The Good Doctor Season 6 Episode 10
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00:00Previously on The Good Doctor...
00:02Glassman found movement in my psoas and glutes.
00:05He and Murphy found an endoscopic solution.
00:08How about I make you dinner?
00:09Sounds good.
00:10It's a date, then.
00:11A date.
00:12Audrey, will you marry me?
00:16Sean, I'm pregnant.
00:19I hope you told us it isn't safe for me or the baby.
00:23Danny!
00:24No, no, no, no.
00:25Danny!
00:26Danny!
00:30Danny.
00:41Good morning.
00:42Morning.
00:43I'll get the coffee.
00:45This is my third stay in a week.
00:47I no longer require guest-level service.
00:49I want the practice.
00:53Two cups.
00:55No cane.
00:57No guarantee how long it'll take.
00:59Well, when it comes to you, my patience is boundless.
01:03One of the many things I adore about you.
01:11It's been three months.
01:13The man's a saint.
01:16I have been recovering from a major surgery and relearning to walk.
01:20Your recovery is remarkable.
01:22So is your procrastination.
01:24I am taking the time to consider the biggest decision of my life.
01:27Clay's fine.
01:28No, ma'am. No person is fine waiting this long for an answer to that question.
01:35Ever done one of whatever this is before?
01:38No. You?
01:42I've been clean for 92 days, I went to rehab for two months, and I go to meetings every single day.
01:48I don't know if you two can ever trust me again, but I'm willing to do whatever it takes to earn back my place here.
01:57And we'll do everything we can to support you in your recovery.
02:00But our number one obligation is to our patients.
02:03For their safety and yours, we need to put some guardrails in place.
02:08You'll be on probation for six months.
02:10You cannot prescribe or administer any controlled substances.
02:14You will be given random drug tests.
02:16And every step of your patient care will be supervised by the senior resident on your case.
02:21Today that is Dr. Allen.
02:23You okay with those terms, Dr. Perez?
02:28Absolutely.
02:30I'm just happy to be here.
02:32How are you?
02:35Better.
02:37A lot better.
02:41I hadn't heard from you.
02:42Which is totally understandable. I just wasn't sure.
02:46I didn't know what to say.
02:51You're not the reason that ... that happened.
02:58As your supervisor on the case, I will oversee your charting, your patient interactions, double check your med orders.
03:08And ... this.
03:20Fetal movement is good. Heart rate is normal at 150.
03:24I've been monitoring the heart rate daily. It ranges from 146 to 163 ppm.
03:29Our last analysis was three weeks ago.
03:31So the nausea is getting better. Great.
03:33And the fatigue. Less improvement on the constant state of terror.
03:37You made it through the first trimester. You're doing great.
03:41You two want to know the sex of the baby?
03:43Yes.
03:44No. Don't look. It'll be a fun surprise.
03:49It is fun to be prepared.
03:52What's going on?
03:56There is a small thinning area on your uterine wall.
04:00It is slightly hypoechoic.
04:02Likely a result of the scar tissue from your prior surgery and Asherman syndrome.
04:07Is that bad? It sounds bad.
04:11If it progresses, we'll know.
04:15Is that bad? It sounds bad.
04:19If it progresses, your uterus could rupture and we would lose the baby.
04:29But it's very possible the lining will remain stable and your pregnancy will progress normally.
04:38What happens now?
04:41We'll put you on bed rest and monitor you closely.
04:50You're wrong. There may be a surgery that can fix this.
04:56I need to talk to Dr. Lim and Dr. Glassman.
05:10Hello. I have admitted Leah for close monitoring and a follow-up MRI which detected a small amount of free fluid in the abdomen.
05:21This plus a slight decline in the hematocrit increases the likelihood of rupture by three to five percent.
05:27Sean, I'm so sorry. How are you and Leah holding up?
05:31Fine. I found a surgery to fix it.
05:35I have spent the last three months researching every complication of Asherman syndrome.
05:39I discovered an experimental procedure to reinforce the uterine lining with collagen fleece that will expand as the uterus grows.
05:46I have studied the technique and I will teach you how to do it.
05:50How many times has this procedure been done?
05:52Five. Three had good outcomes and the babies were carried to full term.
