All language subtitles for The.Good.Doctor.S06E14.Hard.Heart.1080p.AMZN.WEBRip.DDP5.1.x264-NTb

Ohh.

Sorry.

Did I wake you?

Yes.

The baby's pressing
on my bladder,

so I have to pee approximately
78 times every night.

We can talk about baby names
since we are both awake.

I keep coming back
to one name, Kelly.

It reminds me
of a Kelly clamp,

and I will think about
grasping onto tissue or vessels

every time
I'm holding our son.

What about Addison?

Addison Murphy.

Addison is the name
of a disease.

I'll worry our son is not
producing enough cortisol

or aldosterone.

You can go
back to sleep.

I have to go pee again anyway.

Morning!

Pancakes, anyone?

They are not just
ordinary pancakes.

They are
Dutch baby pancakes.

Also known as Bismarcks,
Dutch puffs,

and even Hootenannies.

- I looked it up.
- That is correct.

They are baked in an oven,
not fried.

I was up very early.

Oh, sorry if my frequent
bathroom trips kept you up.

Oh, don't be silly.
You're making a human.

Thank you.

So, Kelly and Addison
are out.

I don't disagree.

How about Munchausen?

Shaun.

- Or Parkinson?
- Oh. Ohh.

Our bedroom conversations
are meant to be private.

All of them?

Well, it's not like
you were talking about...

Never mind.

Let's eat.

A friend on the San Jose
school board reached out.

They're looking for someone
to give a series
of online talks

to high schoolers
about careers in medicine,

specifically
to young women of color.

That's great.

I thought
you'd be perfect.

Oh.

That wasn't the reaction
I was expecting.

Maybe Dr. Tooks
can do it.

Tooks is a mom.

These high school kids
don't see themselves in her.

There's gotta be
someone else.

There isn't,
which is the whole point.

Only 2% of surgeons
in the U.S. are Black.

Don't be afraid to
step into the spotlight.

I'm not afraid.
I'm just very busy.

Okay. It will only take
a couple hours of your time.

"If you can see it,
you can be it" is a real thing.

It is not my responsibility
to be the one they see.

Okay.

Nathan hit his head
on the trampoline frame

at his birthday party
two days ago.

He got a bump,
but he seemed fine.

Where's Daddy?

I told you.
He's away for work
helping people.

He'll be back
in a few days, okay?

Is it possible to develop
a concussion two days later?

Well, let's see if we can
find out what's going on.

Nathan,
what's your puppy's name?

Patches.

Can I look into Patches' eyes
with this little light,

make sure he's okay?

Or you can do it?

Just look in here.

Can you pick this back up
and give it to the doctor?

I can't.
Where's Daddy?

Can you give me
a high five, bud?

Good.
Now high ten.

What's happening?
Is-- Is this a concussion?

It's not a concussion.
Your son is having a stroke.

You are late.

No, I'm not.

It's 8:01 a.m.

Oh, it-- It is now,

but I'm pretty sure
it was still 8:00

when I walked through
the door.

Were you getting
your hair cut?

No.

Are you using drugs again?

No.

You are on probation,
and I am responsible for you.

Common signs of drug abuse

include ignoring responsibilities

and secretive behavior.

I promise you,
I'm clean.

I'll pee in a cup if you want.

Okay.

I'm going to assist Dr. Park.

You can join the case if your
sample comes back clean.

I wasn't even late.

Sorry, a chance to help
young, diverse women

and kiss the hospital
president's ass

at the same time?

There's only
one answer to that.

It starts with a "Y,"
ends with a "Yes."

- That didn't work.
- I know, I should've bailed.

But I stand by my point.

Aren't we busy enough?

And why do I have the burden
of extra homework

just because I have
more melanin than you?

And why is my Grandma E
texting me right now?

You shouldn't think of it
as homework,

and you definitely shouldn't
think of it as a burden.

And you shouldn't think
you know
what it's like to be me.

Point taken.

Hm.

What the...?

Okay, can we just focus on
our patients, please?

Thank you.

Quinque, there you are.

