The Good Doctor Season 4 Episode 3
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00:00Hello, I'm Freddie Highmore.
00:03The following episode portrays our hope for the future.
00:06A future where no one will have to wear masks or
00:08take other steps to stay safe from COVID.
00:11Until then, please protect yourself and others.
00:17I'm Jordan Allen.
00:19My first year in med school,
00:20I designed an ankle brace that monitors
00:22extent of immobilization via a phone app.
00:24When I licensed it to BioVentus,
00:26I was able to pay off over half my student loans.
00:30John Lundberg.
00:31I've worked every summer since I was 16
00:33at Camp Hope Heartland,
00:34a summer program for kids with cancer in Des Moines,
00:37where I grew up.
00:38Asher Wolk.
00:40When I was 18, I left the Hasidic community
00:43that I was raised in.
00:45I realized if there really was a God,
00:47it had to be a cruel being
00:49that I felt nothing but contempt for.
00:52That's also when I decided to go to med school
00:54and start dating men.
01:00I'm Olivia Jackson.
01:01I'm 25, from Chicago.
01:06I play ragtime piano alone in my apartment.
01:12Is that interesting?
01:13Will Hooper.
01:15Technically, I'm a professional athlete,
01:17although in a sport nobody pays attention to,
01:19and the stipend barely covers our training expenses,
01:22but I'm on the US national rowing team.
01:25Men's eight.
01:27Hey, I'm Enrique.
01:30I spent last summer in Costa Rica,
01:32where I learned to surf,
01:33which I'm totally obsessed with now.
01:37I had a pretty interesting encounter
01:39with a saltwater crocodile.
01:41I just thought it was a big...
01:43Why are you wearing a swimsuit?
01:48They're actually hybrid boy shorts.
01:51I like to work hard,
01:52and it's easier to do when you're comfortable.
01:56Plus, I think the casual dress puts patients at ease.
02:06And Dr. Lim said that the shorts were fine.
02:10Hospital policy requires all residents to-
02:13He's not a resident.
02:14He's a resident applicant,
02:16one of six finalists for four openings.
02:18Now, they'll be shadowing for two days.
02:20Give them the grand tour, show them the ropes,
02:21feel free to turn up the heat a bit,
02:23see how they react under pressure.
02:24You will be responsible for supervising them,
02:26so I want your totally honest input
02:28before I make any final decisions.
02:30Oh, shorts.
02:31Let's call them strike one.
02:33Oh, and in addition to being an Olympian,
02:36Will Hooper is a Rhodes
02:37and graduated top of his class at Stanford.
02:40He is very handsome.
02:42He's very full of himself.
02:43He's ranked first by every top program,
02:45so whatever you can do to recruit him to ours, do it.
02:47I can already give you my input on-
02:49Don't judge a book by its board shorts.
02:54I don't think she's gonna receive it.
03:02You wanted to see me?
03:04Good morning.
03:05Sorry.
03:06Good morning.
03:08What'd I do wrong?
03:09Just wanted to check in,
03:10see how the new role was coming along.
03:12Honestly?
03:15You could start a new supervisor-resident
03:17relationship with a lie.
03:19That's always fun.
03:21Internal medicine is...
03:24boring.
03:25Between smokers and obese diabetics,
03:28seems like all I'm doing
03:29is protecting people from themselves.
03:33As a surgical resident,
03:35you never treated drunk drivers
03:36or extracted random objects from guys-
03:39I get it. People are stupid.
03:40Not my point, but true.
03:45Not the same adrenaline rush,
03:46but internal medicine can be rewarding.
03:49Rewarding?
03:51Given time, if you're patient.
03:55Thanks.
03:58That is not how I thought this meeting was gonna go.
04:02I thought one of the nurses complained about me.
04:04It wasn't just one.
04:06And if it happens again,
04:07this meeting will go exactly how you thought it would.
04:20Sorry, I should have just canceled the appointment.
04:23You were right.
04:24Dizziness went away
04:25as soon as I stopped drinking coffee and Red Bull all day.
04:28No worries.
04:30Can you lie flat on your back, please?
04:31Yeah.
04:33You get that scar in a fire?
04:35Sort of.
04:36Homemade Roman candle when I was 12.
04:39You'd be surprised how many of us
04:40at the firehouse were pyros as kids.
04:43I made a potato gun for my sixth grade science fair.
04:46Almost got a job.
