Previously on TheGood Doctor ...
I want to do anotherembryo transfer ASAP.
You have some lettuce.
- Oh.- No, no, no. Here.
Dr. Glassman, it wouldbe hard to lose my father
just as I am aboutto become one.
Do the scan for me.
Please hold still.
I'm breathing.
You moved your head.
Shaun, go away and letthe technician do his job.
I sent him out for coffee.
I am now scanning thelocation of your prior tumor.
Did you declinemaintenance chemotherapy?
It's hard to hold stillwhile I'm talking.
Dr. Blaize recommended sixcycles of temozolomide.
The slight benefit of that stuff
wasn't worth theconstant nausea.
The benefit is statistically...
Shaun, I made my choice.
You chose wrong.
There's a spot on your brain.
There's the right ovary.And that looks like the...
Corpus luteum.
The endometrium is smoothand around 13 millimeters,
which means my uterineinfection is cleared.
Carrying the pregnancy to termshould be a lot easier this time.
Your transfer is on myschedule for tomorrow evening.
Fantastic.
And you have two high-gradeembryos available.
Do you want a boy or a girl?
You don't have to decide now.
Just let me know beforethe embryo transfer.
Seven and a half hours.
Uninterrupted?
Didn't even have to wakeup to use the bathroom.
So?
Six hours, 45 minutes.
Oh, winner, winner,pancakes for dinner.
I really thought Ihad it in the bag.
How'd you do, Danny?
How much sleep youget? Over or under?
No clue.
Hold up.
- Morning, all.- Morning.
Dr. Allen.
Good morning, Dr. Kalu.
Park is doing a hiparthroscopy today.
I'd like to scrub in.
Sorry, I'm alreadyassigned to Park.
I'm thinking aboutspecializing in ortho,
so how about a trade?
How about no?
Sorry I asked.
Go, team.
Brady Sullivan. Oil rigworker. Metal sheet hit him.
Severe chest andpelvic injuries.
O2 sats are critical.
Brady, I'm Dr. Andrews.
He's non-responsive.Sluggish pupils.
There's major hemorrhage.
GCS six, no head trauma.
Three-inch right-sided suckingchest wound. Collapsed lung.
That's from the support hook.
The metal sheet he waswelding caused another injury.
How deep does this go?
Down to the spinal column.
He's nearly cut in half.
It's scar tissuefrom the radiation.
Could be, but the FA value...
Is more consistent with aglioblastoma recurrence.
That's right, and the path
of the radiationthey blasted me with,
that Swiss cheese look,textbook necrosis.
The irregular shape implies amultifocal cancerous lesion.
I've been looking at brain scans
since before electricity.
I think I know whatscar tissue looks like.
You are not objective here.
Oh, right, and you are?
Neither of you are.
If that lesion is cancer,
a DNA spinal fluidanalysis will confirm it.
Yes.
That is objective.
I'll do a spinal tapand send it to the lab.
Should have results in 24 hours.
Fine.
I'll set it up.
O2 sat's 68.
Chest tube's in,draining a lot of blood.
Every time I clamp ableeder, another one pops up.
Dr. Lim? Where do you want us?
We're busy withthe chest trauma.
I need you guys onthe pelvic injury.
How do we remove it?
You don't. It's the onlyreason he didn't bleed out.
I need you four tofigure out a plan
to reattach his lower half.
Read every journal.Study every case report.
Check all the internationalsurgery registries.
Look everywhere.
PA ruptured. Gotta move him.
OR one, now.
- Give me the baby.- No, no, no, no, no, no.
I'm here for Jazz.
- Just hand her to me.- I don't know you.
I don't know you.I don't know you.
- Sir, please.- Hold on, let me talk to him.
I'm a doctor here.I can help you.
I don't need adoctor. I need Jazz.
Jazz. Is Jazz the mother?
Yes.
You're trying to help the baby?
Jazz... Jazz passed out
and then the, uh... theflashing lights took her.