05:56And the odds are better for Leah because you are above average surgeons.
05:59Sean, I don't need to remind you but this procedure can induce labor and can cause major bleeding.
06:04You could lose the baby.
06:06If we wait and the uterus ruptures, we will definitely lose the baby and Leah could suffer a catastrophic hemorrhage.
06:16Due to the size of the uterine window, there's a good chance it won't.
06:19No. With Leah's prior surgery and the significant scar tissue, I put the likelihood of rupture at close to 65 percent.
06:25Those chances? Not good.
06:33Leah's body. Her call.
06:36Drew Dewitt has recurrent desmoid tumors caused by Gardner syndrome.
06:40The one on his liver is benign but it hasn't responded to chemo.
06:43It's encroaching on the stomach and spleen. It has to come out.
06:46Thus, surgical consults.
06:51He has almost no small intestine.
06:53He needed a major resection a year ago. He's been living off IV nutrition ever since.
06:57I've treated him for post-op infections and pain management over the last year.
07:01I've never seen this much scar tissue in a patient. How many surgeries has he had?
07:0420. Plus 16 rounds of chemo and 34 hospital stays.
07:08Unfortunately, we have to add one more surgery to that list.
07:12Will this surgery affect his place on the transplant list? We've been waiting over a year for a small bowel.
07:17Apparently, I'm too healthy to move to the top.
07:20It shouldn't, barring long-term infection or other organ damage.
07:23When you're ready, we can take you to pre-op.
07:33You got this, D. You know it.
07:37Oh.
07:48I have no idea.
07:50Would you like us to go over the risks and benefits again?
07:54No, I know everything that could go wrong. All I can see is what can go wrong.
07:57You don't have to decide right now. We can continue to monitor.
08:00If we wait, the uterine window could expand and make the surgery more risky.
08:05Now is the safest time.
08:07Don't pressure her, Sean.
08:14Okay, okay. I know I trust you.
08:17So if you think surgery is the right decision, then we should do it.
08:21On one condition.
08:24I want you in the OR.
08:27Not for me, but if something were to go wrong and we lose our baby, I need you to be with her.
08:38Or him.
08:44With my guidance, I think there is a very good chance our baby will be fine.
08:52Hmm.
08:58Forceps and meths.
09:04How does it feel to be in the OR again?
09:07Very good, sir.
09:09We're all very glad to have you back.
09:11We've exposed the surface of the liver.
09:14Tumors invaded the liver capsule and parenchyma.
09:19That's twice the size it appeared on imaging.
09:22If we take out all of the tumor, you'll only have half a liver left.
09:26I don't have a choice. Ultrasonic dissector for resection.
09:42Make sure to approximate the edges so it overlaps with the uterine window.
09:47I internalized that the first three times you told me, Sean.
09:51I'm sorry you and Leah are going through this.
09:54Dr. Lim was able to place the fleece patch seven seconds faster, but your laparoscopic suturing technique is superior.
10:01You will be in charge of that. Practice it now. Please?
10:05Sean, I've done it a million times.
10:07You have never done them on my wife.
10:11Fair point.
10:17Because we had to take more of your liver than we'd hoped, your liver function is declining.
10:24Getting your nutrition through an IV is tough on your body.
10:27The TPN that's keeping me alive is also killing me.
10:32It's gnarly.
10:34So what's the alternative to TPN? How do we get him nutrients?
10:37We're looking into it. For now, we're going to manage your symptoms and keep you stable until a small bowel becomes available.
10:43There's no way those organ cops can say I'm too healthy now.
10:52I'll order cholesterolamine for the itching and liver function testing every few hours.
10:56I'll call Unos and do whatever I have to to get him moved up the list.
11:04Where are you sneaking off to?
11:06I'm walking down the hall. In plain sight.
11:09The alarms, the pills, the classic Morgan Evasion techniques.
11:14You're getting your embryos implanted, aren't you?
11:18Congrats on cracking that already wide open case.
11:21I have to give myself a time-sensitive injection now, then yell at some nice transplant people.
11:25Why didn't you tell me? I could help.
11:27I'll refer you to the minutes of our previous meeting.
11:31We need boundaries.
11:40I remember you put on my hospital socks for me last time, too.