04:47I made a potato gun for my sixth grade science fair.
04:49Almost got me kicked out of school.
04:50Well, you'll have to come visit us sometime.
04:52Fit right in.
04:56You see something?
04:57Don't talk, just read normally.
05:07You have a large tumor on the wall of your heart.
05:11Cancer?
05:12I don't know,
05:13but you're definitely gonna need surgery
05:15as soon as possible.
05:17I appreciate you letting me share your case
05:19with the whole class.
05:20No problem.
05:21I stopped being shy after the hundredth time
05:23I had to do this.
05:24I'll be using a version of Le Jour's technique I've adapted.
05:27We'll divide the breast into three pedicles
05:29and then redistribute the tissue
05:31and insert saline implants
05:32to correct the tumor's breast deformity.
05:34Why would you want breast implants?
05:36I don't know.
05:37It's not like I don't have a breast.
05:39I don't have a breast.
05:40I don't have a breast.
05:41I don't have a breast.
05:41I don't have a breast.
05:42I don't have a breast.
05:43I don't have a breast.
05:44I don't have a breast.
05:45I don't have a breast.
05:46I don't have a breast.
05:47Breast implants.
05:48You're beautiful and your breasts look fine
05:50just the way they are.
05:51No, no, they don't.
05:53The base is constricted.
05:55Horizontal development is deficient
05:57and the nipple areola complex.
05:59Murphy?
05:59It's okay.
06:00He's right.
06:01That's why I'm here.
06:05I know that you're trying to be nice.
06:07My friends and family have been telling me for years,
06:10you're beautiful just the way you are,
06:12but I don't feel beautiful.
06:14You're 17.
06:16Every girl your age feels like that.
06:18That can't be true.
06:20Tuberous breast deformity is a rare condition.
06:22We're not going to debate a personal decision
06:25the patient's already made.
06:28I've been thinking about this since I was 13.
06:31Every time I look in the mirror.
06:33I'm about to start college
06:34and there is no way that I'm gonna begin this new chapter
06:37until I'm fixed.
06:40Great.
06:42You thinking median sternotomy or right thoracotomy?
06:45I'm thinking I should finish my review of the imaging.
06:47Sure.
06:48No rush.
06:50Actually, there is a bit of a rush,
06:52but you know what I mean.
06:54So newbies, what up?
06:55Where are y'all from?
06:56Like hometowns or?
06:57Med schools.
06:58Why would I care where you grew up?
06:59Stanford.
07:00NYU.
07:01Harvard.
07:02Preferred specialties?
07:03Ortho.
07:04All the way.
07:05Neuro.
07:06I'm planning a dual specialty in neonatal and pediatric surgery.
07:09Dual specialty in neonatal and pediatric oncology.
07:12Impressive.
07:13Also unlikely.
07:14I know, it's a ton of work,
07:15but I'm pretty good at multitasking.
07:16In med school, I did a combined MD, PhD.
07:19What's your mom do?
07:20My mom?
07:21Don't stall, just answer.
07:22She teaches high school French.
07:24Homemaker?
07:26Surgeon.
07:27Ouch.
07:27Dad?
07:28Also a surgeon.
07:29Double ouch.
07:30And yours?
07:31Prosthetic rabbi.
07:32You've left the nest.
07:33Actually, the whole forest.
07:35And yours obviously works on Wall Street.
07:37But not a trader.
07:39I'm guessing an MNA lawyer.
07:41How do you know?
07:42She's read your resume,
07:43researched your social media.
07:45She's probably run a credit check, too.
07:47And you're under 50,
07:48but wear Brooks Brothers button-downs.
07:50Are you done yet?
07:52Left thoracotomy with a possible incision
07:54into the right atrium and into atrial septum as needed.
07:58Left atrial approach through Sondergaard's groove
07:59makes more sense.
08:01Not to me.
08:04He's my patient.
08:05But you're not a surgeon,
08:07which is why there is no reason for you
08:08to be grilling them or picking the approach.
08:11Stop worrying about protecting your turf.
08:12Stop stepping all over it.
08:13You're looking at tests I did for my patient.
08:16How am I stepping all over your turf?
08:17I think what Dr. Brown is trying to say is,
08:20given there's no perfect approach,
08:21maybe it's best to defer
08:22to the surgical department's recommendation.
08:26Did he just mansplain?
08:28Not at all.
08:29I was just trying-
08:30So are you just gonna do it again?