An ambulance?
There's an encampmentover on Elm.
Is that where you and Jazz were?
Then she's a patient here.
They didn't see thebaby in her tent.
She didn't sound good.She... she needs her mama.
You did the right thingbringing her here.
Can I examine her?
Uh...
and you'll... you'llfind... you'll find Jazz?
I promise.
We have a code pink. Thebaby's in heart failure.
You may have saved her life.
Found another tear inthe pulmonary artery.
A big one.
Every major artery inthis lung is damaged.
His body needs to divertevery resource it has
to his vital organs.
We should amputatehis lower half.
- We're not there yet.- It's barely hanging on.
But it is. We'regonna try to save it.
It's a big job tohand the residents.
Good thing I hire the best.
This vessel's toodamaged to repair.
I need to clamp the trunk.
Start the clockon lung ischemia.
I think we should sack
the upper segmentalpulmonary artery.
That would mean he'dlose his upper lung lobe.
He has a physical job.
If we end up amputating,
he's not gonna beworking oil rigs.
But he could be playingwheelchair basketball.
PTFE graft on his arterycould save his lung.
Okay.
Central line is in.
Pushing milrinone toincrease cardiac output.
Severely decreasedheart function,
but her chambers look normal.
Increasing high flow oxygen.
- BP is improving a little.- Found it.
In her posterior chest,there's a critical...
Narrowing of her aorta.
Her eye spacing is approximately
six millimeters wider thanthe upper limit of normal.
She also hasslightly low-set ears
and her hands are swollen.
She has Turner syndrome.
If we don't get that narrowingfixed in the next few days,
she'll die.
It won't be easy toaccess, but I need an angio
for a better view.
I'll locate the motherand get consent.
Brady's pelvis is broken
and separated fromthe spinal column.
So to reattach his lower half,
we need to repair the pelvis,plus all the damaged organs,
plus the majorvascular injuries,
and then find a way toensure it all heals.
Are we even doing the rightthing by trying to fix this?
You want to give upbefore we even start?
I've just never read anything
supporting reattachingthis kind of injury.
Could kill him.
Amputation is thesafest thing to do.
Lim already knowsabout that option.
- Our job is to find a better one.- No, our job...
Danny's right. We needto divide and conquer.
I will work on organ damage.
I'll focus on public fractures.
I need intraoperativeimaging to build a 3D model.
Oh, well, I'll go with you.
I need to see the full extentof the vascular injuries.
That leaves you to figureout how these repairs heal.
I'll see what I can find.
- This is the baby's mom?- We think so.
She was broughtin a few hours ago
from a homeless encampment
with a delayedpostpartum infection.
She's septic.
They're optimisticshe'll pull through.
Soon, let's hope.
We've got some big decisionsto make for her baby.
Her name's Jasmine West.
She's homeless andhas bipolar disorder.
County records show the babywas born seven weeks ago.
No dad in the picture,no other family.
And this was all she had onher when EMS brought her in.
We need your consent
for the baby'sdiagnostic angiogram.
Sure.
The baby's Turner syndromemakes every procedure,
even a diagnostictest, a little riskier.
Well, this is yourarea of expertise.
Her baby's name is Eden.
Pretty close to theupper lung bifurcation.
I reinforced it with sealant.
With a synthetic wrap?
Are you questioningmy surgical skills?
Are you getting defensive?
Okay. We're done.
Let's test it.
Good job.
Cardiac function stable.You're good to go.
Inserting the catheter.
What a cute little girl.Little girls are cute.
- Mine would be really cute.- Yeah, she'd be adorable.
A boy could be adorable too.
Are you trying topick your embryo?
I'm leaning towards a girl.
I have a playbook to work from.
My playbook didn't help me much.
A lot of my issueswith Kellan came
from me trying to stop him
from making the mistakes I made.
If I'd had a daughter,maybe I wouldn't have
dumped all my baggage on her.
You should choose a girl.
