor
her and stay until he comes.

Push your hand against mine.

The pattern is errors
in executive function.

Shaun, I'm in the middle
of doing something.

Your brain cancer
may have returned.

- All errors are tied to executive function.
- Shaun...

Specifically to working and
procedural memory governed

by the dorsolateral
prefrontal cortex,

a common site for
a recurrent glioma,

which strongly suggests
your cancer has returned.

My last scan came back
completely clear. I'm fine.

Your last scan was
six months ago.

These errors all took place
in the last four months.

So you need another scan.

The evidence is very compelling.

No, it's really not.

I perform complex
surgeries, Shaun,

more so than any other doctor
on this staff, by the way.

So yeah, the percentages
would dictate

that I might make more minor
and irrelevant missteps,

if that's what you want
to call them, and...

And the rate of
errors has increased.

Yeah, because I take
on the tougher cases,

the ones no one else will.

No, you need another MRI now.

Shaun, what I need is to
get back to my patient.

And you need to knock
first next time.

It's the greening of the...

My turn.

I'm trying to get some of
my cognitive exercises in.

What are you memorizing?

It's a poem from The
Carrying, Ada Limon.

Hmm.

The collection is
mostly about...

not having the life you
thought you'd have, I guess.

The one I was just reading,
it's about spring coming,

Instructions on Not Giving Up.

- Sounds useful.
- Yeah.

Too bad I can't
read it all at once.

I've just graduated from haikus.

I never even thought to look
at a poem before I got sick.

Didn't have the patience
for it at the time,

but it's basically
all I read now.

I started writing, too.

It's kind of a creative therapy.

Mm.

There was a kind of poetry

to the genetic variations
in white clover too.

I'd give anything to...

Your blood pressure
is going down,

and your heart rate's climbing.

I feel kind of dizzy.

Let me check your glucose.

She's having a seizure.
Crash cart now!

We thought something else
was going on with your heart,

but it's a kidney issue.

You have a narrowing
of your renal arteries,

which was exacerbated by
the pulmonary hypertension,

causing your kidneys to fail.

And this is because
of my sleep apnea?

We believe so, yeah.

Uh, can she get a transplant?

I can do a test,
see if I'm a match.

Unfortunately, your other health
concerns rule out a transplant,

but a renal artery bypass would allow
your kidneys to heal on their own.

There's risk of complications,
some quite serious.

But in success, you could
live a full, independent life.

But... oh, but serious,

as in I could die?

Some complications can be fatal.

But the risk is relatively low.

Are there other options?

Well, there's dialysis,

but you'd need multiple sessions
a week for the rest of your life.

Um, that's less risky, but I...

I don't think I could
handle all that on my own.

Mom, Mom, if you want to choose the
dialysis, I'll stay in San Jose.

I'm sorry.

I don't want to keep you.

No, you have nothing
to be sorry for.

All this time you've been
sick and struggling, and I...

I judged you.

But your new job.

It's just a job.

So the medication you gave me

to make my surgery safer

will actually make
it more risky?

That's right.

But without that medication,

I'm much more likely to
have another tet spell.

Yes, and possibly more
severe than the last time.

The brain fog,
all my deficits...

could get worse,

for possibly forever?

Yes.

But if we don't
do the tet repair,

your heart will
stop at some point.

I've already been through

losing my thoughts,
my whole self.

I can't do that again.

Find another way
to fix my heart.

All right, new idea.

We go back to the old idea
and just do the surgery.

It's a non-starter.

We need to present a way to help
her tet without triggering her tet.

A percutaneous valve and VSD
closure could help with blood flow.

That involves
catheters in the heart,

which would cause
the muscle to spasm.

All right. It's
time for some WWSMD.

Whatever you and Jerome
do on your own time is...

It's "what would
Shaun Murphy do?"

What about a shunt?

It would improve blood
flow, buy a few months

to continue her
cognitive recovery.

Once she feels better
about where her brain's at,

maybe she lets us fix her heart.

Her tet will likely
kill her before that,

but placing a shunt
won't trigger a spell,

making it something
she'd actually accept.

I'll take it to her.

I can stay only 45 minutes.

I have to review
Dr. Glassman's OR videos.

Didn't you already review them?

Not for symptoms of
glioma recurrence.

