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The Good Doctor Season 3 Episode 3

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Transcript
00:00It's a very simple procedure.
00:04It's a straightforward procedure.
00:10It was a successful surgery.
00:21Surgery was a success.
00:25We expect a full recovery.
00:30I expect a full recovery.
00:34Baby.
00:36Mom, do you want this?
00:39Uh, thanks, Mom.
00:40Put it by my bag.
00:41I'll have the hospital lab run it.
00:53Nausea and severe abdominal pain after eating.
00:56This patient could need a lap coli.
00:58That would be an ideal first surgery.
01:00Let's not get ahead of ourselves.
01:02She may just need Nantacid.
01:05Hi, Michelle.
01:07I understand your mother is on her way in.
01:09I'm Dr. Brown.
01:09And I'm Dr. Sean Murphy.
01:11You need to fix my sister.
01:13What's your name?
01:15Tisha.
01:15Hi, Tisha.
01:16Well, that is exactly why we're here.
01:18To help your sister.
01:19Foster sister.
01:21When did the pain start?
01:23About an hour ago.
01:24She was on the bus.
01:26My sister rides with me every day to school and back.
01:30My brother and I used to live on a bus.
01:33Cool.
01:34Have you felt like this before?
01:35A few times.
01:36She has extreme upper right quadrant tenderness?
01:42That's consistent with cholecystitis, as is her fever and elevated white count.
01:49Your gallbladder probably needs to be removed.
01:53You must be excited, Claire.
01:55This is going to be your first surgery.
01:58Has your urine changed color?
02:03Gotten darker?
02:15I hear Dr. Brown might have landed her first lap, Coley.
02:19It's not exactly a straightforward case.
02:21The duct is massively dilated.
02:23The wall's inflamed.
02:24The scarring is going to limit visibility.
02:28Well, the thickness of the gallbladder wall does pose a challenge.
02:31What do you think?
02:33It's not her decision.
02:35It's mine as the attending.
02:37Doesn't mean she shouldn't offer her opinion.
02:43I think that, um, Dr. Melendez is right.
02:47With a limited visibility, I shouldn't be...
02:49Only with a laparoscopic cholecystectomy, which I don't think we should do.
02:54An open procedure would provide a clear view of the gallbladder and the surrounding anatomy,
03:00despite the inflammation.
03:09Carly and I went on another date last night.
03:11Mm.
03:11What'd you do?
03:12Dinner?
03:13Movie?
03:13We walked 12 minutes to a deli and had some food and talked.
03:17Where are we going?
03:20Andrews is starting an open Coley.
03:22Sounds like it's going well with you and Carly.
03:23Oh, yes.
03:24She answered all of my questions.
03:27How many did you ask?
03:2883, although some had multiple parts.
03:33Do you want to have children?
03:35If yes, how many and when?
03:36Where do you plan to raise them and what religious tradition?
03:41Those are pretty intense.
03:43They're good questions, Claire, about important topics.
03:46Early on, people usually stick with lighter stuff.
03:49Favorite movies, bands, hometowns, smell talk.
03:56Put some laughs in the upper right quadrant.
03:59Here's the boby, Dr. Andrews.
04:01Isn't the point of dating to gather information to determine compatibility?
04:07Retract the omentum?
04:08Sure.
04:10Isn't that best achieved by finding out what's important to the other person?
04:15Hey, Mr.
04:17It's a process, Sean, like peeling an onion.
04:20People are more comfortable revealing their layers gradually
04:24as opposed to getting sliced right down the middle.
04:26I heard Dr. Lim selected you for the first lead.
04:29I'm guessing you drew a cholecystectomy.
04:32Sponge on the stick.
04:33What's your approach to dissecting, retrograde or antegrade?
04:36Antegrade once I've located the port of hepatitis.
04:39I think Carly was comfortable.
04:42Why does it matter what kind of questions are asked when?
04:45Aren't the answers what's important?
04:47I'm sure you're right.
04:48Yes.
04:49What is the plan for the next date?
04:51Hmm.
04:52We didn't make another date.
04:56Then I grasped gallbladder fundus and elevated witchcraft.
04:59Superiorly.
04:59Is that significant?
05:01No follow-up date?
05:02Not necessarily.
05:04How did the night end?
05:05Good night kiss?
