Original subtitles

You okay?

I stamped and addressed all the Save the Date cards.

I hope two months' notice is enough.

The wedding planning books all said four to six is best.

You definitely could have waited until you had a day off.

I couldn't sleep.

I'm sorry.

I know change is hard for you.

Salen's changes are not hard because of my ASD.

The new soap, hand dryers, and scrubs

are all inferior to what we had before.

Now I have to bring my own soap and paper towels.

I've seen you adapt to things before.

Like the toilet paper and how I cut avocados.

She uses the same stuff at her other hospitals,

and the staff apparently likes them.

I need to show her my evidence.

I'm sure Salen has her own evidence.

She's all about collecting data.

I'm not wrong.

I didn't say you were.

Maybe you should see what the others think first.

If the studies prove I'm right,

what others think doesn't matter.

To you, yes,

but she installed smile-frown buttons in every room.

To get Salen to change her mind,

you need to think about what's important to her, not you.

That is...

Good advice.

Uh, thank you.

You're welcome.

And thank you for taking care of these.

I will mail them out today.

This is so exciting.

Yes, it is.

Well, you signed a year lease.

Might be worth buying a couch, putting some art on the wall.

The art I like I can't afford.

And you didn't like watching TV in bed?

I definitely liked not watching TV in bed.

At least get a damn coffee maker.

Si, Jefa.

Andrews is tu jefe now.

Mmm, suerte la mia.

I know it's been a while since you've been supervised.

I've got enough on my plate dealing with Salen,

so please... Make it work.

I've worked with trust fund donors and dictators.

I can manage Andrews.

Somebody's in a good mood.

Just had my first personal training session

in our new fitness center.

I highly recommend Rafael.

Cute? Very.

And he knows just how hard to push when stretching you out.

I'll stick to working out at home.

Where he can pretend he's Rocky Balboa.

More like Soo Woong Lee.

Salen would probably install a heavy bag if you asked.

She seems eager to upgrade the amenities.

She's eager for a reduced rate on our health insurance, which a gym gives her.

And you prefer she pay more?

After she's done with the paint and window treatments,

the cuts will come.

You're complaining about upgrades you agree with

because you're annoyed about cuts

that haven't even been proposed?

If you're so optimistic,

why were you tossing and turning all night?

I was hot, and I hate your mattress.

Don't you have an ACL to repair?

It was in the low 60s last night.

I got tacos on the way home,

and then I couldn't...

You know, while we were in bed.

I am still in so much pain and totally bloated.

Would you fart in front of a boyfriend? Absolutely no.

I'm all for being real, but not that...

Good morning.

We were just saying...

How much we love the gym. It's...

Stop talking.

I had an inspiration in the shower.

I never wait to jot down a good idea.

All right.

First time I sleep over at a guy's place,

in the morning, while he's in the shower,

I go in, take a seat on the toilet, drop a deuce.

Really separates the men from the boys.

We need some help over here!

27-year-old male. Severe craniofacial trauma.

Non-responsive. Breathing's shallow.

Need an airway cart and ICP bolt set-up.

He get hit by a car?

His front tire got caught in a drain grate.

Flew over the handlebars and crashed face-first into the curb.

His mouth is full of blood.

We need to secure his airway before we lose it.

I need to get a brain and face CT.

We're also going to need 3-D CT recon scans.

To create a stereolithographic model of the two...

Actually three surgeries he'll need

to repair his mandible, nasal bones, frontal sinus,

and skull and the orbital blowout fractures.

Damn. That's gonna be awesome.

That we get to help him.

It's also going to be some very cool surgeries.

Thank you.

Surgery number one will be a creation of

a submental airway.

The new soap smells awful

and it takes too long to rinse.

Do you agree? I like it.

Surgery number two will be an ORIF

to repair his nasoorbitoethmoid frontal bone

and sinus fractures.

And the jet air hand dryers are too loud,

and they aerosolize germs, increasing their spread.

They're better for the environment,

and if you've washed properly,

there shouldn't be any germs to spread.

Okay, you're wrong.

I'll show you the research before I talk to Salen.

The third and final surgery will be ORIF

of the bilateral mandible fractures, ZMC,

and complex repair of all orbital fractures

with free tissue transfer, customized miniplates,

and PEEK implants.