08:31No, I'm just trying-
08:32Shut up.
08:34We're gonna go in through a left thoracotomy.
08:37Not my preference, but it'll work.
08:41What were you thinking?
08:43You thought you'd impress me
08:44by undermining the patient's confidence in my judgment?
08:48I'm sorry, that wasn't my intent.
08:50You're supposed to be a mentor now,
08:51modeling professional behavior,
08:53not making it worse, Murphy.
08:55She questioned your surgical plan.
08:58I defended it.
08:59How can we both be wrong?
09:00I don't need you to defend me.
09:02And I never wanna have a surgical debate
09:04in front of a patient.
09:06We're not in front of the patient now.
09:10The patient's breasts are small and a bit asymmetrical,
09:13but no woman's breasts are perfectly shaped.
09:16You're wearing Prada shoes and a Dolce & Gabbana blouse,
09:20which cost more than most med students' rent,
09:22so clearly you understand your appearance
09:24has a tremendous impact on how people treat you.
09:26There's a difference between nice clothes
09:29and a major surgery.
09:31And I also understand the cosmetic surgery industry
09:33is dominated by male physicians with a sexist bias.
09:44I've invited you to observe as a learning opportunity,
09:48so I'd suggest less lecturing and more listening.
09:54We'll access the tumor via an incision
09:56in the chest wall between your ribs.
09:58It'll be an easier recovery than if we opened your sternum.
10:01Are you sure you don't want us to call your family
10:04before we put you under?
10:05Why, so they can freak out and worry?
10:07I'd rather just give them the good news when it's over.
10:10It is going to be good news, right?
10:12With a bit of cardiac rehab and a positive attitude,
10:15which I know you have,
10:16you'll be back sliding down the fire pole in no time.
10:19Our firehouse is upstairs.
10:20Hmm, bummer.
10:23It's a social media group where we all pretend to be ants.
10:27Why?
10:28Because ants don't care about politics, sports teams,
10:32or anything else people get so savage about.
10:35Male ants develop from unfertilized eggs,
10:37which means they don't have a father and can't have sons,
10:40but they do have grandfathers and can have grandsons.
10:44Interesting and confusing.
10:46Is it just me or are those doctors watching us?
10:49They're the new resident applicants.
10:52They're here so Park Claire and I
10:53can evaluate them for Dr. Lin.
10:56So why are they standing over there?
10:58Park had a video chat with Callan
11:01and I had a real lunch with you.
11:03Sean, you can't just have them stand there while you eat.
11:07A part of being a good boss is being a good host.
11:10You need to introduce them to people.
11:14Like me, right now.
11:18Come here, please.
11:22Dr. Allen, Dr. Lundberg, Dr. Darin.
11:24This is my girlfriend, Leah.
11:25She runs the IT department now.
11:27Okay.
11:28Nice to meet you all.
11:29Please join us.
11:30Sean's been telling me all about you.
11:34No, I haven't.
11:36So, I hope Sean's not being too hard on you.
11:39No, he's been great.
11:41The case we're observing is really interesting.
11:44We're correcting a 17-year-old girl's
11:46tuberous breasts with saline implants.
11:48Dr. Allen told Dr. Andrews it was unethical.
11:51He got mad.
11:52I didn't say it was unethical.
11:54I just, I suppose I shouldn't have interfered.
12:00Well, I don't know what a tuberous breast is,
12:02but I think implants are way overrated.
12:06That's because your breasts are excellent.
12:11That's exactly my point.
12:13Mine aren't huge, but every guy who's ever seen them up
12:16close and personal has been thrilled.
12:19I definitely was.
12:21I am thrilled by every part of your body.
12:25Sorry.
12:27My bad. Total TMI.
12:28I'm not even bothered by your adenoidal voice,
12:31except when you talk to your mom on the phone,
12:33but I just put on headphones.
12:40At least you'll know he'll be a totally honest boss.
12:50The incision is extended superiorly to meet the atriotomy,
12:53and then the interatrial septum is opened up.
12:55Retractor.
12:56A copontia retractor is used to visualise the mitral valve.
13:00That will allow a clear view of the tumour.
13:01Can we turn the channel?
13:03Colour commentary is getting a bit annoying.
13:05With the right atrium opened oblique...
13:09How's team brown? Any early standouts?
13:12Jackson's a bit timid, but smart.
13:14Walk is definitely enthusiastic.
13:17And your star recruit is pretty full of himself.