But you're having a boy.
We didn't get to choose.
In all long-term health metrics,
females are more likelyto outperform males,
although they'llprobably make less money.
The narrowing is longerthan it measured on echo.
We should resectthe narrowed segment
and do an aortic anastomosis.
Huge surgery for a baby.
It's the onlydefinitive treatment.
Very definitive ifshe dies on the table.
Balloon dilation is safer.
We can do a bigger procedure in afew years when Eden can tolerate it.
Her heart failure couldrelapse between surgeries.
Your two-step approach is safer,
but only if the babygets daily medication
and regular follow-up care.
That's a lot to askof a homeless mom.
I'll page CPS and get consent.
You two practice the surgery.
A lot.
His pelvis looks like a jigsawpuzzle with a 100 missing pieces.
Jared may be right.
You're taking his side.
I'm not taking anyone's side.
- Scans don't lie.- Okay.
I'm not sure if you'remad at him or me,
but we all need to get along.
Well, you two seemedto be getting along
pretty well at the tacotruck the other night.
That was nothing.
Mm-hmm.
You're spying on me?
I was getting a taco.
This green-eyed monster thingis not a good look for you.
I'm not jealous.
But you're right.
We're supposed to be a team.He's just not a good fit.
Let's just focus on the patient.
Fine.
Can't see how we're gonna repair
all of that arterial damage.
What if we don't?
They could bypass it.
All of it.
This paper byDr. Alice Chen features
interesting data ontumor treating fields
for GBM tumors.
I'm trying toenjoy my tuna melt.
Dr. Chen is startinga new study soon.
You should call her.
I'm not gonna spend the daychasing down cancer treatments
because I don't have cancer.
Okay, there is a higherprobability of cancer relapse
because you refusedmaintenance chemotherapy.
I'm not gonna talk about this.
Recurrent GBM causesmuch worse symptoms
than temozolomide.
That's the decision I made.
I'm going crazy. There arethree crib sets I like.
I just can't decide.
Could you guys go to thestore after work tonight
and pick your fave?
Okay.
I have to go practicethe baby's surgery.
I will see you after work.
Oh, my God!
Should I be worried?
About me? No.
We're going to kill him
trying to save thelobe of his lung.
Removing it still leaveshim with 4/5ths capacity.
When there's a chance youmight lose half your body,
everything youhave left matters.
I need lobectomy instruments.
This is my OR, my department.
My hospital.
And when a doctor'sjudgment is compromised,
it's my responsibility to stepin and protect our patients.
In what possible wayam I compromised?
Are you implying that my time in awheelchair is affecting my objectivity?
How could it not?
This is my patient.
And I'm your boss.
You can either do this with me,or I'll find someone who will.
Deaver retractor.
After they fix thecolon, Lim can use
some preserved bowelto create a new bladder
like these Korean surgeons did.
That would work perfectlywith what I found.
We can bypass all ofthe artery injuries
through two Dacron conduits
directly to hislower extremities.
And the improved blood flowwould help with my idea
with his pelvis.
So skin flaps,
Dacron arterybypass, neo-bladder,
bowel repair withbiomaterials, and...
a badass, Wolverine-likeadamantium skeleton.
It's experimental, butit's pretty damn cool.
Now, how do we makesure all this heals?
There's one study in Canada.
A cocktail of recumbentgrowth hormones
and pentoxifylline showeda threefold increase
in traumatic woundhealing rates.
That's great.
There's only four patients,
and none of them had thesame injuries as Brady.
So no one got cut in half
with a metal sheeton an oil rig?
Great, I guess we justtoss that study out.
I'm just saying, I wishwe had something better.
I'll happily take athreefold increase.
This is a workable plan.
Good, because Limwants an update.
Some promising ideas,
but there's a lot offrail tissue to heal.
I found a studyusing growth hormones
to accelerate the healing.
Interesting. Wouldthat work here?
There was a threefoldplan that we had...