11:45I hate that we have a routine.
11:48This time is different.
11:53Hi.
11:54I love you.
11:55How are you? Do you need anything?
11:58No.
11:59There's funfetti cake and beads for Nurse Hawk's birthday. Do you want me to get you these?
12:03Just this is great.
12:05Please leave.
12:06Having visitors increases the risk of perioperative infection and stimulation can raise blood pressure,
12:11which increases the risk of intraoperative complications.
12:21I need to do your pre-op exam.
12:29He just doubled over.
12:31My gut is drinking me.
12:33Please, can you give him something?
12:36I'll up his morphine and check the cipher infection.
12:39Hang on. You're going to be okay.
12:43Dr. Allen, his wound is...
12:45What does that mean?
12:47His muscles couldn't hold the stitches it tore open.
12:59Move the patch three millimeters to your right.
13:01It should overlap with the wound margin.
13:03Got it.
13:04Yes, there. That is good.
13:06Dr. Wolfe, take the scalp, please. Sutures.
13:085-O-proline sutures in the myometrium defect need to be placed exactly one millimeter apart.
13:13Dr. Murphy, take one more step. I'm going to have to ask you to leave.
13:17Applying the glue.
13:19No, no, that's too far. The view is obscured.
13:23Sean, a little to your left.
13:28She's bleeding.
13:30No signs of rupture.
13:31You may have placed the sutures too deep because you didn't have a clear view.
13:35The sutures are fine.
13:36I should take over.
13:38Sean.
13:39There, a small bleed underneath the patch.
13:41Must have nicked a vessel.
13:43I'll clip it.
13:46Suction.
13:51Okay, we can continue to close.
13:53Yes, Leah and the baby are fine.
13:56In spite of the avoidable errors.
14:03His abdominal wall is too weak and damaged for prior surgery, so hold the sutures.
14:07We covered the wound with plastic, but we need to take him back to the O.R. and close him up before he gets infected.
14:11The tissue will just tear open again. His skin and muscles need time and nutrition to heal.
14:15I have a small bowel for Drew.
14:21Drew's wound dehisced. We can't take that organ.
14:27I'm not turning it down.
14:29This is Drew's only chance.
14:34Tell Eunos we need to run some more tests.
14:36Buy us a few hours.
14:37That's how long we have to figure out how to stitch his kid back together.
14:53What about component separation?
14:55That could weaken the tissue even more.
14:57Right.
14:58Maybe a four-step Fabian procedure.
15:01Except Drew doesn't have time for four steps.
15:21Hi.
15:23I'm here to check Leah's post-op vitals.
15:26I also brought supplements.
15:31All right, your post-op ultrasound looks good.
15:34Fetal movement and heart tones are great.
15:38Oh, thank God.
15:40When can I go home?
15:42You need to be here for monitoring for several more days.
15:48I can't go days like this, Sean.
15:51I hate it here.
15:52You are here for work every day.
15:55Not in this room.
15:57In this bed.
15:59Thinking about everything.
16:03Jerome and I can visit on our lunch break.
16:06Oh, we could take the What Yankee Candle Aren't You quiz.
16:09It's on page 17.
16:11Rest will help you recover faster so you don't have to be here anymore.
16:16Her ultrasound does look good. Thank you. You can go.
16:37Juno's called again.
16:38I told him we have to rerun Drew's liver function test and get a CT scan.
16:41I bought us an hour at most.
16:43What about a circlosure device?
16:45Too high a risk for ventral hernia, which could lead us to needing to resect his large intestine, leaving him even worse off.
16:50I already played it out.
16:55And for your embryo thing, whenever that is, I can give you a ride if you need one.
17:02I'll get an Uber.
17:04You really want to go to the most important appointment of your life with a stranger in a Camry?
17:08I've chosen to do this alone.
17:11I'm fine with it.
17:13And I'm trying very hard not to care about what anyone else thinks about that.
17:19So having you imply how sad it is that I have to take a cab to a doctor's office is not helpful.
17:38He threw up and his pain is getting worse.
17:40He's already maxed out on morphine. I'm overriding.
17:42There's increased redness and swelling on the edges, early signs of infection.
17:45I love you, Mom.
17:46You're going to be fine.