13:23I'm looking for surgeons, and according to his recs,
13:26he can dissect and suture like a pro.
13:28Thought you were also looking for our input.
13:30He's ranked first by every top programme.
13:33You really think they're all wrong and you're right?
13:38So, what brings you all to the biz?
13:40Had my ACL reconstructed in high school.
13:43Both my rotators in college.
13:45I love the idea of fixing people.
13:47Helping them be the best they can be.
13:51Surgeons are the ones with the God complex, right?
13:56I have that.
13:59I spent my life speaking Yiddish, studying the Talmud,
14:01and not shaving the sides of my hair,
14:03because someone up there supposedly cares.
14:06But then I realised...
14:09..no-one's up there.
14:12No-one cares.
14:14No benevolent higher power is going to save us, so...
14:19..we have to save each other.
14:24Can you top that?
14:25Definitely not. Try anyway.
14:28You're obviously smart. You've got two degrees from Harvard.
14:31My parents are Harvard alums, so I'm sure that helped me get in.
14:34You're not going to get hired by undermining your own ex...
14:38Something went wrong.
14:39Looks like they nicked a pulmonary artery.
14:41No, if they had, Brown would be suctioning
14:43instead of limb-reaching with her hands.
14:45What are they doing now?
14:47Nothing.
14:49We can't access the tumour without compromising
14:51his entire cardiac outflow tract.
14:53What about going in the way I suggested, the median sternotomy?
14:55The tumour's too far back. We need to close him up.
15:04Proton beam radiation would be too toxic to the heart.
15:07So is immunotherapy.
15:09We can't access the entire tumour without compromising
15:12We can't access the entire tumour surgically,
15:14and we can't kill it without killing his heart along with it.
15:17What if we cut out the parts we can access
15:19and try our luck with chemo and what's left?
15:22IV doxorubicin and ifosfamide might slow the growth,
15:25give him a few more months.
15:27No, I'm not sending my patient home with just a few extra months.
15:30That's better than nothing. What about a transplant?
15:32Not an option. Heart tumours are a contraindication.
15:35What if we transplant his own heart?
15:38If we take it totally out of his chest,
15:40we'd have access to the posterior heart.
15:42We could excise the tumour, fix the defect left behind,
15:44and then put it back in.
15:45Cool.
15:46Not cool.
15:47At least with a normal heart transplant, you'd be getting a healthy heart.
15:50Her idea keeps the risk of removing the heart
15:53and adds the risk that the heart we'd be putting back in
15:55has just been severely compromised having had a tumour cut out of it.
15:58He's young, and the part of his heart not infiltrated with tumour is strong.
16:05Do a cardiac MRI and see if the tumour's infiltrated the coronary arteries.
16:09If it hasn't, Morgan's idea could work.
16:11I'll schedule it.
16:15Dr. Murphy's dividing the breast parenchyma into three pedicles.
16:19Anyone know where this technique's derived from?
16:22Breast reduction surgery.
16:24That's right.
16:25And why would I use a breast reduction technique
16:28to make the patient's breasts larger?
16:31The technique frees up the tissue.
16:33You can bring the pedicles together to make the breasts smaller
16:36or spread them out over an implant to make them larger.
16:40Very good.
16:42And now I'm going to turn the sound off.
16:45Don't worry, nothing's wrong.
16:46I just want to talk about you behind your back for a little bit.
16:51So, first impressions.
16:53Murphy?
16:54I like Dr. John Lundberg.
16:56I haven't even heard him speak yet.
16:59He has the highest USMLE scores.
17:01And that's important to you?
17:03Yes.
17:06It shows he has a broad knowledge of medicine.
17:09What is important to you?
17:12Well, I'm more interested in what they can do with their knowledge,
17:15which is why so far I'm most impressed with Jordan Allen.
17:18No, no, you said she undermined you.
17:22Which takes courage and an assertiveness that will serve her well.
17:26Then why did you tell her to stop lecturing you?
17:30Easier to teach an aggressive resident restraint than a passive one to assert themselves.
17:37What about you, Park? What's important to you?
17:40I want to know who I can stand and be around for 80 hours a week.
17:43One thing I learned as a cop, you don't really know a person until you've had a few drinks with them.
17:54LAD and circumflex look clean.
17:56Those are the right coronary.
17:58It looks narrowed at the origin.
18:01It's a bit narrow, but looks like a normal variant.