Well, hang on, I want to hearfrom the guy who did the research.
I'm not confident it would.
You guys said youhad a workable plan.
It can work. Jared'sbeing overly cautious.
If you close the pelviswithout good vascular support,
all these repairswill get necrotic.
We will have good support. The Dacronconduit to restore blood flow...
Not normal flow andnot quick enough.
Oh, dude, you've been doomand gloom from the start.
- I've been...- Enough.
Find a way to heal him.
I don't care who it comesfrom, but I need it soon.
The nurse said she'sresponding to the medication.
How long will Eden be in thehospital after the surgery?
Two weeks.
Jasmine's on the wait listfor long-term housing.
She might have a place by then.
Also, uh,
is this safe if shekeeps breastfeeding?
The police foundthis in her tent.
This is a bipolarmood stabilizer.
It's safe.
How long has shebeen taking this?
She saw her psychiatristfor the first time in years
about five weeks ago.
She responded to it in the past.
She had a follow-upscheduled with him tomorrow.
There's another treatmentoption for Eden.
I know, I know.It's disgusting.
You're gonna think, "Whatare the percentages?"
Trust me, you change his diapers
and you are gonnabond with your son.
Okay, here is theAngelic Dream Set.
And be attentive toLea. Be extra attentive.
She's gonna be sleep-deprived.
You are gonna be sleep-deprived.
You're both gonna wantto lose it. Don't.
This mattress isvery comfortable.
This dark wood is alittle bit funereal.
The baby won't careabout the color.
It's all aboutfirst impressions.
It's a newborn, youknow? Clean slate.
You want to surround itwith beautiful things.
A stuffed, soft... No,you don't want to do that.
That's a hazard.
But these spinny things...What do you call these?
Mobiles, mobiles.
You know, everywhere he looks,
you want him to beinterested, stimulated.
Beautiful sounds.Beautiful music.
Mozart. Joni Mitchell.
If you want to talkabout something
other than selecting a crib,
it should be braincancer treatments.
Oh my God! I don't wantto think about that.
I can't not think about it.
In 12 hours, wewill have results...
- Exactly.- We should be prepared.
Okay, Shaun, stop. Just...just stop for a second
Sit down.
Okay.
If I have cancer,
I'd be at stage four, right?
There's no miraclecure for that.
You still haven't calledDr. Chen in Cleveland.
I read her paper.
It doesn't workwith recurrent GBM.
How can you think about teddybears when you might be dying?
If you're right, Shaun,
then I won't be herewhen your son is born.
I won't be here to help you.
We'll know when we know.
I like the lighter wood.
So do I.
What else should Iknow about diapers?
Lung lobe is out.
These segmentalvessels are damaged.
Running 7-0 suturesshould fix them.
Why bother? Theupper lobe is out.
If we can get Perez'sDacron graft to work,
we could use them tosave his lower half.
Very unlikely.
The residents are working on it.
And obviously not succeeding.
First, I'm compromised,
now you're slaggingon the residents?
Two are on probation,you let another one go,
and her replacementis someone I fired.
He's also the world's mostexperienced first-year,
and he brings a newperspective to the mix.
And training theseguys is my job.
Your job is tomake my job easier.
I thought it was to run agreat surgical department.
If you were doing that,I wouldn't have to think
about that department asmuch as I have recently.
Vessel loops.
You changed the baby's surgery?
We weren't givingJasmine enough credit.
She's done a lot toturn her life around
since Eden was born.
For seven weeks.
And with this newtreatment plan,
she has to keep itup for seven years.
A baby can change a person.
Code pink, NICU bed three.
That's Eden.
Code pink, NICU bed three.
Lim asked for my opinion.
I met so many rich, entitledguys like you in college,
and I couldn't stand them...
Even the ones I slept with.
If you can't handlethe hard work,
just get in yourLamborghini and go home.
Sherry Lewis.
One of my lastpatients in Denver.