Grandma E,
what are you doing here?

I was told they have
doctors here.

I've got tightness
in the chest,

shortness of breath,
swollen ankles.

Why didn't you go see
your doctors in Oakland?

Those idiots said
that my ascites indicated

I had "cirrhosis of the liver"
like I'm some kind of a drunk.

And I figured,
with my family connections,

I could get some
top-shelf care here.

I can't be involved
in any of your--

But I can.

Delighted to meet you,
Grandma E.

I'm Dr. Wolke.

Okay.
Jordan, baby, you stay

and keep an eye
on little mister here.

He might try to skate by
on his good looks.

Ah.

Can you lean back for me?

Jordan, you never mentioned
having a sister.

See? I like him.

Distended jugular veins
with increased JVP.

Kussmaul's sign
and pulsus paradoxus.

Maybe I don't like you
so much now.

She does have a history
of chest radiation.

Echo-brightness
of the pericardium.

What does that mean?

The sac around your heart
is inflamed.

There are
calcium deposits.

Grandma?

All right,
those are faint pulses.

Okay, if we don't do something,
she's gonna arrest.

Set up an OR stat
for a pericardiotomy.

No, Rick, stay.

I-I promise
I've got this.

Sorry to interrupt.
We're ready.

Can you please
talk to my husband?

Of course.

This is Dr. Park.

How does a four-year-old
end up with a stroke
from bumping his head?

Head trauma's
one of the main causes.

Well, I feel like I should
get on a plane now,

but Linda's telling me
to stay.

How far are you?

Alabama.
We still have people missing

after the tornado
ripped through.

I can't tell you
how to prioritize,

but I can tell you I'm hoping
to make your son better

well before
you could get here.

Thank you.

We're okay.

You'll be back
in a few days anyway,

so just stay
and keep helping.

Okay.

Evacuating
the hematoma.

I saw on the Weather Channel
that the Alabama tornado

was the 15th to reach a 4
on the Enhanced Fujita Scale

in the last 3 years.

Together, they have caused
116 fatalities.

Luckily, we have people
like his dad

who run towards
a crisis.

But he also has a crisis
right here with his son.

He didn't know that
when he left.

I'm not seeing
an active bleeder.

There is a hyper-vascularized
brain parenchyma

in this resection cavity.

Oh, the major named vessels
are all smaller than usual

and look scarred in.

The hemorrhage was not
from hitting his head.

This boy and his brain are even
sicker than we thought.

Widening
the sternal retractor.

So, why does she call you
Queen K?

It's Quinque.

Latin for five because
I'm the fifth child of six.

So does she call
your little brother "Sex"?

Please focus so you don't
kill my grandmother.

Cauterizing the edges
of the sternal periosteum.

She's so charming.

Why didn't you get
any of those genes?

Charm is one of the many layers
of a very complicated woman.

Grandma E drove me
like a drill sergeant
from the day I was born.

Ensure the pericardium is free
from both the pleurae
and the diaphragm.

15 blade.

Oh.

We need a new 15 blade.

What's happening?

I can't pierce it.

Never seen constrictive
pericarditis this severe.

It's completely calcified.

Your grandma has what's known
as a coconut heart.

Your son has a rare
auto-immune disorder called
primary CNS vasculitis.

It's causing inflammation
of his blood vessels
throughout his brain.

Okay, um...

Wh-What are
the next steps?

Cyclophosphamide
infusions.

That's chemo.

My mother had that
when she had breast cancer.

And she-- she lost her hair,
she threw up, she got sores
all over her mouth.

Letting this go untreated
is far worse--

Recurrent brain bleeds,
possibly large
territory strokes.

It could be fatal.

Nathan will be on
some form of immunosuppression
his whole life.

I'm sorry.

Thank you, Doctor.

How do you
crack open a coconut

without puncturing
what's underneath?

Constrictive pericarditis.

Please stop
saying "coconut."

It's my grandmother
and it's serious.

Not your case.

I'm just having a snack.
And trying to help.

Mm-hmm.

We need ideas.

