All language subtitles for The Good Doctor S03E12 Mutations

Those are yours.

We bought them together.

Because you found the pattern soothing.

I'm gonna miss you, Shaun.

I love Carly.

And that's great.

I am so happy for you.

Now you can hang
the toilet paper incorrectly

any time you want,

and Carly and I can go back
to the way things were before our fight.

Well, sometimes couples
need a little time to recover.

We won't.

Carly asked for you to move out.

You are moving out.

How many kidneys do I need
in my body to attend prom?

- Ryan...
- Even if the surgeon removes my kidney,

it'll be laparoscopic,

so my in-patient time
will be seven days, tops,

and then three more days
of rest at home.

I can take my girlfriend to prom, right?

That's not a purely medical decision.
I have to draw blood.

What are the chances Dr. Melendez

might remove the tumor
but spare Ryan's kidney?

Well, the MRI will let us know
how much the chemo

has shrunk the tumor,
but you shouldn't count on it.

One chili burger,
extra mustard, extra pickles.

Hey. Morning, Mr. Cooper.

He can't have that with his surgery.

Oh, he's fine until about 6:30 tonight.

I know you.

Angie Valens.

I helped put in your chemo port.

I owe you a big thank you. Ha-ha.

- We met in chemo.
- Mm.

They should put us in a public service
announcement or something.

Yeah. I lost a tumor
and gained a boyfriend.

Thanks, chemo.

- James McDougall?
- That's who we're here for too.

All of you can head over
to Bay Four.

Guy saw me six months ago
for a stress fracture.

He's a lunatic ultra-marathoner.

I just hope he didn't go too hard
too soon and break it again.

He didn't break it again.

Your GP was right to start you
on ketoprofen for the swelling,

but clearly it isn't working.
That's why Murphy and Reznick

are going to block off
some of your lymphatic channels.

It should reduce production.

- The more pressing concern is why.
- Ever had surgery on your lymph nodes?

What about cancer,
or radiation treatment?

No. Physically,
I've always been healthy.

Physically?

I was diagnosed with persistent
depressive disorder when I was 16.

That's why you gotta get me back
out on the road, doc.

Are antidepressants not effective?

I mean, they help,
but running really is key.

It saved my marriage and my life.

Lymphedema can be caused
by an infection.

He doesn't have a fever.

Ketoprofen can suppress fevers.

Let's get cultures and start him
on broad-spec antibiotics.

As requested,
your restock on enemas.

Nice cover.

- How've you been feeling?
- The methotrexate is working great.

No pain, no redness.

- Stiffness, flu-like symptoms?
- No, all good.

How long are you planning
to hide out doing RA exams

and clipping diabetics' toenails?

Dizziness, headaches, nausea?

Uh, sometimes I'm a little queasy
after I eat.

You had to love neurosurgery.

How about we try to get you a medication
that doesn't irritate your stomach?

No. My hands feel great,
that's all I care about.

You used to open up skulls
and poke around people's brains.

No way this fulfills you.

I enjoy it.

Or rather, I usually enjoy it.

I'll let you get back to it.

Maybe someone out there
needs an enema.

Got a measurement
on the Wilms' tumor?

Not quite there yet.

You mentioned seven centimeters as
our limit to doing this laparoscopically.

What if we pushed it to 7.2?

It would speed up recovery.

By a few days.

Forget I brought it up.

Ryan wanting to take his
girlfriend to prom

should not factor into our surgical plan.

- Is he nuts about her?
- Oh, crazy, head over heels in love.

They both are.

Idiots.

I wouldn't mind being an idiot
like that again.

Though I'm not sure
I ever felt that way.

You know, totally happy.

So therapy's going well?

No metastasis in the lungs.

Look at that.

Your tumor is gone.

Gone?

How's that possible?

The chemotherapy worked
better than we expected.

Wait, like, no tumor? Zero?

- No need for surgery whatsoever?
- That is right.

- These are discharge forms.
- Oh, my God.

