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00:00موسيقى
00:30The timing was good. I just got a job transfer. Gretchen will start at a new school. I'm gonna start
00:36a whole new life
00:37It's very exciting. In college my dad majored in cheerleading
00:44That was a joke Gretchen's got a great sense of humor. I'm laughing on the inside
00:49Soon you'll be laughing on the outside too. Dr. Parker
00:54Möbius syndrome is a paralysis of the sixth and seventh pair of cranial nerves. The seventh pair controls facial expression
01:00Luckily in Gretchen's case. We haven't found any limitation to the sixth pair
01:04I'm a lucky girl. We'll be taking two slivers of muscle from your thighs along with their nerves and blood
01:09supply and
01:10Transplanting them into your cheeks. There'll be considerable recovery time before you'll be able to smile at will and maybe
01:15three months
01:18So, what do you say? Are you up for this?
01:21Can I sleep on it?
01:24See what I have to live with? Nobody knows when I'm joking. Sorry, Dr. Andrews. Yes, I am very up
01:30for this
01:31Okay, great. So unless there are any other questions... Do you want to be a comedian?
01:38People getting your jokes must be very important to you if you think it's worth the risk of dying during
01:44elective surgery
02:04I
02:05Apologize for dr. Murphy. He's still learning that silence is the right choice when you have nothing useful to offer
02:12We are required to have an honest risk benefit discussion with our patients
02:18We are giving a lovely young girl a smile. That's a simple equation. Well, it's more than the smile or
02:23the jokes
02:24She can't express any emotions at all. No one can tell if she's happy or sad
02:30or scared
02:32anything
02:33She's never had much of a social life ever since her mother died. She's been completely withdrawn
02:41All I want to do is bring my baby girl back into the world
02:46Don't worry, Mr. Melman. We're gonna take great care of her. All right
02:55Lucy has a post-op infection of unknown origin
02:58Infusing 900 milligrams of clindamycin
03:00It's terrible, isn't it?
03:02Yes, it is. Have you been changing your dressing?
03:05Every day
03:05soaking it in clean warm water. Yes taking your antibiotics one pill three times a day
03:11That's a no
03:14Lucy, I know I gave you a script for antibiotics along with one for pain meds. Why haven't you been
03:18taking your antibiotics?
03:21Did you have a bad reaction to them?
03:24I never filled my prescription
03:27I didn't think it was necessary until it got really bad and then I was two weeks to go myself
03:33And I didn't have anyone to pick it up for me. Okay mystery solved
03:39I'm sorry. I know it was stupid very stupid
03:57Okay
03:58Hey sean
04:01Oh hello
04:02I haven't seen you in ages. What's what's new?
04:06I'm buying an apple. I can see that here. I'll get it for you. No, thank you
04:11Thank you sean
04:13What else is new?
04:15You didn't want to be friends
04:18Yeah, no, I we we we're colleagues you know where whatever we are we can still talk we should talk
04:26I have a new friend Kenny
04:28Here you go
04:29Thank you, Debbie Kenny, huh? That's uh, that's great. Do you have a new friend?
04:37No
04:39Okay, thank you. Thank you
04:42We can talk, you know, we could talk about sports. We can talk about weather. We can talk about Debbie
04:47Why would you want to talk about Debbie? Debbie was flirting with you
04:51She was yes, I noticed her exhibiting two typical signs not the trifecta
04:56No, not the trifecta and one a typical thing she's just trying to be friendly gave you an extra dollar
05:02and change
05:04And the fact that you didn't notice means you like her too
05:10Maybe she's just bad at math
05:20My dad said that you're on the spectrum
05:23That's why you said that about people getting my jokes
05:25People always get my jokes
05:28Then you're very lucky
05:32That was a joke
05:34I see what you did there
05:39They call me resting gretch face
05:46Sean the moron
05:50Not very witty. I'm obviously quite smart. I drew this to their attention
05:59I'm on a spectrum too
06:03Somewhere between inscrutable, unapproachable and
06:08actively scorned
06:10I don't want to be more approachable
06:13And I prefer people not reading my emotions
06:17They're mine
06:19That's what you do with friends
06:29You really think this surgery is too risky?