Left anterior thoracotomy

and partial excision
of the pericardium.

Avoids sternal infection
and seems likely
the safest route.

It will require
more surgeries.

Please go away.

What-- What are you
advocating for?

Complete removal.

Hear me out.

A median sternotomy
gives us clear access
to the diseased pericardium

from phrenic nerve
to phrenic nerve.

That's way too risky.

Complete decortication fixes
her heart... completely.

You are advocating
for an extensive,
high-risk surgery.

Meanwhile, a partial
removal offers your
70-year-old grandmother

a shot at full health
for what will likely amount
to the rest of her life.

Shouldn't you let
the patient decide?

No.

I don't present something
if it's not a viable option.

I think it is viable.

Her surgeon doesn't.

Jordan,
go be a granddaughter.

If I hadn't
become a surgeon, I think
I would've been a writer.

I would've...

You never told me
your grandmother
worked at Marcus Books.

Was I supposed to?

I was just
a lowly clerk.

It came up when I heard
his name was Marcus.

There is nothing lowly
about being at the center
of a cultural landmark.

My Auntie Winn used to
take me to author readings

by Toni Morrison,
Maya Angelou.

And you were there
every day!

I probably served you
some cookies.

You ever meet
James Baldwin?

- I did.
- What?

Okay.

She can probably use
some rest.

Yes. Absolutely.

If you need anything at all,
Miss Evelyn,
you know where to find me.

- Thank you, Marcus.
- Yes, ma'am.

Marcus Books.
Wow!

That was weird.

Not as weird as you refusing
to do his mentorship program.

Let's talk about you...

and your heart.

Your pericardium
has become hardened,

likely from
your cancer treatments.

So what happens now?

Dr. Lim has decided on
a partial removal.

And-- And you think
that's best?

Jordan Jacqueline Allen,
you look at me and you tell me

if you think it's best.

Wow. It took you guys a while
to get home, huh?

We went out to dinner
because Lea thought that--

Why are you
on the floor?

What's with
the high chairs?

I stopped at Costco
on the way home.

Surprisingly diverse
selection of wines.

There's an open bottle
if you-- if you guys want,

although that might
be empty.

Danger.

Oh, I remember wine.

Are you drunk?

No. Maybe a little.

I'm baby-proofing.

Danger.

Are you okay?

Oh, you guys
gotta get down here
and check this out.

From the baby's
perspective,

this place is
a frickin' death trap...

for Nicholas.

Placeholder name.

We can call him
Nick or Nicky.

I like Nicky.

Okay, why did you buy
three highchairs?

Well, one's a gift
for you, and the other two
I'll take back.

Danger.

That could be dangerous.

Y-You don't have
to buy us anything.

I also got you
a nanny cam.

It's a-- it's--
it's a teddy bear,

but you wouldn't
believe it,
there's a camera inside.

That is very practical.
And cute.

Ugh, okay. We will not
need a highchair
or baby-proofing for a year.

And we will not name our son
Nick, Nicholas, or Nicky,

or any variation thereof.

Okay.

Okay, well,
that's fair enough.

But you-- you're
gonna want this.

It's a book by Dr. Spock
on parenting.

Everyone read this book
back in the day.

He was so popular,
he ran for president.

Danger.

I'm going to bed.

Yeah, but you're gonna want
to r-read this

before the baby comes
and you get exhausted.

Already there.

Danger!

What were you thinking?

That my grandmother deserved
the good muffin?

She told me she will only agree
to complete decortication,

which she shouldn't even
know about.

You do not present a patient
with an option

that I have deemed unsafe
and wouldn't even perform.

- It's unacceptable.
- You're right.

I felt like your plan was
a little conservative, but I--

You are a resident.

Your feelings
about my decisions
are not relevant.

I'll let her know
I was wrong.

And convince her
I'm right.

Or find her
another hospital.

Yes, ma'am.

Um, your muffins
are ready.

How's he handling
the chemo?

You doing okay, bud?

Nathan, can you answer
Dr. Park, please?

Is everything okay?

No.

You're right.
It's not okay.