Both of my kidneys
are taking you to prom.

Hell, yeah they are.

I'm so... I'm s...

Angie?

- Angie!
- She's having a seizure.

Angie.

Two milligrams of lorazepam
and portable oxygen, stat.

Let's get that under her head.

His lungs are filled with fluid.

I need a chest X-ray
and a bedside ultrasound.

And page Dr. Reznick.

Imaging has confirmed
reoccurrence of your brain tumor.

What stage?

Three.

Now, the best approach is surgery.

A wide resection of the tumor
followed by radiation and chemo

to encourage full remission.

Sounds like a fun couple of months.

Full recovery will probably
take closer to eight.

We can get through this, baby,
just like last time.

When will the surgery be?

We need to do additional imaging,

and I'd like to consult a colleague
about the best approach.

That'll take a few days.

Take your time.

Prom?

Yeah. Now that Ryan can go,

- I have to go. I can't...
- Angie, honey.

This is your health
we're talking about.

Mom, please.

I just wanna do this one thing
like a normal kid.

Can you tell her it's okay?

We can't. Until we remove
your tumor, you're at risk

of potentially fatal seizures.

After you're recovered,
you and Ryan can get all dressed up

and we'll go have dinner
at the Grandview. Okay?

Prom sucks.

My buddy had a fake ID.

I got so drunk I passed out
and never made it into the dance.

Maybe that wasn't
everybody's experience.

I was prom king, my date was queen.

What? I had the dress, the date,
I had the mom who got arrested.

Spent the night picking her up
from the drunk tank.

You see Park while you were there?

Go to Scheduling,
get Angie's surgery set for Friday

with the best neurosurgery OR nurses.

Let's go see Glassman.

Now I'm identifying
the sub-millimeter lymphatic vessels.

I need an 11-0 micro suture
and a 70-micron needle.

Instead of harvesting nodes
to this area,

could we redirect lymphatics
away from his lymph system?

We could.

If you identify an appropriate vessel,
you can make the connection.

We're clearly not dealing
with an infection.

There must be a blockage
somewhere in his lymph system.

Most likely cancer.

His CBC didn't show
any abnormal cells.

Lymphoma doesn't always show up.

We need to run cytology
on his lymphatic fluid.

It's either gonna be nasty
or very nasty,

depending upon how it attaches
to the thalamus and fornix,

which no imaging or testing
can possibly determine.

So our options are...

Between an endoscopic approach
or an open anterior one.

That is correct.

I'd run a stereotactic MRI
with fiducials

and DTI to gauge how close
the white matter tracts actually are.

You should scrub in.

Another doctor can cover the clinic.

I haven't been in an OR
in over a year,

and then, as a patient.

I'm not asking you to cut,

but it'd be a huge value to have you.

I appreciate that.

I'll consider it.

Hello. We need to run cytology
on this lymphatic fluid.

I would be happy to.

Lea moved out this morning.

Thank you.

You're welcome.
Can you come over tonight?

- Uh, that probably won't work.
- Or we could go to your apartment.

I can't.

Lea said that
it might take time for us

to recover from our fight,
but I told her that we were okay.

We are.

I made plans tonight,

to hang out with a friend
who just got fired.

But I would love
to come over tomorrow night.

Okay.

I'll put a rush on this test too.

Your lymphovenous
anastomosis technique,

I was impressed.

It's a little early in the morning
to be sucking up, Reznick.

Not for me,
I like to get a jump on things.

I'm fascinated by the way
you use plastic procedures

like microsurgery
in other surgical specialties.

I thought it might make
an interesting topic for a paper.

Wanna write it with me?

- Yes.
- Let's talk and eat.

That's not breakfast.

I'm buying.
What publications do you wanna target?

Last time,
Angie had bad post-op vomiting.

- Of course, I'll make a note of it.
- Excuse me.

She's asleep.
She needs her rest.

- I'll wait until she's awake.
- Ryan, your immune system is weak.

