The Good Doctor Season 4 Episode 6

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The Good Doctor Season 4 Episode 6  #TheGoodDoctor #ShowMoviesTV

Transcript

00:00I've got hydroxychloroquine, ribavirin. I'm twice the size of SJ General. I should have twice the amount of tests.

00:30I'm a doctor. What happened?

00:58I don't know. He was running. I honked. All of a sudden, he was in front of my car.

01:04Pedestrian versus car, GCS5 at scene. Rigid abdomen with active bleeding. Failed chest with pneumo.

01:13He needs an X-Lap now.

01:17I've got a massive hemoperitoneum. I need two large suctions and lap pads in all four quadrants.

01:22There's a grade three liver laceration in right lateral segments.

01:29They were such no-one chromic and a blunt needle in the combat gauze.

01:41What were you doing on your bike at that hour?

01:43Heading into work. Trying to prep for my budget meeting with Glassman.

01:47Mobilize the lever to check for any associated diaphragm injury.

01:50It's the other side of town.

01:52I was taking the scenograph.

01:54PP's dropping. He's got another bleed. Add more lap pads and run the bowel.

02:00There's a perforation near the terminal ileum.

02:03Something tore through the intestinal wall.

02:09It's shrapnel from the accident. Coat's eroded. It looks like it's been in there a while.

02:17Must have gotten dislodged in the accident.

02:21How does Asher seem to you?

02:37He seems fine.

02:39Too fine for someone who's just lost their first patient.

02:42I don't have time to worry about people being too fine.

02:44He's faking it.

02:45Good. The brain releases serotonin when you smile even if you're miserable.

02:49I feel better already.

02:50Denial is not a proven strategy for psychological health.

02:54Dwelling on things you can't change doesn't help either.

03:0824-year-old woman came into the ER complaining of abdominal pain and headaches.

03:11And surprise, she's pregnant.

03:13Apparently not a happy surprise. She wants an abortion.

03:17What's wrong with her?

03:18I assume you haven't recently learned the value of sharing,

03:21which makes me think there's another reason you're unloading this onto the surgical department.

03:25She has a congenital IgA deficiency and a history of severe infections.

03:28She'll need IV antibiotics and close post-surgical observation.

03:32I figured one of your newbies may as well learn something.

03:34Leah's birthday is tomorrow.

03:48There are many cute frogs and many romantic songs.

03:51I can't decide.

03:56It is my first gift as her boyfriend.

03:59It needs to be awesome.

04:02Well, then maybe singing frogs, however cute, might be a mistake.

04:07Try something more personal or romantic.

04:10And find a resident who hasn't done a suction DNC and teach them.

04:15Oh, no. No, I'll do it myself.

04:19I'm not going to teach anymore. I'm a good surgeon. I'll do surgery.

04:23Dr. Murphy, part of your job as a surgeon is to teach.

04:26You can't opt out because it's difficult.

04:28I am opting out because I'm bad at it.

04:31Well, you can't opt out for any reason,

04:32but I may have given you too much responsibility too soon.

04:36So I will supervise your supervision until you get the hang of it.

04:41Pick someone.

04:42Did you two lose something?

04:44Our patient, Rose Babcock.

04:47She's post-op from repair of a distal radius fracture.

04:50Sixties, white hair.

04:52Looks at you like she's staring into your soul.

04:54Does she have a limp?

04:56No, I don't think she does now.

04:57Ms. Babcock, did you fall down again?

04:59Oh, no, I'm fine.

05:01But there's a poor man in room 318 who's in a lot of pain.

05:07Let's get you back in bed.

05:08Oh.

05:13Yep.

05:15Apply a new tegaderm, not antibiotic ointment.

05:23They breathe.

05:24Don't make us handcuff you to the bed, Rose.

05:26We charge extra for that.

05:27Dry the skin more, so it'll stick.

05:30You're doing just fine, dear.

05:34Heart rate spiking in the 130s, BP 162 over 95.

05:38Are you feeling any pressure in your chest?