17:47It's okay. We can get here someday.
17:51I'm ready.
17:54No.
17:56I am not giving up on you.
17:58Don't give up on me, Dean.
18:01Please.
18:02I'm sorry.
18:11I will take those.
18:17They're from all the nurses.
18:19We just want you both to know that we're thinking about you.
18:22I will pass that along.
18:24But not these.
18:26AP's breath has a strikingly unpleasant odor.
18:32Is there anything you need?
18:35We're fine.
18:38502's family is on their way in.
18:41Heads up, they are a loud bunch.
18:42They're very excited to be taking Meemaw home.
18:52I don't think Leah's fine.
18:54She's lonely and bored.
18:57And being back in that room is bringing up a lot of painful memories.
19:02And I know you're just, you're trying to protect her, but...
19:07But it's making you kind of a pain in the ass.
19:10Your wife, who's carrying the tiny human,
19:14she needs her loud bunch.
19:16People asking how she is doing and being worried will only make Leah worry more.
19:22That is not helpful.
19:23Not for you.
19:25But I think Leah needs more than just you right now.
19:29She needs lots of people showing concern and love.
19:34And maybe you do too.
19:37More than you think.
19:53Question for you.
19:55Does it bother you that this has been sitting here for three months?
20:00No.
20:02Does it bother you?
20:03No.
20:06I'm feeling a little pressured.
20:10I barely brought it up.
20:11And I appreciate that.
20:14But sitting here is kind of pressure.
20:19It was meant to be a cute gesture.
20:21A subtle, not so subtle,
20:24reminder that the offer is still at the table.
20:29Which has clearly overstayed its welcome.
20:31And the last thing I want is for it to come between us.
20:38Are you un-proposing?
20:40No, I'm un-pressuring.
20:45I love you.
20:47And I'm not going anywhere.
20:49When you're ready, we'll put it back on the table.
20:55What about a Velcro biocompatible patch?
20:57It would facilitate his granulation tissue growth.
21:00How do we keep it from adhering to other organs?
21:03Yeah.
21:11This should be turmeric chicken with asparagus.
21:16That's what I was going to make you for our date.
21:19And after work, all I had to do was go to the store and get some chicken.
21:26But instead, I texted my dealer.
21:31For a thousand reasons, none of which excuse nor explain anything.
21:38You don't owe me an explanation.
21:40I do.
21:43And I wish I could give you one.
21:44Every day for the past 92 days, I've asked myself,
21:48why didn't I just go get the chicken?
21:51I mean, we would have had a great dinner.
21:53I mean, you would have been funny and beautiful.
21:58And I would have tried way too hard to be charming.
22:03And then...
22:06Who knows?
22:08Who knows?
22:13I'd give anything to go back.
22:16Start over.
22:19Give us a clean slate.
22:24Me too.
22:26What if we did that for Drew?
22:29What if along with a new bowel, we gave him a whole new abdominal wall?
22:34Clean slate.
22:36Has it ever been done before?
22:39Not exactly.
22:56I'm going to look down and see someone else's abs.
23:00Replacing it is the only way to get you a new small bowel.
23:03You'll be able to eat again. You'll get stronger.
23:07What are the chances it'll work?
23:09It's never been done in tandem with another transplant.
23:12There are increased risks of rejection or infection,
23:15but both organs are in great shape and a good match.
23:18It's our best shot to save your liver and give your body time to heal.
23:23Thank you so much.
23:32Okay.
23:34Let's do this.
23:53If we don't keep quiet,
23:55Shawn is going to come down on us with the hammer of Thor, okay?
23:59So nice to laugh.
24:01Into Shawn with the chest plate and a red cape with a millionaire.
24:07I don't want to get kicked out before I know.
24:10Boy or girl.
24:11I have to start scoping out the latest baby fashions.
24:14I don't know.
24:18I don't want to know.
24:20Don't want to know.
24:26Last time when we found out we were having a girl,
24:29Shawn and I were choosing her name.
24:32I liked Sage and Skylar and Sophia.
24:36Something with an S after my grandma Susie.
24:41And then she was gone.
24:46And I can't do that again.
24:51Maybe you should tell Shawn about this.
24:54He's already so worried.
