All language subtitles for The.Good.Doctor.S06E18.1080p.WEB.h264-ELEANOR

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Previously, on The Good Doctor…

Going to the club or work?

These early calls
need some getting used to.

-Brown Retractor.
-No brown Retractor.

I thought I put it on your tray.

Dr. Kalu is not your peer.

He's your employee, you're 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.

I don't appreciate
being treated like an intern.

Dr. Andrews is judging
my performance off yours

and it 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 want to prove I belong.

When I checked Yara post-op,
I noticed you only used eight sutures

and she had a small bleed.
You should've 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.

450 calories ingested,
assuming you kept it down?

-Yes.
-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?

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 troubling pattern
needing attention--

Shaun, the surgery was a success, right?
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 Beyoncé.
-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."

It's gonna be a party when there's
double punctuation involved.

Just the chance to unwind,
get to know you all better.

-Sounds fun. Thanks.
-Prepare to be destroyed.

My "Someone Like You" slays.

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

Sorry, ER.

You two are it. Room One.

When did the chest pains 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,
and I just started Guanfacine

and N-acetylcysteine,
which may actually be helping, finally.

When was your initial infection?

Eight months ago. 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.

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.

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.

First was a few months ago, I think?

That was the sprained ankle.

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 wants her
on hormone replacement therapy.

Orion insisted
I 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 visit me anytime
you want, Mom.

Not with a busted knee.

To move forward with HRT,

I need to confirm all your medications
over the last five years.

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's 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?

Did I fall asleep again?

Yes.

Could I take a quick look in your mouth?

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
an 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 missed it in your case.

You have a rare presentation.

The right ventricle obstruction
is 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.

I would've 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 Nuñez to it.
-You're a champion.

One Splenda, half sugar
in the raw, light almond milk.

Now who's the champion?

-I have something for you.
-Really?

An agreement acknowledging
a consensual relationship.

I, Marcus Andrews, would like
to take you Dalisay Villanueva on a date.

And as hospital president,
I've already signed it.

This is so romantic.

Give me the pen.

-Dinner this weekend?
-Let me see.

I'm needed on the ward. Sorry.

-Lock it down later?
-Sure.

-Iced coffee?
-I'm good.

How about hot coffee?

In honor of Daphne's
successful tonsillectomy.

I got a few options.

Is that a latte?

It was a routine tonsillectomy.

Those were unusually large tonsils.
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's spiked, she's hypoxic.
-Turn up oxygen to max.

Loud murmur, right ventricle
and atrium.

Chronic damage from apnea could have
increased the pressure,

causing right heart failure.

-BP's dropping.
-Get her to the cath lab.

Positioning coiling system.

Two vessels left to close.

Deploying the coil.

Her 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.

Tet repair surgery
will be much more risky.

Pressure in Daphne's lungs
is 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, forgetful.

She's been sleeping
oxygen-deprived for decades.

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
caring for someone else.

She's throwing a lot of PVCs.
Maybe an electrolyte issue?

BP is dropping, heart rate 172.

Barely getting a pulse. She's in v-tach.
Defib paddles.

BP and heart rate stabilizing.

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

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

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 pleased about that.

He is not. You are being sarcastic.

Performance review is a standard practice,
benefits doctors and patients.

I've noted three additional errors
from last four months.

-I don't see a pattern.
-Dural tear on scar tissue,

closing with a running nylon
instead of Monocryl. That a mistake?

Dr. Glassman has always used
subcutaneous Monocryl.

These are variations, minor missteps.

Pore through four months
of any surgeon's reports

-and you'll find discrepancies like this.
-No.

-Yes.
-Not in mine.

-That's probably true.
-Yeah.

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 do
the Tet repair?

There's a medication, propranolol,
that'll significantly reduce the risk

of having another spasm during surgery.

But 'cause of your long COVID,
you're at risk for some rare side effects.

-Are they serious?
-Yes.

Not some, like nausea,
vomiting, muscle aches.

But others,
such as hypoglycemia or visual--

Start with propranolol.

Good chance you won't experience
the 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,
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?

I'm working a double both days.
Been hectic since Baker and Linh left.

-Two travelers are starting Monday.
-I need staff nurses.

They're highly skilled.