05:40No, it's just anxiety.

05:43Not mine.

05:44It's one of yours.

05:49We're going to pretend since it's not your chest,

05:51we're going to pretend since it's happening in your chest,

05:55that it's yours.

05:5720 milligrams IV libetalol.

05:59I'm fine.

06:00I'm an empath.

06:01I can feel what other people are feeling.

06:04And one of you is very stressed out.

06:10Olivia, stay where you are.

06:12And one milligram of Ativan.

06:21Keep away from me.

06:35No, step back.

06:37Sir, you are in an accident.

06:39We're taking care of you.

06:40Stop it.

06:41Stop it!

06:42No!

06:43Get away from me.

06:44I need you to hold him down while I administer Haldol.

06:47Sir, please, just...

06:48Warning you, this room is being cleared.

06:51No one is going to hurt you.

06:54Ben?

06:57You're having a flashback.

07:01You're not in Afghanistan.

07:05You're in the hospital.

07:08Look around.

07:10What do you see?

07:21Zoe?

07:22Yeah.

07:23Yeah, baby, it's me.

07:24Zoe, I couldn't sleep.

07:25I...

07:27I went for a run and I heard an explosion.

07:31I don't know what happened after that.

07:36You were hit by a car.

07:38We had to do surgery, but you're going to be okay.

07:42It's okay.

07:43Take him back to his room.

07:44Make sure he didn't open his wound.

07:48Just worry about me.

07:50I'm just worried.

08:05Dr. Murphy?

08:13Rose is not your patient.

08:15She was teaching me about her gift.

08:18She says the basis of empathy is curiosity, which I find curious because...

08:23I'm curious about the job you're supposed to be doing.

08:26Who are you leading through the DNC?

08:29None of them.

08:30The only one who hasn't done one does not want to, so I will.

08:35Which resident?

08:37Wanting to is irrelevant.

08:38It's their job.

08:40Wanting to is irrelevant.

08:42It's your job.

08:44I'm a Christian.

08:45Performing an abortion goes against my beliefs.

08:49Okay.

08:52You may encounter a situation one day where this procedure could save a woman's life.

08:58Then I hope someone else can...

08:59And it's my job to make sure you can perform all surgeries, including abortions.

09:08So where does that leave us?

09:11I'll do the surgery.

09:13I've only done one.

09:14I'm sure there's a lot I still can learn.

09:20Dr. Murphy, you have a new student.

09:22Get her started running pre-surgery assessments.

09:24Thank you, Olivia.

09:26That's the kind of ambition I like to see.

09:30He did three tours.

09:32He came home after he was injured in some kind of explosion.

09:36I don't really know what happened.

09:39He's tried to tell me about it several times, but he just...

09:42He breaks down.

09:43When was he diagnosed with PTSD?

09:45Two years ago.

09:47But he hasn't been the same since he got back.

09:52At first, he was moody, irritable.

09:56Little things would set him off.

09:59And then the insomnia started.

10:02His mind is just never at rest.

10:06Nights are the worst.

10:07You know, he gets these terrible nightmares.

10:13Flashbacks.

10:15We can't sleep in the same room anymore.

10:21Make sure he stays off his feet.

10:23Would you like us to arrange a psych consult?

10:26We've been down that road.

10:29Talk therapy, group therapy, exposure therapy.

10:34Endless medications.

10:37Let us know if you change your mind.

11:13I need those stats on elective surgeries for my budget meeting.

11:34And a coffee.

11:38Jillian?

11:41She's not there.

11:42I need approval for this.

11:46And this.

11:49You said I couldn't give her the frogs.

11:52Oh, you can't give her this either.

11:54You don't know what it is?

11:56I know it would mean more if you had to leave the building to get it.

12:02I would like to do the suction DNC surgery.

12:06I assume your religious convictions haven't changed in the last few hours?

12:10No.

12:11But I believe I was put in this program for a reason.

12:13So if you think it's important for me to learn how to do an abortion, then I should learn.

12:21Take Jordan to the skills lab.

