All language subtitles for S07E02 - Skin in the Game

Grasp is good,

but Steve's not gaining weight
quite as quickly as I'd like.

I'm feeding him every two
to three hours during the day,

every three to four at night.

And pumping in between
to increase milk production.

Well, I'm going to recommend
you start supplementing with formula.

But everyone says
"breast is best"?

Breast milk is the ideal.

Right now, Steve just
needs a little extra.

Some samples to get you started.

This is an excellent product,

and it will make it
easier for me

to do more nighttime feedings.

Yeah. Yeah.

I thought being co-presidents

meant we would
do things together.

I was aiming for...

you do some things
and I do some things.

Funny how your "some things"
leads to more work for me.

I have no idea
what you're talking about.

The affiliation deal
with San Jose Med School?

We had to cover the overages
because the nurses unionized.

In exchange, we teach
a few med students.

You won't be teaching anyone.

I will have
the useless baby docs

wandering around the department

like lost children
with scalpels.

We made a good deal. That's it.

It's a good deal.

We should go
introduce ourselves.

No, they are baby ducklings,
and I will not be their mommy.

Let them imprint
on Shaun and Park.

Hi!

Bye.

Hi, I'm Dr. Park.
This is Doctor...

Dr. Shaun Murphy.

I... I can't believe
it's really you.

I'm just so excited,
I'm about to pee myself.

Please do not.

Of course not.
You're... You're not a shaker.

There was a March 2012 abstract

that demonstrated
a reluctance to shake hands

could be used as a diagnostic
marker for ASD.

But I love a good, firm grip.

That's why they call it
a spectrum.

We could shake.

That's not very firm.

Okay. That's better.

I'm Charlotte Lukaitis.

Nice to meet you, Charlotte.

I go by "Charlie" for now,
"Dr. Lukaitis" soon.

Only two years away
from my goal,

which I've had since I was 17,

ever since I saw that
viral video of you saving

that boy at the San Jose Airport

using a homemade one-way valve.

It was the coolest,
most heroic thing

I've ever seen
from a person with ASD.

It was very heroic.

I picked San Jose
for medical school

hoping to engineer
a run-in with you,

but then your hospital
partnered with my school,

and it's like what Taylor Swift
says in "Mastermind"...

Charlie.

Dom helps me when I,
you know, talk too much.

Hi, I'm Dominick Hubank.

And we're happy to have such
eager future doctors joining the team.

Future surgeon.

I don't want to be a surgeon,

but I'm excited
for the rotation.

Okay.

Charlie, you are on my team.

Yes!

Would you like to present?

I'd love to.

- Richard Shelford, 53...
- Call me Rich.

Not that I'm wealthy.

Right, Rich Shelford,
53 years old...

Don't feel a day over 52.

That's funny.

Okay. This is taking too long.

Please tell us what happened.

He was coughing so hard
he couldn't catch his breath,

and then he fainted
and hit his head.

Cough syncope.

He's thinner and way more tired

than the last time
he visited me.

Yeah, but I'm fine.

It's just a little cold.

You could barely breathe, Dad.

Um, chest X-ray shows
multiple lung nodules

and enlarged lymph nodes

in the hilar
and mediastinal areas.

Get an ABG, CBC,
perform a bronchoscopy,

and send biopsies to path.

Can you apply a wound dressing
using the Turban Technique?

I sure can.

Hey, uh...

how long until
we could get out of here?

My daughter, she took some time
off work to show me around.

She's got her own business.

Works as a tech consultant for a
few companies around the Valley.

- Dad.
- Let the man brag.

- It's every proud father's right.
- Yeah.

- Hold this, please.
- Oh.

Basic Turban Technique
for head bandaging.

Step one, tie the ends of two
bandages together in a knot.

Step two,
starting from one ear...

The patient
was a good sport about it,

but his daughter was not happy.

A wound dressing
is very low stakes.

Did Charlie do a bad job
following the tutorial?

Uh, no. Actually, the dressing
was pretty decent.

But the point is, the patient's
family were uncomfortable.

