The Good Doctor Season 4 Episode 6
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00:01I've got hydroxychloroquine, ribavirin.
00:03I'm twice the size of SJ General.
00:04I should have twice the amount of tests.
00:30I'm a doctor what happened I don't know he was running
00:59I honked all of a sudden he was in front of my car.
01:04Pedestrian versus car GCS 5 at scene.
01:06Rigid abdomen with active bleeding fail chest with pneumo.
01:12He needs an X-lap now.
01:17I've got a massive hemoperidoneum.
01:19I need two large suctions and lap pads in all four quadrants.
01:26There's a grade 3 liver laceration in right lateral segments.
01:29There's a stitch, number one chromic and a blunt needle and a comeback gauze.
01:41What were you doing on your bike at that hour?
01:43Heading into work.
01:44Trying to prep for my budget meeting with Glassman.
01:47Mobilize the lever to check for any associated diaphragm injury.
01:50It's the other side of town.
01:52I was taking the scenic route.
01:54PP's dropping.
01:56He's got another bleed.
01:57Add more lap pads and run the bowel.
01:58There's a perforation near the terminal ilium.
02:03Something tore through the intestinal wall.
02:09It's shrapnel.
02:11From the accident?
02:13Coat's eroded.
02:14It looks like it's been in there a while.
02:17Must have gotten dislodged in the accident.
02:19How does Asher seem to you?
02:37He seems fine.
02:39Too fine for someone who's just lost their first patient?
02:42I don't have time to worry about people being too fine.
02:45He's faking it.
02:45Good.
02:46The brain releases serotonin when you smile even if you're miserable.
02:49I feel better already.
02:50Denial is not a proven strategy for psychological health.
02:54Dwelling on things you can't change doesn't help either.
02:5624-year-old woman came into the ER complaining of abdominal pain and headaches.
03:11And surprise, she's pregnant.
03:13Apparently not a happy surprise.
03:15She wants an abortion.
03:17Well, what's wrong with her?
03:17I assume you haven't recently learned the value of sharing, which makes me think there's
03:22another reason you're unloading this onto the surgical department.
03:25She has a congenital IgA deficiency and a history of severe infections.
03:28She'll need IV antibiotics and close post-surgical observation.
03:32I figured one of your newbies may as well learn something.
03:34Leah's birthday is tomorrow.
03:48There are many cute frogs and many romantic songs.
03:51I can't decide.
03:56It is my first gift as her boyfriend.
03:59It needs to be awesome.
04:01Well, then maybe singing frogs, however cute, might be a mistake.
04:07Try something more personal or romantic and find a resident who hasn't done a suction
04:13DNC and teach them.
04:15Oh, no.
04:16No, I'll do it myself.
04:19I'm not going to teach anymore.
04:21I'm a good surgeon.
04:22I'll do surgery.
04:23Dr. Murphy, part of your job as a surgeon is to teach.
04:26You can't opt out because it's difficult.
04:28I am opting out because I'm bad at it.
04:31Well, you can't opt out for any reason, but I may have given you too much responsibility
04:36too soon, so I will supervise your supervision until you get the hang of it.
04:41Pick someone.
04:42Did you two lose something?
04:44Our patient, Rose Babcock.
04:47She's post-op from repair of a distal radius fracture.
04:51Sixties.
04:51White hair.
04:52Looks at you like she's staring into your soul.
04:54Does she have a limp?
04:56No.
04:56I don't think she does now.
04:57Miss Babcock, did you fall down again?
05:01Oh, no, I'm fine.
05:03But there's a poor man in room 318 who's in a lot of pain.
05:09Let's get you back in bed.
05:11Oh.
05:17Apply a new tegaderm, not antibiotic ointment.
05:20They breathe.
05:27Don't make us handcuff you to the bed, Rose.
05:29We charge extra for that.
05:31Dry the skin more so, it'll stick.
05:34You're doing just fine, dear.
05:38Heart rate spiking in the 130s.
05:40BP 162 over 95.
05:42Are you feeling any pressure in your chest?
05:44No, it's just anxiety.
05:46Not mine.
05:47It's one of yours.