This is gonna be awesome.

You're gonna talk to Salen about the hand dryers?

And the soap and scrubs.

Start prepping him for the submental airway

while I brief Dr. Lim.

There's new soap?

The device was implanted into my skull two years ago.

And you're still experiencing the seizures.

No.

For the first time in my life, I'm able to go on walks alone,

drive a car, actually interact with clients at work.

Well, if it's working so well, why does Dr. Karlson want to take it out?

The company that made the implant

wants to turn it off.

That doesn't make any sense.

They can't force her to have it removed.

Yeah, but they can stop

the software updates it needs to work,

which could make her seizures even worse.

The implant's an experimental prototype.

Worked only for a tiny percentage of patients,

which makes it not profitable enough to continue support.

That's absurd. It's evil.

It's capitalism.

Karlson's right. It has to come out.

But he's wrong that going back to the old meds

is her best treatment option.

What if we swapped the RNS device

for a vagal nerve stimulator?

She already had one. Didn't work.

I was thinking laser interstitial thermal therapy.

Would only be partially effective.

She was having 50 seizures a day.

"Partially" can make a big difference in her life.

Not big enough.

What about combining multiple subpial transections

within the eloquent cortex with intraoperative ECoG

to resect the adjacent seizure focus?

That would be complex, and being even a few millimeters off target

could leave her a hemiplegic.

Could happen... If another surgeon was doing it.

I'm confident with you at the helm, we can pull it off.

Trying to "manage up"

is not the way to get an idea approved by me.

But I'll never turn down a good idea

because it was presented poorly.

And it's actually a great idea.

I see you've scheduled a surgery

that has no billing code

because it's never been done before.

Yes, the client consented,

and we've already gotten insurance pre-approval.

Fantastic. Have you also run it past legal?

Why would we do that?

Because we could get sued and it sounds risky.

Is there a Plan B?

There isn't a comparable option. Not even remotely?

Well, as is usually the case, there is a less risky option,

but would also be less effective.

Seems better to start with an approach

that leaves us with less liability.

But as long as it's covered by insurance...

It's your call.

That was weird.

More like totally inappropriate.

Hold up.

She's not even a doctor.

She is our boss.

So we're gonna tell the patient,

"Sorry, that surgery we just told you about isn't happening

"because we're afraid you'll sue us"?

No. We're gonna do exactly as we planned

after we get Salen on board.

Salen needs to stay in her lane. No, you do.

We've got time, right?

There's no harm in you and I doing a bit more research

while he works on Salen.

Keep me posted.

Great, let me just finish this up,

and then I can meet you in 10.

You've got a client scheduled for three surgeries,

one of which includes custom prefabricated

polyetheretherketone implants.

All this for a guy who fell of his bike?

Actually, better make that 20. Mmm-hmm.

He didn't fall, he crashed face-first

into a cement curb at over 30 miles an hour.

And PEEK implants are the gold standard

for facial reconstruction.

Hmm, no doubt.

Problem is, your client's got Aluminum insurance,

so anything that's not fully covered we can't offer him.

He can't be transferred. There's too much brain edema.

And without the PEEK, he'll have vision deficiencies

and difficulty eating solid food.

Mmm. That's unfortunate.

W...

I seem to remember this impassioned speech

about how your struggles with healthcare

inspired you to start Ethicure

and how dedicated you were to improving the system.

For people who make responsible choices.

He's an adult with a good job

who thought a $10,000 European road bike

was a better investment

than a premium health insurance plan.

He was wrong.

And decisions have consequences.

Salen won't let us ...

Can I help you?

Oh, hello. Where's Nicole?

She's been reassigned.

I'm Ellen, Aaron's new executive aide.

And he's unavailable at the moment.

Can I ... Where is he?

As I said, he's unavailable.

Can I take a message?

Yes. Salen told Dr. Lim

everything we do needs to be covered by insurance,

so Dr. Lim told me to prep our patient for his first surgery

while she ties to get the polyetheretherketone implants covered.

Was that two "ethers"? Is there a space?

Okay, Dr. Glassman needs to change things back

to the way they were before.

Okay, I'll make sure he gets that message.

Good.

And, uh, what's your name?

Dr. Shaun Murphy.

Dr. Glassman will know if you just say Shaun.

You try drinking every meal for the rest of your life

through a straw.