06:32Possible complications include embolism, hemorrhage, collateral paralysis, asymmetry, brain damage and stroke
06:42It's also expensive and medically unnecessary
06:47Okay, look straight ahead
06:52There's a two hour wait in the ER and what are we doing?
06:55Treating a woman because she willfully ignored doctor's orders
06:58I know what a parasite looks like and it's not Lucy
07:01So this is the mom thing with you
07:03Growing up with a whack mother means that you can identify any and all problem personalities
07:07And that is the sole upside to my miserable childhood
07:10Well, at least you had a mom
07:12Mine died when I was six and dad instantly married a child-hating bitch with a buttload of debt
07:18Morgan, I'm sorry
07:19I didn't tell you to get sympathy
07:20Just that I know parasites too
07:30Got your book first thing tomorrow morning
07:33Dad
07:33What, too soon?
07:36It's
07:36You're nervous
07:38I get it
07:40If you have any more questions, feel free
07:45I've changed my mind
07:49I'm not having the surgery
08:01Murphy
08:07Hello
08:11Gretchen's father is very upset
08:13Seems you talked her out of the surgery
08:15No, I didn't talk her out of it or talk her anywhere
08:19I just gave her the list of potential risks
08:21Embolism, hemorrhage, collateral paralysis, asymmetry, brain damage, and stroke
08:26Stroke?
08:27Yes, there was a case in Brazil in 2004 and the patient suffered
08:33It seems that you don't believe that restoring this girl's smile is that important
08:38Smiles are overvalued
08:40There are studies that support that
08:42And there are studies that don't
08:44When we smile we produce endorphins
08:47They make us happy
08:48They make other people happy
08:49When we see smiles
08:50Our basotemporal lobes are activated and we duplicate what we see
08:54Murphy's smiles are contagious
08:57You see
08:59I feel good
09:00I feel good
09:01You feel good
09:02Everybody likes smiles
09:07I don't
09:08In any case your smile wasn't sincere since it didn't demonstrate the duchenne marker
09:14There was no involvement of the orbicularis oculi muscles around the eyes
09:18Which means you didn't release endorphins
09:21You know if you can talk her out of a surgery she's wanted for years
09:25I'm pretty sure a conversation with someone objective can talk her back into it
09:29Get park come with and keep quiet
09:34Okay
09:39Dr. Kalou
09:41You remember me?
09:44Fish girl
09:45Uh hi
09:46Selez hi
09:47Yeah
09:47Yes
09:48Of course I do
09:50I hope it's okay that I requested you
09:52I'm glad you did
09:54How are you doing?
09:56That's what you're going to tell me
09:59I've been wearing the tilapia skins for five months
10:04Getting really tired of being followed home by stray cats
10:08How's the pain?
10:09Compared to what it was
10:11Nothing
10:14Uh any any fever itchiness or swelling?
10:17Nope
10:18Well looks very good
10:19But
10:22How much longer?
10:24Um
10:26How do you feel about tomorrow?
10:30Seriously?
10:31I never joke about tilapia
10:38What's the matter?
10:40I just wasn't expecting that
10:44I
10:48I'm afraid of how I'm going to look
10:51You're going to look beautiful
10:58Tomorrow
11:00I know Dr. Murphy informed you about the risks of this surgery
11:03And some risks are significant and some just aren't
11:07This is as close to risk-free surgery as we can get
11:11It'll give you a smile
11:13It'll let you laugh
11:14No
11:16Dr. Murphy didn't talk me out of it
11:21He inspired me
11:25He helped me realize that this could actually make me stronger
11:30I don't want to run from it anymore
11:43She's lying
11:45She's a smart sarcastic young woman not exactly someone who's prone to
11:50Inspirational stories
11:50Why was she lying about changing her mind?
11:52Well when I was a cop I had a lot of people change their minds about testifying in court
11:55And it always came down to one of three reasons
11:57Fear
11:58Confusion
11:59Why they were paid off
12:01She doesn't seem confused
12:02And I don't think she's afraid
12:03So Gretchen was paid off?