18:03Yeah, but it seems hazy, like there could be some tumor infiltration.
18:08What do you guys think?
18:10Us?
18:11Yeah. Come take a look.
18:16I guess...
18:17It's angiogenesis.
18:18Stop.
18:20Interrupting a female co-worker is almost as annoying as mansplaining.
18:24This isn't a rowing race. You don't always have to speak first.
18:28I do not love the interruption.
18:34But I like the enthusiasm.
18:38What were you going to say?
18:41First, I'm not sexist.
18:45Of course not.
18:46He's shifting from right to left, dominant circulation to feed blood to the tumor.
18:50Angiogenesis...
18:51I doubt it. Surgery already showed his tumor extending to the right side as well.
18:54What were you going to say?
18:56The pulmonary artery is right behind that vessel.
19:00It's causing radiographic scatter in this area.
19:03The haze is just an artifact.
19:05His arteries are clean.
19:08I think she's right.
19:13Your idea might just work.
19:19If you invert the sutures and bury them under the skin, the scar will be invisible.
19:24No one will ever know we were here.
19:28Nice work, both of you.
19:32Her BP's dropping.
19:33Push fluid, start IV pressors, check for bleeding.
19:36She's in V-tach, moving the crash cart.
19:40No bleeding, no hematomas.
19:43Charging.
19:46Clear.
19:55Sinus rhythm. Her BP's stabilizing.
20:00Get her to the ICU. I want post-op labs, CTA chest, and full 24-hour cardiac telemetry.
20:07We need to figure out what just happened.
20:15She's stable, but diffuse delta waves slowing minimal brain activity.
20:20An undiagnosed metabolic disorder could have caused an adverse reaction to the anesthesia.
20:25Yeah, but her pre-op labs were all normal. It's got to be some sort of hidden heart condition.
20:30You're big on opinions. How are you with ideas?
20:32What would you do next?
20:36I'd check trinophores and reverse the paralytics with neostigma.
20:40If Dr. Murphy's right, she should wake up.
20:43Smart, but risky.
20:45The meds will stress her heart. If Park's right, she could arrest again.
20:51I saw a similar case last year in Borneo.
20:53You interned at a hospital in Borneo?
20:55No, I volunteered at an orangutan rescue foundation.
21:00Our guide, a local villager, fell out of a tree. He was like 80 feet up.
21:04How is falling out of a tree similar to a patient arresting during breast reconstruction surgery?
21:10Well, he broke his back, but when we got him to the hospital, I found he also had heart damage from rheumatic fever and metabolic abnormality from iodine deficiency.
21:18It's right here, but it's common there. We only realized it when we ran a nuclear perfusion scan of his entire body.
21:25Good catch.
21:26But a scan that extensive requires multiple radioactive tracers. Do you think her heart could handle that?
21:32Not tonight. I'll get consent from the mom. We'll do it first thing in the morning.
21:38Once we confirm atrial closure, we'll put the heart back in.
21:41Dr. Lim will reconnect the aorta and the superior venous connections while I connect the inferior.
21:47During my sub-internship, I assisted in multiple heart transplants. Even sutured the atrial cuff in one.
21:53I got to scrub in on a liver transplant once. The patient died.
21:58What'd you learn?
22:00That bile duct leaks are a lot harder to detect than bleeds.
22:02Good. Next time I'd lead with that instead of the patient's death.
22:09Are you all done yet?
22:11Why?
22:12Dr. Park wants everyone to join him in the break room.
22:18I'm Alex Park. I'm a former amateur martial arts competitor who once thought it'd be fun to spar with a pro boxer visiting my dad's gym.
22:31And that guy was, uh, Mike Tyson.
22:36Who's Mike Tyson?
22:38He's a guy from The Hangover with the tiger and the tattoo on his face.
22:44Nice. You've just revealed you're crazy and old.
22:50I've seen the musical Wicked over 50 times. The San Francisco Tryout, Broadway, Chicago.
22:56I've even seen a friend's boyfriend's niece play Glinda at stage door summer camp.
23:01Nerd. Next.
23:04I'm Clara Brown. Um, I love music but I hate musicals and I don't, I don't really like to talk about myself so it's Sean's turn.
23:23My name is Dr. Sean Murphy. I used to not like music but my girlfriend Leah, she changed my mind.
23:30I also like to watch the Weather Channel on TV and I think pickles are disgusting.