12:23Run the surgery steps.

12:24You two will handle the DNC yourselves.

12:26With you?

12:29How are you going to supervise my supervision if you're not there?

12:33I will help you prep and debrief afterwards.

12:35But this patient doesn't need a gallery of strangers standing around

12:38gawking at her most private experience.

12:40Sorry to interrupt.

12:41Ben woke up complaining of pain.

12:43Did you check the incision?

12:44The pain is in his arm.

12:48Now test external rotation of the shoulder.

12:51We're almost done.

12:53Can you describe the pain?

12:58I'll call it a 10.

12:59It's been hurting for years, but this is something else.

13:03How did you injure your shoulder before?

13:08I was in a...

13:11I was in a convoy in Kandahar, and there was a...

13:19I dislocated my...

13:23You don't need to discuss it with us.

13:26What did you find?

13:27Swelling, sensitivity to touch, discoloration.

13:30Could be CRPS.

13:31What is that?

13:32Well, it appears the car accident aggravated a prior injury.

13:36You've developed complex regional pain syndrome.

13:38We'll start you on gabapentin and allotted.

13:41Opioids make me a little insane.

13:44We could do a stellate ganglion block.

13:46It's an injection of anesthetic near the spine that blocks the pain signals

13:51and could also help the PTSD.

13:54I've been treated for PTSD for years.

13:57Why haven't I heard about this?

13:58It's experimental, but promising.

14:01Procedure comes with risks.

14:02Vascular injury, infection, major hematoma.

14:05Dr. Lim, I've been taking a risk every time I go to sleep.

14:11I want to do it.

14:13Stellate block is an accepted procedure for treatment of pain,

14:15which you wouldn't have suggested if the patient didn't also have a mental health condition.

14:20I hear Jordan's back on the DNC in spite of her righteous indignation.

14:23Is something chirping?

14:25I think you're being unfair.

14:26Well, if anyone's being unfair, it's me.

14:28I told Jordan to do it.

14:30I told her.

14:31We make decisions that are hard to live with all the time.

14:34We make them anyway.

14:35And I told her pissing off the chief was a very bad way to start your residency.

14:38Glad to hear you're still moonlighting a surgical department counselor.

14:42But I don't mean you were being unfair to Jordan.

14:44You're being unfair to the patient.

14:46She's facing an emotionally fraught procedure.

14:48She needs the support of her doctors.

14:50And who she's getting is a rookie who thinks she's committing murder.

14:54And Sean.

14:59I have a point.

15:02I'll lead Jordan through the DNC myself.

15:04You're happy.

15:05Dr. Murphy will be happy.

15:07My cup runneth over.

15:08Now get whatever's in that box out of my department.

15:21Morning sickness.

15:23Nurse Alice.

15:25Rose claims she can feel the pregnancy.

15:27She was right about the guy in room 318.

15:29He had a clot in his ankle.

15:31I'm sure she picked up on some subtle clues like the guy moaning and grasping his ankle.

15:36Get a CT to rule out abdominal injury from her fall.

15:42We're going to insert a thin needle into your neck so we can inject the anesthetic.

15:46It may sting a bit.

15:53Use an in-plane approach to place the needle between the C6 tubercle and carotid artery.

16:01So...

16:21He might feel some discomfort.

16:31What's wrong?

16:55It's always hurt.

16:56I'm okay.

16:57It's nice.

16:58Now you take a look.

16:59What happened?

17:00I hit her.

17:01I was laying next to him.

17:03I know I shouldn't but the shot just made his pain feel so much better.

17:07I thought...

17:07Zoe.

17:09You didn't do anything wrong.

17:12There was a noise in the hall.

17:14I lashed out.

17:14I know.

17:16I didn't mean to.

17:17I'm sorry.

17:25Nothing's broken.

17:27I can get you something for the swelling.

17:28No, I'm okay.

17:29I'm gonna go home.

17:30Get cleaned up.

17:33I just need some time.

17:37I love you.

17:50I think we can help them.