12:06I admit the analogy isn't perfect
12:09It's close enough
12:19Guess who's back in the ER
12:22You're happy so I'm guessing it's a non-compliant patient
12:26Who misjudged Lucy?
12:28She made an honest mistake forgetting her prescriptions
12:31You called her didn't you?
12:33She didn't spontaneously remember you had to remind her
12:37Is that a mom thing too?
12:39Gretchen
12:41Are you worried that your dad can't afford this surgery?
12:44The insurance company is paying for it
12:47Dad
12:49I know it isn't
12:51It's elective
12:53It's medically unnecessary
12:55No one can put a value on your smile
12:59Not bullies, not an insurance company, not even Dr. Murphy
13:03In my opinion, this surgery is medically necessary
13:13Gretchen, sweetie
13:16My first memory of your mother
13:19Was of her smiling at me from across the room
13:22And because of that smile
13:25We ended up with you
13:28And my last memory of her is that radiance
13:33Lighting up the world one last time
13:39I mean, we never had much money
13:41But as long as I had that smile
13:44It didn't matter
13:52I love you, dad
13:55And that's why I can't let you give up everything for this
14:11Lucy Callard?
14:12I'm here
14:18Lucille Elizabeth Callard?
14:20Yes, that's me
14:21Dr. Brown called me to pick up my prescriptions
14:31You're the victim of identity theft, Lucy
14:33There's an imposter using your name and medical ID to get benefits
14:36Did you have your purse stolen recently?
14:38Six weeks ago
14:40And you had your driver's license and credit cards replaced
14:42But not your health insurance card?
14:45Is this why the pharmacy refuses to fill my prescriptions?
14:49I'm on pain meds for post-herpetic neuralgia
14:52It's getting really bad
14:54Once the imposter filled her prescription for pain meds
14:57The pharmacy must have thought you were overfilling opiates
14:59Oh
15:00It always flares up when I get upset
15:03Don't worry, Lucy
15:04We'll get you your meds
15:12We can't
15:14We're already treating Lucy Callard
15:22Nice game, Tony
15:23Hi, Jim
15:25Marcus
15:25Marcus, hey
15:26You coming or going?
15:27Neither
15:28Fifteen-year-old girl with Mobius syndrome
15:30Your company denied coverage
15:33No respiratory issues
15:35Deformities, pain
15:36She doesn't even drool
15:37She's fully functional
15:38She can't smile
15:40That's a function
15:42Marcus
15:42I think it's wonderful you want to give this little girl her smile
15:45But if we pay for everything wonderful we'll go bankrupt
15:48And then who are we helping?
15:49We all know doctors cheat diagnoses to get coverage
15:52Deviated septum gets you a free nose job migraine
15:55Get you Botox
15:56Do you really want me to play that game?
15:59This isn't a game for me
16:00We're a reputable company with very high standards
16:03Very high bonuses
16:04They get even higher with your denial rate
16:07I was going to suggest we end this before we say something with regret
16:10But I believe that just happened
16:13Gretchen's socially isolated, depressed, and that's only going to get worse
16:16What if she slashes her wrist?
16:18Do you prefer to cover that?
16:19Are you threatening me with a teenage girl suicide?