05:06I've exposed the triangle of callo and ligated the cystic duct and artery.
05:11What is the risk at this juncture?
05:12Lacerating a liver during section.
05:14Correct.
05:14We didn't kiss.
05:16Ironically.
05:17Complication, which I've inadvertently just demonstrated.
05:20Hold direct pressure.
05:21I need better exposure.
05:22I sliced instead of peeled.
05:25You are familiar with the Pringlet procedure, Dr. Brown?
05:27Yes.
05:28Although I've never...
05:28Clamp down the portal triad with an atraumatic hemostat.
05:31Clamp.
05:32Then use number two cat gut suture.
05:33You are familiar with the Pringlet procedure.
05:45You are familiar with the Pringlet procedure.
05:45You are familiar with the Pringlet procedure.
05:46Okay.
05:47I'm not familiar with the Pringlet procedure.
05:47I don't know.
05:48I don't know.
05:48Sean?
05:48Sean?
05:49Just go to her and explain it.
05:51If what I said made her uncomfortable, then saying more could make her more uncomfortable.
05:56I sliced instead of peeled.
05:59After Michelle's surgery, I will go and talk to Carly.
06:04Good.
06:10You can talk to her soon.
06:13The R2 had a cancellation.
06:15Your surgery is in 45 minutes.
06:16Hey, I'm Dr. Brown.
06:21I will be performing Michelle's surgery.
06:26I will be removing her gallbladder.
06:28It is a simple procedure.
06:31Okay.
06:31Make sure your daughter is well taken care of.
06:35Ow!
06:36Sir, we need to decapitate it.
06:38No.
06:39Don't.
06:40I'm begging you.
06:41Don't.
06:42Please.
06:44I can't get an image.
06:45How did that...
06:46Is that a swordfish?
06:47With that dorsal fin?
06:49It's a marlin.
06:49I hooked him with a naked ballyhoo.
06:51Battled me for over an hour.
06:53Suddenly, he just leapt out of the water.
06:55He came right at me.
06:55Save the story for the bar, Quint.
06:57Right now, we need to cut the damn thing in half.
06:59No.
07:00Forty-plus years, I've been chasing a fish like this.
07:02You can't just behead him.
07:03Can't leave his nose in your leg, either.
07:05His bill.
07:08Can't you just pull him out gently?
07:11I'll sign a waiver.
07:12The pull-out method never works.
07:14If any of your blood vessels are damaged, it gets messy.
07:17Congrats.
07:17I hear your surgery is on the schedule.
07:19How's his distal pulse?
07:20A little thready, but still there.
07:21We need to get him to an MRI.
07:22I'm not going anywhere without Franklin.
07:26I named him after my father.
07:28You and Franklin both won't fit.
07:30Ow!
07:32Ow!
07:32You said he was dead.
07:33I didn't take a pulse.
07:34Go get something to kill it.
07:35Don't.
07:36It's dead.
07:36It's moving.
07:37It's a post-mortem response.
07:39You guys are doctors.
07:40Don't people do this?
07:41No!
07:47I'll help you with you at lunch.
07:49Surgery's in 20 minutes.
07:51Good luck.
07:52You too.
07:53I want to...
08:07No.
08:08No, I haven't left.
08:09I don't want to be great or nothing.
08:15Got it.
08:17I'll be back as soon as I can.
08:20Hi.
08:21You must be Michelle's mother.
08:22I'm Dr. Brown.
08:23I'll be...
08:23How long will she have to stay in here?
08:25Hospitals make me nervous.
08:27Three days to a week, depending on...
08:29She's going to miss a lot of school.
08:32And she watches Tisha and her brothers in the afternoon.
08:34Your daughter has a serious infection in her gallbladder.
08:37She's been experiencing symptoms on and off for a while now.
08:40She never told me that.
08:43Why didn't you tell me that?
08:45Mama.
08:46My point is she's been ill for a while, so her recovery may take...
08:50Mom.
08:54Please.
08:54Please.
08:55My...
08:55My chest hurts.
08:57What's wrong?
08:57Her oxygen levels are dropping.
08:59She's tachycardic.
09:00I need a chest CT step.
09:06You had a blood clot in the artery that feeds your lungs.
09:09It's called a pulmonary embolism.
09:11This medicine broke it up.
