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1
00:00:04,676 --> 00:00:06,911
I'm incising
the uterine wall.
2
00:00:07,259 --> 00:00:09,806
You're doing great,
really great.
3
00:00:09,939 --> 00:00:11,400
It's gonna be okay.
4
00:00:11,674 --> 00:00:13,127
You promise?
5
00:00:14,744 --> 00:00:17,689
- Baby's out.
- Umbilical clip. Suction.
6
00:00:17,790 --> 00:00:18,885
Please...
7
00:00:19,291 --> 00:00:20,947
can I see my daughter?
8
00:00:21,110 --> 00:00:22,259
Yes.
9
00:00:22,392 --> 00:00:23,643
Of course.
10
00:00:25,921 --> 00:00:27,207
Sorry.
11
00:00:27,293 --> 00:00:29,335
We'll need to get her
into surgery.
12
00:00:29,421 --> 00:00:31,188
We'll take good care of her.
13
00:00:44,205 --> 00:00:46,961
Your New Chief
is fashionably late.
14
00:00:47,268 --> 00:00:48,572
Our Chief.
15
00:00:48,807 --> 00:00:51,463
Just because I endorsed
Dr. Han to the Board
16
00:00:51,549 --> 00:00:53,135
doesn't mean
I don't have any concerns.
17
00:00:53,221 --> 00:00:55,478
Connections like Dr. Han's
come at a premium
18
00:00:55,564 --> 00:00:57,494
and, he assures me,
will be well worth it
19
00:00:57,580 --> 00:00:59,550
given our current predicament
with the Medical Board.
20
00:00:59,635 --> 00:01:01,604
I'm not just worried
about the money.
21
00:01:02,119 --> 00:01:03,643
When you pay that much,
22
00:01:03,736 --> 00:01:05,542
they tend to think
they're worth it.
23
00:01:06,376 --> 00:01:08,361
Makes a person think
they don't have to show up
24
00:01:08,447 --> 00:01:10,087
for their own welcome brunch.
25
00:01:21,656 --> 00:01:23,280
The baby's bowel protrusion
26
00:01:23,366 --> 00:01:25,832
seemed less severe
on the prenatal imaging.
27
00:01:26,124 --> 00:01:27,436
And it'll have to wait until
28
00:01:27,522 --> 00:01:28,976
we're done
with her heart problem.
29
00:01:29,153 --> 00:01:30,296
Now that I'm in here,
30
00:01:30,382 --> 00:01:32,835
her septum looks more like
Swiss cheese.
31
00:01:36,022 --> 00:01:38,437
Page the on-call
neonatal cardiac surgeon.
32
00:01:38,718 --> 00:01:40,772
That won't be necessary.
I'll scrub in.
33
00:01:41,062 --> 00:01:42,569
And who are you?
34
00:01:42,827 --> 00:01:44,101
I'm Jackson Han.
35
00:01:44,319 --> 00:01:45,968
Your new Chief of Surgery.
36
00:01:50,077 --> 00:01:52,233
*The Good Doctor*
Season 02 Episode 15
37
00:01:52,386 --> 00:01:55,358
*The Good Doctor*
Episode Title: "Risk and Reward"
38
00:02:02,697 --> 00:02:04,429
Echo probe, please.
39
00:02:06,155 --> 00:02:07,905
And let's turn
that music on.
40
00:02:12,525 --> 00:02:14,616
Advance the delivery sheath.
41
00:02:16,600 --> 00:02:18,522
It's in the patient's heart,
Dr. Murphy.
42
00:02:18,726 --> 00:02:21,453
I think the music
is a little distracting.
43
00:02:21,538 --> 00:02:24,483
I feel the same way about
operating without music.
44
00:02:25,085 --> 00:02:26,554
I'll take a longer sheath,
45
00:02:26,687 --> 00:02:29,272
and Dr. Murphy
will need some forceps.
46
00:02:30,580 --> 00:02:32,858
♪ Well, the neon lights ♪
47
00:02:32,944 --> 00:02:34,593
♪ Glowed red and gold ♪
48
00:02:34,679 --> 00:02:37,804
- ♪ I came to hear my fortune told ♪
- 5-second rule.
49
00:02:37,890 --> 00:02:40,338
♪ I can't imagine what she saw ♪
50
00:02:40,423 --> 00:02:44,742
- ♪ While gazing in her crystal ball ♪
- It was a joke.
51
00:02:45,147 --> 00:02:46,177
What about her bowels?
52
00:02:46,262 --> 00:02:49,312
Why isn't Dr. Lim inserting it
into the abdomen right now?
53
00:02:49,444 --> 00:02:51,582
There is not enough room.
54
00:02:52,077 --> 00:02:54,202
There's...
There's not enough room
55
00:02:54,288 --> 00:02:55,967
without increasing
abdominal pressure,
56
00:02:56,053 --> 00:02:59,272
which would critically decrease
blood flow to the bowel.
57
00:02:59,358 --> 00:03:01,625
According to what
hemodynamic principle...
58
00:03:02,131 --> 00:03:03,124
Dr. Browne?
59
00:03:03,210 --> 00:03:05,217
Vascular impedance...
blood flow is driven
60
00:03:05,303 --> 00:03:06,942
by the force induced
by the pressure gradient.
61
00:03:07,027 --> 00:03:08,905
And how do you
calculate it?
62
00:03:10,102 --> 00:03:11,835
Uh. Um...
63
00:03:11,975 --> 00:03:14,022
I-I'd have to look it up.
64
00:03:15,405 --> 00:03:18,499
8 times L.Nu. divided by Pi.R.4.
65
00:03:18,616 --> 00:03:20,477
Very good, Dr. Murphy.
66
00:03:20,631 --> 00:03:22,545
That's also why
this occluder won't work.
67
00:03:22,639 --> 00:03:24,578
It won't hold up against
the huge pressure gradient
68
00:03:24,663 --> 00:03:26,491
- in her heart.
- Is there a fix?
69
00:03:26,577 --> 00:03:28,483
Long-term,
I don't have one.
70
00:03:28,577 --> 00:03:31,053
Right now,
I need umbilical tape and PE tubing.
71
00:03:31,139 --> 00:03:33,957
♪ I gotta get away from here ♪
72
00:03:34,042 --> 00:03:37,060
♪ I'll never see the golden sunrise ♪
73
00:03:37,510 --> 00:03:41,510
- ♪ Oh, I gotta get away from her ♪
- You're making a pulmonary artery band.
74
00:03:41,596 --> 00:03:42,737
That should buy us
some time
75
00:03:42,823 --> 00:03:45,364
to come up with a plan
before we lose this baby.
76
00:03:46,354 --> 00:03:48,596
♪ Oh, if I leave this place alive ♪
77
00:03:51,770 --> 00:03:53,854
Lab technician to O.R. 6.
78
00:03:53,984 --> 00:03:56,197
Lab technician to O.R. 6.
79
00:03:58,143 --> 00:04:00,248
You canceled
my hernia repair?
80
00:04:00,541 --> 00:04:03,026
With no advance notice.
Sorry about that.
81
00:04:03,237 --> 00:04:04,674
But so great to meet you.
82
00:04:04,760 --> 00:04:05,877
Jackson Han.
83
00:04:05,963 --> 00:04:07,658
- Neil Melendez.
- Oh, I know.
84
00:04:07,829 --> 00:04:10,057
You did great work on
that piggyback heart transplant.
85
00:04:10,143 --> 00:04:11,213
Huh.
86
00:04:11,299 --> 00:04:13,565
I need a consult
on Minesh Goyal.
87
00:04:13,651 --> 00:04:14,736
He's the founding CEO
88
00:04:14,822 --> 00:04:16,120
- of a company...
- What's his diagnosis?
89
00:04:16,205 --> 00:04:17,416
He doesn't have one.