17:52There have been some promising results using vagal nerve stimulation to treat PTSD.

17:57Scarring would make it impossible to expose and find the nerve without damaging it.

18:01Those scars are the reason that we need to try.

18:04Imagine reliving your worst nightmare over and over again.

18:08Why doesn't anyone around here want to do the job they were hired for?

18:10What Ben needs is psychological help.

18:12I've ordered a consult.

18:13Leave it to the people who are trained to do it.

18:17Sets a bad precedent to force a resident to do a procedure they're not comfortable with.

18:20Wow.

18:20Does anyone around here not have an opinion about who should do that damn abortion?

18:24Jordan had a choice and in my opinion,

18:26she made the right one.

18:27It's not a true choice if you're coerced by your boss.

18:29I asked her to do her job.

18:31You took an opportunity from a resident who wants to learn in favor of one who doesn't.

18:36Is it song and dance about Jordan doing the procedure or your niece not doing it?

18:41Neither.

18:42There's a misconception that Olivia came to St. Bonaventure because of me.

18:46She's here because of your reputation.

18:49The great Dr. Lim.

18:50A master class in technique, professionalism, empathy.

18:54Lately, it doesn't seem like that reputation holds up.

19:01I'm giving you an antibiotic to prevent infection.

19:05The vacuum aspiration will take about 15 minutes and you'll be numbed with the local anesthetic.

19:10Conscious sedation is also an option, but you will need someone to drive you home afterwards.

19:19Do you have any questions for me?

19:24I'm scared.

19:39Are you certain you want to go ahead with the abortion?

19:50Yes.

19:54Then you don't have to be scared.

19:57You're making the right decision for you.

20:06Give her another 400 micrograms of mesopristol.

20:09I'll be back for the procedure.

20:12This doesn't work.

20:13I need these numbers in spreadsheet format.

20:21Dr. Park?

20:23Rosa's CT was normal.

20:24Get an upper GI barium study.

20:27First quarter supply cost you requested.

20:29Also, one of your first years seems upset.

20:32He's been in the stairwell for a while.

20:37Everything okay in here?

20:41I just needed some quiet.

20:46Surgeons come into the stairwell for two reasons.

20:49Fire drills or doctor trauma.

20:51You're having a fire drill?

20:54I just wish we had a more effective treatment for Ben.

20:58His head's so messed up and we can't help him.

21:05I don't think this is about Ben.

21:07Have you ever lost a patient you knew you could have saved?

21:17When COVID was at its worst,

21:19we had to cancel all non-urgent procedures.

21:23A young mom with a baby in her arms,

21:25and a young dad with a baby in his arms.

21:28We had to cancel all non-urgent procedures.

21:31We had to cancel all non-urgent procedures.

21:33We had to cancel all non-urgent procedures.

21:36A young mom with a heart condition was

21:40more urgent than I thought.

21:43And she died waiting for me to put her on the schedule.

21:53How do you get past that?

21:57You get past it because that's the job.

22:02You will always remember it.

22:04And you will eventually stop reliving it.

22:10How can you be so sure?

22:14Because if you don't, you can't be a surgeon.

22:20And I'm pretty sure you're a surgeon.

22:29I have to get back to work.

22:34I have to get back to work.

22:44Insert the speculum.

22:55Now dilate the cervix.

23:04Now dilate the cervix.

23:20Begin gentle suction in the uterus.

23:29Is anything wrong?

23:31You're okay.

23:32Dr. Allen, I can take it from here.

23:40Don't worry. We're almost done.

23:42You're gonna be just fine.

23:47You have no idea what that woman was going through.

23:50And you made it worse for her.

23:51I know. I didn't.

23:51You had an opportunity to opt out before you walked into that room.

23:54But you agreed to do the procedure.

23:56You took on an obligation to that patient.

23:58And you failed her.

23:59If you ever do anything like that again,

24:00I will have you removed from my program.

24:02Maybe you should be cleaning bedpans for a while.

24:04Hopefully, there's no moral objection to that.