No, no, don't put me on hold.

Your day going any better?

Park and I just spent two hours debating the merits

of surgeries neither of us believes we should do

because I already came up with

what Andrews thinks is a "great idea."

But Salen thinks it's too risky,

and Andrews won't do anything

without her unqualified support.

So you're mad because your boss likes your idea

and wants to do it but won't do it right away.

Think maybe your real problem

is that you're not used to having a boss?

Could you try not being right all the time?

Your pushback forced me to think of this differently.

Magnetoencephalography.

Brain scan before the surgery.

It'll help give us an accurate picture

of where Jenna's seizures are starting.

And we may be able to do the surgery

entirely using laser ablation,

which would significantly reduce the risk.

Cool.

Let me know what you find out.

Marcus.

Thanks for coming to me.

I'm gonna have to go with "Vitality Puffs."

Mmm.

How's wedding planning going?

Not bad.

Ugh, tastes like a toenail dusted with stevia.

And "not bad" sounds pretty bad.

When I went to mail the Save the Dates this morning,

I found one addressed to Shaun's mom,

who he hasn't talked to since his dad died.

Could be messy.

I want the day to be about our future, not the past.

I don't want to reopen old wounds

and, and risk him melting down

right before I walk down the aisle.

I sound so selfish.

I should just send it.

You do sound selfish.

Which is fine. It's your wedding.

But it's his wedding, too.

And do you think he'd hesitate to tell you

if he didn't want your mom there? No.

But he's already so stressed with all the changes here.

You've never handled Shaun with kid gloves.

No need to start coddling him now.

Mmm.

Do you fart in front of Shaun?

Uh, doesn't everyone stop holding them in

after, like, the third date?

I like to be seen as sexy. It keeps the spark alive.

When I first moved in with Shaun,

I convinced him to order in atomic wings,

and I got terrible diarrhea.

But Shaun prescribed the perfect mixture

of Pepto and ginger root.

It was disgusting, but I was also totally vulnerable,

and that can be a turn-on, too.

Not in the moment.

Long term.

But you think the man

who happily helped you with your explosive diarrhea

can't handle your opinion about his estranged mom?

So this is where you're hiding.

It's my home. It's not a safe house.

Your home that has a phone you're refusing to answer.

You okay?

Yeah, I'm good. I'm great.

Always wanted a bit more time to perfect my dovetails.

I have an issue with a patient's insurance company.

Could use some presidential clout.

I have presidential clout?

Do you even want to know what the problem is?

You want to do everything you can for an underinsured patient,

and Salen wants to do as little as possible

for a client who can't pay.

Okay, fine.

I'll call the insurance company, but it's not gonna help,

and Salen will come down on you like a bat out of a barn.

Since when are you so defeatist?

Since I was defeated.

You have a minute?

Mmm.

Yes.

When I went to mail the Save the Date cards, I...

It won't work.

There's nothing as good as the PEEK.

Shaun, could you take a break for just a minute?

We agreed we would each make

our own invite lists, but I'm...

Everything is worse.

The dryers are loud and distracting,

the soap smells terrible,

and I can't properly repair my patient's face.

Hey.

You're brilliant.

You'll figure it out.

It's time to go stabilize his airway.

We're gonna turn off the implant

so we can get a look at your brain

while you're having a seizure.

It's gonna help us figure out the safest surgical approach.

Got the submental airway stable.

Let's close.

2-0 vicryls.

Do you want the air conditioning turned up, Murphy?

Yes, please.

It's already freezing in here.

I'm wearing long underwear

so I won't feel the synthetic scrubs against my skin.

Placing a stay suture.

And the elastic ankles ride up my legs.

Careful, don't want to put too much tension.

You all must agree the new scrubs

are incredibly uncomfortable.

Maybe a bit, but they do look better on me.

Oh, I kind of like them, too.

I think the new scrubs

are the least offensive change Ethicure's made.

Oh, yes, the hand dryers are worse.

I hear they're shrinking the chapel

to make room for VIP birthing suites.

Well, they can invest the profit in patient care.

Having a place for families to pray

is an investment in patient care.

It's not a good one.

Encouraging people to waste their time

begging some magic man in the sky for help?

That's not a good use of finite resources.

Silk ties.

What if we didn't need three surgeries?