It would be easy for you
to pick up a bug and pass it to Angie.

I haven't been around
anyone but my dad.

He could wear a mask.

After Angie's surgery,
we'll see about arranging a visit.

You just tell her Ryan came by.

I'm sorry if I overstepped.

I'd like to change Angie's status
to "no visitors" on her chart.

Yeah.

Please take Mr. McDougall
to his room. I'll be there in a moment.

Personnel...

Is that James McDougall?

- And the woman with him?
- His wife.

Is it cancer?

No, worse.

His lymphedema is caused
by a genetic mutation.

If you don't find a medication
he responds to,

he'll drown from the inside.

The mutation is on James' ARAF gene.

It makes an enzyme called kinase,

which can cause cells
to over-proliferate.

It's a genetic condition.

What set it off now?

Probably the stress fracture.

Sent his immune system into overdrive,
fired up his lymphatic system.

What treatment protocol
targets this mutation?

An MEK inhibitor.

The problem is, which one?

There are 41 possibilities,
each with different side effects.

Good luck.

I was hoping you could stay.

Okay, sure.

We need you to stay completely still.

Not a problem.

You okay?

Ryan totally bailed.
He hasn't come back to see me.

If you tell her that her mom said
he couldn't visit,

she'll be pissed at her mom.
How's that gonna help?

He's probably busy
catching up at school.

We had a pact.

As long as we were together,
cancer wasn't gonna beat us.

He broke it.

Cancer wins.

Do you mind finishing?

- Imaging finished?
- Not quite.

Mrs. Valens,
Angie would really like to see Ryan.

I know you're concerned about infection,
but there is minimal risk.

Actually, none,
if they do a video chat.

Interesting idea.

I'll think about it.

Angie's depressed,

and studies have shown
that can have a negative impact

on her surgical outcome.

You know, Ryan doesn't always
improve Angie's mood.

A couple of weeks ago,
they had some silly fight

and she cried for days.

Thank you for letting me know.

I'm gonna do my best
to cheer her up.

She's a 16-year-old,
she wants her boyfriend.

Yeah. And how smart were you
when you were 16?

Well, what about selumetinib?

It's shown promising results
on related conditions.

And a high occurrence of liver disease.

Binimetinib is similar,
but has fewer complications.

Any objections?

Let's start James on that.

This is exciting, working together.

It is, although I'm used to...

samples and slides
instead of patients.

Patients can be difficult,
but you will be fine.

Do you need something?

I was curious how James
was responding to binimetinib.

Urine output is up,

which suggests
the lymphatic fluid...

And his potassium is a little low.
Can you give him this?

I wasn't really...

Hi, I'm Dr. Lever.

The tumor is abutting
and possibly infiltrating

the white matter tracts
of her fornix.

We'll likely have
to remove a section.

That'll affect her ability
to form memories.

With neuropsych rehab, she may be able
to compensate with other pathways.

Studies have shown positive attitudes
lead to positive outcomes.

- Worried about her attitude?
- She's worried about young love.

I'm worried about
what Angie is facing after surgery.

Physical therapy,
cognitive therapy,

one challenge after another,
and what she wants is so simple.

Wanna make a sad kid happy?

I guess I do. Which isn't my job
and I need to stop

getting sucked into personal issues.

Is there a way to do that
without antagonizing the mother?

Maybe.

Then make her happy.

We've never gotten
this far before.

No, we haven't.

And you're okay?

I am very okay.

Oh, Carly.

Okay.

Did I do something wrong?

No. I'm sorry, it's me.

You said we were okay.

I thought we were.

- I want us to be.
- You have no reason to still be mad.

I'm not mad. I'm just...

It's Morgan.

The medication
caused James an upper GI bleed.

Have you localized
the source of the bleeding?

Working on it.

Seems to be coming
from the antrum of the stomach.

We've stopped the binimetinib.

On top of causing this,

it hadn't done much
to curtail swelling.

- Where's Dr. Lever?
- There's the ulcerative lesion.