09:12How could that happen?
09:14According to our scan, it was part of a larger clot in your leg that broke off and traveled there.
09:18As for why the larger one formed, when I asked you if you were taking birth control pills, you said no.
09:25Is that the truth?
09:27You asked me in front of Tisha.
09:30I'm doing it with my boyfriend, and I don't want babies, so I'm taking birth control pills.
09:34How long are you going to take them?
09:35I don't know.
09:36A year?
09:37I'm prescribing condoms for your boyfriend.
09:40You need to go off the pill to prevent further clots.
09:43Dr. Brown is going to place an IDC filter via your femoral vein in case other parts of the clot break off.
09:48Your gallbladder surgery is going to have to wait until tomorrow.
09:51What are you doing?
09:52This is where the catheter goes in?
10:07How did you get these scars?
10:09I cut myself climbing a fence.
10:11Those scars, they're straight, in a row, all the same length.
10:28I don't believe you got them from a fence.
10:30I don't care what you believe.
10:40Kids who cut, most of them are really sad and a lot of pain.
10:48They say cutting makes them feel better.
10:50Is that how it is with you?
10:51I don't want to talk about it.
10:57Okay.
10:58Okay.
10:58Okay.
10:58my life sucks okay tell me how why it won't change anything
11:28talking might make you feel better and maybe i can help
11:35i live in a foster home but i'm not a foster kid
11:40i'm a whole mother but i've never had a baby
11:43my mom brought three kids in our home and that was my job to take care of them make breakfast
11:52get the kids dressed take them to school go to school pick them up dinner homework laundry repeat
11:57i barely ever leave the house without a kid attached to me can you help me with that
12:03michelle wouldn't hurt herself on purpose michelle is unhappy she feels pressure to look after her
12:12foster siblings help out at home yeah her home life is fine i'll talk to her it might be helpful to
12:20have her speak with a psychiatrist my daughter is not crazy we don't do psychiatrists you know that
12:24that needs to change when are you doing a surgery tomorrow thank you i will speak to my daughter
12:31don't it's her job to fix her gallbladder not her life
12:40it's her first surgery it's her first surgery bucket to strap her
12:44have you talked to carly no
13:01blood pressure is 62 over 31 your patient is in cardiac arrest i know
13:08you're practicing the pringle maneuver in the event of a liver bleed
13:15yes
13:16that was better thanks now you can talk to carly i need to practice
13:24dr lim says getting away from things every now and again having balance in our lives can be just as
13:38important to our performance as practice maybe you should get some balance by talking to carly i don't
13:44know
13:45i'm nervous about my surgery sean practice will make me less nervous that will improve my performance
13:52okay
13:59okay
14:01you should also practice not causing a liver bleed planning on it
14:07also how you will recover if you cut the portal vein that's potentially fatal
14:14or if you perforate the small bowel which could cause sepsis leading to death or if you cut the
14:21common bile duct which would cause right now right now aren't you still nervous nope all better
14:31what blade for the coca what incision for the collie what blade
14:36uh
14:4010.
14:43they won't both fit in the mri
14:45a fish boy doesn't buy it location of the incision
14:52why are you trying to help me
14:54limb picked you for the first surgery everyone knows that makes you the front runner for chief
14:58residence this is me sucking up
15:02i've never been big on pretense
15:08are you okay what the hell just happened
15:12the marlin must have metal in his body
15:14where does it stop i think a license plate flew by me
15:17franklin
15:18oh no franklin
15:24oh it's okay franklin's okay it all came out one side
15:30it won't show when i mount him
15:33i think it is for small miracles
15:35i've got a femoral
15:43hold the or we're coming
15:55hang on dr brown
15:57just need to make an incision above and below the arterial injury site
16:01you need to clamp the femoral proximal to the bleed without clipping the femoral nerve
16:05got it i feel the nerve right above my index finger one down
16:09and a starting to cramp
16:11lean over this way a little bit
16:12rotate your wrist just a little bit more
16:17let's see if that holds
16:29go get cleaned up we'll take it from here
16:41i wanted to check the patient's blood work
16:42he's negative for hiv hep b and c you don't need prophylactic meds
16:50i'm nervous about my surgery
16:52you'll be fine
16:56and don't ever say that again
16:59why
17:01weren't you nervous before your first lead
17:03if i was i didn't volunteer that to the chief of surgery
17:07or anyone
17:08we're women we're not white and we're surgeons unicorns consider us a fabled species
17:14we don't get the luxury of public insecurity
17:16i will aspire to repress stoicism in the future we don't need to be insecure
17:24because every step of the way we've had to be twice as good as everybody else
17:27i'll suck it up you got this
17:40so
17:45so
17:51Don't forget we have our session with Dr. Donovan today.