16:21And god forbid something does happen to her
16:25Because I'll make sure that this conversation is part of the permanent record
16:40Dr. Andrew said smiles are contagious and I'm testing that hypothesis
16:46Well I'm not sure your study will prove anything
16:48It might have something to do with the lack of the Duchenne marker
16:51Oh yes
16:53But here you go
16:58That wasn't a smile
17:00Sure it was
17:04I want to show you something
17:16You need to follow me
17:20Okay
17:22The imposter has poisoned the real Lucy's medical record
17:25We have to go through every medication, every notation, every test to determine who's is whose
17:29Doing that with zero tolerance for errors could take six months
17:32Well the paperwork is our problem not hers
17:34Not if the confusion results in a harmful treatment or incorrect diagnosis
17:38Well we have to do something
17:39This woman is in serious pain
17:41So we treat her
17:42Just be clever about it
17:48Sean
17:49Sean I've already had two iced coffees
17:52Debbie
17:52Hello Debbie
17:53You
17:54Sean have flirted with Dr. Glassman
17:56Oh my god
17:58Because I have a new friend and he needs one too
18:01I'm so sorry
18:02Okay
18:02Look Dr. Glassman
18:03Debbie's facial proportions are close to optimal
18:06Okay
18:060.38 vertical and 0.48 horizontal
18:09I'm so sorry
18:10So you should find her attractive
18:12Thank you
18:12Sean I'm so sorry
18:14And I think you're both Jewish
18:19Tribal commonality is highly conducive to social bonding
18:30Shalom
18:32Bullies can't put a value on your smile nor can Dr. Murphy
18:36But it seems the insurance company can
18:38They've agreed to pay $43,750 about 85% of the entire cost
18:46I can cover the rest of that
18:49I swear
18:51Oh sweetie
18:51Please
18:53Let me do this for you
19:01Okay
19:04Okay
19:10Jane Doe
19:10That's the only way that we can treat you right now
19:12Go home and get some rest
19:14The records department will call you to sort all this out
19:19A year ago I was playing tennis
19:22And then the shingles hit and I was laid up for six weeks
19:25And I've been on pain meds ever since
19:28I lost my job
19:29My husband treats me like I'm an old lady
19:31And my daughter thinks I'm too medicated to be around the new baby
19:38Maybe I'll be better off as Jane Doe
19:48The imposter returns
19:59Lucy? Lucy can you squeeze my fingers?
20:03Lucy?
20:06She's in septic shock
20:07Order a lactate level, blood cultures, and a broad spectrum antibiotic
20:10I'll tell Melinda as we've initiated the sepsis protocol
20:12But we should report her
20:14She's a criminal and a flight risk
20:16And very, very sick
20:17We should put someone outside her door and arrest her when she's stable
20:19We don't report patients we find with drugs or non-violent people with guns
20:24We do report people who steal from us
20:26What would happen if people who needed her help thought they would be arrested?
20:30If they thought they would be arrested for stealing an ID
20:32Maybe they wouldn't steal an ID
20:34I don't remember anything in the Hippocratic Codes
20:35About checking pay or sources before treatment
20:38Mr. Only suggesting there was no health insurance in fourth century B.C. Greece
20:44We have a duty to treat
20:47And we have the right to get paid
20:50But first things first
20:52I really do not want to be sued by either one of these women
20:59Maintain the pretense
21:01And as soon as she's stabilized, we're going to press charges
21:08Dr. Park
21:10A little muscle please
21:11We don't want any excess gathering in the suture line
21:16Thank you
21:18Okay, remove retractors
21:25Ready?
21:33You sure you don't want something for the pain?
21:35No, no I'm good
21:37As long as you keep talking to me
21:40Especially if you share something very painful
21:43Painful?
21:46Okay
21:49Like the time I mistook my biology teacher for my girlfriend and picked her up in the hallway
21:55Yeah, twirled her around three times before I realized my mistake
21:59Act kind of painful
22:01You may have to dig even deeper than that
22:07How about
22:11The time I finally found myself in the perfect situation
22:16You know, work
22:19Friends, future
22:22Something I never really had before
22:26Maybe that's why I screwed it up
22:31You're not responding to the antibiotics like we'd hoped
22:36Lucy
22:38You know, don't you?
22:41When the real Lucy Keller showed up, it kind of gave you room
22:47Is there anyone we can contact?
22:50Do you have any children?
22:52A son
22:54Oh, but he'd be so ashamed of me
22:58Where is he?
22:59College
23:00First one in our family
23:02I had to choose between premiums and tuition
23:08Your son is very lucky to have such a loving mother
23:14I just wish you got your antibiotics when you got your pain meds
23:18I didn't get either medication
23:20Are you sure?
23:23Because the real Lucy was having problems with the pharmacy
23:25I didn't want to risk using the card again
23:29Is she okay?
23:37Maybe it's time to move on
23:40Take the lesson with you
23:42Find new friends
23:43I went to Denver for an interview last week
23:47And?
23:51And we're done
23:55Really?
23:57Take a look
24:00Hey, trust me
24:09See?