24:16Why are there adult toys on my desk?

24:18I've heard good things about the llama,

24:20but online reviews aren't always accurate.

24:23Do you have a favorite?

24:27They're for Leah.

24:28Which one do you like the most?

24:30Claire.

24:36Evidence suggests that trauma changes the way the brain works.

24:39An overactive amygdala can heighten someone's response to emotional stimuli,

24:43including fear.

24:45I think we should consider amygdala ablation for Ben.

24:48That's crazy.

24:50And completely outside the scope of our care.

24:52We're...

24:59We're surgeons.

25:00We fix physiological problems, not mental ones.

25:02It is a physiological problem.

25:04His brain isn't functioning properly.

25:05If it was a tumor that was causing these reactions,

25:08you wouldn't hesitate to remove it.

25:09But there is no tumor.

25:11You're talking about inflicting damage on his brain.

25:13He could suffer a stroke or come out in a coma or not come out at all.

25:17If you use a stereotactic laser approach

25:20rather than an open craniotomy,

25:22you would greatly reduce the risk.

25:23This is not your case.

25:24You cannot jump into this one

25:26because you don't want to do the one assigned to you,

25:28which is to teach,

25:29which you've made my problem

25:31just like you made Leah's birthday gifts my problem.

25:33You need to grow up and accept some responsibility.

25:51I was diagnosed with PTSD last year.

25:56I kept it mainly private.

26:00Melinda's really helped me through it.

26:04It was nice to have a friend to lean on.

26:09So if you need one,

26:11you can always come to me.

26:15I'm not sure I'm the only one.

26:18I'm not sure I'm the only one.

26:20I feel off.

26:42Disconnected.

26:44Like I can't catch my breath.

26:46But it comes with a job.

26:54I'll get over it.

27:03It's Ben.

27:07Ben, no one is going to hurt you.

27:12You're having a flashback.

27:16I know where I am.

27:23Every day since I came home,

27:25I thought there's a monster chasing me.

27:27I try to outrun it.

27:31But I end up hurting the one I love the most.

27:37I'm a threat to everyone around me.

27:39No, Ben, you just need help.

27:42Nothing helps.

27:44I can't smile.

27:45I can't laugh.

27:46I can't feel anything but pain.

27:52I make everyone around me suffer.

28:03Ben, there's a surgery that may help.

28:13I would like to scrub in on the amygdala ablation surgery.

28:33Rose said you're feeling overwhelmed.

28:35I don't want to hear any more things that woman has said.

28:38Your job is to supervise your residents.

28:40Why are you here instead of doing that?

28:42You said you were going to supervise my supervision,

28:45but you didn't.

28:45You took over my case.

28:47I don't know what I was supposed to learn or how.

28:53Scrub in.

28:59Dr. Murphy, walk Asher through the probe placement

29:02and trajectory to the amygdala.

29:07I will supervise your supervision.

29:09Okay, insert the probe perpendicular

29:11to the cortical surface.

29:27Stop.

29:28You're off course.

29:29On the current trajectory, you will penetrate a branch

29:32of the choroidal artery and cause a hemorrhage.

29:34Step away from the probe.

29:35Your job is to teach, not take over.

29:48Adjust the probe one millimeter inferiorly.

29:52Avoid the temporal horn on your right.

29:56I can't see it on the image guidance.

30:01Tell Asher what you see.

30:05It should point toward your six o'clock on the y-axis.

30:17You have to feel it.

30:22The tissue plane along the parenchyma is smooth.

30:29It should feel like gliding.

30:35You've reached the amygdala.

30:45Ready to begin thermal laser ablation.

30:53Rose's upper GI and labs are normal.

30:55Should we keep her in the day to observe?

30:57No, she's stable.

30:58Let's send her home.

30:59Okay, I'll have Olivia.

31:00Open your mouth.

31:02Pardon me.

31:03Open your mouth.

31:09I can, uh...

31:10Shut your mouth.

31:14There's this rat.