18:21I won't.
18:31You're patient. What are they like? Man, woman, young, old?
18:37Woman. Girl, actually. She's tough, smart, really sad.
18:49Her mom is her taking care of three foster kids.
18:55At least you were only stuck looking after me.
19:02How old?
19:04Fourteen.
19:06She acts a lot older. She's been having sex for almost a year.
19:12Are you about that age when you were with Wayne?
19:14I don't have sex with Wayne.
19:16What?
19:18He was in love with you, always sniffing around that place.
19:22Maybe. You didn't get any.
19:24So who?
19:25Junior prom guy. Derek.
19:26Derek? No.
19:28I didn't lose my virginity until sophomore year of college.
19:34What were you hoping for? A proposal?
19:36No.
19:38I wanted it to be special.
19:44Oh, good for you.
19:46I mean, I wouldn't have held out, but good for you.
19:48I thought for sure you and Wayne were doing it.
19:54You were okay with that?
19:56You were so serious, so restrained.
20:00We talked about birth control.
20:02I figured, good for her, she's finally relaxing, having some fun.
20:06No, I was so restrained and serious, because I never knew when you were going to fall apart.
20:20Gotta get to work.
20:32I'll be back before Michelle goes into surgery.
20:34Have you had a chance to talk to her?
20:36What about her cutting?
20:38Some fool friend of hers gave her the idea.
20:40She's not unhappy, it's just peer pressure.
20:42She sounded unhappy to me.
20:44She's upset I didn't let her go hang out with her friends.
20:46It's typical teen drama.
20:48She promised me she's done cutting.
20:50Self-harming behavior doesn't just stop.
20:52Michelle might need...
20:54Dr. Brown, my daughter needs to have surgery and get out of this hospital.
21:06You didn't tell your mom the truth.
21:12About why you caught yourself.
21:16About how unhappy you are.
21:18I tried.
21:19She didn't want to hear it.
21:20Just said that things aren't always going to go my way and I need to be more responsible.
21:24Like I'm not already.
21:26Growing up I had to take care of my mom.
21:42What was wrong with her?
21:44She's mentally ill, bipolar disorder and a drinking problem, pills.
21:50When things were bad she'd forget to buy groceries or clean the trailer or pick me up.
21:58Or she'd spend all her rent on something stupid.
22:02And I thought if I could make her life easy enough, if I cooked and cleaned and got good grades, she'd get better.
22:12But she never did.
22:14And for the longest time I thought it was my fault she was sick.
22:20I probably still would if a psychiatrist hadn't refused to believe me when I said I was fine.
22:30You've been to a psychiatrist?
22:35But you're like a fancy surgeon.
22:43I could have a therapist come by and see you for your surgery.
22:50Okay.
22:52Okay.
22:56Okay.
22:57Okay.
22:59Okay.
23:01Okay.
23:03Okay.
23:04We should be getting better.
23:06It's gotta be an infection from the mother.
23:08Okay.
23:09Okay.
23:11Okay.
23:12Okay.
23:13Okay.
23:14Okay.
23:15Okay.
23:16Okay.
23:17We should be getting better.
23:18It's got to be an infection from the Marlin, Aromomus, or Mycobacterium marinum.
23:23Would have responded to the antibiotics.
23:25Guys, I'm trying to focus.
23:28What if he has an underlying autoimmune disorder?
23:31It could have been triggered by the surgery, or even the initial fish stabbing.
23:35That would explain why the leg ulcerations are progressing despite good arterial flow.
23:39We could see if he responds to steroids.
23:41Which could kill him if it is an infection.
23:48But we could run an ANA, see if he's positive.
23:52Would have got a parasite.
23:53Renospiridium sebori, or...
23:55Have you talked to Carly?
23:58Sorry, I got sidetracked by Marlin.