Doesn't matter.
Travel nurses disrupt workflow,

don't build long-term relationships.

We don't have the resources
for permanent staff.

You just hired a new full-time resident
to replace someone who left recently.

That was Lim's department.

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…

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…

Oh, my…

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.

-I'm in the middle of something.
-Your brain cancer may have returned.

-All errors tied to executive function.
-Shaun.

Specifically procedural memory
in 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.
-Last scan was six months ago.

These errors are from last four months.
You need another scan.

-The evidence is very compelling.
-It's not.

I perform complex surgeries,

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

So the percentages would dictate

that I might make more minor
and irrelevant missteps,

if that's what you wanna call 'em.

The rate of errors has increased.

Yeah, 'cause I take on 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 trees."

My turn.

Trying to get my cognitive exercises in.

What're you memorizing?

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

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

I've just graduated from haikus.

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

Didn't have the patience for it,
or the time.

That's basically all I read now.

Started writing, too, as kind of a…

creative therapy.

There was a kind of poetry

to the genetic variations
in white clover, too.

I'd give anything to…

Your blood pressure's dropping,
heart rate's climbing.

-I'm dizzy.
-Checking your glucose.

She's having a seizure. Crash cart now.

We thought it was your heart,
but it's a kidney issue.

Narrowing of your renal arteries,
which was exacerbated

by the pulmonary hypertension,
causing kidney failure.

-This is 'cause of my sleep apnea?
-We believe so. Yeah.

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 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.

That's less risky, but I don't think
I could handle all that on my own.

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

I'm sorry.

-I don't want to keep you.
-You have nothing to be sorry for.

You know, all this time you've been sick
and struggling, and 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.

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.

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

It's a nonstarter.
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--

"What would Shaun Murphy do?"

What about a shunt?
It would improve blood flow.

Buy a few months to continue
her cognitive recovery.

When she feels better about her heart,
maybe she lets us fix her heart.

Her Tet would 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.
Have to review Dr. Glassman's OR videos.

-Didn't you do that?
-Not for glioma recurrence symptoms.

New evidence will convince him
to get a scan.

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 a song list.

Plus Jared's our friend. He just
moved back. Celebration is in order.

I will review the videos in the morning.

Sounds pretty wild in there.

Because maybe

You're gonna be the one that saves me

And after all

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.

And Jerome.

So it's just us four.

Which means that all these snacks

and song binders are for us.

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--

Okay. I'm playing the pregnant lady card.

-We're going, Shaun.
-Okay.

Thank you. Goodbye.

I should head out, too.

Early morning.

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.

at different schools, cities, countries.

But wherever we were,

my parents had a big house
and I knew how to throw a party.

Closest I 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.

-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.

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 going to be on it.

And let your daughter do the same.

Prague is beautiful in the spring.

We've scheduled a 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 could redo 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.

That could work.

-Extending the incision.
-Sternal saw.

Starting the sternotomy.

O2 dropped to 78. Sixty-five.

She's having a Tet spell.

Give her 500cc fluid bolus
and 100% oxygen,

Giving a mini-bolus
to increase pulmonary flow.

Oxygen sat's on 50. Forty-five.

Come on, come on.

Give her more oxygen and up the opiates.

It has stopped registering.

O2 is 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.

To a successful renal artery bypass.

Cheers. Facilitated by a moving speech
from a wise and persuasive surgeon.

With a great surgical save by a guy

who's about to have
some life changing tacos.

Okay.

Oh, my God. Okay, this is amazing.

-It's amazing.
-Told you. Blue. Corn. Tortilla.

I could get used to this.

You have some lettuce.

Here. No, mirror image.

-Now?
-No.

No laughing.

No. Right. Very serious matter.

Here, let me.

There. Just.

We should go.

Yeah.

We need to get back early
for Daphne post-op.

Yeah, right.

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

We expect a full recovery.

How are you feeling, Mom?

I am 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 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 will accept FaceTime calls.

And once I recover, I'll come visit.

I hear that Prague
is beautiful in the spring.

It sounds like a plan.

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.

It probably was a mistake
to leave them for him to read.

I'll reorder the files and go to
his office to review with him.

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 an uncertainty--

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.

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 30th, 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 am 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 pond.

'I'll take it all.'"