90
00:04:17,502 --> 00:04:20,510
He's here for a full physical,
complete diagnostic workup.
91
00:04:20,643 --> 00:04:23,236
I have a long-standing
Executive Wellness...
92
00:04:23,322 --> 00:04:25,643
I'm a surgeon,
not an internist.
93
00:04:25,955 --> 00:04:27,443
I don't do preventative medicine.
94
00:04:27,666 --> 00:04:29,861
No matter
how rich the patient is.
95
00:04:30,729 --> 00:04:32,940
You know what's great
about rich patients?
96
00:04:33,549 --> 00:04:35,799
They allow us to treat
poor patients.
97
00:04:36,510 --> 00:04:38,291
Also, I promised Minesh
the very best.
98
00:04:38,377 --> 00:04:40,229
So, really,
who else am I gonna get?
99
00:04:42,042 --> 00:04:43,658
Dr. Johansen to pre-op.
100
00:04:43,743 --> 00:04:45,910
Dr. Johansen to pre-op.
101
00:04:47,359 --> 00:04:49,549
BP's 110 over 70.
102
00:04:50,151 --> 00:04:52,588
Uh, Jackson...
Dr. Han...
103
00:04:52,705 --> 00:04:54,377
says great things
about you.
104
00:04:55,763 --> 00:04:57,385
That's very kind.
105
00:04:58,517 --> 00:05:00,877
Normal EKG, optimal BMI,
106
00:05:00,963 --> 00:05:02,065
heart and lungs sound good.
107
00:05:02,151 --> 00:05:04,127
Any reason you're worried
enough about your health
108
00:05:04,213 --> 00:05:06,057
to endure
an entire day of tests?
109
00:05:06,232 --> 00:05:07,830
I'm not worried.
110
00:05:09,669 --> 00:05:11,307
Knowledge is power.
111
00:05:11,799 --> 00:05:13,400
Whenever I enter
a new market,
112
00:05:13,486 --> 00:05:15,924
I learn everything I can
about the landscape...
113
00:05:16,119 --> 00:05:18,955
consumer needs,
target market, competitors.
114
00:05:19,041 --> 00:05:21,002
You're aware
your body isn't a business.
115
00:05:22,330 --> 00:05:24,338
I know I sound like
a rich lunatic
116
00:05:24,424 --> 00:05:27,658
with fantasies about controlling
every aspect of my life.
117
00:05:28,691 --> 00:05:30,338
And I guess
I kind of am.
118
00:05:33,830 --> 00:05:36,091
My dad was
in good shape, too.
119
00:05:36,905 --> 00:05:39,295
Until he dropped dead
on his daily jog.
120
00:05:50,386 --> 00:05:51,637
Hi.
121
00:05:52,044 --> 00:05:55,340
Dr. Markiel, please
come to the mental health unit.
122
00:05:55,598 --> 00:05:59,458
Dr. Markiel, please come
to the mental health unit.
123
00:06:10,159 --> 00:06:11,324
Hi.
124
00:06:12,598 --> 00:06:14,915
Hi. I'm Larry Childs.
125
00:06:15,152 --> 00:06:16,895
I'd shake your hand,
but, you know,
126
00:06:16,981 --> 00:06:18,871
no functioning immune system.
127
00:06:19,538 --> 00:06:21,871
- Aaron. Hi.
- Good to meet you.
128
00:06:21,973 --> 00:06:23,621
What flavor cancer
do you have?
129
00:06:24,847 --> 00:06:26,664
- What flavor?
- Yeah.
130
00:06:26,812 --> 00:06:28,195
Glioma.
131
00:06:28,331 --> 00:06:29,696
Shut the front door.
132
00:06:29,980 --> 00:06:31,576
Brain or spine?
133
00:06:32,051 --> 00:06:33,500
- Brain.
- Dude...
134
00:06:33,772 --> 00:06:34,855
we're tumor twins.
135
00:06:34,988 --> 00:06:37,355
Wh-What do they have you on?
136
00:06:37,801 --> 00:06:39,238
Ooh. Vincristine.
137
00:06:39,324 --> 00:06:40,387
I hear that's intense.
138
00:06:40,473 --> 00:06:42,274
My doc thought
it would wipe me out.
139
00:06:42,699 --> 00:06:44,855
You doing okay
or longing for death?
140
00:06:44,941 --> 00:06:46,896
I am hanging in there.
Thank you.
141
00:06:47,503 --> 00:06:50,082
I'm on my third round
of temozolomide.
142
00:07:00,533 --> 00:07:02,488
I've seen you in here a few times.
143
00:07:04,559 --> 00:07:06,359
I've seen you in here
a few times.
144
00:07:06,445 --> 00:07:08,262
You kind of keep
to yourself, huh?
145
00:07:08,986 --> 00:07:10,236
Yeah.
146
00:07:10,473 --> 00:07:12,137
Well, I'm happy
to introduce you around.
147
00:07:12,223 --> 00:07:13,255
It's a really friendly group.
148
00:07:13,340 --> 00:07:14,477
I'm okay. Thank you.
149
00:07:14,563 --> 00:07:16,426
You have a support group
you go to?
150
00:07:17,105 --> 00:07:18,638
I do not.
151
00:07:19,410 --> 00:07:21,504
Everyone needs
a cancer community.
152
00:07:54,861 --> 00:07:56,560
And try to hold still.
153
00:07:57,761 --> 00:07:59,049
Thank you.
154
00:07:59,536 --> 00:08:00,753
For bringing us in.
155
00:08:00,839 --> 00:08:03,534
This is the new Chief's patient.
It's a great opportunity.
156
00:08:03,722 --> 00:08:06,331
Or it's a bunch of
pointless tests.
157
00:08:07,987 --> 00:08:09,862
Uh, for which I thank you.
158
00:08:10,534 --> 00:08:12,081
Tell us about Dr. Han.
159
00:08:12,167 --> 00:08:14,682
He's direct, charming,
160
00:08:14,768 --> 00:08:16,069
very sure of himself.
161
00:08:16,155 --> 00:08:17,635
Big ego.
162
00:08:21,814 --> 00:08:24,776
There's nothing wrong with
an ego if you can back it up.
163
00:08:24,862 --> 00:08:26,831
And Dr. Han's
arterial switch technique
164
00:08:26,917 --> 00:08:28,862
is performed all over the world.
165
00:08:29,057 --> 00:08:30,924
The tests aren't all pointless.
166
00:08:31,010 --> 00:08:32,416
Way to stand firm, Park.
167
00:08:32,501 --> 00:08:33,839
No, look at the monitor.
168
00:08:34,002 --> 00:08:35,604
He has a tumor.
169
00:09:00,795 --> 00:09:02,445
Percy's stable?
170
00:09:02,880 --> 00:09:05,448
We're naming her
Persephone.
171
00:09:05,677 --> 00:09:09,240
Yes. I put in a central line
for nutrition.
172
00:09:09,326 --> 00:09:10,810
Percy is stable right now.
173
00:09:10,896 --> 00:09:13,349
We're looking for solutions
to her problems.
174
00:09:13,662 --> 00:09:15,560
W-Wh-Why does...
175
00:09:15,683 --> 00:09:18,388
Why does she have
all these birth defects?
176
00:09:18,474 --> 00:09:19,703
Diane.
177
00:09:20,048 --> 00:09:21,740
We spoke to our obstetrician.
178
00:09:21,826 --> 00:09:24,427
She said these defects can
happen for no reason, right?
179
00:09:26,100 --> 00:09:27,216
That's true.
180
00:09:27,302 --> 00:09:30,154
Over 50% have no known cause.
181
00:09:32,092 --> 00:09:36,998
I was taking paroxetine
for clinical depression.
182
00:09:37,084 --> 00:09:38,279
And you went off the meds
183
00:09:38,365 --> 00:09:39,741
as soon as you found out
you were pregnant.
