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The Good Doctor Season 2 Episode 15

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Transcript
00:00you're doing great really great it's gonna be okay you promise
00:13baby's out umbilical clip suction please can i see my daughter yes of course
00:24sorry we'll need to get her into surgery we'll take good care of her
00:45your new chief is fashionably made our chief just because i endorsed dr hong to the board doesn't
00:53mean i don't have any concerns connections like dr hong's come at a premium and he assures me
00:57will be well worth it given our current predicament with the medical board i'm not just worried about
01:01the money when you pay that much they tend to think they're worth it makes a person think
01:08they don't have to show up for their own welcome brunch
01:10the baby's bowel protrusions seem less severe in the prenatal imaging
01:26and it'll have to wait until we're done with her heart problem
01:29now that i'm in here her septum looks more like swiss cheese
01:33page the on-call neonatal cardiac surgeon that won't be necessary i'll scrub in
01:41and who are you i'm jackson hong your new chief of surgery
01:46echo probe please
02:04and let's turn that music on
02:09advance the delivery sheath
02:15it's in the patient's heart dr murphy
02:19i think the music is a little distracting
02:22i feel the same way about operating without music
02:25take a longer sheath and dr murphy will need some forceps
02:30five second rule
02:37it was a joke
02:42what about her bowels why isn't dr limb inserting it into the abdomen right now
02:50there is not enough room
02:52there's there's not enough room without increasing abdominal pressure which would
02:57critically decrease blood flow to the bowel
03:00according to what hemodynamic principle
03:02dr brown
03:04ascular impedance blood flow is driven by the force induced by the pressure
03:07gradient and how do you calculate it
03:09uh um i'd have to look it up
03:15eight times l nu divided by pi r4
03:19very good dr murphy
03:21that's also why the secluder won't work
03:23it won't hold up against a huge pressure
03:25now i need umbilical tape and pe tubing
03:32you're making a pulmonary artery band
03:37that should buy us some time to come up with a plan before we lose this baby
03:44you cancelled my hernia repair
03:55with no advance notice sorry about that
03:59but so great to meet you jackson han
04:01you melinda's oh i know you did great work on that piggyback heart transplant
04:06i need a consult on manesh goyle he's the founding ceo of a company
04:11what's his diagnosis
04:12he doesn't have one he's here for a full physical complete diagnostic workup
04:16i have a long-standing executive wellness
04:19i'm a surgeon not an internist
04:21i don't do preventative medicine
04:23no matter how rich the patient is
04:25you know what's great about rich patients
04:28they allow us to treat poor patients
04:31also i promised manesh the very best
04:34so really who else am i going to get
04:37bp is 110 over 70. it jackson
04:48dr. han says great things about you
04:52that's very kind
04:54normal ekg optimal bmi heart and lungs sound good
04:58any reason you're worried enough about your health to endure an entire day of tests
05:02i'm not worried
05:06knowledge is power
05:08whenever i enter a new market i learn everything i can about the landscape
05:12consumer needs target market competitors
05:15you're aware your body isn't a business
05:18i know i sound like a rich lunatic with fantasies about controlling every aspect of my life
05:25and i guess i kind of am
05:30my dad was in good shape too
05:33until he dropped dead on his daily jog
05:35you're welcome
05:36you're welcome
05:37you're welcome
05:38hi
05:39hi
05:40Hi.
06:06Hi.
06:07Hi.
06:09I'm Larry Childs. I'd shake your hand, but, you know, no functioning immune system.
06:15Aaron, hi.
06:17Good to meet you. What flavor of cancer do you have?
06:21What flavor?
06:22Yeah.
06:23Glioma.
06:24Shut the front door. Brain or spine?
06:28Brain.
06:29Dude, we're tumor twins. What do they have you on?
06:34Ooh, vincristine. I hear that's intense. My dog thought it would wipe me out.
06:38You doing okay? You're longing for death.
06:41I am hanging in there. Thank you.
06:43I'm on my third round at Tamazolamide.
06:56I've seen you in here a few times.
07:00I've seen you in here a few times. You kind of keep to yourself, huh?
07:05Yeah.
07:05Well, I'm happy to introduce you around. It's a really friendly group.
07:09I'm okay. Thank you.
07:10You have the support group you go to?
07:13I do not.
07:15Everyone needs a cancer community.
07:17I do not.