I think someone should tell her

no more how-to videos
in front of patients.

Oh. You can if you want.

We were able to repair
your skull fracture

and evacuate
a large subdural hematoma.

Lucky day.
Is there a Wi-Fi password?

I need to get
League Pass in here.

Uh, the accident report says

that you stepped right
in front of an oncoming car.

I just didn't see it.

Big day today.

I got the Clips and the points,
the money line, and the over.

And it's the last leg
of a six-team parlay

that I need to come through.

That's a lot of action.

Well, having some skin in
the game makes life more fun.

Hey, you're The Dominator.

Uh, just "Dom" now.

My football days are behind me.

That pancake block you had
against Stanford?

Cleared the way
for that 75-yard run?

Made me 10 grand, that one play!

Why aren't you in the league?

Decided I wanted to help people

instead of hurt them.

Okay, let's draw blood
for post-op hematocrit.

Once the brain swelling
comes down, you can go.

Have you done a blood draw yet?

It's my first day
out of the classroom.

Five bucks he gets an A.

No.

All right. You're going
to palpate for a vein.

Oh, and remember,
when introducing the needle,

always bevel up and insert
the tube into the vacutainer.

And you just passed
phlebotomy 101.

Oh, God.

You could be up five right now.

He went down.

I mean, hard.

Frontal and parietal lobes
look clear.

I'm sorry.

I did deadlifts
and squats this morning.

Didn't have time
to eat breakfast.

Feeling okay now?

My ego took a hit,
but I'll be okay.

Whoa!

Is that our patient's brain?

Mm. You just passed
anatomy 101.

Which part's the front?

Oh, spoke too soon.

This is the axial plane,

which means we're
looking down from the top.

These are the temporal and
occipital lobes here. Also clear.

How can you tell?

We injected gadolinium,
which leaks out

around the areas of injury

and makes them show up
brighter on the scan.

Like that?

Yeah. Like that.

That's a tumor,

completely interwoven
with his brain stem

and cranial nerves

and extending
to his upper spinal cord.

I guess we know
why he didn't see that car.

You are descending
through the larynx

to the trachea
and onto the carina.

- Nicely identified.
- Thank you.

Positive affirmations are
empowering for people with ASD.

"My autism is awesome."

Onto the bronchi
and bronchioles.

I use Taylor Swift mnemonics.
Do you guys do that, too?

- No.
- I do.

I wonder if ours are the same.

Basic airway anatomy,
L, T, C, B, B.

"Lover," "Treacherous,"
"Cardigan," "Babe," and "Bejeweled."

I used "Bad Blood" for both
bronchi and bronchioles. Two for one.

Mm.

He knows one song.

Look at the patches
on the bronchial mucosa.

There's a luminal narrowing

from the enlarged lymph nodes.

This definitely isn't pneumonia.

Cool.

My first medical mystery.

Can I page Dr. Murphy?

Did you ever
cut quartz countertops?

Yeah.

I started off
in a fabrication shop.

How'd you know that?

Cutting quartz produces
toxic fine-dust particles

that have embedded
in your airway and lungs.

You have silicosis.

It's like watching
a magic trick.

Uh, my doc said it was
just a recurring pneumonia.

Silicosis can often be
misdiagnosed until it's too late.

You will need
a bilateral lung transplant.

He needs new lungs?

Yes. With your declining
respiratory function

and extensive damage,

you should be prioritized
for transplant.

But you will need full-time
home care for the rest of your life.

But I live alone
back in Florida.

Dad, one step at a time.

I think you should
get the surgery here,

then move in with me.

I can't do that.

Of course you can.

Your career has just taken off.
I'm not gonna burden you.

It's not a burden.
You're my dad.

You peeled my oranges
and coached my soccer team.

Then you put me through college
and business school.

Let me take care of you.

Someone raised his girl right.

Okay.

We will call
a transplant coordinator.

Where's Steve?

Down the hall,
flirting with the nurses.

I need you to write me
a prescription for domperidone.

It increases
breast milk production.

All the mom message boards
say so.