184
00:09:39,826 --> 00:09:42,017
She was five, six weeks at most.
185
00:09:42,254 --> 00:09:43,974
My OB told me studies show
186
00:09:44,060 --> 00:09:46,568
antidepressants are safe
to take during pregnancy.
187
00:09:46,654 --> 00:09:47,912
But is that true,
188
00:09:47,998 --> 00:09:49,888
or is she protecting me?
189
00:09:52,013 --> 00:09:55,162
There was a study that
associated paroxetine
190
00:09:55,248 --> 00:09:56,685
with these kinds of defects.
191
00:09:56,771 --> 00:09:58,732
It is a possibility.
192
00:10:10,377 --> 00:10:12,513
You can't tell whether
it's cancerous or benign?
193
00:10:12,660 --> 00:10:14,146
Not until we do the biopsy,
194
00:10:14,232 --> 00:10:15,970
which I've scheduled for later.
195
00:10:16,056 --> 00:10:17,966
We'll know what's going on
by the morning.
196
00:10:19,455 --> 00:10:20,638
Good.
197
00:10:20,724 --> 00:10:22,191
That's good.
198
00:10:24,982 --> 00:10:27,482
Maybe you'd like to call someone?
199
00:10:27,568 --> 00:10:29,451
A family member, a friend?
200
00:10:29,935 --> 00:10:32,146
I'll worry
when I know it's cancer.
201
00:10:41,394 --> 00:10:43,918
We could use
a transcatheter route
202
00:10:44,004 --> 00:10:46,414
and patch each hole
individually.
203
00:10:47,277 --> 00:10:48,801
Her heart's the size of a walnut.
204
00:10:48,887 --> 00:10:50,855
It's too small to maneuver inside.
205
00:10:51,339 --> 00:10:53,723
A single large patch
to close the holes
206
00:10:53,809 --> 00:10:54,970
would withstand the pressure.
207
00:10:55,056 --> 00:10:56,389
Yes.
208
00:10:58,009 --> 00:11:00,504
It would also block
electrical conduction,
209
00:11:00,590 --> 00:11:02,562
causing deadly arrhythmias.
210
00:11:02,793 --> 00:11:04,432
Dr. Murphy...
211
00:11:05,449 --> 00:11:08,387
did you tell the mom that she
caused her baby's birth defect?
212
00:11:08,582 --> 00:11:12,746
No. I said that
her antidepressants could have.
213
00:11:13,613 --> 00:11:15,246
Why did you tell her that?
214
00:11:15,762 --> 00:11:17,443
It's the truth.
215
00:11:17,750 --> 00:11:20,719
And is that relevant to
her current medical situation?
216
00:11:21,700 --> 00:11:23,196
No.
217
00:11:23,866 --> 00:11:27,385
And how did you think
that answer would make her feel?
218
00:11:27,633 --> 00:11:29,602
What did you think
would happen?
219
00:11:31,282 --> 00:11:33,191
The mother is devastated.
220
00:11:33,391 --> 00:11:35,078
The father is furious.
221
00:11:35,165 --> 00:11:36,414
I would be, too.
222
00:11:36,500 --> 00:11:38,209
Shaun is a resident.
223
00:11:38,295 --> 00:11:40,094
Residents make mistakes.
224
00:11:40,891 --> 00:11:42,875
Managing these parents'
emotional concerns
225
00:11:42,961 --> 00:11:45,883
is as much a part of this job
as operating on their daughter.
226
00:11:46,281 --> 00:11:48,305
Social cues are hard for Shaun,
227
00:11:48,391 --> 00:11:49,572
but we've been working with him...
228
00:11:49,657 --> 00:11:51,547
You should be focused
on your own shortcomings,
229
00:11:51,633 --> 00:11:54,232
like retaining the formula
for vascular impedance.
230
00:11:55,143 --> 00:11:56,711
Dr. Han.
231
00:11:59,266 --> 00:12:01,805
We could patch each
individual hole in the heart
232
00:12:01,891 --> 00:12:03,828
if we cut open the ventricle...
233
00:12:03,914 --> 00:12:05,446
Don't change the subject,
Dr. Murphy.
234
00:12:05,532 --> 00:12:06,985
I didn't, Dr. Han.
235
00:12:07,071 --> 00:12:09,211
We were talking about the baby.
236
00:12:09,297 --> 00:12:10,623
Really?
237
00:12:11,750 --> 00:12:14,171
You don't see a difference
in the nature of your discussion
238
00:12:14,257 --> 00:12:16,039
before I arrived and after?
239
00:12:17,571 --> 00:12:21,407
We were
talking about the baby.
240
00:12:27,055 --> 00:12:29,571
They tried the approach you
suggested at L.A. Children's.
241
00:12:29,657 --> 00:12:31,227
The baby died a week later.
242
00:12:31,407 --> 00:12:34,235
The suture line didn't hold,
and the cardiac wall ruptured.
243
00:12:34,704 --> 00:12:35,906
Keep looking.
244
00:12:35,992 --> 00:12:37,821
Dr. Murphy,
245
00:12:38,305 --> 00:12:40,813
do not talk with
those parents again.
246
00:12:44,442 --> 00:12:46,047
I'll walk with you.
247
00:12:49,305 --> 00:12:51,321
You're pretty tough
on my residents.
248
00:12:51,446 --> 00:12:52,727
Rebuking them in public,
249
00:12:52,813 --> 00:12:54,837
pimping them with questions
during surgery.
250
00:12:55,086 --> 00:12:56,922
Shame-based learning isn't my style.
251
00:12:57,039 --> 00:12:58,836
I'll bear that in mind.
252
00:12:59,038 --> 00:13:01,133
But this isn't about
my treatment of "the residents."
253
00:13:01,219 --> 00:13:02,392
You're concerned about Dr. Murphy.
254
00:13:02,477 --> 00:13:05,203
Well, a lot of doctors have
less than ideal bedside manner.
255
00:13:05,289 --> 00:13:06,985
- He's young...
- Would you ever have said
256
00:13:07,071 --> 00:13:08,969
something like that
to a patient as a resident?
257
00:13:09,055 --> 00:13:10,286
As a med student?
258
00:13:10,372 --> 00:13:12,883
And Murphy doesn't even understand
he did anything wrong.
259
00:13:13,016 --> 00:13:14,633
Shaun has hard-wired differences
260
00:13:14,719 --> 00:13:16,602
- in the way he perceives things.
- Exactly.
261
00:13:16,688 --> 00:13:17,852
No matter how hard he works,
262
00:13:17,938 --> 00:13:20,407
no matter how hard
you try and help him,
263
00:13:20,696 --> 00:13:23,227
his limitations are
not going to change.
264
00:13:23,313 --> 00:13:26,641
He's going to continue to
inflict them on our patients...
265
00:13:26,749 --> 00:13:29,477
all in the name of diversity
and inclusion.
266
00:13:31,762 --> 00:13:33,875
Shaun deserves to be here.
267
00:13:34,735 --> 00:13:37,446
Once you see what he's
capable of, you'll agree.
268
00:13:37,655 --> 00:13:40,016
I look forward to being
proven wrong.
269
00:13:45,110 --> 00:13:46,906
Stay seated for 20 minutes.
270
00:13:46,992 --> 00:13:48,376
Don't want you passing out
in the lobby.
271
00:13:48,461 --> 00:13:50,180
I know, I know. Thank you.
272
00:13:55,399 --> 00:13:57,211
This disease
changed my relationships,
273
00:13:57,297 --> 00:13:59,532
changed my priorities,
changed...
274
00:13:59,786 --> 00:14:01,068
who I am.
275
00:14:01,360 --> 00:14:02,578
Cancer is an identity.
276
00:14:02,664 --> 00:14:04,992
Cancer is cellular mutation.