07:28I do not.
07:28I do not.
07:29You could be two patients where they're sick.
07:30I do not.
07:35I do not.
07:35I'm trying to hold still.
07:55For bringing us in.
07:57This is the new chief's patient.
07:58It's a great opportunity.
08:00Oh, it's a bunch of pointless tests.
08:04For which I thank you.
08:06Tell us about Dr. Hahn.
08:08He's direct.
08:10Charming.
08:11Very sure of himself.
08:12Big ego.
08:18There's nothing wrong with an ego if you can back it up.
08:21Dr. Hahn's arterial switch technique is performed all over the world.
08:25The tests aren't all pointless.
08:27Way to stand firm, Park.
08:28Now look at the monitor.
08:30He has a tumor.
08:31Percy's stable?
08:31We're naming her Persephone.
08:33Percy's stable?
08:47We're naming her Persephone.
09:00Yes.
09:02I put in a central line for nutrition.
09:05Percy is stable right now.
09:06We're looking for solutions to her problems.
09:10Why does she have all these birth defects?
09:14Diane.
09:16We spoke to our obstetrician.
09:18She said these defects can happen for no reason, right?
09:22That's true.
09:23Over 50% have no known cause.
09:25I was taking paroxetine for clinical depression.
09:33And you went off the meds as soon as you found out you were pregnant.
09:36She was five, six weeks at most.
09:38My OB told me studies show antidepressants are safe to take during pregnancy, but is that
09:43true or is she protecting me?
09:45There was a study that associated paroxetine with these kinds of defects.
09:53It is a possibility.
10:06You can't tell whether it's cancerous or benign?
10:09Not until we do the biopsy, which I've scheduled for later.
10:12We'll know what's going on by the morning.
10:15Good.
10:17That's good.
10:21Maybe you'd like to call someone?
10:24A family member?
10:25A friend?
10:26I'll worry when I know it's cancer.
10:38We could use a transcatheter route and patch each hole individually.
10:42Her heart's the size of a walnut and it's too small to maneuver inside.
10:47A single large patch to close the holes would withstand the pressure?
10:51Yes.
10:54It would also block electrical conduction, causing deadly arrhythmias.
10:58Dr. Murphy, did you tell the mom that she caused her baby's birth defect?
11:05No.
11:06I said that her antidepressants could have.
11:10Why did you tell her that?
11:12It's the truth.
11:13And is that relevant to her current medical situation?
11:18No.
11:21And how do you think that answer would make her feel?
11:24What did you think would happen?
11:25The mother is devastated.
11:30The father is furious.
11:32I would be too.
11:33Sean is a resident.
11:35Residents make mistakes.
11:37Managing these parents' emotional concerns is as much a part of this job as operating on their daughter.
11:43Social cues are hard for Sean, but we've been working with him.
11:46You should be focused on your own shortcomings, like retaining the formula for vascular impedance.
11:52Dr. Hahn, we could patch each individual hole in the heart if we cut open the ventricle.
12:00Don't change the subject, Dr. Murphy.
12:02I didn't, Dr. Hahn. We were talking about the baby.
12:06Really?
12:08You don't see a difference in the nature of your discussion before I arrived and after.
12:12We were talking about the baby.
12:23They tried the approach you suggested at L.A. Children's.
12:26The baby died a week later.
12:28The suture line didn't hold and the cardiac wall ruptured.
12:31Keep looking.
12:32Dr. Murphy, do not talk with those parents again.
12:36I'll walk with you.
12:46You're pretty tough on my residents.
12:48Rebuking them in public, pimping them with questions during surgery.
12:51Shame-based learning isn't my style.
12:53I'll bear that in mind.
12:55But this isn't about my treatment of the residents.
12:57You're concerned about Dr. Murphy.
12:59A lot of doctors have less than ideal bedside manner.
13:02He's young.
13:02Would you ever have said something like that to a patient as a resident?
13:05As a med student?
13:07And Murphy doesn't even understand he did anything wrong.
13:09Sean has hardwired differences in the way he perceives things.
13:12Exactly.
13:13No matter how hard he works, no matter how hard you try and help him,
13:17his limitations are not going to change.
13:20He's going to continue to inflict them on our patients.
13:23All in the name of diversity and inclusion.
13:28Sean deserves to be here.
13:29Once you see what he's capable of, you'll agree.