23:43Cops know how to manage up. Managing down's another story.
23:46He's mature. Thoughtful. Doesn't have an ego.
23:50Neither does Murphy. But do you think that qualifies him to supervise first years?
23:54Murphy's smart. Brutally honest. Has no regard for social convention. Works for Bill Belichick.
24:02The Patriots are the most corrupt, dishonest organization in the history of the NFL.
24:06The Seahawks suck.
24:09So, how's your experience been here?
24:12It's been good.
24:17Did you consider any other programs or was this your first time?
24:21Did you consider any other programs or was this your first choice?
24:25This was my only choice. Why do you hate God?
24:31Oh, actually, I don't believe there is a God.
24:36I thought maybe it was because you believed he hated homosexuals.
24:41I don't think this is something that we should be discussing at work.
24:47Why not?
24:51Because it's personal.
24:57Do you have a boyfriend?
24:59I'm sorry, but you can't ask that question in a workplace.
25:02Dr. Park, he wants us to get to know you. How can I do that without asking personal questions?
25:09I have a girlfriend and she is very important to me. It affects my life in every way.
25:16Probably should have thought of that before you told her how much her voice annoyed you.
25:20I said it didn't bother me. It was a compliment.
25:26What I heard is you criticizing her voice and you bringing her mother into it.
25:33You're in trouble.
25:40What about Brown? She may have as much problem being a leader as Murphy and without his gifts.
25:46She has her own gifts.
25:47Yeah, dealing with patients and their families. But with her colleagues, she can be insecure.
25:54Her assertiveness has always been a question mark for me.
25:57They've all got areas that need improving, but I've gotten to know Brown a bit better these past few months.
26:02She's stronger than she looks.
26:06When's the last time you saw anyone digging a ditch in a suit and tie?
26:09Surgeons don't dig ditches. They help people at the most vulnerable time in their life.
26:14And you shouldn't take the responsibility on if you're not fully committed to it.
26:19You're entering a new phase in your career, a position of authority.
26:23Maybe my clothes are making you feel disrespected.
26:26The truth is, I just hate wearing anything that makes me feel like a suit.
26:33Great news. I was able to get Swinsky on anesthesia for tomorrow.
26:38Why? What happened to Foley?
26:39Nothing. I just think Swinsky's better. And we definitely need an A.A. team on this.
26:43Yeah, I agree, which is why I went out of my way to get Foley.
26:48Foley doesn't dwell under pressure.
26:50Morgan, you need to butt out. You're not a surgeon. This is not your job.
26:56My job is to help my patient through the entire treatment process.
27:00The best anesthesiologist for transplant surgery is Swinsky.
27:03And I've already cleared it with Lim, so that's who it's going to be.
27:05Deal with it.
27:10Are you mad at me?
27:14I said your voice doesn't bother me. It was a compliment.
27:20Actually, what you said is that you love my breasts so much
27:24that with the help of noise-canceling headphones,
27:27you're willing to put up with my annoying voice.
27:30I just...
27:32I just...
27:33With the help of noise-canceling headphones,
27:35you're willing to put up with my annoying voice.
27:38I just...
27:40Not a compliment.
27:42Oh. So you are mad at me?
27:46I'm not mad, John. I'm just busy trying to keep like a billion bots and hackers out of our network.
27:52Actually, no. I'm not doing that. I'm going to go home.
27:55You want to have some tequila stat? We also have some pizza left.
28:00No, I don't want tequila. Or pizza.
28:03I mean, you're mad.
28:05I'm just upset. And confused.
28:09And I really don't think there is anything you can do about it,
28:12so you just need to stop trying and leave me alone.
28:24She's not mad at me.
28:27She's definitely mad at you.
28:29She doesn't usually hide what she thinks.
28:31She's not mad at him.
28:34She knows how he is. How he talks.
28:37She's mad at herself. And scared.
28:40We all have stuff that we're insecure about.
28:43That's why it's so risky falling in love.
28:47We all hope that when we let our guard down, it's for the one person that doesn't see our flaws.
28:55So...
28:57What do I do?
28:58You're being honest. You can't apologize that way.
29:01You gotta figure out what she needs to feel secure in the relationship again.
29:07Don't look at me. I'm single.
29:14It's not my place to comment on your personal life.
29:18You have an opinion. Let's hear it.
29:20Fine.
29:22Can you zoom in on her skull base?
29:25I can, but why? We're worried about her heart.