Late-stage ovarian cancer.
Treatment's pelvic exenteration.
You remove everything.
The bladder, colon,uterus, and vagina.
Now, in success,
the patient lives withcolostomy and urostomy bags,
severe menopause, andabsolutely no sex life.
Well, it's brutal but effective.
Would have been.
But I talked myattending out of it,
in favor of anexperimental surgery.
A wide excisionof all the tumors,
then you reconstruct the entirepelvic floor with TRAM flaps.
Incredibly advanced.
The type of stuff you'retalking about doing to Brady.
Sherry, um...
Sherry died on the table.
And I left Denver.
We take risks and people die.
But if we play it safe,
they die too.
I'd rather regret fightingtoo hard for a patient
than not hard enough.
Why would your daughtershave your cat?
Long story. Pointbeing, don't get a cat.
Kids are gonna tell you they'regonna clean the litter box.
They're not gonna clean the litterbox. Don't fall for that trap.
You made a lot of mistakes.
Yeah.
It all boils down to
Maddy's mom basically raised her
while I focused on work.
You were a surgeon. Shewas a real estate agent.
I love surgery.
I love poking aroundin people's brains.
It's very exciting.
And I get to save somelives while I'm at it.
Saving lives is very exciting.
So were Maddy's firststeps, her first words,
her first pianorecital, or so I heard.
Work over family, andthat's what you get.
You're not gonna makethe same mistakes.
I don't think I will.
We are very different people.
Are we?
I have learned some veryuseful things from you.
Well, right back at you.
The baby needs surgery.
The crib needs to be assembled.
Go.
But you chose workway too often.
When should I prioritize family?
When you have a sick baby
and a piece of furniture, thesick baby wins every time. Go.
I got this.
Serial debridement.
Helps healing a little, but...
it increasesinfection risk a lot.
Well, then I'm tapped out.
Me too.
I guess we should tell Lim.
Lamborghinis.
Now, most sports cars usepressurized combustion
to achieve that kind ofperformance, but not Lambos.
No, no, no, no.
To reduce enginewear, they use vacuums
to pour gas into the pistons.
Now, Brady's organs won't heal
because we can't getenough flow to them,
but if you force more blood
into the area, well, thenwe cause lethally high
abdominal compartmentpressure. So...
Let's pull in the bloodpassively by creating a vacuum
using internal suction devices.
A low pressure system with lowtissue stress is better for healing.
That's...
That's a brilliant idea.
But it won't work.
Not without blood cominginto the right areas.
I need your help with that.
Where do you need the blood?
It's what we proposed earlier,
plus a healingplan that Jared...
I can read.
Good work.
It's four experimentaltechniques
rolled into an eight-hour surgerywith lousy odds of success.
Let's give it a try.
Dacron conduits areconnected to the aorta.
Do the anastomosis siteslook secure enough?
Any weak spots in therewill move that metal.
He'll bleed out.
They know.
On three.
One, two, three.
We have hemostasis.
And good blood flowthrough the conduits.
Tissue's perfusing.
Yes! Yes!
Time to move on tothe pelvic fractures.
This is much more importantthan assembling a crib.
But patients willalways need surgery,
and my family willalways need attention.
If there's no clearchoice between a patient
and your family, pick theone that's related to you.
Hmm.
Obviously, choosefamily when you can,
but sacrifice ispart of the job.
That's a good point.
But you are divorced.
That is moresacrifice than I want.
Fair.
Eden's O2 sat justdropped a bit.
I'm nowhere near her lungs.
Turner syndromecauses leaky vessels.
The stress on Eden's body iscausing lymph fluid to build up.
We can drain itwith a chest tube.
Her chest is so small, you'd risk acollapsed lung and pleural infection.
I could clear thelung with diuretics.
The risks and benefits of bothtreatments are nearly identical.
But that also means it doesn'tmatter which one we choose,
which makes the choice easy.
I find inserting chest tubesparticularly satisfying,
so I will do that.
