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الطبيب الجيد 1 - Episode 12
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00:01Previously on The Good Doctor
00:02You need to take a break
00:04Clear your head
00:05You need a vacation
00:08I'm gonna quit my job
00:09I'm not looking forward to moving
00:12to Hershey, Pennsylvania
00:14I don't want kids
00:16Ever
00:21I've just been fired
00:22for physically assaulting an employee
00:25Go ahead, drop us an F
00:28When will they wake up?
00:30They should have already
00:50We were worried about you, Jenny
00:51I'm so glad you're back
00:54I am gonna give you three words
00:56Try to remember them
00:57Apple
00:58Ball
00:58House
01:00Can you count back from 100 by 7 for me?
01:04I'm going to Harvard, you know
01:0893
01:1086
01:1179
01:1372
01:1465
01:16And what city you were in?
01:18San Jose
01:19And what were those three words?
01:21Apple
01:22Ball
01:23House
01:25Look out, Harvard
01:26We'll be doing a lot more tests to know for sure
01:29But your heart does sound better
01:32Ask Katie
01:35You woke up before her
01:36So, too soon to tell
01:39There's virtually no alpha or beta brain activity
01:41You must have missed something during the separation surgery
01:44We didn't
01:45Katie's BP was steady
01:46Sats were fine
01:47Regional blood supplies were reconstructed
01:49Just like Jenny, yet she's awake
01:51Katie's in a coma
01:52Katie's got the new sagittal graft
01:54A problem with blood flow in that vein could cause a condition
01:57An MR angiogram should tell us if the graft is open or not
01:59Hello
02:02I will proceed with the angiogram
02:04Whoa
02:05Murphy, you've been gone for two days
02:07How about we start there?
02:09Okay
02:09Just because you talk to the president doesn't qualify his permission
02:13Okay
02:14Yes
02:15I will notify Dr. Melendez next time I go on a road trip with my girlfriend
02:22Amazing
02:23Road trip?
02:25Dr. Glassman said you were dealing with a personal crisis
02:28That is true
02:31Do you know the definition of personal crisis?
02:33Yes
02:34A stage and a sequence of events at which the trend of all future events is determined
02:40A death, an illness
02:42Yes
02:42No, not a road trip
02:45Okay
02:48You and Dr. Brown get going on Katie's angiogram
02:51Unless of course you have any personal emergencies to attend to
02:54No, my crisis is over
03:00Come in
03:03Hey
03:06How are the twins doing?
03:08Jenny's in recovery
03:09Her numbers look good
03:10She's talking
03:11Katie not so good
03:13We need to talk about Murphy
03:15I told you he's on personal leave
03:17Yeah, well, that's not what he said
03:20You talked to him?
03:22Yes
03:23In the surgical unit
03:24Five minutes ago
03:28There's the sagittal vein graft we constructed for Katie
03:31It's open with good flow
03:34The graft is fine
03:36Which means we still have no explanation for our coma
03:40Going closer?
03:45In the middle cerebral vein
03:47It has low flow out of the brain
03:49You're thinking low flow out means low flow in?
03:52Yes, that is what I'm thinking
03:54We should look at the arterial inflow phase
03:59We'd like to look at the arterial inflow phase
04:02Please
04:05So what you do on your trip?
04:09Well, sometimes when we take a road trip
04:13We're running away from something
04:14I kissed Leah
04:18And Dr. Glassman is mad at me
04:21What is he mad at you about?
04:25It's almost entirely blocked
04:27And there's a malformation in the circle of Willis
04:31Katie is barely getting any blood to her brain
04:35Excuse me
04:36Sean, may I speak with you, please?
04:39Dr. Melendez, he was not angry
04:41Oh, no, Sean
04:42Dr. Melendez is angry with you
04:45He's also angry with me
04:47Why?
04:48Why?
04:49Because I lied to him for you
04:52Why did you run away?
04:54I didn't run away
04:56When you leave without notifying your attending
04:58When you drop all of your responsibilities at this hospital
05:02When you leave without telling anyone, including me
05:05Then you are running away
05:09Did this trip with this girl help?
05:13Yes
05:13Yes, it did
05:15Okay
05:17How?
05:20I would like to give two weeks' notice
05:35Mom, can you ask him to bring me some more ice chips?
05:39I'll get them, sweetie
05:41I'll get them, sweetie
05:42I'll get them, sweetie
06:22I'll get a doctor
06:23Mr. No, I'm just ...When you left, there was no one here
06:31I've just ...when you left, there was no one here
06:33I'll get a doctor
06:34No, I'll get a doctor
06:36No, I'll get a doctor
06:38It felt... cold.
06:43Well, sometimes it is cold.
06:47But you know what?
06:49Someday, you might find that you like it.
06:57Wrongful termination.
06:58Dr. Kalou assaulted an attending surgeon.
07:01I don't think you have strong legal footing here.
07:03There's more to the story.
07:09And I am sympathetic to Dr. Kalou,
07:12but his ends don't justify his means.
07:14Obviously, we can't tolerate staff members.
07:16And yet, you do. Please, read on.
07:28The middle cerebral has narrowed. It's less than two millimeters.
07:31You bypass the artery here and restore blood flow.
07:34Well, open her back up. She's just been through a massive operation.
07:38The brain tissue hasn't settled.
07:40Another could very well stroke Katie out.
07:42Other options.
07:47I don't see how an intravascular ultrasound gives us a better picture.
07:50I'm not imaging. He wants a stent in the middle cerebral artery in the angiolab. I like it.
07:55Stenting is usually reserved for the heart and the carotid.
07:58It's not the usual, but we are way past the usual.
08:00What would lower the danger of a stroke?
08:05Dr. Murphy, would you like to assist?