277
00:14:05,078 --> 00:14:07,039
The people in this room
are my people.
278
00:14:07,125 --> 00:14:09,810
What are you... 20 years old?
I'm triple your age.
279
00:14:09,997 --> 00:14:11,563
I don't think you're my "people."
280
00:14:11,649 --> 00:14:13,509
The last time I hung out with
my law-school friends...
281
00:14:13,594 --> 00:14:14,446
epic fail.
282
00:14:14,532 --> 00:14:16,399
The fact that you use
the phrase "epic fail,"
283
00:14:16,485 --> 00:14:17,547
kind of case in point.
284
00:14:17,633 --> 00:14:19,673
They're all focused on what firm
they're gonna land at,
285
00:14:19,758 --> 00:14:21,734
and I'm all about whether...
286
00:14:22,063 --> 00:14:23,773
Candice's leukemia is responding
287
00:14:23,859 --> 00:14:25,179
to her new chemo regimen.
288
00:14:25,265 --> 00:14:26,929
By the way,
she has this peppermint oil
289
00:14:27,015 --> 00:14:28,807
that is great for headaches.
290
00:14:32,929 --> 00:14:34,843
Ooh, I know that look.
291
00:14:35,222 --> 00:14:36,663
Here, here.
292
00:14:41,842 --> 00:14:43,409
Got you, brother...
293
00:14:43,963 --> 00:14:46,039
whether you like it or not.
294
00:14:49,141 --> 00:14:50,958
Show me where we are.
295
00:14:51,504 --> 00:14:54,718
That angle runs pretty close
to the sacral nerve roots.
296
00:14:55,836 --> 00:14:57,023
How are we doing?
297
00:14:57,172 --> 00:14:58,781
Tumor's abutting
the iliac artery.
298
00:14:58,867 --> 00:15:00,610
I'm trying not to disrupt
the entire blood supply
299
00:15:00,695 --> 00:15:01,695
to his lower body.
300
00:15:01,781 --> 00:15:03,570
Dr. Han, I'm Morgan Reznick.
301
00:15:03,656 --> 00:15:05,843
I really enjoyed
your article on Myotomy
302
00:15:05,929 --> 00:15:08,867
for infantile hypertrophic
pyloric stenosis.
303
00:15:09,679 --> 00:15:12,405
I appreciate the thorough
research behind your sucking up.
304
00:15:13,023 --> 00:15:14,207
And you are?
305
00:15:14,578 --> 00:15:15,675
Alex Park.
306
00:15:15,968 --> 00:15:18,144
Park... you were a cop.
307
00:15:18,578 --> 00:15:20,746
Medicine as a second career...
good stuff.
308
00:15:21,034 --> 00:15:23,156
Tends to bring a fresh perspective.
309
00:15:25,640 --> 00:15:28,031
I hit an artery. Take the needle.
310
00:15:28,155 --> 00:15:29,499
Blood's pooling in the pelvis.
311
00:15:29,585 --> 00:15:30,812
- Should we open him up?
- No.
312
00:15:30,898 --> 00:15:32,843
Prep the femoral artery.
Get me an art cath set.
313
00:15:32,929 --> 00:15:35,039
- Pressure's dropping.
- Platinum coil.
314
00:15:42,179 --> 00:15:43,703
Nice save.
315
00:15:44,355 --> 00:15:46,086
Next time, don't hit the vessel.
316
00:15:47,836 --> 00:15:49,441
There is no next time.
317
00:15:49,728 --> 00:15:51,601
The biopsy's too dangerous.
318
00:15:57,445 --> 00:16:00,718
It is likely that it's
a benign notochord cell tumor.
319
00:16:00,804 --> 00:16:02,320
They look like chordomas,
320
00:16:02,406 --> 00:16:03,790
but they're harmless
and way more common.
321
00:16:03,875 --> 00:16:05,257
But you don't know.
322
00:16:05,343 --> 00:16:07,265
Since we can't do the biopsy,
no.
323
00:16:08,343 --> 00:16:10,578
This is the problem with
broad testing.
324
00:16:11,320 --> 00:16:12,718
Everyone has abnormalities.
325
00:16:12,804 --> 00:16:14,265
Most of them are nothing.
326
00:16:14,351 --> 00:16:16,070
But when we do find them,
327
00:16:16,156 --> 00:16:17,852
we have to make some tough choices.
328
00:16:19,346 --> 00:16:22,422
So, what exactly is my tough choice?
329
00:16:23,805 --> 00:16:25,397
We could remove the tumor.
330
00:16:25,586 --> 00:16:27,179
This is a very risky surgery.
331
00:16:27,265 --> 00:16:29,303
There's a chance of
paralysis or worse...
332
00:16:29,389 --> 00:16:31,174
you may not make it off the table.
333
00:16:31,704 --> 00:16:33,414
Or you do nothing.
334
00:16:33,797 --> 00:16:35,390
We'd continue to monitor it,
335
00:16:35,515 --> 00:16:36,906
do imaging every few weeks.
336
00:16:36,992 --> 00:16:38,906
But chordomas move very quickly.
337
00:16:38,992 --> 00:16:41,226
By the time any change
showed up on imaging,
338
00:16:41,312 --> 00:16:43,843
it's most likely metastasized
throughout your body.
339
00:16:45,454 --> 00:16:48,873
So,
it probably isn't cancer,
340
00:16:49,070 --> 00:16:52,726
but if it is and I wait,
then I'll die.
341
00:16:52,812 --> 00:16:54,046
That's true.
342
00:16:54,132 --> 00:16:58,179
And if I don't wait
and I get the surgery,
343
00:16:58,265 --> 00:16:59,917
then there's a good chance I'll die.
344
00:17:00,003 --> 00:17:01,156
Yes.
345
00:17:06,562 --> 00:17:08,625
I'm gonna
need to think this over.
346
00:17:23,352 --> 00:17:27,695
This... is the May
Annals of Neonatal Surgery.
347
00:17:27,781 --> 00:17:30,953
I just finished March.
I need to read April now.
348
00:17:31,039 --> 00:17:32,593
Oh, I have April, Shaun.
349
00:17:32,679 --> 00:17:34,031
No.
350
00:17:34,148 --> 00:17:36,367
No, you're supposed to be reading.
351
00:17:36,453 --> 00:17:38,648
New Approaches
in Neonatal Surgery.
352
00:17:38,741 --> 00:17:41,718
Claire has the British Journalof Neonatology...
353
00:17:49,797 --> 00:17:51,443
Shaun...
354
00:17:51,867 --> 00:17:55,211
I think maybe you should
be quiet around Han
355
00:17:55,328 --> 00:17:56,928
for a little while.
356
00:17:57,609 --> 00:18:00,336
But then how will I answer
his questions?
357
00:18:01,984 --> 00:18:04,757
Direct questions,
absolutely answer.
358
00:18:04,843 --> 00:18:07,257
Otherwise, outside of the O.R.,
359
00:18:07,343 --> 00:18:09,281
you should stay out of his way.
360
00:18:11,656 --> 00:18:14,625
If someone had convinced Shaun
to do that with Dr. Melendez,
361
00:18:14,711 --> 00:18:17,000
he would still be on suction.
362
00:18:20,390 --> 00:18:22,562
Code blue... NICU, Bed 4.
363
00:18:22,726 --> 00:18:25,043
Code blue... NICU, Bed 4.
364
00:18:27,847 --> 00:18:30,431
O2 SATs dropped and central
venous pressure shot up.
365
00:18:30,922 --> 00:18:32,391
The Pulmonary Artery Band is failing.
366
00:18:32,476 --> 00:18:34,421
- Eight of dopamine.
- Let's get a mask on her.
367
00:18:34,507 --> 00:18:36,684
She won't last much longer.
We need other options.
368
00:18:36,770 --> 00:18:38,536
I'll update the parents.