It is not approved
as a lactation aid anywhere.

Doctors in Canada and Mexico
are using it off-label.

Does Steve not like the formula
Dr. Hyland recommended?

I don't like it, Shaun.

I feel like... I feel
like a failure as a mom.

But you are not a failure.

You are following
all the recommended guidelines.

In fact, the only guideline
you're not following

is supplementing
with formula as advised.

Shaun...

I've been wanting
to be a mom for so long,

and part of that is my body
is supposed to give Steve

everything he needs,
and mine won't.

And I hate it.

Come in.

Good. You're both here.

An invite to Baby Eden's
Sip and See.

So everyone
can officially meet her

in a cute dress
instead of a hospital gown.

Is Dr. Glassman going?

- I think so.
- Then I do not want to go.

I thought you and Glassy
had worked things out.

He took Steve the other night.

Hmm.

Who cares if he's there?

As long as you
and that gorgeous baby make it.

Wouldn't miss it.

Isn't being a mom great?

The greatest.

You just said
you feel like a failure.

I think that is because
of a postpartum decrease

in estrogen and progesterone.

Did you just call me hormonal?

- No, actually reduced hormonal.
- Okay, Shaun.

- Time to go.
- This is my office.

Let's not have it
be your gravesite.

Huh. There's gotta be
something you can do.

We can't safely remove the tumor

without permanent injury
to your brain stem.

If you survive
the surgery at all.

I'm sorry.
I know it's a lot to take in.

But there's... there's new
technology all the time.

Nadal's back
with the stem cells,

and Bartolo Colon...

Experimental treatments on
athletes' orthopedic injuries

are completely different
than brain surgery.

C-Could you remove
some of the tumor?

Buy me more time?
How about chemo?

This type of cancer
doesn't respond to chemo.

We did read a paper in class
about a TCR approach.

Could that be something?

That was only done a few times,

and never
with brain stem involvement.

TCR.

It's my new favorite letters.

Whatever they stand for,
let's do that.

TCR means we would
saw up through your mandible

and dislocate your lower jaw.

Then we cut open
from the roof of your mouth

to the back of your throat.

That's just to access the tumor.

That tumor is woven
into your brain stem.

Removing it would very likely
leave you quadriplegic,

unable to speak or move,
if you survive the surgery.

Okay.

Maybe it's not my favorite.

But let's try.

Sal, you should enjoy
your remaining time.

Travel.

Connect with family.

Who am I gonna connect with?

Wife kicked me out
when I gambled away

the kids' college fund.

None of them
have talked to me for years.

I got a break coming my way.

I can feel it.

We've got
our annual presentation

to the managed care companies.

They want detailed reports
on patient outcomes

for diabetes, geriatrics...

That's great.
Schedule that for never.

- No, I've set it for tomorrow at 9:00.
- That's the wrong answer.

Unfortunately, I have
back-to-back surgeries.

Thank goodness I have a partner
to do the things I can't.

Oh.

You know, med students are
allowed to eat with the residents.

I find the sound of people
chewing to be unsettling.

Well, if you want some guidance

and you don't mind the sound
of sipping noises,

Jordan and I
can take you for coffee.

Ha...

Uh, baby, let me call you
right back.

Where did you get your bra?

I've always been intrigued
by lace. Is it okay?

Kind of busy right now.
Can we talk upstairs later?

What are you doing?

Just talking to a friend.

You called him "Daddy,"
but your dad's upstairs.

He's a client, a regular.

He paid me five grand
for a last-minute session.

Lucky for me,
he's into exhibitionism.

Five grand?
That's more than I made

a whole month waitressing,
including tips.

Do people tip sex workers?

Charlie, this isn't
any of our business, so...

Plenty of people know what I do.

Just not my actual father.

Please, you cannot
say anything to him.

Of course not.

Ah. Good news.

Donor lungs
just became available.

"Happy birthday, Daddy," indeed.

The donor's upstairs
on life support.

His family is ready
to withdraw care.

We'll take you
for some additional testing,

but the transplant could happen
as soon as tomorrow.