What if we could do it in two?

We could contour mesh ourselves

and use an SCA flap instead of a free tissue transfer.

That will let us fix the upper and midface, orbit,

and mandible all at the same time.

That would be a much more risky surgery

and still doesn't get the PEEK implants covered.

It would save us almost $90,000.

Which could cover the cost of the PEEK.

Salen wouldn't have a problem

if the total cost remains the same.

Good idea.

Like the entrepreneurial spirit.

Can someone wipe the sweat off my forehead?

Her previous seizure frequency was 50 a day,

so we should be seeing what we need within the next...

She's seizing.

...two seconds.

Two epileptogenic zones.

Three. Four.

Her seizures have gotten worse

since the device was implanted.

And your great surgical idea just got even riskier.

Maybe Salen was right. It is too risky.

No. With 50 of those a day, she'll have to quit her job,

stop seeing her friends.

She needs this, and we can still do it.

We have a client who needs surgery even more than we thought

and a boss who was worried about the risks

that are worse than we thought.

So who's it gonna be, the boss or the patient?

I reject your premise.

We can still do your surgery,

and I'll get Salen to support it.

Are you afraid of Salen?

No, I'm not afraid. It's her hospital.

Then you need to come back to work

and help me stop her from making all these terrible changes.

What I need to do is stomp on grapes.

I'm gonna stomp grapes and, and make Zinfandel,

a jammy and peppery Zinfandel.

They're very hard to come by. Okay.

Looks very unpleasant.

It's really not. It's really a lot of fun.

You want to try?

Mmm... No.

It's just grapes. You like grapes.

Not to walk on.

Why don't you jump in and give it a try?

If you don't like it, then you can step right on out again.

Okay?

Take off your shoes and socks.

Roll up your pants.

Okay.

There you go.

Come on.

Whoop. There you go.

Hmm.

There you go.

Just ... No, no, no. Wait, wait, wait, wait, wait.

Get into a rhythm. Okay.

Okay, ready? One and two.

Hold on. One, two.

One, two.

One, two.

Now one and a-two.

No, no, no.

No, it's okay. No! No!

No, I got you. I... Don't do that. No, I...

No, thank you. I told you I don't like it,

and I don't believe you like it, either.

You don't love tying flies or woodworking

or walking on grapes.

But you used to love doing your job.

I hear I'm not the only one with a Salen problem.

And I hear Jordan solved yours. This time.

She's not unreasonable. Just has other priorities.

She has one priority, making money.

People play the roles you cast them in.

Make her an adversary, that's how she'll act.

That why you cast Mateo in the role of resident?

Hoping he'll play along?

If your boyfriend has a problem

with the way I'm managing our client, or him,

he can speak to me directly.

Rendon and Andrews, two alphas.

How's that going?

Gas still keeping you up?

If you want to keep a secret, don't talk about it at work.

I've seen the lacy bras you've been wearing

since Mateo showed up.

You obviously agree with the importance

of maintaining sex appeal.

Undergarments are a choice. Digestion isn't.

But you can choose when and where to let 'em rip.

This isn't about farts.

You're afraid that Park won't be as turned on by the real you

as he is by the facade he started sleeping with.

Hey. Clever idea in the OR. Wish it had been mine.

Of course, surgery won't be as fun as Shaun's would have been, but still.

What?

You must think I'm pretty stupid

to waste my time talking to "a magic man."

I-I don't think you're stupid,

but I do think praying is a waste of time.

It's just my opinion.

Doesn't make it any less offensive.

Look, I'm sorry that you're offended.

That's not an apology.

And I'm sorry that you're upset that I won't apologize

for saying prayer is pointless, but... It is.

So you're gonna double down.

If you're going to insist on...

We need O-neg, a central line kit,

fluids, pressers, and broad-spectrum antibiotics.

He's in hemorrhagic shock. The wound's infected.

We can't risk combining surgeries now.

Risk of septic shock is too high.

Our plan won't work.

Maybe if we wait?

Once the antibiotics have cleared the infection ...

He doesn't have time.

We need to reduce the deformities before they ossify,

and my original plan was better.

But Salen won't let us do that. We need something new.

Like a miracle, maybe?

I thought we were friends. We are.

Then why do you keep going out of your way

to insult the things that matter to me?