05:52We're going to pretend, since it's happening in your chest, that it's yours.
05:5720 milligrams IV livetolol?
05:59I'm fine.
06:00I'm an empath.
06:01I can feel what other people are feeling.
06:04And one of you is very stressed out.
06:10Olivia, stay where you are.
06:12And one milligram of Ativan.
06:14Keep away from me.
06:35No.
06:36Step back.
06:37Sir, you were in an accident.
06:39We're taking care of you.
06:40Stop it.
06:41Stop it!
06:42No!
06:43Get away from me!
06:44I need you to hold him down while I administer Haldol.
06:47Sir, please, just...
06:48Warning you, this room is being cleared.
06:51No one is going to hurt you.
06:54Ben.
06:55Huh?
06:55You're having a flashback.
07:01You're not in Afghanistan.
07:05You're in the hospital.
07:07Look around.
07:10What do you see?
07:11Zoe?
07:23Zoe?
07:24Yeah.
07:25Yeah, baby, it's me.
07:26Zoe, I couldn't sleep.
07:28I...
07:28I went for a run, and I...
07:31I heard an explosion.
07:34I...
07:34I don't know what happened after that.
07:38You were hit by a car.
07:40We had to do surgery, but you're going to be okay.
07:44It's okay.
07:45Take him back to his room.
07:47Make sure he didn't open his wound.
07:50Just hurry.
07:51Dr. Murphy?
08:05Rosa's not your patient.
08:15She was teaching me about her gift.
08:18She says the basis of empathy is curiosity,
08:21which I find curious, because...
08:23I'm curious about the job you're supposed to be doing.
08:26Who are you leading through the DNC?
08:28None of them.
08:30The only one who hasn't done one does not want to,
08:34so I will.
08:34Which resident?
08:37Wanting to is irrelevant.
08:38It's their job.
08:40Wanting to is irrelevant.
08:42It's your job.
08:44I'm a Christian.
08:45Performing an abortion goes against my beliefs.
08:49Okay.
08:51You may encounter a situation one day
08:55where this procedure could save a woman's life.
08:58Then I hope someone else can...
08:59And it's my job to make sure you can perform all surgeries,
09:03including abortions.
09:04So where does that leave us?
09:11I'll do the surgery.
09:13I've only done one.
09:15I'm sure there's a lot I still can learn.
09:16Dr. Murphy, you have a new student.
09:22Get her started running pre-surgery assessments.
09:24Thank you, Olivia.
09:26That's the kind of ambition I like to see.
09:27He did three tours.
09:31He came home after he was injured and some kind of explosion.
09:36I don't really know what happened.
09:39He's tried to tell me about it several times, but he just breaks down.
09:42When was he diagnosed with PTSD?
09:45Two years ago.
09:47But he hasn't been the same since he got back.
09:50At first, he was moody, irritable.
09:56Little things would set him off.
09:59Then the insomnia started.
10:00His mind, it's just never at rest.
10:06Nights are the worst.
10:07You know, he gets these terrible nightmares.
10:13Flashbacks.
10:14Just can't sleep in the same room anymore.
10:17Make sure he stays off his feet.
10:23Would you like us to arrange a site consult?
10:26We've been down that road.
10:29Talk therapy, group therapy, exposure therapy.
10:34And less medications.
10:36Let us know if you change your mind.
10:47Let us know if you change your mind.
11:17Jillian, I need those stats on elective surgeries for my budget meeting.
11:34And a coffee.
11:38Jillian?
11:41She's not there.
11:42I need approval for this.
11:43And this.
11:49You said I couldn't give her the frogs.
11:52Oh, you can't give her this either.
11:55You don't know what it is.
11:56I know it would mean more if you had to leave the building to get it.
12:02I would like to do the suction DNC surgery.
12:04I assume your religious convictions haven't changed in the last few hours?
12:10No.
12:11But I believe I was put in this program for a reason.
12:13So if you think it's important for me to learn how to do an abortion, then I should learn.
12:21Take Jordan to the skills lab.
12:23Run the surgery steps.
12:24You two will handle the DNC yourselves.
12:26With you?
12:27How are you going to supervise my supervision if you're not there?