Cautery.

Zebrafish.

They're used in medical research
because of their quick maturation

and 84 percent of genes
associated with human disease

have a zebrafish equivalent.

You think we should do
a transgenic expression

of James' ARAF mutation
into the zebrafish genome.

Translation for those of us
without a genetics textbook handy?

We make mini-Jameses,
as zebrafish,

all with the same disorder.

Then we test every conceivable drug
on those fish.

How long before
we could start testing?

If we implant the embryos now,
probably late afternoon tomorrow.

Get going. Shaun, go with her,
you have path experience.

I understand no means no.

If you don't want to have sex...

I accept that.

But I am very confused.

So am I.

I thought I was fine until I...

I told Lea to move out
like you wanted.

You said that things were okay.

They aren't.
How do I make them okay?

I can't tell you
because I don't know.

When I was in chemo, the nurses
used to force that stuff down my throat,

so I know you're not drinking it
because of the taste.

Fast, easy nutrition.

That and you don't end up
puking your guts out in the bathroom.

I was president of this hospital
for over 10 years.

I made a few friends,
including Jack the janitor.

Talks a lot, A's fan, horrible gossip.

If the methotrexate is making you sick,
we should try another medication.

How can you guarantee
you're not gonna throw up

in the middle of surgery?

It won't happen.

Because it only happens
if I eat solid food,

and I've stopped.

At least at work.

That is a lot of fish tanks.

Forty, so we can test all
of the possible medications for...

Are you throwing a party?

Hope so.

Oh.

How are you doing, Shaun?

Since your father passed away?

Don't think about him very much.

My mom died recently.
I don't know if you knew that.

She pops into my head
all the time.

Not always the nicest thoughts.

It's okay not to love them.

They didn't make us who we are.

Has your mom gone home?

There is one more thing
we have to deal with tonight.

Come on.

How many more sets of imaging
can you possibly do?

One of these is your prom dress.

I like the pink, but I think
you'd look gorgeous in both.

Hurry up and choose.
Your date will be here soon.

All the medications are in.

Which means more waiting to see
which medicine works.

It's hard to be patient.

Do you think the fish control
how they react to the meds?

No.

It's just how their bodies respond.

That's how I felt last night.

I thought I was ready for us
to be together, but...

my body had a different response.

I can't turn that response off
any more than these fish can control

how their mutation reacts
to the medication.

Was our mutation...

me going to Wyoming with Lea?

Do you think...

we can find our right medication?

♪ I found a love for me ♪

♪ Darling, just dive right in ♪

♪ And follow my lead ♪

♪ Well,
I found a girl beautiful and sweet ♪

You look amazing.

♪ I never knew you were the someone
Waiting for me ♪

So do you.

♪ 'Cause we were just kids
When we fell in love ♪

♪ Not knowing what it was ♪

♪ I will not give you up ♪

♪ This time ♪

♪ But, darling, just kiss me slow ♪

♪ Your heart is all I own ♪

♪ And in your eyes you're holding mine ♪

♪ Baby ♪

♪ I'm dancing in the dark ♪

♪ With you between my arms ♪

♪ Barefoot on the grass ♪

♪ Listening to our favorite song ♪

♪ When you said you looked a mess ♪

♪ I whispered underneath my breath ♪

Looks like you might be feeling
a little idiotic happiness right now.

Mm.

Maybe a touch.

Dance with a prom king?

Oh. Ha-ha.

♪ You look perfect tonight ♪♪

He's tachycardic.

We were talking,
and then he just stopped.

We need to do a pericardial tap.

Call the Cath lab, tell them we're coming.

No time. We're doing it here.
James,

the pain in your chest
is too much fluid around your heart.

We'll put a tube
into your chest to drain it.

Call Shaun and Carly,
tell them we're running out of time.

♪ I will be loving you till we're 70 ♪

♪ And, baby, my heart could still fall as ♪

It was good.