24:56No matter what he says.
24:59And what if talking about it...
25:06I have something for you.
25:11My faith.
25:13Not just in God.
25:15I have faith in the surgery you had.
25:18I have faith in you and Shawn.
25:23And that your baby, whatever it is,
25:27is going to be okay.
25:35Your ten minute visit has run over.
25:40I have to scrub in anyways.
25:43Pencil me in for the next ten minute opening, Thor.
25:49Thank you. I needed that.
25:58But not that. I kind of feel nauseous.
26:04We should do another ultrasound.
26:13No.
26:26The surgery could buy you a year, maybe more.
26:30Give you back some quality of life.
26:33But...
26:35it should be what you want.
26:43You're 17.
26:45And you've suffered more than some people their whole lives.
26:49No one would fault you for deciding you're done.
26:56I can't.
26:59Your mom has given you all the support in the world.
27:02But this is your fight.
27:05Do you want to keep going?
27:08The worst part about all of this is knowing
27:11one day it'll end.
27:14My mom will be alone.
27:17She's been with me through all the hardest parts of my life.
27:21And I won't be around when she has to go through the hardest part of hers.
27:25If I can put that off,
27:28if even for a little bit, then I'm going to be okay.
27:32I'm going to be okay.
27:36If even for a little bit, then I'm going to do that
27:40and hope that makes the day she'll face alone
27:44a little easier.
27:58You're all set.
28:00I'll take you to surgery soon.
28:05Okay.
28:36I love you.
28:41And whatever happens,
28:44you don't need to worry about me.
28:49I'll be okay.
29:05I love you too, Mom.
29:36She was feeling nauseous, so I did an ultrasound
29:39which detected increased fluid in the abdomen.
29:41But then she lost consciousness.
29:43It is almost certainly internal bleeding.
29:45I'll scrub in right away.
29:47No, no, you can't come in.
29:49This is likely a complication from the first surgery.
29:51It is my fault, and I need to fix it.
29:53Dawn, if we can't stop the bleeding,
29:55we may have to take Leah's uterus in order to save her life.
29:58If we get there, we're going to make the decision quickly
30:01and with medical factors only.
30:03No emotion.
30:05Leah would want me in there in case we lose the baby.
30:09If that happens, if that happens,
30:11I will come back and get you, I promise.
30:23The surgical site looks good.
30:25Hatch is intact.
30:27No signs of acute placental abruption.
30:29Bladder's clean.
30:31And the ovary's all the fallopian tubes.
30:33And the bowel is intact.
30:35It's got to be coming from the uterus.
30:37If we clamp the uterine vessels, we may slow down the bleeding.
30:40But we put the baby at risk.
30:42We don't stop at seeing if we're going to put Leah at risk.
30:47I'll clamp the internal iliac on the side of the bleed.
30:49Buys us some time.
30:51Give two more units of blood and stay four ahead.
30:53Get your actor.
30:55If the site is hemostatic,
30:58they will look for placental abruption.
31:03Next, they will check
31:06the bladder, ovaries,
31:09and fallopian tubes.
31:12Sean.
31:20They can't clamp the uterine vessels
31:23without hurting the baby.
31:26But they can place an atraumatic vascular clamp
31:29on the internal iliacs, which will
31:32slow down the bleed while they try to locate it.
31:42Once they stop the bleed,
31:47they should be able to repair it
31:50and be done by
31:54526.
32:11The surgery went really well.
32:13You should be able to start eating real food again in a few days.
32:15Better make sure my new six-pack is looking good.
32:19The abdominal wall is holding together.
32:22No signs of infection.
32:25We'll see how long that lasts.
32:27One step at a time, D.
32:31We'll let you get some rest.
32:35No alcohol in that new gut of yours.
32:39Not for four more years.
32:42One step at a time.
32:49Hey, I don't want to help because I feel bad for you.
32:53I feel bad for me.
32:58You're gonna be an amazing mom because
33:00you're amazing at whatever you put your mind to.
33:03And I'm a little conflicted, I guess,
33:05because I won't be a part of it.
33:08Making my single mother IVF journey about you
33:11is uncharacteristically self-absorbed.
33:14I'm impressed.
33:17You changed me.