12:33I will help you prep and debrief afterwards, but this patient doesn't need a gallery of strangers standing around gawking at her most private experience.
12:40Sorry to interrupt.
12:41Ben woke up complaining of pain.
12:43Did you check the incision?
12:44The pain is in his arm.
12:45Now test external rotation of the shoulder.
12:51We're almost done.
12:53Can you describe the pain?
12:58We'll call it a 10.
12:59It's been hurting for years, but this is something else.
13:03How did you injure your shoulder before?
13:05I was in a...
13:10I was in a convoy in Kandahar.
13:15There was a...
13:17I dislocated my...
13:22You don't need to discuss it with us.
13:26What did you find?
13:27Swelling, sensitivity to touch, discoloration.
13:30Could be CRPS.
13:31What is that?
13:32Well, it appears the car accident aggravated a prior injury.
13:36You've developed complex regional pain syndrome.
13:38We'll start you on gabapentin and allotted.
13:41Opioids make me a little insane.
13:44We could do a stellate ganglion block.
13:47It's an injection of anesthetic near the spine that blocks the pain signals and could also help the PTSD.
13:54I've been treated for PTSD for years.
13:57Why haven't I heard about this?
13:58It's experimental, but promising.
14:01A procedure comes with risks.
14:03Vascular injury, infection, major hematoma.
14:05Dr. Lim, I've been taking a risk every time I go to sleep.
14:11I want to do it.
14:13Stellate block is an accepted procedure for treatment of pain.
14:15Which you wouldn't have suggested if the patient didn't also have a mental health condition.
14:20I hear Jordan's back on the DNC in spite of her righteous indignation.
14:23Is something chirping?
14:25I think you're being unfair.
14:26Well, if anyone's being unfair, it's me.
14:28I told Jordan to do it.
14:30I told her.
14:31We make decisions that are hard to live with all the time.
14:34We make them anyway.
14:35And I told her pissing off the chief was a very bad way to start your residency.
14:39Glad to hear you're still moonlighting a surgical department count counselor.
14:42But I don't mean you were being unfair to Jordan.
14:44You're being unfair to the patient.
14:46She's facing an emotionally fraught procedure.
14:48She needs the support of her doctors.
14:50And who she's getting is a rookie who thinks she's committing murder.
14:53And Sean.
14:58I have a point.
15:02I'll lead Jordan through the DNC myself.
15:04You're happy.
15:06Dr. Murphy will be happy.
15:07My cup runneth over.
15:09Now get whatever's in that box out of my department.
15:11Morning sickness.
15:23Nurse Alice.
15:25Rose claims she can feel her pregnancy.
15:27She was right about the guy in room 318.
15:29He had a clot in his ankle.
15:31I'm sure she picked up on some subtle clues like the guy moaning and grasping his ankle.
15:35Get a CT to rule out abdominal injury from her fall.
15:41We're going to insert a thin needle into your neck so we can inject the anesthetic.
15:46It may sting a bit.
15:53Use an in-plane approach to place the needle between the C6 tubercle and carotid artery.
16:05Use an in-plane approach to place the needle between the C6 tubercle and carotid artery.
16:35I don't know if it wasn't for me.
16:37It's a COVID-19 attack.
16:38I don't know if I'm part of it.
16:53What's wrong?
16:55I was always hurt.
16:56I'm okay.
16:57It gets nice.
16:58Let me take a look.
16:59What happened?
17:00I hit her.
17:01I was laying next to him.
17:03I know I shouldn't, but the shot just made his pain feel so much better, I thought.
17:07Zoe.
17:09You didn't do anything wrong.
17:12There was a noise in the hall.
17:14I lashed out.
17:14I know.
17:16I didn't mean to.
17:17I'm sorry.
17:25Nothing's broken.
17:27I can get you something for the swelling.
17:28No, I'm okay.
17:29I'm gonna go home.
17:30Get cleaned up.
17:33I just need some time.
17:37I love you.
17:38I think we can help them.
17:52There have been some promising results using vagal nerve stimulation to treat PTSD.
17:57The scarring would make it impossible to expose and find a nerve without damaging it.