24:10Beautiful
24:19The kid, college, it's just a convenient sob story
24:22Why would she lie? She may be dying
24:27Here's what we don't know about fake Lucy
24:29Whether her story is true
24:30Here's what we do know
24:31She's a liar who just found out she's busted
24:34Speaking of lies
24:36That shingles virus that the real Lucy had last year
24:39According to Dr. Spindler at Santa Clara General
24:42She had it the year before too
24:43And according to Dr. Milhouse at SF Muni the year before that
24:48She wasn't denied the payments because of her imposter
24:51She was denied because she is a goring variety addict
24:56Well played, sir
25:07Dr. Park says the surgery went well
25:10It's been too long
25:12What has?
25:13She should be breathing on her own by now
25:16Even after prolonged anesthesia it should only take 60 to 90 minutes
25:26Is she okay?
25:28She should have protective airway reflexes
25:31motor activity and a return of consciousness
25:36I need to pitch Dr. Andrew's staff
25:38Well, what's going on?
25:40Something bad
25:48Gretchen's glucose is within normal limits
25:51And her electrolytes are also normal
25:53And we've ruled out hyper and hypothermia
25:55Doesn't leave much, what about hypoxia?
25:57She maintained normal oxygen as well as entitled CO2 throughout the entire case
26:01And we've given her reversal agents
26:03Which we will repeat
26:06Do you feel bad?
26:10It's okay
26:12You told them it was close to risk-free
26:15They knew there were risks
26:16And I told them to
26:19Get a CT, rule out clots, hematoma, bleeding and stroke
26:36And I told you that
26:37WBC's in lactate arising
26:38O2 satin map are falling
26:40The sepsis protocol isn't working
26:42Multiple organ dysfunction syndrome
26:43Medications
26:44Add another aneurotic
26:46Uh continue crystalloids
26:48Increase her vasopressors
26:49Rotosteroids
26:50Give them all a try
26:50An intubator and insert a swan
26:52And yes, I understand this is out of our own pocket
27:10Um, do anything exciting for Purim?
27:15Purim?
27:15Uh, no
27:16Yeah
27:17You know, the usual
27:18Mm
27:18I ate a little matzah
27:22And celebrated our exodus from slavery
27:26Which I think is passover and not Purim
27:31Truth of the matter is I'm only half jewish
27:34So only half the knowledge?
27:37The truth is I'm not jewish at all
27:42Ah
27:42Yeah
27:43Yeah, my first husband was
27:46So I guess we have our lack of jewishness in common
27:53You know what, Debbie, I think I should get going
27:57Okay
27:58Well, it was nice, uh, finally meeting you officially
28:02Same
28:06Oh, no, look at that
28:10A 1975 300d
28:13One of the most perfect Mercedes ever
28:15Just got a little less perfect
28:17I'd like to differ
28:18If you're looking for perfection
28:19You look no further than the 1967 280 se
28:22Cabriolet or coupe
28:24The coupe
28:24An all-time classic
28:26Well, an owner of a 300sl gullwing
28:29Might argue otherwise
28:31A gullwing
28:32Can I get you another coffee?
28:37Yeah
28:40Iced large black
28:41That's it
28:42I know
29:00That's a little bit unsettling, Murphy
29:09Why are you studying the current of ions during electrolysis?
29:14Uh, it's not the chemical kind of transference
29:17It's the doctor-patient kind
29:20I'm dealing with a personal situation
29:22I don't think the internet is very helpful for solving personal situations
29:27True
29:29But I can't exactly ask Claire for her advice and I barely know Park and Morgan
29:33Morgan would be bad
29:36Very bad
29:40Very bad
29:42I'm a person
29:45Yeah
29:46No, no, yeah, of course, Sean
29:47I'd, uh, I'd love your advice
29:49Okay
29:51Uh, so I think Seles, my burn patient, has feelings for me
29:56And I may have feelings for her too
30:02But there's a good chance her feelings aren't real
30:05And if they are real, then they may not be permanent
30:11You know, it's kind of textbook transference
30:14She's grateful and she's vulnerable
30:19And all I've ever known in my life is unrequited love
30:27From Claire and from my parents
30:34And that makes me vulnerable too
30:46You should call in sick
30:51Leah says calling in sick is all you need to gain superior wisdom and knowledge
30:58She was right
31:10The CT showed no abnormalities and the reversal agents have been repeated without effect
31:16So what else could it be?