33:21Doing things alone isn't sad.
33:25Still doesn't mean you have to do them that way.
33:28Come on.
33:44From here on, I'm gonna request not to be supervised by you.
33:49Why?
33:53I didn't know D because of you.
33:55Or us.
33:57But I knew I couldn't be with you if I wasn't okay.
34:00So...
34:02I convinced myself I was.
34:05Jordan, if I let myself get close to you,
34:08I will fall for you.
34:10Again.
34:11And...
34:13And I will want so badly to be okay.
34:17To be ready for us.
34:22I can't risk that.
34:28I wouldn't want you to.
34:34I can't believe how much I'm gonna miss somebody.
34:37I'll still see you every day.
34:42Lee is in emergency surgery.
34:50Two more units, right on.
34:52Moving the packing over the uterus.
34:57Fetal heart rate 101.
34:59Intermittent decells.
35:01No injury to the vena cava.
35:03Where's all this coming from?
35:05Heartline BP 75 over 43.
35:08And falling.
35:28Heartline BP 75 over 43.
35:30Heartline BP 75 over 43.
35:32Heartline BP 75 over 43.
35:34Heartline BP 75 over 43.
35:36Heartline BP 75 over 43.
35:38Heartline BP 75 over 43.
35:40Heartline BP 75 over 43.
35:42Heartline BP 75 over 43.
35:44Heartline BP 75 over 43.
35:46Heartline BP 75 over 43.
35:48Heartline BP 75 over 43.
35:50Heartline BP 75 over 43.
35:52Heartline BP 75 over 43.
35:54Heartline BP 75 over 43.
35:56Rain clouds stuck in the middle.
36:02Waiting for the breeze.
36:18Lee's BP 67 over 35.
36:21She's bleeding out.
36:27Hysterectomy tray.
36:29Clem?
36:35After you ligate uterine vessels,
36:37I'm gonna go get Sean.
36:40Tell him I would.
36:46Clamping the uterine horn.
36:48Ligated the round ligament.
36:50Preparing to transect.
36:52Met scissors.
36:56Audrey?
37:18Leigha?
37:39Leigha and the baby are gonna be just fine.
37:43Leigha's left uterine artery
37:45was tethered to some scar tissue.
37:48As the uterus grew, it ruptured.
37:50That was inevitable.
37:52It had nothing to do with your first surgery.
37:55Okay.
37:58Had Leigha not been in the hospital
38:00when this happened,
38:02she might not have survived, Sean.
38:05Your surgery saved both their lives.
38:08Okay.
38:11Okay.
38:28Thank you, Dr. Glassman.
38:30I got you.
38:36Okay.
38:40Okay.
39:07Okay.
39:10Okay.
39:16Good morning.
39:18Can I get the to-go?
39:20I gotta stop at my place and grab a shirt for work.
39:22I'm sure you have a minute.
39:24Stay.
39:26Am I about to be punished for something?
39:28No.
39:33I was just thinking.
39:37I love you.
39:39I love you, too.
39:40And I love us.
39:41Same. Always good to hear.
39:43And I've decided I want us to move forward.
39:47At my own learning-to-walk kind of pace.
39:56Play a quarter.
40:02Will you move in with me?
40:04I would kneel, but I'm not sure
40:06I could gracefully get back up again.
40:10It's so sparkly.
40:12Love it.
40:17Audrey Lim.
40:21You've made me the happiest man alive.
40:40This is a one-time thing.
40:42Don't expect me to drive you to your next colonoscopy.
40:45And here I was looking forward to that.
40:47Take my clock down to Williams Street.
40:49The freeway's backed up this time of day.
40:51All right. Just don't forget the tip.
41:10The fleece patch is holding well
41:12and expanding with the uterus.
41:14Everything looks great.
41:16Your baby is very cute and squirmy.
41:19So, you want to know what it is?
41:30You already know, don't you?
41:34I have been looking at your uterus a lot.
41:39But I can keep a secret.
41:51The light blue is very...
41:53Heteronormative.
41:55I was going to say pastel.
41:58But yes, that too.
42:00I think he's going to like something in the grey palette.
42:03Calming, but warm.
42:05Elegant, yet understated.
42:10I think our son would like that very much.