18:01Those scars are the reason that we need to try.
18:04Hey, imagine reliving your worst nightmare over and over again.
18:08Why doesn't anyone around here want to do the job they were hired for?
18:10What then needs a psychological help?
18:12I've ordered a consult.
18:13Leave it to the people who are trained to do it.
18:17Sets a bad precedent to force a resident to do a procedure they're not comfortable with.
18:20Wow.
18:20Does anyone around here not have an opinion about who should do that damn portion?
18:24Jordan had a choice, and in my opinion, she made the right one.
18:27It's not a true choice if you're coerced by your boss.
18:29I asked her to do her job.
18:31You took an opportunity from a resident who wants to learn in favor of one who doesn't.
18:36Is this song and dance about Jordan doing the procedure or your niece not doing it?
18:41Neither.
18:42There's a misconception that Olivia came to St. Bonaventure because of me.
18:46She's here because of your reputation.
18:49The great Dr. Lim, a master class in technique, professionalism, empathy.
18:55Lately, it doesn't seem like that reputation holds up.
18:56I'm giving you an antibiotic to prevent an infection.
19:06The vacuum aspiration will take about 15 minutes, and you'll be numbed with the local anesthetic.
19:11Conscious sedation is also an option, but you will need someone to drive you home afterwards.
19:20Do you have any questions for me?
19:21No.
19:26I'm scared.
19:39Are you certain you want to go ahead with the abortion?
19:50Yes.
19:50Then you don't have to be scared.
19:57You're making the right decision for you.
20:06Give her another 400 micrograms of misopristol.
20:09I'll be back for the procedure.
20:12This doesn't work.
20:14I need these numbers in spreadsheet format.
20:16Dr. Park?
20:22Rosa's CT was normal.
20:24Get an upper GI barium study.
20:27First quarter supply costs you requested.
20:29Also, one of your first years seems upset.
20:32He's been in the stairwell for a while.
20:37Everything okay in here?
20:38I just needed some quiet.
20:46Surgeons come into the stairwell for two reasons.
20:49Fire drills or doctor trauma.
20:52You having a fire drill?
20:55I just wish we had a more effective treatment for Ben.
20:59His head's so messed up and we can't help him.
21:02I don't think this is about Ben.
21:19Have you ever lost a patient
21:21you knew you could have saved?
21:24When COVID was at its worst
21:31we had to cancel all non-urgent procedures.
21:36A young mom with a heart condition
21:38was
21:38more urgent than I thought.
21:43And she died
21:44waiting for me to put her on the schedule.
21:45How do you get past that?
21:57You get past it because that's the job.
22:01You will always
22:03remember it.
22:05And you will
22:06eventually stop reliving it.
22:10How could you be so sure?
22:14Because if you don't
22:15you can't be a surgeon.
22:20And I'm pretty sure you're a surgeon.
22:29You should get back to work.
22:43Insert the speculum.
22:45Now dilate the cervix.
23:03Begin suction.
23:03begin gentle suction
23:20in the uterus.
23:27Is anything wrong?
23:30You're okay.
23:31Dr. Allen, I can take it from here.
23:33Don't worry, we're almost done.
23:42You're going to be just fine.
23:47You have no idea
23:48what that woman was going through
23:50and you made it worse for her.
23:51I know, I didn't.
23:52You had an opportunity to opt out
23:53before you walked into that room.
23:54But you agreed to do the procedure,
23:56you took on an obligation to that patient,
23:58and you failed her.
23:59If you ever do anything like that again,
24:00I will have you removed from my program.
24:02Maybe you should be cleaning bedpans for a while.
24:04Hopefully, there's no moral objection to that.
24:07Why are there adult toys on my desk?
24:18I've heard good things about the llama,
24:21but online reviews aren't always accurate.
24:23Do you have a favorite?
24:27They're for Leah.
24:28Leah, which one do you like the most, Claire?
24:36Evidence suggests that trauma changes the way the brain works.
24:39An overactive amygdala can heighten someone's response
24:42to emotional stimuli, including fear.
24:44I think we should consider amygdala ablation for Ben.
24:48That's crazy, and completely outside the scope of our care.