13:34I look forward to being proven wrong.
13:41Stay seated for 20 minutes.
13:43I don't want you passing out in the lobby.
13:45I know, I know.
13:52This disease changed my relationships, changed my priorities, changed who I am.
13:58Cancer is an identity.
13:59Cancer is a cellular mutation.
14:01People in this room are my people.
14:03What are you, 20 years old?
14:05I'm triple your age?
14:06I don't think you're my people.
14:08Last time I hung out with my law school friends, epic fail.
14:11The fact that you used the phrase epic fail kind of case in point.
14:14They're all focused on what firm they're going to land at,
14:16and I'm all about whether Candace's leukemia is responding to her new chemo regimen.
14:21Oh, by the way, she has this peppermint oil.
14:23It is great for headaches.
14:29Oh, I know that look.
14:32Here, here.
14:32Got you, brother.
14:40Whether you like it or not.
14:46Show me where we are.
14:47That angle runs pretty close to the sacral nerve roots.
14:52How we doing?
14:53Tumor's abutting the iliac artery.
14:55Try not to disrupt the entire blood supply to his lower body.
14:58Dr. Hahn, I'm Morgan Resnick.
15:00I really enjoyed your article on myotomy for infantile hypertrophic pyloric stenosis.
15:04I appreciate the thorough research behind your sucking up.
15:09And you are?
15:11Alex Park.
15:12Park?
15:13You were a cop.
15:15Medicine has a second career.
15:16Good stuff.
15:17Tends to bring a fresh perspective.
15:22We hit an artery.
15:23Take the needle.
15:25Blood's falling in the pelvis.
15:26Should we open him up?
15:27No.
15:27Prep the femoral artery.
15:28Give me an arcast set.
15:29Press is dropping.
15:30Platinum coil.
15:34Nice save.
15:41Next time, don't hit the vessel.
15:44There is no next time.
15:46The biopsy's too dangerous.
15:54It is likely that it's a benign notochord cell tumor.
15:57They look like chordomas, but they're harmless and way more common.
16:00But you don't know.
16:02Since we can't do the biopsy now.
16:04This is the problem with broad testing.
16:08Everyone has abnormalities.
16:09Most of them are nothing.
16:11But when we do find them, we have to make some tough choices.
16:16So, what exactly is my tough choice?
16:20We could remove the tumor.
16:22This is a very risky surgery.
16:24There's a chance of paralysis or worse.
16:25You may not make it off the table.
16:28Or you do nothing.
16:30We'd continue to monitor it.
16:32Do imaging every few weeks.
16:33But chordomas move very quickly.
16:35By the time any change showed up on imaging, it's most likely metastasized throughout your body.
16:39So, it probably isn't cancer.
16:45But if it is, and I wait, then I'll die.
16:49That's true.
16:50And if I don't wait, and I get the surgery, then there's a good chance I'll die.
16:56Yes.
16:57I'm going to need to think this over.
17:04This is the May annals of neonatal surgery.
17:24I just finished March.
17:25I need to read April now.
17:27Oh, I have April, Sean.
17:29No?
17:30No.
17:31You're supposed to be reading new approaches in neonatal surgery?
17:35Claire has the British Journal of Neonatology?
17:46Sean.
17:48I think maybe you should be quiet around Han for a little while.
17:54But then how will I answer his questions?
17:56Direct questions, absolutely answer.
18:01Otherwise, outside of the O.R., you should stay out of his way.
18:08If someone had convinced Sean to do that with Dr. Melendez, he would still be on suction.
18:17Code blue, NICU, bed four.
18:19Code blue, NICU, bed four.
18:21Oh, two sets dropped in central venous.
18:26Pressure shot up.
18:27Pulmonary artery band is failing.
18:29Aid of dopamine.
18:30Let's get a mask on her.
18:31She won't last much longer.
18:32We need other options.
18:33I'll update the parents.
18:36Let's get her on full cardiac support.
18:38What do you got?
18:55Anything?
18:56This Cleveland group repaired a bowel protrusion using enterolysis.
19:00I could cut out this excess inflammatory tissue and segment of bowel atresia.
19:04Might make her intestines small enough to fit.
19:06Promising.
19:08Given the size of her abdomen, I need to remove a lot of bowel.
19:10There's a good chance she wouldn't be able to absorb food.
19:13We'll have to find the right balance.