New evidence will convince
Dr. Glassman to get a scan.

Okay, you binged months
of data in one day.

You'll have a clearer
head in the morning.

Until then, here we
are, karaoke rager.

- Yay.
- It is yay.

We have song lists.
Plus Jared's our friend.

He just moved back.
Celebration is in order.

I will review the
videos in the morning.

Yay!

It sounds pretty wild in there.

I was just warming up.

- Where is everyone?
- There is a lot of food.

Yeah, I had it catered.
You're the first to arrive.

And so far,
last-minute rain checks

from Morgan, Park, Asher, Danny.

Oh, and Jerome.

So it's just us four?

Which means that
all these snacks

and song binders are for us.

Oh. Yes.

The low turnout is the perfect
opportunity to discuss symptoms.

In your recent surgeries
with Dr. Glassman,

do you recall observing
any balance issues,

tremors, or motor weakness?

That sounds like
the perfect option.

How soon can you do
the shunt procedure?

I'll try to schedule
it for tomorrow.

I've had a strange year myself.

Eleven months ago,

I was attacked

and paralyzed from
the waist down.

I thought it was permanent.
Almost everyone did.

At first, all I wanted
was to walk again.

I was ready to risk my life
to get back to the old me.

But as time went on,

I started to appreciate
my new life, my new self.

I started a new relationship

that wouldn't have
happened otherwise.

In many ways, my life improved.

You recognize you walked
in to tell me this story?

I only agreed to do the surgery

once I knew my life
wasn't at risk.

And even then, I had doubts.

I liked who I'd become.

I wanted to hold on to her.

I'm not...

losing my mind...

all over again.

You don't strike me as
someone who's lost her mind.

That covers the thrombectomy.

In February, you
assisted on a...

Okay, I'm playing the
pregnant lady card.

We're going, Shaun.

Okay.

Thank you. Goodbye.

I should head out, too.

- Early morning.
- Yeah.

Maybe focus on being
a first-year resident

before adding party
planner to your resume.

The catering may have
been a bridge too far.

Yeah.

I bounced around growing up.

Different schools,
cities, countries.

But, um, wherever we were,
my parents had a big house,

and I knew how to throw a party.

Closest I'd get to
feeling like I fit.

Old habits die hard, I guess.

Fitting in takes time.

But I never have, anywhere.

Maybe not everyone

finds their place.

Daphne is getting
septic. We have to go.

Morning.

Hello.

Mm.

You should not have that.

I'm permitted 12 ounces
a day. Experts agree.

Yes, but that was brewed
when I woke up at 3:30 a.m.

You make it through the videos?

Yes, and integrated
the observations

Doctors Kalu and
Allen made last night

regarding possible
glioma symptoms.

I am now ready to present Dr. Glassman
with the revised evidence,

which is very compelling.

Mm.

Thankfully, your infection is
responding to the antibiotics.

The infection started
around your dialysis port.

That could easily happen again.

The renal artery bypass
is still an option.

It's too risky.

So is sepsis.

Thank you, Doctor, but I'll
settle for being alive.

You shouldn't.

You deserve more than that.

I know you've had a whole
life of feeling sick

and stuck and repeating
the same old, bad patterns,

but your past does not have to
tell your future where to go.

You can choose a different path

and who you're gonna be on it.

And let your
daughter do the same.

Prague is beautiful
in the spring.

We've scheduled the shunt
placement for this afternoon.

And that whole
speech last night?

I stand by it, but
it's your decision.

I've been waiting for the
old me to come back, and...

That person may
not exist anymore.

And...

maybe I should be
okay with that.

Do the tet repair.

Releasing the proximal clamp.

What made Daphne
change her mind?

Dr. Allen has a way of
getting through to people.

Blood flow looks obstructed.

There's a kink in the graft.

We can undo it, but most
likely, it happens again.

We could anchor the bypass
off of the aorta instead.

At that angle, less
chance of a kink.

Could work.

- Extending the incision.
- -Sternal saw.

Starting the sternotomy.

O2 dropped to 78.

- 65.
- She's having a tet spell.

Give her 500 cc fluid
bolus and 100% oxygen.

Giving a mini bolus to
increase pulmonary flow.

O2 sats are 50.45.

Come on, come on.

Give her more oxygen
and up the opiates.