31:18A noxic brain injury, a complication of anesthesia
31:25Unfortunately, we believe your daughter is brain dead
31:33What?
31:44All for a smile
31:48I made her think she wasn't good enough the way she was
31:54I should listen to you
31:56Yes
31:57There's just no predicting how individuals will react to anesthesia
32:11Park, you just walked out on that man
32:13The last thing a grieving family member needs is to see their doctor tap out
32:17Maybe she's still under anesthesia
32:22Cessonal choline is one of the anesthetic's Gretchen was administered
32:26Yeah
32:26Now what if she has a plasma cholinesterase deficiency
32:30It'd mean her body couldn't break down that specific drug
32:32Complete deficiency is extremely rare
32:35I've never personally seen it and I don't know anyone who has
32:37Yeah, but if she does have it
32:39She's just gonna wake up
32:45Should I tell her father?
32:46No, not yet
32:48No way we're letting him grieve twice
32:54Your labs are not improving
32:56Your organs are shutting down
32:59You're running out of time
33:03I'd like to stop calling you Lucy
33:23You're welcome Beatrice
33:35What are you doing?
33:38Corneal reflex
33:42It's mediated by the nasociliary branch of the ophthalmic branch
33:54What does it mean?
33:56It means we were wrong
33:59She's gonna be just fine
34:05Thank you doctor
34:07Thank you
34:09Thank you
34:11Thank you Dr. Murphy
34:26I was drawing a bath and I leaned over to turn it off and I dropped the pill bottle
34:30And before I could fish it out
34:32All the pills were ruined
34:33So you need a refill?
34:35My pain has made me so clumsy
34:38Lucy, you're a liar
34:40And a cheat
34:41And an addict
34:45We know about the frequent prescriptions
34:47The multiple doctors
34:48And the ever-recurring shingles
34:53You have a serious medical problem
34:58Let me help you
35:06Three months
35:08Hopefully
35:09But we might be able to give you a pretty good idea of what you're gonna look like
35:13Those things by your ears are neurostimulators
35:16When we activate them
35:18Instant smile
35:19Sound good?
35:23Dr. Murphy
35:36It's your mother's smile
35:38She seemed like a good template
35:43There is no Duchenne marker
35:47Her smile is not real
35:54Thank you
35:59All the other ones are
36:06All the other ones are
36:08I spoke with Jim Ranssler
36:10He made it very clear that we all went big time for this
36:15Don't worry Marcus, I can handle him
36:18I'm very impressed
36:20It was all very
36:22Precedential of you
36:23You really went above and beyond
36:26Yes I did
36:27I thought I was saving her life
36:29Instead I nearly ended it
36:34Celeste
36:35Hi
36:36This is the brilliant Dr. Murphy
36:39He'll be assuming your care from here on
36:42Though I don't expect you'll need much
36:45I understand
36:48I don't think you do
36:50You see doctors aren't allowed to date their patients
36:58What are you doing tomorrow?
37:00I'm calling in sick
37:07I think
37:09You may still have some friends here
37:23I guess there is one upside to all this
37:28If she hadn't bought the stolen insurance card
37:31The real Lucy wouldn't be in rehab right now
37:36I'm surprisingly nice
37:38I thought of what she needed to hear to get out
37:42Trust me I get it
37:43Too soft people take advantage of you
37:46With your badass upbringing no one messes with you
37:50Upside's everywhere
37:52I mean you have way more street cred than say
37:56Someone whose mom's a Johns Hopkins cardiologist
37:59Whose dad's a pathologist and whose parents have been happily married for 37 years
38:07Coming from privilege zero respect
38:11Must be really hard to overcome
38:17I'll call the code
38:18No
38:21There's nothing left to save
38:36Time of death 8 14 p.m
38:50Time of death 8 14 p.m
39:01I think she's being a part of the code
39:02We can make it clear her way
39:02We're gonna show you that we're tough
39:08We're gonna show you that we're tough
39:14Knock us down
42:18ترجمة نانسي قنقر
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