Okay,
these aren't toys.

We okay, Mom?

He got dozens of new toys
for his birthday.

He shouldn't have to be
building castles
with pill bottles.

I'm sorry.

Maybe you shouldn't be
trying to do all of this alone.

My husband's saving lives.
I can't pull him
away from that.

I can.

Give me your phone.

Hi, Rick.

Dr. Park.

Mm.

You okay?

Yeah, I'm fine.

But you're not.

What happened?

I was wrong to question
Dr. Lim's surgical advice.

She's the best.

I hope to be her someday.

And if she thinks the partial
removal of the pericardium

is the best course of action,
then I agree with her.

Okay.

Then that's
what I'll do.

But why did you go against
her advice in the first place?

I felt like I needed
to do extra, to be a hero.

Why?

Since I was little, you told me
I had to work twice as hard,

be twice as good
as everybody else.

After all these years,

I'm still striving
to be good enough for you.

Yeah, see,
that's a lot of pressure.

But it's what
the world requires

from people that look
like you and me.

When's my daddy coming?

Your daddy's getting
on a plane.
He's gonna be back soon.

But now, we have to see if
the medicine's working, okay?

If it is,
can I stop taking it?

I'm so sorry.

You still need it.

I hate it.

I know.

Let's play a game,
like hide-and-seek, okay?

Okay, lie down.

You get to go
in the tunnel.

And stay very still
so nobody can find you.

I'll come back and get you
when the coast is clear.
Sound good?

You are very good
with him.

Starting the imaging.

Thanks.

Nathan, you're about to hear
some banging.

It's just the machine.

But remember to
stay really still, okay?

I am.

Try a little harder,
okay, bud?

Ah, motion artifact.

We might have to
sedate him.

Those are not artifacts.

He does not have
CNS vasculitis.

He has
moyamoya disease.

What the heck is that?

A narrow carotid artery
is reducing blood flow
to his brain.

This area here,
looks like a puff of smoke?

That's what moyamoya means
in Japanese.

A bunch of new, tiny vessels
have developed
to circumvent the blockage.

But because the vessels
are abnormal,
they're prone to bleeds.

We can fix the problem
with a very interesting
brain surgery.

Well, so-- so now
that you're done

poisoning our son with chemo
that he didn't need,

we should trust you
to crack open his skull?

We will use a small craniotomy
to access--

I get why
you're frustrated.

Moyamoya is rare and
notoriously hard to diagnose.

Many kids get chemo they
don't need for a lot longer.

We're hoping to do Nathan's
first brain surgery tomorrow.

He needs more than one?

What's brain surgery?

Hey.

It's how we're gonna
make you all better.

No more chemo?

No more chemo.

Are you gonna be here?

My plane got cancelled, buddy.

But, uh-- but, look,
I-I promise

I'm gonna be there
as soon as I can, okay?

Can Patches get
brain surgery, too?

N-No.

Patches is
a stuffed animal.

It does not
have a brain.

Oh.

Ohh!

Oh!

I just peed
in our bathtub.

Glassman has to go.

Aah!

- Sorry!
- Hey!

Sorry!

First years.

You are late again.

Come on.
Like one minute.

And last time...

Your drug test from yesterday
was negative.

You are not using.

So what is causing
your tardiness?

Look, I'm sorry.

I've been doing
really well.

And the reason
I'm doing so well...

is my daily meeting.

Sets my mind right.

It's kinda far,
and there's morning traffic.

Support is
very important.

And so is punctuality.

I'm going to map a complex
double-barrel vascular bypass.

Mnh! Dang it!

That's the sixth time
you've killed my grandmother.

It wasn't working
with the rongeur.

I'm trying to sell Lim
on a little more power.

I just need to find
the right torque.

That's reassuring.

Stop hovering.
Go visit, visitor.

Convincing Evelyn Allen
to do a surgery,

after convincing her not to,
was a little bumpy.

Details, please.

I took the opportunity to
explain how much pressure
she's put on me over the years,

and she took
that opportunity

to make me feel inadequate
once again.