Wow.
- You'll need a bedroom on the ground floor

and an easily
accessible bathroom.

I can convert my office.

As long as you have privacy
elsewhere for your work.

Whoa, whoa, whoa.
Why'd you say "work" like that?

I mean, how much privacy do you
need for tech consultations?

Charlie's speech pattern
can be a bit unusual.

Her autism is awesome.

Thank you.

Don't mention it. Really.
Do not.

Love you, Daddy.

So many daddies, so little time.

Whoa, whoa.

What does that mean?

Uh, Dad, nothing.

I'm not asking you.
I'm asking her.

Saying "observe" isn't enough.

You need to tell them,
"Don't speak."

I realize that now.
So does The Dominator.

What are your thoughts
about the TCR?

You're considering the surgery?

It's either that or do nothing
and Sal is dead in a year.

A year is a year.
You're not his executioner.

So you wouldn't do it?

No, I'm not making
this decision for you.

You're an attending now.

Your surgery, your call.

What are you doing?

Work order says
deliver them here.

Signed by the president.

Co... president.

Once Rich's questions
picked up speed,

it wasn't long before
Charlie mentioned "sex worker."

Shortly thereafter, he banned Grace
from the room and called off the surgery.

Okay.

His oxygen saturation
is decreasing.

He is profoundly hypoxic.
Rich needs new lungs now.

I told him that.

He booked a flight
back to Florida.

Said he'll get
on the transplant list there.

No, no, no. His lungs
cannot handle transport.

Charlie's mistake is
endangering our patient's health.

Our patient is doing that
all on his own.

But Rich would not be upset
if Charlie had not revealed...

She didn't violate
any HIPAA laws.

The only thing she did wrong

was not keep Grace's
secret life a secret.

Which kind of sounds like
something you might have done

back in your first year.

Hmm.

Our patient needs a bilateral
whole-lung lavage

in order to get home safely.

Please get his consent.

Charlie can do scut work.

Dissecting the tumor
from the ventral surface

of the pons and cranial nerves.

Applied too much pressure.
Bleeder.

- Oh, God.
- What? Dom,

it's not even real.

Oh, God.

Again?

Again.

Have you eaten?

Two double cheeseburgers,

fries, coleslaw, cottage cheese,

a pudding, and fruit salad.

You know, hemophobia can make

for a pretty rough
surgical rotation.

You got any idea
how to get over it?

I gotta.

My brother and I,
we have this deal

to become family docs,
then move back home.

When our mother got sick,

we saw how lousy
medical care can get.

You could try exposure therapy,

watch a few hours
of blood draws.

Ooh, there's a twist.

You good?

Okay. Just breathe.

Shaun doesn't like her?
But she worships him.

Charlie blabbed to the patient,

blew up his double
lung transplant.

Double lumen
endotracheal tubes and clamps.

My guy did the same thing,
but in reverse.

Mentioned a virtually
impossible surgery.

Now the patient wants it.

I think I actually saw smoke
come out of Park's ears.

Well, 20% of med school
students don't make it,

and most of that happens
during surgical rotation.

I wonder which one
of our ducklings goes first?

Ten bags of saline.

Oh, you're gonna need a cart.

The big guy's on a mission.
I'll take the girl.

I've never said
those words before.

Done with my scut work.

You guys need a cart.

I'll be right back.

Hey.

Are you not going to go to Morgan's
baby thing because I might be there?

Yes.

Well, that's pretty dumb.

Don't you think it's time
we moved past this stuff?

No.

Well, I'm trying to.

I'm the one
who should be mad at you.

You should have met Steve
on the day he was born.

Yes. I should have.
I should have done that.

I was pretty upset back then.

You humiliated me,

and I'm not a surgeon now
partly because of you.

Did you forget that?

That is not an apology.

Drained ninth liter of effluent.

Left lung output
is looking clearer.

Did everyone
look at Grace's cam-girl site?

What is she doing here?

She was done with scut work.

Infusing another liter
of saline.

Grace put herself online
because she wants customers.