It has stopped registering.

O2's rising.

Heart rate's stabilizing.

She was in prolonged
gross hypoxia.

That could extend
cognitive deficits...

or worse.

We won't know until she wakes.

Let's get her on bypass
before she has another one.

- Okay.
- Mm-hmm.

To a successful
renal artery bypass.

Cheers. Facilitated
by moving speech

from a wise and
persuasive surgeon.

Mm, with a great
surgical save by a guy

who's about to have some
life-changing tacos.

Okay.

Mm! Oh, my God.

Okay, these are
amaz... You're amazing!

Told you. Blue corn tortillas.

- Mm-hmm. I can
get used to this.

- You have some lettuce there.
- Oh.

- No, no, no, mirror image.
- Mm.

Now?

- No.
- No laughing.

No, right, right, right. Very...

Very serious matter.

Here. Um, yeah.

Oh.

Just a little bit more.

- We should go.
- Mm.

- Yeah.
- Um, we need to get back early for Daphne's post-op.

Yeah, right. Um, let's go.

The bypass went smoothly,
and post-op labs look good.

We expect a full recovery.

How are you feeling, Mom?

I'm...

Breathing.

Kind of feels like the
first time in my life.

The post-op swelling from the
tonsillectomy has gone down.

You're finally breathing
without any obstruction.

You'll need to stay on top of your
medications and follow-up visits,

observe some dietary guidelines,

but the discharge
plan lays it all out.

I'll be there to help, Mom.

No.

You won't.

You need to live your own life.

But I... I will
accept FaceTime calls.

And once I recover,

I'll come visit.

I hear that Prague is
beautiful in the spring.

That sounds like a plan.

Mm, things not go
well with Glassy?

He returned the files
with a note saying

he did not look at them
and does not intend to.

I'm sorry. He probably...

It was a mistake to leave them
for him to read on his own.

Once I reorder the files, I will go to
his office to review with him in person.

He made it pretty clear he
doesn't want to see them.

But he doesn't know
about the new evidence.

Maybe he doesn't want to know.

Cancer survivors have to live
with that uncertainty that...

Knowing is better
than not knowing.

If he's not ready
to look at this,

you can't force him.

Maybe he's scared, Shaun.

And I think maybe
you're scared, too.

We're about to have a baby,

you're about to be a dad,

and I think you're
worried about family,

and Glassman is a part of that.

But if you keep pushing,
you risk damaging

one of the most important
relationships in your life.

Hey.

- Hey.
- Hey.

I've been thinking,

and I need a break
from our coffees.

Dalisay...

I don't think dinner's
a good idea either.

So we have a different point of
view about hospital business.

That doesn't change the
way I feel about you.

On or off the clock,
I'm the same person.

To me, if you don't
value what the nurses do

enough to treat us like
a resource to invest in,

not a line item to be cut,

how much can you care about me?

And to be honest,

if that is your point of view...

it undercuts the
respect I have for you.

Harper Louise Decrane,

March 30, 1994.

And do you know why you're here?

For my heart issues.

I had another tet
spell, didn't I?

We'll need to
conduct more tests,

but your speech and
memory seem intact.

And with regard to your heart,
we expect a full recovery.

And with time, you may recover your
full cognitive abilities as well.

Maybe.

But for now, I'll just
focus on being here.

"It's the greening of the trees

That really gets to me

When all the shock
of white and taffy

Leave the pavement strewn
With the confetti of aftermath

The leaves come

Patient, plodding

A green skin growing over
Whatever winter did to us

A return to the strange
idea Of continuous living

Despite the mess of us

The hurt, the empty..."

Shaun, what?

Lea thinks that because
I'm going to be a dad,

I am worried about my family.

Okay.

She also thinks you are scared.

I'm not scared,
Shaun. I'm fine.

She says if you don't want to
do the scan, I should let it go.

She...

is right.

Good. Thank you.

I am scared.

Dr. Glassman...

I am asking you to do the scan

because...

the data and the
evidence are sound...

and because...

it would be hard
to lose my father

just as I am about
to become one.

Do the scan for me.

Shaun, I'll do the scan.

"'Fine then, I'll take
it' The tree seems to say

A new slick leaf unfurling
Like a fist to an open palm

'I'll take it all'"