I'm not offended by your devotion to religion.

Why should you be offended by my devotion to atheism?

That's not even the same thing. Stop talking.

You're wasting time on an irrelevant issue

and distracting me.

Mmm, but constantly fussing about the scrubs

and the soap in the bathrooms is relevant?

Nice, Asher. Trivialize his autism.

Because you haven't offended enough people.

ASD doesn't make me irrational.

The changes are objectively worse, okay?

I'm sorry, Shaun.

See?

How hard was that?

A retired neurosurgeon taking up woodworking's cute.

Winemaking's a sad cliche.

But abstract painting?

That's a cry for help.

Jealous?

No.

But props. You clearly outfoxed Salen.

What'd you give her?

Anything I might be able to trade?

You thought coming to my house and insulting me

was a good intro to asking for help?

You'd be helping a woman with a severe seizure disorder.

Doing it for the desperate patient

seems more believable coming from Lim.

Is the surgery covered by insurance?

Yes. Okay, then Salen can't stop you.

Which you obviously already knew,

so this isn't about helping a patient.

It's about getting help to keep the new boss off your back.

You're an accomplished professional.

You can handle it yourself.

What's this supposed to be, anyway?

A sailboat.

It's not supposed to be anything.

It's supposed to help me forget

how much I miss working with you so closely every day.

Well, you're welcome back anytime.

Come on, clearly,

you're bored out of your mind.

But it must feel good to have people

driving over to your house

begging you for pearls of wisdom.

Yeah. I feel like a real hero.

Salen, I think I may have approached things the wrong way.

Obviously, we're not adversaries,

and I agree we need to be fiscally responsible.

I ran a credit check on our client.

He makes six figures, lives in Palo Alto...

7%.

The average amount hospitals collect

from out-of-pocket medical expenses.

More importantly, when I make a decision,

I expect my team to carry it out.

Not try to subvert it

by having Glassman run to the insurance company.

When you took over, you made a commitment

to the board and to the state to be an asset to the community.

The Ethicure system prioritizes efficiency

because that's the best way to deliver top-quality care

with our finite resources.

Pursuit of profit drives innovation.

Innovation creates the treatments

that you and I both want and our clients need.

Sucks for Bob, but the more money this place makes,

the more people we can help.

Marcus?

The test didn't go the way we'd hoped.

In fact, it... You can skip the minutia.

I still think you should agree to do Mateo's surgery.

You understand the business of medicine.

I understand the mind of a surgeon.

We need to feel like heroes sometimes,

especially surgical jocks like Mateo.

Give him one inefficient miracle surgery,

and he'll happily give you 50 high-billing knee replacements.

Not everyone's on board with the changes you're making here.

You'll need allies.

I'll back Mateo's miracle.

And tomorrow, you're both on knee replacements.

I cannot do this.

It sucks, but we have no choice.

We'll do everything we can.

As long as it's covered.

Yeah, and send him home maimed.

I'm not talking about the surgeries.

I can't wear these scrubs.

It was too hot with long underwear,

but the feeling of them on my skin is much worse.

I'm going to change.

Okay.

Okay, please...

Please!

Uh, Shaun, I'm kind of in the middle of something ...

The American Society of Microbiology,

Mayo Clinic, Clinical Microbiology.

All show the use of paper towels

results in lower rates of contamination

than jet air dryers,

and foaming soaps are less concentrated,

which reduces effectiveness.

Added fragrances increase allergic reactions,

and synthetic fabrics can be abrasive

and contribute to microplastic pollution.

Shaun, we talked about this.

Okay, you made these changes without asking us first

because you're not trying to help us or protect patients.

You're doing it to save money, and it's wrong!

Shaun... Okay?

You're wrong.

I'm so sorry. He's just really passionate.

You're wrong!

It's okay.

You're right.

Okay.

I didn't ask the staff here.

But I did ask other experts,

whose research proves I'm not wrong.

But that doesn't mean you are.

Mmm, we can't both be right.

Yes, we can.

Because some doctors are different.

And sometimes...

Your ASD gives you...

No! No, thank you. It's not my ASD.

Yes, it is.

But if you'll just let me finish,

I was going to assure you that I'm not dismissing you.

I value your unique perspective

because my ADHD gives me a unique perspective.