369
00:18:39,963 --> 00:18:42,195
Let's get her
on full cardiac support.
370
00:18:56,819 --> 00:18:59,004
What have you got?
Anything?
371
00:18:59,090 --> 00:19:00,906
This Cleveland group
372
00:19:00,991 --> 00:19:03,425
repaired a bowel protrusion
using enterolysis.
373
00:19:03,511 --> 00:19:06,089
I could cut out this excess
inflammatory tissue
374
00:19:06,175 --> 00:19:07,544
and segment of bowel atresia.
375
00:19:07,629 --> 00:19:09,656
Might make her intestines
small enough to fit.
376
00:19:09,741 --> 00:19:10,916
Promising.
377
00:19:11,074 --> 00:19:12,441
Given the size of her abdomen,
378
00:19:12,527 --> 00:19:13,810
I need to remove a lot of bowel.
379
00:19:13,896 --> 00:19:16,314
There's a good chance she
wouldn't be able to absorb food.
380
00:19:16,535 --> 00:19:18,144
We'll have to find
the right balance.
381
00:19:18,229 --> 00:19:19,746
It's our only workable plan.
382
00:19:20,152 --> 00:19:22,285
Best bet on the heart is
to cut through the ventricle,
383
00:19:22,371 --> 00:19:23,652
like Murphy suggested.
384
00:19:23,902 --> 00:19:26,941
Uh, you were concerned about
the suture line holding.
385
00:19:27,027 --> 00:19:28,320
Well, I still am.
386
00:19:28,405 --> 00:19:30,715
Hopefully, horizontal
mattress sutures will work.
387
00:19:30,824 --> 00:19:32,184
They should be able
to withstand the tension
388
00:19:32,269 --> 00:19:33,582
at the suture line.
389
00:19:33,668 --> 00:19:35,727
There's still
a risk of an aneurysm forming
390
00:19:35,812 --> 00:19:38,043
in the tissue underneath.
391
00:19:40,776 --> 00:19:42,459
Dr. Lim?
392
00:19:42,747 --> 00:19:44,998
I have an idea I'd like to share,
393
00:19:45,122 --> 00:19:47,789
even though Dr. Han
didn't ask me a question.
394
00:19:51,995 --> 00:19:53,840
Yeah, go ahead, Shaun.
395
00:19:54,063 --> 00:19:55,847
If we go in through the atrium,
396
00:19:55,932 --> 00:19:57,715
we wouldn't have to worry
about the suture line...
397
00:19:57,800 --> 00:19:59,613
It's the same issue
we discussed.
398
00:19:59,738 --> 00:20:01,613
There's not enough room
inside the baby's heart
399
00:20:01,699 --> 00:20:02,887
to stitch the patches in the place.
400
00:20:02,972 --> 00:20:05,389
Oh, we don't need to, Dr. Han.
401
00:20:05,537 --> 00:20:08,074
We can make a plug
small enough for her heart...
402
00:20:08,175 --> 00:20:10,511
a PTFE disc with a stem like a mushroom.
403
00:20:10,597 --> 00:20:12,559
Then we can insert the stem
through one of the holes
404
00:20:12,644 --> 00:20:14,028
until the disc presses against the wall,
405
00:20:14,113 --> 00:20:15,566
covering all the holes.
406
00:20:16,485 --> 00:20:20,112
L-Like a stopper in a bathtub.
407
00:20:20,198 --> 00:20:21,380
Yes.
408
00:20:21,474 --> 00:20:23,542
The higher pressure on
the left side of her heart
409
00:20:23,628 --> 00:20:24,933
would keep it in place.
410
00:20:25,019 --> 00:20:26,925
We wouldn't even need to stitch.
411
00:20:28,331 --> 00:20:29,808
Great idea.
412
00:20:30,409 --> 00:20:31,793
We should take this to the parents.
413
00:20:31,878 --> 00:20:33,594
Great idea for the heart.
414
00:20:33,801 --> 00:20:36,286
But we need to tell them that
our current plan
415
00:20:36,371 --> 00:20:37,737
for the abdominal repair
416
00:20:37,823 --> 00:20:39,628
is considerably more
of a long shot.
417
00:20:39,778 --> 00:20:42,363
And that fixing the heart
takes an option off the table.
418
00:20:43,456 --> 00:20:45,144
Withdrawing care.
419
00:20:54,555 --> 00:20:56,357
You can't move that card.
420
00:20:56,815 --> 00:20:58,108
Excuse me?
421
00:20:58,201 --> 00:20:59,441
Who cheats at solitaire?
422
00:20:59,527 --> 00:21:01,011
You're literally only
cheating yourself.
423
00:21:01,096 --> 00:21:02,379
Again.
424
00:21:02,464 --> 00:21:03,746
Good morning, Larry.
425
00:21:03,831 --> 00:21:05,347
Is it a macho thing?
426
00:21:05,433 --> 00:21:07,550
Like a real man should
be able to make it through
427
00:21:07,636 --> 00:21:10,308
without leaning on a label
or the people who go with it?
428
00:21:11,968 --> 00:21:14,073
Embracing cancer as an identity
429
00:21:14,159 --> 00:21:16,261
is the last thing
any one of us should be doing.
430
00:21:16,347 --> 00:21:19,761
It underscores everything
horrible right now.
431
00:21:20,206 --> 00:21:22,196
We're in a daily battle for our lives.
432
00:21:22,282 --> 00:21:24,483
I see no value in dwelling on that.
433
00:21:28,786 --> 00:21:30,352
Candice is late.
434
00:21:31,499 --> 00:21:34,344
Which means either her niece
forgot to pick her up.
435
00:21:34,789 --> 00:21:36,188
Again.
436
00:21:36,731 --> 00:21:38,607
Or she got some bad news.
437
00:21:39,578 --> 00:21:41,244
Or she's already dead.
438
00:21:43,961 --> 00:21:46,250
We are in a daily battle.
439
00:21:49,076 --> 00:21:51,164
I'd rather have some company.
440
00:22:07,087 --> 00:22:09,228
I spoke to my mother
and brother,
441
00:22:09,314 --> 00:22:11,640
and they both think
I shouldn't do the surgery.
442
00:22:12,212 --> 00:22:14,149
Apparently they're more scared
of your surgical skills
443
00:22:14,234 --> 00:22:15,895
than they are of this tumor.
444
00:22:17,197 --> 00:22:18,697
And where do you stand?
445
00:22:18,887 --> 00:22:20,771
I need numbers.
446
00:22:21,317 --> 00:22:22,616
Please.
447
00:22:25,779 --> 00:22:28,782
The stats on something like this, it...
448
00:22:29,382 --> 00:22:30,565
there are a lot of variables.
449
00:22:30,650 --> 00:22:32,876
What are the odds
I make it through the surgery
450
00:22:32,962 --> 00:22:35,039
without any complications?
451
00:22:35,704 --> 00:22:37,564
It's a challenging procedure.
452
00:22:37,724 --> 00:22:40,947
Zero complications, I'd say 80%.
453
00:22:42,198 --> 00:22:45,216
But it is very unlikely
this tumor is malignant.
454
00:22:45,371 --> 00:22:47,099
Give me a number.
455
00:22:47,834 --> 00:22:50,783
About 5% chance it's a chordoma.
456
00:22:58,040 --> 00:22:59,712
The numbers agree with your family.
457
00:22:59,822 --> 00:23:01,322
So do I.
458
00:23:10,153 --> 00:23:11,939
I've always been
more comfortable with action
459
00:23:12,025 --> 00:23:13,353
than inaction.
460
00:23:16,876 --> 00:23:19,196
I want you to do the surgery.
461
00:23:22,638 --> 00:23:24,766
Certainty comes at a price.
462
00:23:33,359 --> 00:23:36,110
She'll be able to get off
the life support machines?