19:15It's our only workable plan.
19:17Best bet on the heart is to cut through the ventricle, like Murphy suggested.
19:21Uh, you were concerned about the suture line holding.
19:24Well, I still am.
19:25Hopefully, horizontal mattress sutures will work.
19:27They should be able to withstand the tension of the suture line.
19:30There's still a risk of an hour.
19:32There's still a risk of an hour.
19:32There's still a risk of an hour.
19:33There's still a risk of an hour.
19:35Oh, God.
19:37Dr. Lim, I have an idea I'd like to share.
19:42Even though Dr. Hahn didn't ask me a question.
19:49Yep, go ahead, John.
19:51If we go in through the atrium, we wouldn't have to worry about the suture line.
19:54It's the same issue we discussed.
19:56There's not enough room inside the baby's heart to stitch the patches into place.
20:00No, you don't need to, Dr. Hahn.
20:02We can make a plug small enough for her heart, a PTFE disc with a stem like a mushroom.
20:07Then we can insert the stem through one of the holes until the disc presses against the wall,
20:11covering all the holes.
20:14Like a stopper in a bathtub?
20:17Yes.
20:18The higher pressure on the left side of her heart would keep it in place.
20:21We wouldn't even need to stitch.
20:25Great idea.
20:27We should take this to the parents.
20:29Great idea for the heart,
20:30but we need to tell them that our current plan for the abdominal repair is considerably more of a long shot
20:36and that fixing the heart takes an option off the table.
20:40Withdrawing care.
20:41You can't move that card.
20:54Excuse me?
20:55Who cheats at solitaire?
20:56You're literally only cheating yourself.
20:58Again.
20:59Good morning, Larry.
21:00Is it a macho thing?
21:02Like a real man should be able to make it through without leaning on a label or the people who go with it?
21:09Embracing cancer as an identity is the last thing any one of us should be doing.
21:13It underscores everything horrible right now.
21:17We're in a daily battle for our lives.
21:19I see no value in dwelling on that.
21:21Candice is late.
21:28Which means either her niece forgot to pick her up.
21:32Again.
21:33Or she got some bad news.
21:36Or she's already dead.
21:41We are in a daily battle.
21:46I'd rather have some company.
21:51I spoke to my mother and brother and they both think I shouldn't do the surgery.
22:09Apparently they're more scared of your surgical skills than they are of this tumor.
22:14And where do you stand?
22:15I need numbers.
22:18Please.
22:21Stats on something like this, there are a lot of variables.
22:27What are the odds I make it through the surgery without any complications?
22:32It's a challenging procedure.
22:35Zero complications, I'd say 80%.
22:37But it is very unlikely this tumor is malignant.
22:42Give me a number.
22:45About 5% chance it's a chordoma.
22:47The numbers agree with your family.
22:57So do I.
23:07I've always been more comfortable with action than inaction.
23:09I want you to do the surgery.
23:20Certainty comes at a price.
23:21She'll be able to get off the life support machines?
23:33If everything goes well, yes.
23:35She'll have a strong heart.
23:36How soon can you do it?
23:40You should know we feel less confident about our plan for her bowel.
23:43Well, the chance of failure is quite high.
23:47How high?
23:48I put it at 90% that the repair won't work, which would lead to irreversible malnutrition.
23:54Your daughter would slowly starve to death over months.
23:58Right now, her body is working very hard just to stay alive.
24:02If we were to turn off the machines...
24:08Turn off the machines?
24:12She would pass quickly and peacefully.
24:16If the heart surgery is a success, that won't be an option.
24:22Why not try to fix the bowel first to see if it works?
24:25We won't know if the bowel is viable until after the heart is.
24:28We have to do the surgery.
24:33But if this doesn't work, she could starve to death.
24:35It's worth the risk.
24:36It's not our risk, it's hers.
24:38So instead, you're ready to give up on our daughter?
24:42I mean, it's like we're right back at the ultrasound.
24:44We decided together to continue this pregnancy, so this is as much my fault as it is yours.
24:49My fault?
24:50Because of the medication?
24:53I cannot turn off that machine.
24:56Our guilt is stopping you from admitting what we need to do.
25:00My guilt has nothing to do with this.
25:03I am fighting for my daughter.
25:05So am I.
25:08Since the parents can't agree, the decision about the baby's care will be made by a judge
25:13who will rely on our recommendation.