I'm giving her what she wants.

You actually subscribed?

I am a feminist,
and she's very beautiful.

Her site offers
tasteful nude portraits,

sensual shower videos,
and gritty bondage.

No amount of money
is worth selling your body.

Uh, $3.6 million a year
might be.

What about you, Dr. Murphy?

How would you feel if your son
ended up doing sex work?

What if he ends up sick

from cutting quartz countertops
for a living?

We can clear Rich to fly home.

But I need to talk to him first.

How long ago did she wake up?

About an hour or so.
I just fed her.

The patient wants to go for it,

and there's a non-zero
chance it works.

So do it.

Only the best of the best
could pull this off.

And what if that's you?

I've been in the OR with you.

I know your steadiness,

your precision,
your persistence.

I believe you can do this.

Maybe Eden should decide.

She agrees with her mama.

You are able to fly home now.

But you should listen
to your daughter.

Dad.

Please.

Dr. Murphy says
it's very unlikely

they'll find another donor
match before you die.

Take the lungs.

You don't have to live with me.
I'll find a place for you.

You have to stop
what you're doing.

No.

I like what I do.

I'm successful,
and I'm not hurting anyone.

You're hurting me.

My son, Steve,
is three weeks old.

I have been thinking about what
he might do when he gets older

that I would not approve of.

But I can't imagine
not wanting him in my life

unless he was cruel
or unkind to others.

She is kind and generous.

She loves you
and wants to care for you.

She seems like
a very good person.

You did raise Grace right.

You're a gambling addict
who showed up here

having already
thrown everything away.

The only way I do this surgery

is if I know you'll make
better use of the extra time.

- This doesn't seem ethical.
- It's not.

Convince me you'll
lead a life worth saving.

My name is Sal Zacharia,

and I have a gambling addiction.

I promise I will get treatment.

And you'll reach out
to your ex-wife,

try to reconnect
with your family.

How is this any business
of yours?

Tell me
why I should believe you.

Because I die if you don't.

I don't wanna die.

Let's get prepped for surgery.

Scrub your arms to three
inches above the elbow.

How did you get Rich
to change his mind?

Did you trick him?

I related to him as a father.

I have become very good
at displaying empathy.

Neurotypicals are weird.

Yes, they are.

Rinse your hands and arms
from fingertips to elbows,

one direction only.

I am displaying empathy now,
by allowing you into the OR.

You should be grateful
I was able to fix the case.

Hands up,
and don't touch anything.

My first time
being gowned and gloved.

Do we get to shave his chest?

It was done in pre-op.

Oh, I shave my own body hair,
so I'm great at it.

Not my chest, though.

I mean, my underarms,
my legs, my... Charlie.

Okay.
Please stop talking.

I... I, uh,
was just trying to...

You cannot touch your skin.

I didn't, I touched my earring.

You can't touch
any non-sterile item.

You've just contaminated
the surgical field.

You have to re-scrub in,

and we have to re-drape
everything.

- You're speaking very loudly.
- Go read the literature

on operating-room
sterile technique.

That won't help.
I'm an auditory learner.

You need to leave.

Okay? Leave now.

That looks fun.

Why did you e-mail
"Will not attend"?

You're clearly
skipping my baby's party

because you feel
like a failure as a mom.

But you're not.
And that's stupid.

And how can I help
if you won't just tell me

that you're having
breastfeeding problems?

Mm. I'm sorry.

I feel like a jerk complaining
to you about all of this.

I know I'm lucky
to breastfeed at all,

and I am not being rational.

You're not the only one failing.

When Eden cries
during the night,

Alex is the one who wakes up.

Every time.

During one
of his overnight shifts,

I slept through my own baby
crying for almost 20 minutes.

I mean, that's actual neglect.

Yeah, I'm pretty sure Child
Protective Services is downstairs.

Shut up, raisin boobs.

Mm.

You are the greatest mom.

Adopting a baby
with Turner syndrome,

caring for her
after two heart surgeries,

and somehow throwing a party
while being so put together.

And I use formula exclusively.