463
00:23:36,196 --> 00:23:37,845
If everything goes well,
yes.
464
00:23:38,017 --> 00:23:39,666
She'll have a strong heart.
465
00:23:39,790 --> 00:23:41,623
How soon can you do it?
466
00:23:43,364 --> 00:23:45,095
You should know
we feel less confident
467
00:23:45,181 --> 00:23:47,111
about our plan for her bowel.
468
00:23:47,744 --> 00:23:49,962
The chance of failure is quite high.
469
00:23:50,048 --> 00:23:51,431
How high?
470
00:23:51,696 --> 00:23:54,548
I put it at 90%
that the repair won't work.
471
00:23:54,697 --> 00:23:57,650
Which would lead
to irreversible malnutrition.
472
00:23:57,814 --> 00:24:01,251
Your daughter would slowly
starve to death over months.
473
00:24:01,806 --> 00:24:04,103
Right now, her body is
working very hard
474
00:24:04,189 --> 00:24:05,650
just to stay alive.
475
00:24:08,416 --> 00:24:10,634
If we were to turn off the machines...
476
00:24:10,915 --> 00:24:12,931
Turn off the machines?
477
00:24:15,465 --> 00:24:18,538
She would pass quickly.
And peacefully.
478
00:24:19,216 --> 00:24:21,467
If the heart surgery is a success,
479
00:24:21,592 --> 00:24:23,298
that won't be an option.
480
00:24:23,759 --> 00:24:25,444
Oh.
481
00:24:25,529 --> 00:24:27,346
Why not try to fix the bowel first
482
00:24:27,431 --> 00:24:28,547
to see if it works?
483
00:24:28,632 --> 00:24:30,634
We won't know if the bowel is viable
484
00:24:30,720 --> 00:24:32,689
until after the heart is.
485
00:24:33,370 --> 00:24:35,784
We have to do the surgery.
486
00:24:36,006 --> 00:24:38,224
But if this doesn't work,
she could starve to death.
487
00:24:38,395 --> 00:24:41,213
- It's worth the risk...
- It's not our risk. It's hers.
488
00:24:41,299 --> 00:24:44,439
So, instead, you're ready
to give up on our daughter?
489
00:24:44,715 --> 00:24:47,166
I mean, it's like we're
right back at the ultrasound.
490
00:24:47,392 --> 00:24:49,768
We decided together
to continue this pregnancy.
491
00:24:49,869 --> 00:24:51,737
So this is as much
my fault as it is yours.
492
00:24:51,822 --> 00:24:53,064
My fault?
493
00:24:53,150 --> 00:24:55,116
Because of the medication?
494
00:24:56,701 --> 00:25:00,150
I cannot turn off that machine.
495
00:25:01,056 --> 00:25:03,682
Your guilt is stopping you from
admitting what we need to do.
496
00:25:03,767 --> 00:25:06,317
My guilt has nothing to do with this.
497
00:25:06,533 --> 00:25:09,845
- I am fighting for my daughter.
- So am I.
498
00:25:11,507 --> 00:25:13,376
Since the parents can't agree,
the decision
499
00:25:13,462 --> 00:25:16,220
about the baby's care
will be made by a judge
500
00:25:16,306 --> 00:25:18,095
who will rely
on our recommendation.
501
00:25:18,611 --> 00:25:20,275
So we make the choice,
502
00:25:20,361 --> 00:25:22,189
but the parents live with it?
503
00:25:24,150 --> 00:25:26,392
Well, maybe that's a good thing.
504
00:25:27,384 --> 00:25:29,767
For parents to have to decide between
505
00:25:29,853 --> 00:25:31,306
letting their daughter die
506
00:25:31,486 --> 00:25:34,807
or fighting for her life,
knowing she may suffer horribly,
507
00:25:35,095 --> 00:25:37,712
maybe it's better
if we carry that burden.
508
00:25:40,533 --> 00:25:41,900
Dr. Lim?
509
00:25:42,036 --> 00:25:43,759
Your decision would be?
510
00:25:44,955 --> 00:25:46,681
Take her off life support.
511
00:25:46,767 --> 00:25:48,915
The odds are stacked against
the bowel repair working.
512
00:25:49,001 --> 00:25:51,697
Those numbers reflect the
general population of doctors.
513
00:25:51,869 --> 00:25:54,595
I think Dr. Lim and I
are better than that.
514
00:25:54,768 --> 00:25:56,564
We can beat the odds.
515
00:26:04,026 --> 00:26:05,712
One of the things I'm not going to miss
516
00:26:05,798 --> 00:26:07,392
about being Chief of Surgery
517
00:26:07,478 --> 00:26:10,400
is being responsible
for choices like this.
518
00:26:12,762 --> 00:26:15,447
Dr. Han,
it's your department...
519
00:26:15,533 --> 00:26:16,813
it's your call.
520
00:26:24,541 --> 00:26:26,140
You've been here all night?
521
00:26:26,791 --> 00:26:28,564
I've been working on a case
522
00:26:28,650 --> 00:26:31,071
with the new Chief of Surgery,
Dr. Han.
523
00:26:31,157 --> 00:26:33,415
- How's that going?
- Not very well.
524
00:26:33,501 --> 00:26:35,517
He plays music
in the operating room.
525
00:26:35,603 --> 00:26:36,939
Oh, geez. One of those.
526
00:26:37,025 --> 00:26:38,587
And he says I need to focus on
527
00:26:38,673 --> 00:26:40,454
our patients'
emotional needs.
528
00:26:40,868 --> 00:26:43,275
Well, that's a tough assignment
for you.
529
00:26:43,618 --> 00:26:45,085
Mm.
530
00:26:49,517 --> 00:26:53,189
You ever wish you had, you know,
531
00:26:53,275 --> 00:26:55,454
friends, co-workers
on the spectrum?
532
00:26:56,274 --> 00:26:57,884
Not usually.
533
00:26:58,025 --> 00:27:00,743
But maybe Dr. Han
wouldn't notice me as much
534
00:27:00,829 --> 00:27:03,423
if I weren't the only doctor
with ASD.
535
00:27:06,353 --> 00:27:08,259
There's this kid in chemo,
536
00:27:08,345 --> 00:27:11,431
just obsessed
with having cancer.
537
00:27:11,499 --> 00:27:13,086
It's all he talks about.
He wants to be friends
538
00:27:13,171 --> 00:27:14,242
with everybody in the ward.
539
00:27:14,327 --> 00:27:15,753
That's very smart of him.
540
00:27:15,838 --> 00:27:18,948
Speigel et Al. showed
an increase in overall survival
541
00:27:19,034 --> 00:27:21,382
and quality of life measures
in breast cancer patients
542
00:27:21,468 --> 00:27:24,757
who formed social bonds with
others battling the disease.
543
00:27:25,207 --> 00:27:27,609
What should I do about
Dr. Han?
544
00:27:29,811 --> 00:27:32,202
I don't know.
Um...
545
00:27:32,428 --> 00:27:34,012
just do your work,
546
00:27:34,191 --> 00:27:36,532
be a good surgeon,
be an excellent surgeon.
547
00:27:36,618 --> 00:27:38,768
Over time,
he'll forget about the autism.
548
00:27:38,853 --> 00:27:40,169
Why would that happen?
549
00:27:40,254 --> 00:27:43,241
He'll see that you have
the skill, you have dedication.
550
00:27:43,327 --> 00:27:45,507
I have autism.
551
00:27:45,679 --> 00:27:47,359
It's part of who I am.
552
00:27:57,937 --> 00:27:59,486
The judge...?
553
00:27:59,572 --> 00:28:01,189
Accepted our recommendation
554
00:28:01,275 --> 00:28:03,183
and ruled in favor of surgery.
555
00:28:03,911 --> 00:28:05,444
Thank you, Doctor.
556
00:28:10,725 --> 00:28:12,663
Okay, Percy.