25:16So we make the choice, but the parents live with it.
25:18Well, maybe that's a good thing.
25:25For parents to have to decide between letting their daughter die or fighting for her life
25:29knowing she may suffer horribly, maybe it's better if we carry that burden.
25:34Dr. Lim, your decision would be?
25:42Take her off life support.
25:44The odds are stacked against the bowel repair working.
25:46Those numbers reflect the general population of doctors.
25:49I think Dr. Lim and I are better than that.
25:52We can beat the odds.
25:53One of the things I'm not going to miss about being chief of surgery
26:04is being responsible for choices like this.
26:10Dr. Hahn, it's your department.
26:12It's your call.
26:21You've been here all night?
26:24I've been working on a case with the new chief of surgery, Dr. Hahn.
26:28How's that going?
26:29Not very well.
26:30He plays music in the operating room.
26:32Oh, geez. One of those.
26:34And he says I need to focus on our patient's emotional needs.
26:38Well, that's a tough assignment for you.
26:41Hmm.
26:46You ever wish you had, you know, friends, coworkers on the spectrum?
26:53Not usually.
26:54Not usually.
26:54But maybe Dr. Hahn wouldn't notice me as much if I weren't the only doctor with ASD.
27:03There's this kid in chemo, just obsessed with having cancer.
27:08That's all he talks about.
27:09He wants to be friends with everybody in the ward.
27:11That's very smart of him.
27:13Spiegel et al. showed an increase in overall survival and quality of life measures in breast
27:18cancer patients who formed social bonds with others battling the disease.
27:22What should I do about Dr. Hahn?
27:24I don't know.
27:28Um, just do your work.
27:31Be a good surgeon.
27:32Be an excellent surgeon.
27:34Over time, I'll forget about the autism.
27:36Why would that happen?
27:37I'll see that you have skill.
27:39You have dedication.
27:40I have autism.
27:42It's part of who I am.
27:44The judge?
27:55They accepted our recommendation.
27:58Ruled in favor of surgery.
28:00Thank you, doctor.
28:07Okay, Percy.
28:11Mama loves you.
28:14I love you, Percy.
28:44Should we remove more bowel?
28:55That would take us to the ileum.
28:57She won't gain enough weight to thrive.
28:59Her abdominal muscles are tight from developing around an empty cavity.
29:05They're cinched around her tummy like a corset.
29:07What if we unbuttoned it, released the muscle, and increased the abdominal circumference?
29:12Those muscles are part of her abdominal...
29:14Not if we separate the layers.
29:16Create a plane between the skin and the muscle.
29:20You good if Murphy and I start on the heart?
29:23Dr. Brown, you're with me on the abdomen.
29:27Clearing the field?
29:28Hahn is on the call schedule next weekend.
29:30Maybe Carmen will switch with me so I can cover with him.
29:32Well, maybe you shouldn't try so hard.
29:35Retract her.
29:38Some of us don't have a cool former career or an easygoing melodemeanor.
29:41People are never going to crowd my corner because I'm just so likable.
29:44Well, you could try being nice to them.
29:46Oh, this is easier.
29:47There it is.
29:51Does it look like cancer?
29:53It's not labeled.
29:54We're all going to have to wait for the pathologist's report.
29:58Probe.
30:05The artery's in the way.
30:07We can't get at the tumor without him bleeding out.
30:14We're going to have to take it from the back.
30:16But that's one nerve root.
30:17It's something you can live without.
30:19Dissecting scissors.
30:19Pledge it, anchor.
30:40The plug is in position.
30:42You ready to test the bowel repair?
30:45Let's take her off cardiac support.
30:47Dr. Murphy, what was your idea?
30:49You do the honors.
31:02Abdominal pressure is normal.
31:04Intestines are perfusing.
31:10Pulmonary pressure spiking.
31:12Prostacycline and nitric oxide.
31:13We need to get her lung pressure down.
31:14Oxygen stats are dropping.
31:16In response to pulmonary vasodilators.
31:18The heart's too strong.
31:19It's overpowering our lungs.
31:21She needs to go back on cardiac support.
31:31Persephone won't starve to death.
31:35But she will drown in her own fluid.
31:37I'll talk to the parents.
31:53May I come?
31:54Now that Persephone's heart is pumping at full power, her lungs are overwhelmed.