29:28And metabolic abnormalities.
29:30We shouldn't be. Not anymore.
29:33You and Dr. Murphy were both wrong.
29:36She doesn't have a cardiac or metabolic issue.
29:39She has poor blood flow in the artery supplying blood to the area of her brain that controls consciousness.
29:44There's a small clot in her artery of perseron.
29:47If we don't remove it fast, she's never going to wake up.
29:59That's amazing.
30:01No, it's not.
30:03The heart's totally outside of the body and still beating. It's like it has a mind of its own.
30:08She should have started the re-implantation by now.
30:11Is everything okay, Dr. Lim?
30:13The tumor had tendrils invading the right atrial wall.
30:16We took so much tissue to get a clear margin.
30:18There's not enough left to reconstruct his heart's inflow chambers.
30:21How about expanded PTFE graft?
30:23There's not enough atrial remnant to attach the graft.
30:25You can use that.
30:26There's not enough atrial remnant to attach the graft.
30:28You can use the septal wall.
30:30He's got dense conduction fibers there. It could cause heart arrhythmias.
30:32Not if you use...
30:34He's got low arterial pressure.
30:36He's springing leaks at the cannulation site.
30:38It's a bleeding disorder caused by prolonged bypass. You need to get his heart back in ASAP.
30:41Morgan, we can't put the heart back in with two missing chambers.
30:56If we go rooting around it, we'd definitely damage the PCA.
30:59We'd kill it.
31:01We could inject a dissolving agent into the clot.
31:03There's a 50% probability it won't fully dissolve,
31:07which could leave her with permanent weakness and cognitive difficulties.
31:10Assuming she wakes up at all.
31:16We need to remove the clot with a stent retriever.
31:22If we rupture the posterior cerebral artery, she'll die on the table.
31:27Or total recovery.
31:30That's how she came into this hospital.
31:33That's how she's leaving.
31:37Prep her for stent retrieval.
31:40Hanging platelets and fresh frozen plasma.
31:44His pressure is still in the toilet.
31:46But the bleeding is slowing down. Not for long.
31:49Small intestine submucosa has the right compliance to shape the chamber walls, but...
31:53There isn't enough to cover that much area.
31:54Use too little and he'll have heart failure in a month.
31:57I know. That's the but.
31:59How thick is his deep fascia? If it's over two milliliters...
32:02Morgan, get out.
32:04I'm sorry. I'll be quiet.
32:06No, you won't. You can't. So leave the OR gallery.
32:11Now.
32:13We need 2.6 millimeter thick tissue with perfect compliance for arterial filling and contractile pressures.
32:19If it was just the valve, we'd use bovine pericardial graft.
32:22But cow heart tissue is not durable enough to do an entire chamber.
32:26But pig bladder tissue is just right.
32:28I've used it for bladder reconstructive surgeries, but never hearts.
32:32Let's rebuild the entire atrial walls with it.
32:34Get down to the tissue procurement lab.
32:36We'll get you the blood sample.
32:37Get down to the tissue procurement lab and get 200 centimeters of porcine bladder tissue.
32:39Get down to the tissue procurement lab and get 200 centimeters of porcine bladder tissue.
32:41Get down to the tissue procurement lab and get 200 centimeters of porcine bladder tissue.
32:54Are EEG delta waves are slowing further?
32:57She only has one vessel feeding her thalamus.
32:59That's why the clot landed where it did.
33:02I'm approaching the artery of parcheron.
33:04I'm one millimeter from the clot.
33:07Stop right there.
33:13If we disrupt this clot, we could cause a shower of emboli into her brain.
33:35Deploying the retriever.
33:40EEG just went flatline.
33:42Calm down. I'm almost...
33:45Got it.
33:53Blood's flowing through the artery.
33:55Her brain tracing's looking better.
33:58We've got to get her out of there.
34:00We've got to get her out of there.
34:01Her brain tracing's looking better.
34:09This should fill the gap between the inferior and superior vena cava when the new chambers get sewn in.
34:16Where's that graft?
34:18I need more sponges. The bleeding is getting worse.
34:21He's tanking.
34:23I already did. He's maxing out. I'm running out of ways to keep his pressure up.
34:26I got it.
34:28Pay it 205 centimeters of it.
34:31If you want to gown up, you can watch from down here.
34:34Definitely. Thanks.
34:38I thought telling her how much I love her in front of other people would make her feel good.