557
00:28:14,422 --> 00:28:16,289
Momma loves you.
558
00:28:18,839 --> 00:28:20,374
I love you, Percy.
559
00:28:55,905 --> 00:28:57,687
Should we remove
more bowel?
560
00:28:57,874 --> 00:28:59,241
That would take us to the ilium.
561
00:28:59,327 --> 00:29:01,065
She won't gain enough weight
to thrive.
562
00:29:01,339 --> 00:29:03,101
Her abdominal muscles are tight
563
00:29:03,187 --> 00:29:05,303
from developing
around an empty cavity.
564
00:29:05,765 --> 00:29:07,793
♪ But the days, girl,
just slip away, oh, yeah ♪
565
00:29:07,878 --> 00:29:10,462
They're cinched around
her tummy like a corset.
566
00:29:10,702 --> 00:29:12,124
What if we unbuttoned it?
567
00:29:12,218 --> 00:29:14,976
Released the muscle and increased
the abdominal circumference.
568
00:29:15,062 --> 00:29:16,179
Those muscles are part of
569
00:29:16,265 --> 00:29:18,180
- her abdominal wall.
- Not if we separate the layers...
570
00:29:18,265 --> 00:29:20,843
create a plane between
the skin and the muscle.
571
00:29:22,734 --> 00:29:24,937
You good if Murphy and I
start on the heart?
572
00:29:25,812 --> 00:29:28,130
Dr. Browne, you're with me
on the abdomen.
573
00:29:29,533 --> 00:29:30,750
Clearing the field.
574
00:29:30,835 --> 00:29:32,752
Han is on the call schedule next weekend.
575
00:29:32,837 --> 00:29:34,987
Maybe Carmen will switch with me
so I can cover with him?
576
00:29:35,072 --> 00:29:38,124
Or maybe
you shouldn't try so hard.
577
00:29:38,236 --> 00:29:39,733
Retractor.
578
00:29:40,341 --> 00:29:42,393
Some of us don't have
a cool former career...
579
00:29:42,479 --> 00:29:43,851
or an easy-going,
mellow demeanor.
580
00:29:43,937 --> 00:29:45,608
People are never gonna
crowd in my corner
581
00:29:45,694 --> 00:29:47,116
because I'm just so likable.
582
00:29:47,202 --> 00:29:48,733
Well, you could try
being nice to them.
583
00:29:48,818 --> 00:29:50,718
- Well, this is easier.
- There it is.
584
00:29:53,257 --> 00:29:54,873
Does it look like cancer?
585
00:29:55,062 --> 00:29:56,491
It's not labeled.
586
00:29:56,594 --> 00:29:58,999
We're all gonna have to wait
for the pathologist's report.
587
00:30:00,709 --> 00:30:02,187
Probe.
588
00:30:07,504 --> 00:30:09,054
The artery is in the way.
589
00:30:09,170 --> 00:30:11,470
We can't get at the tumor
without him bleeding out.
590
00:30:16,379 --> 00:30:17,796
We're gonna have
to take it from the back.
591
00:30:17,881 --> 00:30:20,899
- But the S1 nerve root...
- Is something he can live without.
592
00:30:20,984 --> 00:30:22,516
Dissecting scissors.
593
00:30:26,559 --> 00:30:27,876
Pledget anchor.
594
00:30:28,009 --> 00:30:30,540
♪ You'll be leaving me soon,
like hell you will ♪
595
00:30:30,626 --> 00:30:34,962
♪ The owl gazing at the moon ♪
596
00:30:35,079 --> 00:30:38,950
♪ Is the feeling that I get
when I'm lookin' at you ♪
597
00:30:39,035 --> 00:30:42,954
♪ The sun will rise and fade the stars ♪
598
00:30:43,039 --> 00:30:44,181
The plug is in position.
599
00:30:44,267 --> 00:30:46,142
You ready to test the bowel repair?
600
00:30:46,742 --> 00:30:47,825
♪ And you're leaving me soon,
like hell you are ♪
601
00:30:47,910 --> 00:30:49,393
Let's take her off cardiac support.
602
00:30:49,478 --> 00:30:51,311
Dr. Murphy, it was your idea.
603
00:30:51,397 --> 00:30:52,996
You do the honors.
604
00:31:03,736 --> 00:31:06,384
Abdominal pressure is normal.
605
00:31:06,696 --> 00:31:09,063
The intestines are perfusing.
606
00:31:12,120 --> 00:31:14,104
Pulmonary pressure's spiking.
607
00:31:14,236 --> 00:31:15,353
Prostacyclin and nitric oxide...
608
00:31:15,438 --> 00:31:16,554
we need to get her lung pressure down.
609
00:31:16,639 --> 00:31:18,122
Oxygen SATs are dropping.
610
00:31:18,207 --> 00:31:20,540
No response to
pulmonary vasodilators.
611
00:31:20,626 --> 00:31:23,032
Now the heart's too strong.
It's overpowering her lungs.
612
00:31:23,211 --> 00:31:25,277
She needs to go back
on cardiac support.
613
00:31:33,555 --> 00:31:36,955
Persephone
won't starve to death...
614
00:31:37,376 --> 00:31:40,165
but she will drown
in her own fluids.
615
00:31:54,575 --> 00:31:56,024
I'll talk to the parents.
616
00:31:56,109 --> 00:31:57,476
May I come?
617
00:32:09,022 --> 00:32:11,540
Now that Persephone's heart
is pumping at full power,
618
00:32:11,625 --> 00:32:13,358
her lungs are overwhelmed.
619
00:32:15,334 --> 00:32:16,712
The humane thing to do
620
00:32:16,797 --> 00:32:19,529
is to turn off the machines
and let her go.
621
00:32:20,556 --> 00:32:22,464
No, I-I can't...
622
00:32:22,870 --> 00:32:24,631
I can't give up on her.
623
00:32:27,395 --> 00:32:29,334
Because you fought for her
624
00:32:30,268 --> 00:32:32,452
every minute since she was born.
625
00:32:32,678 --> 00:32:35,100
Before that, when you were
taking your medication
626
00:32:35,186 --> 00:32:37,807
for the depression,
you were fighting to keep going
627
00:32:38,239 --> 00:32:40,223
so you could bring her into the world.
628
00:32:56,266 --> 00:32:59,738
But letting go of Percy
is not giving up on her.
629
00:33:01,327 --> 00:33:04,207
It's listening to what
her body is telling us.
630
00:33:08,941 --> 00:33:10,504
She's hit her limit.
631
00:33:27,839 --> 00:33:29,496
Okay.
632
00:34:03,785 --> 00:34:05,839
I want Persephone to look
as good as possible
633
00:34:05,925 --> 00:34:07,292
for the parents.
634
00:34:12,243 --> 00:34:14,176
Let's turn off cardiac support.
635
00:34:19,274 --> 00:34:20,733
Ventilator.
636
00:34:22,260 --> 00:34:23,827
Let's take a minute.
637
00:35:07,099 --> 00:35:08,764
Check valve.
638
00:35:13,020 --> 00:35:15,688
Every time the heart contracted,
639
00:35:15,797 --> 00:35:18,110
blood went into the opposite
side of the heart
640
00:35:18,196 --> 00:35:20,016
and raised lung pressure.
641
00:35:20,102 --> 00:35:22,860
The hole reduced the pressure
when it got too high
642
00:35:22,946 --> 00:35:25,274
because it allowed backflow.
643
00:35:25,360 --> 00:35:27,242
But our repair of the defect
blocked this backwards flow.
644
00:35:27,328 --> 00:35:29,735
What if we made it so
she still had a heart defect,
645
00:35:29,821 --> 00:35:31,258
but only when she needed it?
646
00:35:31,364 --> 00:35:35,230
It'd be like an unlatched door
in the wall of the heart.