24:11Okay, I'll get it.
24:15Come in.
24:17You wanted to see me?
24:19Ms. Reynolds tells me that you went against her wishes and had her daughter speak with a psychiatrist.
24:24Uh...
24:26Michelle asked to see a therapist.
24:29Only after you talked her into it.
24:31I'm gonna report you to the medical board.
24:33You had no right to...
24:34Dr. Brown, were you concerned that Michelle might be a serious danger to herself?
24:39Yes.
24:40In that case, the consult was required.
24:42That said, Dr. Brown's failure to inform you was inappropriate.
24:46You're off the case.
24:48Dr. Melendez will perform the surgery.
24:50How are you doing?
24:51Claire?
24:52I understand today's a big day for you.
24:53For surgery?
24:54We don't need to talk about that.
24:55I think we do.
24:56You've been taking care of your mother for a long time.
24:57That's a pattern you both need to break out of.
25:01I know I haven't always been there for you, and I just...
25:02I'm trying to change that.
25:03I know, Mom.
25:04I'm good.
25:05Everything is fine.
25:06And your first surgery, is that this afternoon?
25:07It's...
25:08Actually, it's not.
25:09Um...
25:10I arranged a psych consult without the mother's permission.
25:12It's...
25:13It's...
25:14So I got thrown off the case.
25:15How could the hospital allow that?
25:29What is wrong with them?
25:30actually it's not um i arranged a psych consult without the mother's permission
25:39so i got thrown off the case how could the hospital allow that what is wrong with them
25:44after how hard you've worked it's okay mom they kind of had to that must be a big disappointment
25:49it is anything else claire
25:55i'm upset humiliated so so mad at my patient's mother for not taking care of her daughter
26:07and i'm i'm relieved i'm so so relieved to have that weight off of me and that makes me feel like
26:16a fraud don't you say that how can i be so scared to do something i've wanted for so long
26:21because things that matter are scary that's how i feel about coming here
26:28talking about my life and our relationship what if i can't fix it
26:35what if i can't make up for all the times i've let you down and then i think
26:46just be like claire
26:47because nothing stops you ever you see what you want and you go after it with everything you got
26:59you are an inspiration
27:03you're my inspiration
27:07carly
27:21hi
27:22do you have a second
27:23ovar 2 is waiting to learn the patient's mask wasn't cancer so they can close then come back
27:27after i'll meet it's a cafe
27:37cancer the marlin guy has cancer ct chest abdomen and pelvis should have no masses it's in his leg it
27:48explains progressive ulcerations despite good arterial flow and why the antibiotics aren't working
27:53we'll send a tissue sample from the ulcerated area and when i'm chief resident i'll remember this
28:04there's a problem with michelle i'm not doing it
28:07i have to calm down you don't get to tell me what to do i want dr brown
28:11michelle what's going on i want you to do my surgery i want her mom and not somebody else
28:16dr melendez is going to do your surgery he is a great doctor he's not you you care about me
28:22everybody here cares about you michelle now please sit down you could rupture your gallbladder
28:26i i don't want to get better don't say that it's the truth michelle you need this surgery that is all
28:32that matters not whether i do it i'm gonna be there i will be watching from the gallery the whole time
28:41you just you need you need to sit down
29:01kid okay
29:04i had to pull you off if you made even the tiniest misstep during surgery
29:07that mom would go from birth to lawsuit
29:13is patricia okay with me watching from the gallery no
29:18can't remove her gallbladder from the gallery
29:21what you're doing michelle's surgery how'd you get the mom to change her mind i explained that
29:27given dr brown's commitment to her daughter she's the perfect choice to lead the surgery
29:31especially with me over her shoulder the whole time
29:33thank you for fighting for me that's what bosses do let's go
29:51you stood me up sorry about that what's up sean's a little worried he may have freaked you out with
29:57his questionnaire the other night oh i thought it was cool small talk bores the hell out of me
30:04well and great i'll tell him sean got worried about that all on his own it doesn't seem like him
30:12i may have mentioned that people don't usually ask deeply personal questions on an early date
30:20claire i like you but we don't really know each other and yet you decided how i was going to react to
30:26sean's questions which isn't your business and you were wrong totally totally wrong sean and i don't
30:35need you or anyone else to run interference on our relationship butt out
30:56so
31:01so
31:05so
31:11so
31:17Is everybody ready for a time out?