34:42But Dr. Guerin said I made her feel insecure and scared.
34:46Women are sensitive.
34:48When commenting on their flaws, total honesty is a high-risk procedure.
34:54That sounds sexist. Aren't men also insecure about their flaws?
34:57Men are much, much worse. And also, we're really stupid.
35:01Okay, okay. What can I do now? I've already said my stupid stuff. I don't want her to be upset with me.
35:11I have a thought.
35:14I think this round of sutures will hold it to the amulus, but I'm worried about leaks.
35:19We can put a second row of pledged sutures to make sure it's hemostatic.
35:22That is unreal.
35:25It's a work of art.
35:28Now let's get it back in while we can still get him off bypass alive.
35:36Reprofusing the heart?
35:40We've got a rhythm.
35:57Hey.
36:12Hey.
36:15There was a complication during the reconstruction surgery.
36:19A clot which caused you to lapse into a coma.
36:23We performed a second surgery on your brain, which was successful.
36:28You're going to be fine.
36:30But my breasts?
36:32The clot occurred after we finished inserting the implants.
36:38I think you're going to be very pleased with the results.
36:52I think I'm sorry.
36:59Dr. Guerin said I should never say anything that might sound negative to a girlfriend.
37:05And Dr. Glassman said total honesty is a high-risk procedure.
37:10With a girlfriend, it's better to show my love than try to explain it.
37:15But I want to be totally honest with you.
37:27I don't like your body because it's excellent.
37:32I like it because it's yours.
37:37And I love hearing you talk when I hear your voice.
37:45Especially when I've had a difficult day, I find it comforting.
37:55Now I want to hug you. Can I?
37:58I'd like that.
38:10I love you.
38:11I love you.
38:16For your total honesty.
38:25Your surgery went well.
38:27With some time in rehab, you should be back to work in a month.
38:32Don't thank me. Thank your surgeon.
38:34She did all the important stuff.
38:41Sometimes Golden Boy's in, nothing we can do about that.
38:44So that leaves three openings.
38:46The thought of working with Will Hooper for the next two years.
38:49If Dr. Lim thinks he'll be a good resident, I'm sure she has good reasons.
38:53She probably thinks arrogance is helpful to a surgeon.
38:57Well, we could try to change her mind.
38:59She asked us to evaluate the applicants, not her.
39:01She asked us to be totally honest.
39:04Yeah, totally honest is a relative term. When you're telling your boss, she's totally wrong.
39:11So, who'll present? Who else?
39:14Dr. Andrews likes Dr. Jordan Allen.
39:17I do too. She's confident, driven.
39:20She won't take a lot of hand-holding, and keeping Andrews happy keeps us happy.
39:24That leaves two more. Who's next?
39:27Asher Walk is very upfront about who he is. I like that.
39:32He's definitely eager. And he couldn't be more open to learning.
39:36I agree. That leaves one more.
39:38John Lundberg.
39:41Smart, professional, mature. He's a no-brainer.
39:45Lundberg's in.
39:47Lundberg's out.
39:49He stopped by my office before he left, said he's no longer interested.
39:53He said you all were unprofessional.
39:57Drinking at work.
39:59Asking inappropriate questions.
40:02Dating drama.
40:03Dating drama.
40:07So who's your alt? Olivia Jackson or board shorts?
40:12Olivia knows her stuff, but she's a bit insecure.
40:16Her answers sound like questions. I like board shorts. He's sensitive, like a woman.
40:28I vote for both of them.
40:30That's not an option. We don't have the budget.
40:35Hooper is the worst.
40:38The person I said was the best?
40:40He is arrogant and obnoxious.
40:43If he works here, we'll hate him. The work will suffer, and we'll either kill patients or we'll kill him.
40:51And there is no way that you don't see that, which makes me think...
40:57You do.
40:59This was a test.
41:01You just wanted to see if we'd be totally honest.
41:07Well done.
41:09Hooper is definitely the worst.
41:13I only let him shadow as a favor to me.
41:15Hooper is definitely the worst.
41:18I only let him shadow as a favor to a board member. I figured I'd give him a second chance after his obnoxious interview.
41:24And also, do a little experiment.
41:29So, it's Jordan, Asher, Olivia, and Enrique.
41:41To the next phase of your surgical training.
41:43You helped pick them. As senior residents, it's now your job to help train them.
41:48And don't take this responsibility lightly, because if you don't train them well, people will die.