24:53We're surgeons.
25:00We fix physiological problems, not mental ones.
25:02It is a physiological problem.
25:04His brain isn't functioning properly.
25:06If it was a tumor that was causing these reactions,
25:08you wouldn't hesitate to remove it.
25:09But there is no tumor.
25:11You're talking about inflicting damage on his brain.
25:13He could suffer a stroke, or come out in a coma,
25:16or not come out at all.
25:17If you use a stereotactic laser approach
25:20rather than an open craniotomy,
25:22you would greatly reduce the risk.
25:23This is not your case.
25:25You cannot jump into this one
25:26because you don't want to do the one assigned to you,
25:28which is to teach.
25:29Witch, you've made my problem
25:30just like you made Leah's birthday gifts my problem.
25:33You need to grow up and accept some responsibility.
25:47I was diagnosed with PTSD last year.
26:03I kept it mainly private.
26:08Melinda's really helped me through it.
26:13It was nice to have a friend to lean on.
26:19So if you need one...
26:20I feel...
26:36off.
26:42Disconnected.
26:44Like I can't catch my breath.
26:49But...
26:50it comes with a job.
26:54I'll get over it.
26:55It's Ben.
27:07Ben.
27:08No one is going to hurt you.
27:12You're having a flashback.
27:13I know where I am.
27:23Every day since I came home,
27:25I felt like there's a monster chasing me.
27:27I try to outrun it.
27:31But I end up hurting
27:33the one I love the most.
27:37I'm a threat to everyone around me.
27:39No, Ben.
27:39You just need help.
27:41Nothing helps.
27:45I can't smile.
27:46I can't laugh.
27:47I can't feel anything but pain.
27:53I make everyone around me...
27:57suffer.
28:04Ben.
28:06There's a surgery that may help.
28:11I would like to scrub in
28:30on the amygdala ablation surgery.
28:33Rose said you're feeling overwhelmed.
28:35I don't want to hear any more things
28:36that woman has said.
28:37Your job is to supervise your residence.
28:40Why are you here instead of doing that?
28:42You said you were going to supervise my supervision,
28:45but you didn't.
28:46You took over my case.
28:47I don't know what I was supposed to learn or how.
28:53Scrub in.
28:54Dr. Murphy, walk Asher through the probe placement
29:02and trajectory to the amygdala.
29:06I will supervise your supervision.
29:11Okay.
29:12Insert the probe perpendicular
29:13to the cortical surface.
29:15Okay.
29:15Stop.
29:30You're off course.
29:31On the current trajectory,
29:33you will penetrate a branch
29:34of the choroidal artery
29:35and cause a hemorrhage.
29:36Step away from the probe.
29:36Your job
29:37is to teach,
29:39not take over.
29:40Adjust the probe one millimeter inferiorly.
29:53Avoid the temporal horn on your right.
29:57I can't see it on the image guidance.
30:03Tell Asher what you see.
30:04I can't see it on the image guidance.
30:10It should point toward your
30:14six o'clock on the y-axis.
30:17You have to feel it.
30:22The tissue plane
30:25along the parenchyma is smooth.
30:29It should feel like gliding.
30:31You've reached the amygdala.
30:45Ready to begin
30:46thermal laser ablation.
30:53Rose's upper GI and labs are normal.
30:55Should we keep her
30:56in the day to observe?
30:57No.
30:58If she's stable,
30:58let's send her home.
30:59Okay.
31:00I'll have Olivia.
31:00Open your mouth.
31:02Pardon me.
31:04Open your mouth.
31:10I can, uh...
31:11Shut your mouth.
31:15There's this rat.
31:16A mouse.
31:17A little dead mouse
31:18in the garage
31:18and the big strong man
31:19is afraid to get it out.
31:20Not afraid.
31:21Disgusted.
31:22Neither of us want to deal with it
31:23so we are settling it
31:24in the only responsible way.
31:26A bat.
31:27A dare.
31:27A series of dares, actually.
31:29Whoever was this out first
31:30has to...
31:30Take those things
31:31out of your mouth.
31:33I will discharge Rose.
31:34You two go home.