Finally got the last box
removed from my office.

- Space is a little tight.
- And yet, I found some.

Well, that's excellent use
of your co-presidential powers.

- I owe you.
- Oh, my God, can we please stop?

Can we...
Can we just have a truce?

- I'll think about it.
- Please?

I promise, from here on in,

I will check in
with all the big stuff.

Okay?

No more gotchas.

Happy birthday!

I sent the memo out
this morning.

Eighty?

You look really good
for your age.

I got booted out
of my first surgery

for contaminating
the sterile field.

I'm probably about to join you.

I fainted twice
at the sight of blood.

I'm already sweating
and seeing little black dots.

- What?
- Feel better?

That activated your sympathetic
nervous system.

More blood flow
means you won't faint.

Too bad I can't
do that to myself.

Try snapping your glove
against your wrist.

All right.
Let's cut.

Stair-step mandibulotomy
complete.

Dr. Wolke, dissect to the floor
of the mouth posteriorly,

then swing the tongue medially
and the mandible laterally.

Transecting eustachian tube
and elevating the pharynx

off the longus colli muscles.

We now have access to the
upper cervical spine and clivus.

Now comes the hard part.

Bring the Fabricius robot in.
Get the arms in position.

Have the Rhoton dissector
and ultrasonic aspirator ready.

25-degree angled
Rhoton dissector.

Dissecting a safe plane
between the tumor

and the ventral surface
of the pons and cranial nerve.

Final step.

Too deep here and the guy's
permanently paralyzed.

All tumor's out.

And heart is still beating.

I'm not okay.

Dad.
- Hmm?

Hey.

Hey! You're here.

Of course.

How do you feel?

Like I can breathe again.

Good.

I found a place that can help
with your meals and medicine.

You know, I...

I'd really like
to stay with you.

If the offer still stands.

Of course it does.

Yeah?

Yeah.

You're a good person.

Hello.

I would like a report
on what you've learned

from the sterile techniques
manual.

I'll e-mail it.

I'm reorganizing
for peak efficiency.

Making a great day greater.

No. Excuse me.
Today was not a great day.

Nor was yesterday.

You made several big mistakes
and dozens of small ones.

My anatomy professor told us
it's okay to make mistakes.

That's how we learn.

Your professor is wrong.

And so is this re-organization.

I had everything
in the proper place.

Restore it, then go home.

Looks like we both
caught a break.

Mm.

Hmm.

Is Janet your ex-wife?

Nice.

Looks like she's pretty excited

about you getting
into treatment.

Mm.

And you got a confirmation
for the bets you just placed.

Good luck, Sal.

You okay?

Dr. Murphy doesn't appreciate
efficient organization skills

when he sees it.

Hmm.

I do.

That doesn't matter very much.

You're not my hero.

Sure about that?

That's that smile
I like to see. Whoo!

You're so sweet.

Formula?
- You were right.

No guilt, okay?

I'm proud of you.

Also, supplementing
has advantages for Mama.

Bless your dear, dear soul.

Because we've had
a long couple of days

with our new babies.

My first med school rotation
was oncology.

I was doing patient intake,
and I asked a woman

if she'd been keeping up
with her mammograms.

It was a follow-up
to a double mastectomy.

Mine was obstetrics.

It was my first delivery,

and the doctor handed me
the newborn,

and I said, "Ew,"
like, out loud.

When I was in my first
ever surgery, open heart,

the attending asked me
what the ACT was.

I proudly said,
"Activated clotting time."

She said,
"I know what it stands for.

"I need you
to tell me the number."

Wow.

Mm-hmm. That attending could
have thrown me out of the OR.

But she mentored me instead.

Yeah.

To taking care of our ducklings.

Yeah.

I have heard valid arguments
both for and against sex work.

Are you considering
a career change?

But it doesn't matter.

It is okay for family
to disagree.

Being a family who argues

is more important
than not being a family at all.

I'm sorry it took me
so long to meet you.

I look forward to spending
some more time together.

Okay?

He was saying that for me.

Hi.

I got ya.