I never thought of you
as someone who lacks
for confidence.

Fake it
'til you make it.

You're a resident in one
of the top surgical programs.

You've already made it.

All I see is the ground
I've still got to cover.

Mnh!

How's it going?

Not ready
for prime time.

This STA anatomy is ideal
as a donor vessel
to bypass the blockage.

So, we'll reroute
the scalp vessel
into the brain here.

Gonna give you
a little tip.

Next time a child asks
if you could do surgery

on his stuffed animal
so that he feels less scared?

Say yes.

I was only
telling him the truth.

Oh.

This branch of
the middle cerebral artery

looks like
an ideal recipient.

You're about to be a father.
Children are illogical.

And we can place
temporary clips
for vascular control,

and then anastomose the STA
to the MCA using 10-0 Prolenes.

I was very logical
as a child.

I did not like being talked to
like I was dumb,

and I definitely did not like
being lied to.

That child there felt that
if his Dalmatian

went through this scary thing
with him,
he'd be less scared.

If can embrace another person's
thought process,

it can strengthen
the relationship.

Lea thinks she should not
have to pee in the tub...

which I understand.

No kidnapping
my grandmother.

I asked him to do a lap
around the floor.

I needed
a change of scenery.

Well, you've had your lap,
now back to your cell.

Thanks for the tour, Speedy.

Speedy?

I'm guessing it's because
I was sprinting through here
this morning.

Yeah, I was late.

Second time this week.

Snooze buttons--
the devil's plaything.

I was actually at
a Narcotics Anonymous
meeting this morning.

I go every day.

"Confess your sins
to each other

and pray for each other
so you may be healed."

James 5:16.

Amen to that.

Good for you,
young man.

There's gotta be
a closer meeting.

I've tried
the closer one.

The hard-liners who run it
think that

wearing a suit and tie
is the key to staying sober.

Start your own meeting,
here at the hospital.

Set your own tone.

And you're never
late for work again.

I'm not--

I'm not qualified
to be a leader.

No such thing.

Leaders lead.

Simple as that.

Hm.

You are annoying.

Well, nice to see you,
too, Shaun.

Not to me,
but to Lea.

And I want to keep
our relationship strong.

She feels your presence
has taken over our apartment,

and she wants
her space back.

I overstepped with
the baby-proofing?

And suggesting names.

And the Dr. Spock thing?

And there's more.
The nanny cam--

Okay, okay, okay.

It was fun
thinking about your baby

and the future, and...

Maybe it has been
a nice distraction.

Yes, it was.

Which you've needed
since your house burned down

and you lost
all of your belongings

and you have
no place to live.

Yes.
Thank you, Shaun.

Dr. Glassman,
you are not exactly my family.

I get it.
I-I know, Shaun.

But I consider you to be
the baby's grandfather.

Wow.

Thank you.

I never thought that
would happen for me.

Thank you.

You can stay.

I will tell Lea,
and she will change her mind.

No, no, no.
I'm going to go.

Where?

I don't know.

Can I get you
a magazine?

No, thank you.

Are your pillows
positioned okay?

Okay,
you're doing it again.

What?

That thing you've been doing
since you were little

where you're just
fussing over people,

when it's you
that's in need.

Okay, come on.

Tell me.

You just met Dr. Perez,

and you were so nice
and supportive.

Do you know how long
I've waited for you to say,

"Good job" to me,
or, "Wow, you're a doctor"?

Do you know
who Rebecca Crumpler is?

No.

She was the first
Black female doctor.

And when I read about her,
I wanted to be just like her.

But, unfortunately, I didn't
know who she was, either...

until you were
in med school.

Quinque, I have been
impressed by you

since you were
in kindergarten.

Grandma?

What's going on?

She's having trouble breathing.

She's hypotensive.

Jugular vein distention
has increased.

Her heart is failing.

Tell me you got through
a practice run.

I was coming to say
we were
postponing the surgery

so we could practice more.

What are you hanging?

Uh, it's...

You can read, obviously.

Is this okay?
I'm sorry.

I should've cleared it
with you first.