31:36We are just being idiots at work
31:37while people are sick
31:39and dying.
31:40Go home.
31:47Fire tests are normal.
31:49We're discharging you.
31:52Right.
31:53Because you're psychic.
31:54I'm an empath,
31:55not a psychic.
31:57Whatever the case,
31:58I would suggest
31:59you take it easy.
32:00No drinking,
32:01no heavy lifting.
32:01You have to let it out, dear.
32:03It was you.
32:05You made my heart rate spike.
32:08You're about to implode.
32:13There's nothing wrong with you.
32:15Or me.
32:16Colored blue.
32:20I don't know.
32:50I don't know.
32:57Yeah.
33:01Dr. Lim, my behavior yesterday was inexcusable and unprofessional.
33:07I let you down. I let the patient down.
33:10I am deeply sorry.
33:13And I promise it will not happen again.
33:16You let your personal judgment get in the way of doing your job.
33:21You're right. That is inexcusable.
33:27You said I had no idea what the patient was going through.
33:32The truth is, I kind of do.
33:34I'm scared, alone, afraid of anyone finding out.
33:42I chose my career over motherhood, over my faith.
33:49But I don't regret it.
33:52And I know God forgave me because I get to be here, living my dream of being a doctor.
34:03But I purposely try not to think about it.
34:12You're off scut duty.
34:21That's not why.
34:22Take it.
34:23My name is Benjamin Allen Harris.
34:34I'm in St. Bonaventure Hospital in San Jose.
34:38Language and memory appear to be intact, and your motor function is normal.
34:43But that doesn't mean it worked, does it?
34:46No.
34:47We'll have to do an fMRI to see how you respond to fear-inducing stimuli.
34:50But we'll let you rest for now.
34:53I'm not going to rest until I know I'm better.
34:58I want you to know how I got these scars.
35:01No, not now.
35:02Just give yourself time.
35:03I was in a convoy, in Condahar.
35:08I was in a husky, big vehicle at the front.
35:11Ben, you don't have to do this.
35:14Ronnie was driving.
35:15He was telling me a story, something about a goat at the base, or maybe it was a chicken.
35:21I don't know, but...
35:23We were laughing.
35:25And the world was on fire.
35:43It's the husky's job.
35:47To spot IEDs.
35:48And I missed one.
36:01I can't see their faces.
36:06Just...
36:07Bodies...
36:09Everywhere.
36:17Dying alone.
36:18Without their families.
36:22All I could do was hold their hand.
36:36Are you okay, Ben?
36:37Are you okay, Ben?
36:48Okay.
36:53Yes.
36:54Oh my God.
36:55Oh my god.
36:56Yes.
36:56Yes.
37:00My God.
37:04I'm okay.
37:06Yes.
37:09Oh my god.
37:10Yes.
37:11Yes.
37:12Fun day.
37:31What do you need?
37:33We have a diagnosis.
37:42I thought I felt someone here.
37:54You've had a long day.
37:59You have Prince Metal's angina rose.
38:02A heart condition, but it's very treatable.
38:04It explains all your symptoms.
38:07And it's exacerbated by stress, which is likely what caused your heart attack.
38:12You need to stop seeking out other people's pain.
38:16It's literally killing you.
38:21You're the chief of surgery.
38:23You could have sent somebody else to tell me this.
38:26Sure.
38:27But then I'd miss my chance to gloat.
38:30You're here because you're hurting.
38:33And you don't know where else to go.
38:34Go ahead.
38:39Use your magic.
38:41Tell me what's wrong with me.
38:44How do I stop feeling like this?
38:48It doesn't work that way.
38:50I don't have a magic wand.
38:51I can only hold up a mirror.
38:56Make you slow down.
38:59Look at the parts of yourself that you've been trying to ignore.
39:03Because you're afraid if you look too closely, you'll break.
39:11Maybe you will.
39:12I don't know.
39:13Maybe breaking is the point.
39:15You can't outrun your pain, Dr. Lim.
39:22If you keep trying, it's going to kill you.
39:24I don't know.
39:50I don't know.
39:53I don't.
39:53Let's go.
40:23Let's go.
40:53Let's go.