647
00:35:35,679 --> 00:35:38,005
When the pressure gets too high
on the right side,
648
00:35:38,091 --> 00:35:40,427
the door swings open, releasing
the pressure on the lungs.
649
00:35:40,610 --> 00:35:42,330
The rest of the time, it stays shut.
650
00:35:42,563 --> 00:35:45,199
It should reduce lung pressure
by a third. Is that enough?
651
00:35:45,284 --> 00:35:46,586
It depends on how high
652
00:35:46,680 --> 00:35:48,633
her pulmonary vascular resistance is.
653
00:35:48,805 --> 00:35:50,993
PVR is pulmonary artery pressure
654
00:35:51,079 --> 00:35:54,055
minus wedge pressure divided
by cardiac output times 80.
655
00:36:04,984 --> 00:36:06,766
The last time I saw my doctor,
656
00:36:06,852 --> 00:36:09,055
he told me I had six months to live.
657
00:36:09,540 --> 00:36:11,438
He also told me I should
marry an accountant
658
00:36:11,524 --> 00:36:12,727
and move to North Dakota.
659
00:36:12,813 --> 00:36:14,194
You don't say.
660
00:36:14,571 --> 00:36:17,118
When I asked if it would
help my cancer, he said no,
661
00:36:17,243 --> 00:36:20,227
just make the six months
seem much longer.
662
00:36:23,008 --> 00:36:26,506
What's the difference between
a Neo-Nazi and cancer?
663
00:36:26,782 --> 00:36:28,836
Cancer doesn't discriminate.
664
00:36:31,547 --> 00:36:33,399
I knew a guy once...
665
00:36:33,618 --> 00:36:36,000
his Zodiac sign was Cancer.
666
00:36:36,086 --> 00:36:38,800
It was really ironic
how he died.
667
00:36:40,422 --> 00:36:42,094
Uh, uh, how's that?
668
00:36:42,219 --> 00:36:44,016
He was eaten by a giant crab.
669
00:36:44,102 --> 00:36:47,149
Oh, geez.
670
00:36:49,305 --> 00:36:51,196
Aaron, glioma.
671
00:36:51,555 --> 00:36:53,477
Candice, leukemia.
672
00:36:53,770 --> 00:36:55,368
Gin rummy or blackjack?
673
00:36:55,454 --> 00:36:57,204
How fast do you want
to take my money?
674
00:36:57,360 --> 00:36:58,670
Blackjack.
675
00:36:58,864 --> 00:37:00,345
Cut 'em.
676
00:37:12,153 --> 00:37:14,001
Did you get it all?
677
00:37:17,493 --> 00:37:18,843
Yes...
678
00:37:18,954 --> 00:37:20,591
totally clear margins.
679
00:37:21,040 --> 00:37:22,524
But the only way to achieve that
680
00:37:22,610 --> 00:37:25,399
involved removing the nerve
that controls your left foot.
681
00:37:26,679 --> 00:37:29,699
Rehab and an advanced orthotic may help,
682
00:37:29,852 --> 00:37:32,251
but you will walk with a limp.
683
00:37:32,588 --> 00:37:35,446
Final pathology will let us know
if it was worth it.
684
00:37:39,067 --> 00:37:40,961
I'll let you know
when it comes in.
685
00:37:43,171 --> 00:37:45,437
It doesn't matter anymore.
686
00:37:48,376 --> 00:37:50,688
It's not like you can
put the tumor back in.
687
00:38:06,021 --> 00:38:08,780
Is she... okay?
688
00:38:09,231 --> 00:38:12,772
She still has a surgery or two
in her future, but, yes.
689
00:38:12,858 --> 00:38:15,139
She's gonna be great.
690
00:38:18,908 --> 00:38:20,489
Can I hold her?
691
00:38:20,575 --> 00:38:22,768
I think that would be very nice.
692
00:38:22,854 --> 00:38:24,720
For both of you.
693
00:38:40,170 --> 00:38:42,537
Hi, angel.
694
00:38:44,098 --> 00:38:46,389
Oh, my baby.
695
00:38:50,397 --> 00:38:52,498
Come hold her.
696
00:38:58,338 --> 00:39:00,838
You were fighting for her, too.
697
00:39:06,247 --> 00:39:08,459
She's beautiful.
698
00:39:15,629 --> 00:39:17,213
Nice work.
699
00:39:18,424 --> 00:39:20,075
Thank you.
700
00:39:20,960 --> 00:39:23,744
She's beautiful.
701
00:39:24,016 --> 00:39:25,801
Listen to her. Oh.
702
00:39:36,776 --> 00:39:38,541
Thank you.
703
00:39:43,503 --> 00:39:45,815
Minesh's biopsy results?
704
00:39:55,661 --> 00:39:57,424
You don't want to know
if we wasted our time
705
00:39:57,510 --> 00:39:58,807
almost killing him?
706
00:39:59,531 --> 00:40:01,398
Can't put the tumor back.
707
00:40:17,533 --> 00:40:19,602
Hello, Dr. Han.
708
00:40:20,322 --> 00:40:22,269
You take the bus, too?
709
00:40:22,354 --> 00:40:23,670
No, Shaun.
710
00:40:24,119 --> 00:40:26,192
I just wanted to talk to you.
711
00:40:28,927 --> 00:40:33,045
You really do have
remarkable diagnostic skills.
712
00:40:33,596 --> 00:40:36,098
I have to admit, you're an
asset to this hospital.
713
00:40:36,580 --> 00:40:38,822
Yes, I am.
714
00:40:41,127 --> 00:40:44,293
I spoke to the Residency
Director of Pathology.
715
00:40:45,018 --> 00:40:48,252
And we both agree
you'll be a great fit there.
716
00:40:50,486 --> 00:40:53,533
I'm a surgical resident.
717
00:40:53,822 --> 00:40:56,213
As a pathology resident,
718
00:40:56,346 --> 00:40:58,504
you'll touch cases and lives
719
00:40:58,589 --> 00:41:01,713
across all the medical departments.
720
00:41:02,159 --> 00:41:04,533
It's an opportunity
for you to help patients
721
00:41:04,619 --> 00:41:07,400
without having to deal with patients.
722
00:41:08,776 --> 00:41:12,493
Given your difficulties with
communication and social cues,
723
00:41:12,579 --> 00:41:15,075
I think it will be a much better fit.
724
00:41:15,798 --> 00:41:17,461
No, thank you.
725
00:41:18,424 --> 00:41:21,416
I have been working very hard
726
00:41:21,502 --> 00:41:23,916
at my communication skills.
727
00:41:24,746 --> 00:41:26,934
Hard work isn't enough.
728
00:41:27,456 --> 00:41:29,377
You have to do the job.
729
00:41:31,846 --> 00:41:36,151
I am a surgical resident.
730
00:41:37,934 --> 00:41:39,572
You were.
731
00:41:40,815 --> 00:41:43,721
And you're gonna do
great work in pathology.
732
00:41:48,771 --> 00:41:52,213
♪ Oh, and when the storms come ♪
733
00:41:52,354 --> 00:41:55,541
♪ Flooding through the hall ♪
734
00:41:55,627 --> 00:41:57,768
♪ Rising to the landing ♪
735
00:41:57,869 --> 00:42:01,498
♪ Tearing pictures from the walls ♪
736
00:42:01,889 --> 00:42:04,686
♪ The currents pull us underneath ♪
737
00:42:04,772 --> 00:42:07,971
♪ That bright tide rips us out ♪
738
00:42:08,319 --> 00:42:11,374
♪ Into a tangled coral reef ♪
739
00:42:11,460 --> 00:42:14,812
♪ Where we could never drown ♪
740
00:42:14,967 --> 00:42:17,748
♪ Now that ♪
741
00:42:17,833 --> 00:42:20,920
♪ We're at the end ♪
54096
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