Yes, you should have.

Because I would've
told you to use the small
conference room up on 6.

It's quieter up there,
and the room has blinds...

to help with
the "anonymous" part.

Thanks.

This is Park.

I had to fly to San Francisco.
I'm just grabbing a cab now.

Can you-- Can you hold
the surgery until I get there?

We can't.

If he hemorrhages again...

Well, can-- can-- Can you
put him on the phone?

He's already sedated.

But what if-- what if
this was my last chance

to talk to him?

I'll treat Nathan
like my own son, I promise.

Thank you.

Try to puncture
the pericardium

and grab an edge so we can
start to peel the shell.

Mm!

Apply more pressure.

We might need to use
another tool to pierce it.
Let's try the rongeur.

- Ah!
- Perforation of the myocardium.

Manually tamponading
the hole.

Pledgeted sutures.

The pericardium's
just too calcified.

It's adherent
to the myocardium.

So what do we do?

Repair the perforation.
After that,
I'm open to ideas.

We could put her
on bypass.

Gently peel off the calcified
pericardium bit by bit.

And then repair the damage
as we go?

That's like poking holes
in a bucket

and then hoping
we can plug them before
all the water leaks out.

I have an idea.

Go ahead.

It's called
the waffle procedure.

I found a novel study that said
dense calcified plaques

can be scored into multiple
cross-hatched sections.

No removal at all?

Exactly.
The shell stays in its place,

but the heart
has room to expand
and contract as it beats.

Mortality rate?

Under 8%.

Talk me through it.

Okay.
Ultrasonic scalpel.

Start by incising
the calcified pericardium.

ICG angio looks great.

Dr. Perez,
you may do the dural closure,
then replace the skull flap.

Before we close...

We're almost a full hour
ahead of schedule.

Why not go ahead
with the bypass
in his other hemisphere?

Mm, that is
not the plan.

Simultaneous
bilateral surgery

risks altering brain flow
too much.

It could cause
another bleed.

But maybe there's a way
to reduce that risk.

The wait for
the follow-up surgery
will be hell on the parents,

the whole time knowing
their son's brain...

The parents' stress
is not medically relevant.

I know, Shaun,
but, please...

Can you think
of any other way?

An
encephaloduroarteriosynangiosis

of the left side
would be relatively low risk.

We could safely
do that now.

Thank you.

Rick, Linda.

The surgery went well.

There she is.

Right on schedule.

How do you feel?

Like I can breathe,
for the first time
in a long time.

Thank Dr. Lim for me.

I will.

Somebody's
all puffed up.

Uh...

You did something.

The surgical team got
a little stuck.

I just gave them
a new idea.

Good job.

Wow!
You're a doctor.

Wow. Okay.

You're just laying it on
a little too thick now.

Looking good.

How are you feeling?

Okay.

Can you give me
a high five?

High ten?

- Hey, good job!
- Good job, buddy!

Good boy, buddy.

Where's Patches?

He is right here.

You did do the brain surgery
on him.

No, I just put bandages
on its head
to make you feel better.

I do.

Uh, I'm sorry.
There's a meeting.

I know. NA, right?

Uh, yeah.

It took me a few minutes
to get the courage
to come in.

It's just us. Sorry.

Where two or more
are gathered...

Oh, um,
have a seat, please.

Hm.

Um, hi.

I'm Danny. Um...

I am an addict.

Almost show time.

Don't say it
like that.

You're making me nervous.

Be yourself.
That's more than enough.

Hi, everybody.

There's so many of you.

That's so good to see.

I'm Dr. Jordan Allen,

and I am a third-year
surgical resident
at St. Bonaventure Hospital.

Where's Glassy?

He will not be staying
with us anymore.

He moved out?

Yes. We had a talk
and decided it was best.

Did you tell him
I was complaining about him?

Yes.

Oh, Shaun!

Now I feel horrible.

Oh.
You don't need to.

He found a vacant apartment
just down the hall.

In this building?

- Yes.
- He's our next-door neighbor?

Our next-door neighbor's
next-door neighbor.