♪ Hard at 23 ♪

♪ And I'm thinking about how ♪

♪ People fall in love
in mysterious ways ♪

I brought Angie's Bearfeet Bear.
It always makes her feel like sh...

♪ Of a hand ♪

It's prom.

Ryan has been wearing his mask
all night.

♪ And I just wanna tell you I am ♪

♪ So, honey, now ♪

♪ Take me into your loving arms ♪

Don't let her stay up too late.

♪ Kiss me under the light
Of a thousand stars ♪

♪ Place your head
on my beating heart ♪♪

Morgan called.
James isn't doing well.

Cross SL-327 off the list.

I see one...

No, two tumors.

Okay. This is my stop.

I'll see you after.

I love you.

I love you too, Mom.

Don't worry, okay?

I got this.

I know you do.

Okay.

Okay.

What if I wake up
and don't remember Ryan at all?

Then...

you'll have a chance to fall in love
with him all over again.

- Okay. Okay.
- Okay.

We're down
to five potential options.

I don't need five potential,
I need one actual.

- There are two that best curb.
- Choose one.

We should try refametinib.

It caused abnormal cell growth.
Trametinib is safer.

Which doesn't mean it's safe.

Well, nothing's safe.
Which do you want us to do?

Trametinib. That's the one.

Saline in.

Advancing scope
toward the third ventricle.

Claire, hold gentle pressure on the tumor
while I cut off its blood supply.

We've got some significant bleeding.

Adjust the scope and suction.

Look higher.

The septal vein,
there's your bleeder. Cauterize away.

Micro-dissector.

The tumor's immobile.

I can't resect it without injuring
the nerve tracts. She'd be comatose.

Try sharp dissection.

- I can't get a plane.
- How bad?

It's completely invaded
her thalamus.

Thin it out
with the suction aspirator.

It's too adherent.

If I keep going,
I'm gonna kill her.

Any ideas?

Tell ICU Angie will be coming
sooner than we planned.

Let's close her up.

What's next?

Another round of radiation?
Chemo?

Her carcinoma is unlikely
to respond to those therapies.

No. We have to try.

- Angie will want to fight.
- She's seizing.

Get me lorazepam and Dilantin, stat.
Have phenobarb and propofol on deck.

You're crying.

Yes.

Why?

I found James on Facebook.

He and Marjorie
wanna go to Costa Rica.

Their dog is a three-legged rescue
named Tripod.

He's not a slide, he's a person.

He is a good person,
and he might die.

This is why
I like to stay in the lab.

That...

is a very dumb thing to say.

If you had stayed in the lab,

James would probably
be dead already.

Your plan with the zebrafish
gave him a chance.

It was a beautiful, perfect idea,

from a beautiful,
almost perfect person.

Your earlobes are lopsided.

I'm so sorry.

We couldn't save her.

Ms. Valens?

Nice call on the zebrafish.

About our paper,
let's meet weekly.

I'm thinking lunch every Tuesday
in the cafeteria.

Perfect.

I heard about Melendez's patient.

Yeah.

You were right,

I should probably try
another medication for my RA.

I need solid food.

Claire, wait up.

You okay?

Fine. I'm just tired.

You did an amazing thing for Angie.

You gave her mother a memory
that she will have forever.

Yeah, well, it won't make up
for the daughter she lost.

You're angry.

I'm not, I am sad.

- Who are you angry at?
- I'm not.

Are you angry at me and Glassman,
because we couldn't save her?

- No.
- At Angie?

No, you can't be mad
at someone for dying!

That's not true, you know that.

She was sick,
and she was trying to get better.

She failed, and left you alone,

after you spent a lifetime
trying to take care of her.

You have every reason
to be mad at your mother.

But I hate feeling this way.

My whole life I have been angry at her,
and now it will never change.

I don't know how to stop.

Therapy will help.

Time will help.

There is one other thing
that's worked for me.

Did we fix our mutation?

- Oh...
- Ha-ha-ha.

That the best you got?