You could be a great asset to this hospital,

but only if I'm able to recognize

that one size may not fit all.

It's not the size of the scrubs.

I'll have maintenance put back the old soap and paper towels

in the residents' locker room and break room.

And you can go back to wearing your old scrubs.

But just you.

Is there anything else I can do for you?

Shaun?

I have to go.

Ligate the right sphenopalatine.

We need an ultrasonic scalpel.

Where have you been? We've been paging you.

I get to keep my old scrubs.

Also, we can create an osteomyocutaneous flap,

so we won't need the customized PEEK implants.

It should be strong enough to allow him

to have full vision function and eat normally.

That's pretty brilliant.

And fully covered by his insurance.

I know.

I also convinced Salen

to put the old soap and paper towels back.

Nice work.

Who needs the ultrasonic scalpel?

Me. Wolke, you're with me.

Allen, help Murphy harvest the graft.

Planting grapes?

Mammoth sunflowers, actually.

They're supposed to be 12 feet tall.

Oh, that's cool.

I'm fine.

Yeah, I wasn't even gonna go there.

Oh, yes, you were.

Yeah, I was.

But only after we talk about Shaun first.

He's fine, too.

No, he's really concerned ab... He's fine.

He's got a new fiancee.

He's got a new boss.

Mmm-hmm. He's planning a wedding.

He's anxious. I would be, too.

Which is exactly why I don't want to stress him out even more.

Okay.

Listen, Shaun gave me the Save the Dates to mail,

and I found one addressed to his mom.

Okay, that's interesting. But not unreasonable.

I know, but I want the day to be about us.

Our future. Our happiness.

I don't want to feel like I need to protect him.

Am I wrong?

Am I being unfair?

Selfish? Paranoid? Feel free to step in anytime.

Trying to decide whether I should plant randomly

or in rows.

That's it? You're not gonna help?

No, I'm not.

More retraction.

We'll use the periosteal to elevate the craniotomy flap.

That can go in the recycling bin.

Park and I will use motor mapping

to ID the border of the eloquent cortex.

I'll lead up the ECoG to guide the resection.

Sorry.

I shouldn't have questioned your motives.

The way you managed Salen was...impressive.

Thank you.

I've learned a few things

about how to deal with administrators.

And when it comes down to us versus them...

I'm a surgeon.

As we expose the buttresses of the midface,

Murphy, I want you to...

Enable reduction with 3-D control

followed by rigid fixation.

Exactly.

Buttress looks too fragmented to stabilize.

You should remove more bone and then graft between...

No, I shouldn't. Yes, you should.

The malar projection isn't... Stop it.

Not the work, the sniping.

You're not just colleagues. You're friends.

You know religion hurt him.

It's what separated him from his family.

That's the context for his disdain for it.

And you know her prayers aren't pointless

if they offer her comfort from the pain in her life

that's just as significant as yours.

And if that's not reason enough,

then you will stop this out of your boundless commitment

to making my life easier.

Right?

Um, why haven't you started yet?

We started over five hours ago.

And finished.

Your post-resection ECoG and neuro exam were perfect.

Thank you.

That was amazing.

I'm sorry.

Sincerely.

Up for a drink?

Tequila.

Stat.

Okay. Okay.

Now, isn't this something?

It's a small world in Argentina, isn't it?

Isn't it?

Why did you marry him?

My husband's a very attractive man.

You all right?

Yeah, fine.

What was that word again, Johnny?

You married him for his money.

Actually I'm not.

Much better.

Oh, thank God.

Now isn't that an amazing coincidence?

A toast.

To me.

I had faith in myself, spoke my mind,

and got everything I asked for.

Totally. I'm proud of you.

Shaun...

I didn't mail the Save the Date card to your mom.

Mmm.

Because I don't want to invite her.

Hmm.

I feel like you two still have a lot to work through,

which you should, but I want our wedding to be fun.

I don't want to complicate it with any pain from the past.

The wedding books said I had to invite her.

Were they wrong?

Maybe in this case.

Would you be okay not having her there?

Yes.

Very.

You were right. I should have listened to you.

And Andrews.

Oh, your confidence is just one of the things I like about you,

especially when it allows you to admit that I'm right.

And what are the other things?

Oh, should I tell you or show you?

I'm surprised he'd agree to that.

I'm sure he didn't.