31:44Dr. Claire Brown, lead surgeon.
31:47Dr. Neil Melendez, attending surgeon.
31:49Dr. Sean Murphy, assisting.
31:52Dr. Jan Lancaster, anesthesia.
31:55Donna Petringa, scrap nurse.
31:57Shani Weldon, circulating nurse.
32:00Patient is Michelle Reynolds.
32:02We'll be performing an open cholecystectomy.
32:05All tools I need are confirmed to be present.
32:08Estimated blood loss, 100 cc's.
32:10Patient will go to the ICU after surgery.
32:12Is everybody in agreement?
32:13Patient.
32:16Dr. Murphy, have you chloroprepped the site?
32:19I have.
32:21Template.
32:46Sponge.
33:01Top layer of abdominal muscle is exposed.
33:04I'll need a bovie to cut through.
33:16Nice work, Dr. Brown.
33:27Book Walter retractor?
33:36I see the liver, and I need a better expose the inferior surface.
33:40Retract the duodenum inferiorly, please.
33:46Gallbladder exposed.
33:57Dr. Brown?
34:00There's more scarring than the imaging suggested.
34:04True.
34:09Talk through your approach.
34:10I grasp the gallbladder fundus forward
34:17and use a right-angle clamp and my suction
34:20to develop a plane around the gallbladder.
34:23Kelly clamp, right-angle clamp, and suction.
34:26That was elegant use of the Kelly clamp.
34:50I see the cystic duct, and behind it, the cystic artery.
35:01I need my first assist to confirm
35:02that I have identified the common bile duct,
35:05and it is out of the way.
35:06Yes, cutting the duct would be...
35:09Very, very bad.
35:11Move the gallbladder cranially a little bit.
35:14Titanium flip-a-plier.
35:16You sure you have a clear view?
35:38Making the cut.
35:39She's hemorrhaging.
36:06I can't see the source of the bleeding.
36:18Map is 45 and dropping.
36:32What do you think is happening?
36:33What do you think is happening?
36:36Most likely, my scissors tip nicked the right hepatic artery.
36:41It happens.
36:42It's happened to me.
36:47I need to clamp the common hepatic artery,
36:50repair the arterial wall with a running 6-oprolein sutures.
36:53That's what I would do.
36:54OK.
36:55Good morning.
37:00Sweetheart.
37:01meu
37:17Hey, hey, hey, slow down.
37:45Slow down, no running, no running.
37:49Dr. Brown, how's my daughter?
37:51Surgery was a success, and we expect a full recovery.
37:56I want to see her.
37:59Is that okay?
38:01Yay!
38:08Michelle says she wants to be a doctor.
38:13She would be a great one.
38:15Uh, that therapist Michelle talked to.
38:22Could I get her card?
38:29I need you.
38:31I need you.
38:32You were right.
38:57He had angiosarcoma of the leg.
38:59I had to amputate, but the margins were clean.
39:03What happened to the...
39:04Franklin!
39:09Franklin, you amazing fess.
39:14You saved my life.
39:17Come on, bring him in.
39:20Bring him in.
39:24Thank you, guys.
39:30Group up!
39:31Do you prefer to work in a team or do you prefer to lead or follow command?
39:43And what machine or appliance in your house aggravates you the most?
39:57Hey, I'm just leaving.
40:02Who's this?
40:04Who's this?
40:24From the greatest heart.
40:33Slow-motion life.
40:40You know I pay to leave these tears behind.
40:46But it's fine.
40:49I know we're all the same.
40:52Slow-motion pain.
40:59Slow-motion pain.
41:05Now it's all blood in the open.
41:10But we're not scared.
41:14Message received at 5.30 p.m. from mom.
41:21Hey, baby.
41:22I got your text.
41:23See, I knew it was just a temporary setback.
41:26We're gonna celebrate.
41:27I made dinner.
41:28And I'm gonna go get some dessert.
41:30I'll see you soon.
41:31I'm so proud of you, baby.
41:39Slow-motion life.
41:44Slow-motion life.
41:47Slow-motion life.
41:51Slow-motion life.
42:01Slow-motion life.
42:09Slow-motion life.
42:22Slow-motion life.