32:13The humane thing to do is to turn off the machines and let her go.
32:17No, I can't give up on her because you fought for her every minute since she was born.
32:30Before that, when you were taking your medication for the depression, you were fighting to keep
32:34going so you could bring her into the world.
32:37And letting go of Persephone is not giving up on her.
32:59It's listening to what her body is telling us.
33:01She's hit her limit.
33:08She's hit her limit.
33:25Okay.
33:26She's hit her limit.
33:56I want Persephone to look as good as possible for the parents.
34:10Let's turn off cardiac support.
34:17Ventilator?
34:20Let's take a minute.
34:26You can't find the human being.
34:35You can't find it.
34:40You can't find it.
34:46You can't find it.
34:48I want to find the human being.
34:53Check valve.
35:10Every time the heart contracted, blood went into the opposite side of the heart and raised lung pressure.
35:17The hole reduced the pressure when it got too high because it allowed backflow, but our repair of the defect blocked this backwards flow.
35:25What if we made it so she still had a heart defect, but only when she needed it?
35:29It'd be like an unlatched door in the wall of the heart.
35:33When the pressure gets too high on the right side, the door swings open, releasing the pressure on the lungs.
35:38The rest of the time it stays shut.
35:40It should reduce lung pressure by a third. Is that enough?
35:43Depends on how high her pulmonary vascular resistance is.
35:46PVR is pulmonary artery pressure minus wedge pressure divided by cardiac output times 80.
36:02The last time I saw my doctor, he told me I had six months to live.
36:07He also told me I should marry an accountant and move to North Dakota.
36:10You don't say.
36:11I asked if it would help with my cancer.
36:14He said, nope.
36:15Just to make the six months seem much longer.
36:20What's the difference between a neo-Nazi and cancer?
36:24Cancer doesn't discriminate.
36:26You got the back.
36:28I knew a guy once.
36:31His zodiac sign was cancer.
36:33It was really ironic how he died.
36:38Uh, uh, how's that?
36:40He was eaten by a giant crab.
36:42Oh, jeez.
36:47Aaron, glioma.
36:49Candice, leukemia.
36:50You didn't write me a blackjack how fast you want to take my money.
36:55Blackjack?
36:56Cut him.
37:10Did you get it all?
37:11Yes.
37:16Totally clear margins.
37:18But the only way to achieve that involves removing the nerve that controls your left foot.
37:24Rehab in an advanced orthotic may help.
37:27But you will walk with a limp.
37:30Final pathology will let us know if it was worth it.
37:37I'll let you know when it comes in.
37:38Okay.
37:38It doesn't matter anymore.
37:46It's not like you can put the trimmer back in.
38:03Is she okay?
38:05She still has a surgery or two in her future, but yes.
38:11She's going to be great.
38:16Can I hold her?
38:18I think that would be very nice.
38:20For both of you.
38:21Angel.
38:35There's my baby.
38:43Come hold her.
38:49Come hold her.
38:56You were fighting for her too.
38:57You were fighting for her too.
38:57She's beautiful.
39:01Nice work.
39:19She's beautiful.
39:20Manesh's biopsy results.
39:43You don't want to know if we wasted our time almost killing him?
39:57Can't put the tumor back.
39:58Okay.
39:58Hello, Dr. Hahn.
40:18You take the bus too?
40:19No, Sean.
40:20I just wanted to talk to you.
40:26You really do have remarkable diagnostic skills.
40:31I have to admit, you're an asset to this hospital.
40:34I am.
40:35I spoke to the residency director of pathology, and we both agree you'll be a great fit there.
40:48I'm a surgical resident.
40:51As a pathology resident, you'll touch cases and lives across all the medical departments.
40:58It's an opportunity for you to help patients without having to deal with patients.
41:06Given your difficulties with communication and social cues, I think it will be a much better fit.
41:13No, thank you.
41:16I have been working very hard at my communication skills.
41:22Hard work isn't enough.
41:25You have to do the job.
41:28I am a surgical resident.
41:35You were.
41:38And you're going to do great work in pathology.
41:46Oh, and when the storms come, flooding through the hall.
41:53Rising to the landing, tearing pictures from the wall.
41:58O the premier's, having to walk.
41:59O know, our love.
42:00Thank you very much.
42:00Thank you very much.
42:01Thank you, Lord.