31:15A mouse, a little dead mouse in the garage,

31:17and the big strong man is afraid to get it out.

31:19Not afraid, disgusted.

31:21Neither of us want to deal with it,

31:22so we are settling it in the only responsible way, a bet.

31:26A dare, a series of dares, actually.

31:28Whoever wishes out first has to...

31:29Take those things out of your mouth.

31:33I will discharge Rose.

31:34You two go home.

31:36You are just being idiots at work

31:38while people are sick and dying.

31:40Go home.

31:47All your tests are normal.

31:49We're discharging you.

31:52Right, because you're psychic.

31:54I'm an empath, not a psychic.

31:57Whatever the case, I would suggest you take it easy.

32:00No drinking, no heavy lifting.

32:01You have to let it out, dear.

32:03It was you.

32:05You made my heart rate spike.

32:08You're about to implode.

32:13There's nothing wrong with you.

32:15Or me.

32:19Code blue.

32:32Code blue.

32:57Yep.

32:59Dr. Lim, my behavior yesterday was inexcusable and unprofessional.

33:05I let you down.

33:06I let the patient down.

33:08I am deeply sorry.

33:12And I promise it will not happen again.

33:15You let your personal judgment get in the way of doing your job.

33:20You're right, that is inexcusable.

33:22You said I had no idea what the patient was going through.

33:27The truth is, I kind of do.

33:33Scared, alone, afraid of anyone finding out.

33:40I chose my career over motherhood, over my faith.

33:46And I chose to be a mother.

33:51But I don't regret it.

33:56And I know God forgave me because I get to be here, living my dream of being a doctor.

34:09But I purposely try not to think about it.

34:20You're off scud duty.

34:21That's not why.

34:22Take it.

34:31My name is Benjamin Allen Harris.

34:34I'm in St. Bonaventure Hospital in San Jose.

34:39Language and memory appear to be intact and your motor function is normal.

34:44But that doesn't mean it worked, does it?

34:46No.

34:47We'll have to do an fMRI to see how you respond to fear-inducing stimuli.

34:51But we'll let you rest for now.

34:53I'm not going to rest until I know I'm better.

34:58I want you to know how I got these scars.

35:00No, not now.

35:02Just give yourself time.

35:03I was in a convoy in Condahart.

35:08I was in a husky, big vehicle at the front.

35:11Ben, you don't have to do this.

35:14Ronnie was driving.

35:15He was telling me a story, something about a goat at the base.

35:20Or maybe it was a chicken.

35:21I don't know.

35:21But we were laughing.

35:32And the world was on fire.

35:43It's the husky's job to spot IEDs.

35:50And I missed one.

36:01I can't see their faces.

36:06Just bodies everywhere.

36:11Dying alone, without their families, all I can do is hold their hand.

36:30Are you okay, Ben?

36:41I'm okay.

37:11Fun day.

37:32What do you need?

37:33We have a diagnosis.

37:41I thought I felt someone here.

37:54You've had a long day.

37:59You have Prince Metal's angina rose, a heart condition, but it's very treatable.

38:05It explains all your symptoms.

38:07And it's exacerbated by stress, which is likely what caused your heart attack.

38:12You need to stop seeking out other people's pain.

38:15It's literally killing you.

38:21You're the chief of surgery.

38:22You could have sent somebody else to tell me this.

38:26Sure, but then I'd miss my chance to gloat.

38:30You're here because you're hurting.

38:33And you don't know where else to go.

38:38Go ahead.

38:38Use your magic.

38:41Tell me what's wrong with me.

38:44How do I stop feeling like this?

38:48It doesn't work that way.

38:50I don't have a magic wand.

38:54I can only hold up a mirror, make you slow down, look at the parts of yourself

39:00that you've been trying to ignore because you're afraid if you look too closely, you'll break.

39:11Maybe you will.

39:11I don't know.

39:13Maybe breaking is the point.

39:20You can't outrun your pain, Dr. Lim.

39:22If you keep trying, it's going to kill you.

40:11So

40:41um

40:55time of death

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