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The Good Doctor Season 4 Episode 3

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