The risks and benefits of a boy anda girl are nearly identical too.
But girls kick ass.
This implant's gonna be a tightfit around the cauda equina.
The bioengineer'smapping algorithm
was designed tooptimize stability.
Well, Brady's not an algorithm.
His nerves are gonnarun where they run.
I'll set it in position.
Nerve impingement.
I'll expand thenarrowing with a rod.
Wait, there's an alternatealgorithm that can fix that.
Settle down,Dr. Allen. I got this.
That's $100,000 worth oftech, and she's using a rod.
Nerve activity flattening.
One more minute.
The old cantilever maneuver.
Nice work.
Can't beat the classics.
Eden's surgery went well, soI was hoping Jasmine might...
V-fib.
Ran a code for an hour, but...
she'd just beenthrough too much.
Vacuum devices are in position.
Let's see if they work.
Keep a close eye on hisintra-abdominal pressure.
We have vacuum.
IA pressure's okay.
Time for the tissue flaps.
Looking good, Lambo.
There's a smallspike in IA pressure.
- Increasing vacuum suction.
Still climbing.
Pressure's compressinghis organs.
He's getting ischemic.
I'm going up to 55.
He's in shock.
I did this.
You didn't do anything.We're in this together.
We need to amputate.
Not yet.
Audrey, pressure's too high.
We're killing his organs.
I think he's wrong.
Then fight for your patient.
We need to amputate.
- Okay.- All right.
We need a Listonamputation knife,
a bone saw, and a setof 5 1/2-inch hemostats.
He can handle 75.
With that kind ofpressure, he'll bleed out.
Normally, yes.
But the Dacron conduitsDr. Perez chose
are more rigid thantypical vessels.
They'll hold up.
Let's do it.
I trust my residents, Marcus,and I need you to trust me.
Let's go to 75.
Brady's family are here.
Is my husband...
The surgery was a success.
It will be a longrecovery, but...
Oh.
Thank you for saving my dad.
I'll take you to him.
I should be dead on myfeet, but I just feel...
- Awesome?- Yeah.
It's been 24 hours.
Yeah.
I just need a minute.
A minute won'tchange the results.
No, it won't.
No cancerous DNA detected.
I was wrong!
Yes, you were.
What?
I'm gonna keep upthis same energy
with some Whitney.
You were right.
You always are.
You're learning.
You know, before when Iwas bitching about Jared,
it's because...
Well, I am a little jealous.
A little?
Okay.
What you saw betweenJared and I...
It's none of my business.
You deserve somebody who'sready to fully commit.
Somebody who makes you happy.
Whoever that may be.
Danny!
We need your boy bandface for the chorus.
- Come here.- Yeah, we need those abs.
Get up here, baby!
The new surgicalrobot is operational,
and I just landed theperfect nephrectomy
for its inaugural run.
Dibs.
Ah, you did the last cool case.
This one's going to Dr. Murphy.
This is cool.
Dr. Park should take it.
I have to finishsetting up our nursery.
Hey.
Good job today.
Thanks.
I've been under the microscope
with the board lately,and I am stressed.
Things were said thatprobably shouldn't have been.
Things weren'tsaid. You said them.
If you don't trust me, fire me.
And if you do, thenstay out of my way.
Hey.
Dalisay?
The baby's upset.
Her heart?
No, everything's fine there.
I just... I think sheneeds some company.
I'll get to her when Ican, but I'm slammed.
I'm here, Eden.
You can open your eyes now.
It's so sweet.
The crib.
The dresser.
It's the Angelic Dream Set.
The dark walnut was funereal,
but it also camein natural pine.
Oh, our little peanutis gonna love it.
Oh.
Whatcha got there?
There are
two screws missing.
That is not good.
No Biggie, Shaun. It'sjust a couple screws.
No, that meansDr. Glassman missed a step.
Dr. Glassman doesn'thave brain cancer,
but there is somethingwrong with his brain.