08:08Yes.
08:11Dr. Melendez, would you like to write me a letter of recommendation?
08:18You see the narrowing there?
08:20And the horizontal segment of the middle cerebral artery?
08:24Oh, yeah. I've heard about you.
08:27You're the one making the old guard nervous.
08:32Why would I make people nervous?
08:37Because you have a gift.
08:39And surgeons judge themselves against their peers, and right now, you're winning.
08:46We're in position.
08:47Dr. Murphy, please inflate the balloon.
08:54Give us another squirt of contrast, and we should have good blood flow.
09:02Yes, the proximal end of the artery is dissecting.
09:05The balloon is damaging her artery.
09:07Wave form is worsening.
09:08The stent won't hold.
09:10She's going to stroke.
09:11I'm aborting.
09:12Okay.
09:21Wave form is normalizing.
09:23We're right back where we started.
09:26Katie's brain is starving.
09:31I want to see Katie.
09:34I know she's in a coma.
09:35I still need to see her.
09:37I miss her.
09:39We can't risk contamination for either of you.
09:41She needs to know I'm there.
09:43We understand.
09:44You can't understand.
09:46No one can.
09:47We have always been there for each other,
09:50and now when she needs me most, I'm not there.
09:52You've just been through a 40-hour surgery.
09:55We need you to focus on your own healing.
09:57And what about her heart?
09:59We're going to do a cardiac catheterization test
10:01to see if her heart circulation has improved.
10:05Inject the contrast to evaluate the heart's blood supply.
10:09How's my soul looking?
10:12That's a different specialty.
10:16Katie says the eyes are the window to the soul.
10:19I say the eyes lie.
10:21It's the heart.
10:22Well, then, so far, your soul is looking good.
10:25Strong, unobstructed blood flow.
10:27The triculogram will tell us
10:28how the muscle function is doing.
10:41It's so quiet.
10:43Is everything okay?
10:46Ventricle's strained and dilated.
10:47We're hoping for some improvement post-separation,
10:50but it's barely pumping.
10:51It just doesn't make any sense.
10:53The separation was supposed to relieve the stress
10:55on Jenny's heart.
10:57Half the need, half the work.
10:58Jenny's heart is even sicker than it appeared.
11:01Seems we couldn't see that
11:02because Katie's heart was doing all the work for Jenny's.
11:04What can we do to fix it?
11:06Give her a new heart.
11:07I'm not going to find a donor match in time.
11:08Yes, we already have the perfect heart for Jenny.
11:12The sisters are monozygotic
11:14and therefore a genetic match.
11:17On the other hand, Katie is alive.
11:19She is GCS3.
11:20Her heart is still beating.
11:21Yes, but she is unresponsive.
11:23And I don't see a way to return blood flow to the brain.
11:26And in all likelihood, Katie's not coming back.
11:29Yes, Katie very well may die,
11:30but we can't predict when that'll be.
11:32It could be today.
11:33It could be 20 years from now.
11:34If Katie stays on the ventilator.
11:35That's not up to us.
11:37I know.
11:38But I also know that based on these scans,
11:40Jenny might not make it through the night.
11:44We need to propose this to the mother.
11:55There's no chance Katie will wake up.
12:02We can't say with 100% certainty,
12:04but from what we saw on Katie's brain scan,
12:09we have little reason for hope.
12:11But what we can say with certainty
12:13is that without Katie's heart,
12:15Jenny will die.
12:18Can we wait?
12:21Just a little?
12:22Maybe you'll know more.
12:22Maybe something will change.
12:24If we don't do anything,
12:25Jenny's heart will stop before the morning.
12:31How do you...
12:37Would it be painful?
12:40No.
12:41We simply power down Katie's ventilator.
12:44Once off-life support,
12:45she will peacefully pass.
13:03Do you want us to explain this to Jenny?
13:05I'm sure she'll want to be present.
13:07No.
13:10I put trust in them from an early age.
13:14Thinking responsibility would build strength.
13:18I think it worked.
13:22But this...
13:23No.
13:26Jenny can't be part of this in any way.
13:28It'd destroy her.
13:34I'll tell her Katie died.
13:43Dr. Sean Murphy
13:45exhibits technical skills beyond his years.
13:48You wrote that.
13:49Yes.
13:50That's why he's saying my name at the bottom.
13:54You think Sean survives at another hospital?
13:57I didn't think he'd survive here.
14:00Without your endorsement,
14:02Sean isn't going anywhere.
14:05I may have my issues with him.
14:07But no matter how stupid an idea this may be,
14:10I'm not going to stop him from going after what he wants.
14:14There's another signature line next to mine.
14:17It's where the president of the hospital has to sign.
14:18I've got a job.
14:18I'm not going to stop him.
14:23I'm not going to stop him.
14:24I'm not going to stop him.
14:25I'm not going to stop him.
14:25I'm not going to stop him.
14:25The chief oncologist.
14:27This is before I came here.
14:28December at 14.
14:30Dr. Marshall shoved a scrub nurse during a post-op discussion of some sort.
14:34Do you remember that?
14:36I do.
14:36Your response was to settle with a nurse
14:38while Dr. Marshall was let off with a warning.
14:41There's another almost identical instance earlier in that year.
14:46In both cases, doctors in question were white.
14:49They were censured.
14:51Dr. Klee was fired.
14:53You think this was a racial matter?
14:56Do you think I'm racist?
14:59That I favor white people?
15:02Then why the leniency then and not now?
15:08They're stars that happen to be white.
15:12Doctors like Marshall allow St. Bonaventure to compete with other West Coast institutions.
15:18So that's our defense.
15:20We're not racist.
15:21We just allow our doctors to assault people as long as they bring in enough donors.
15:25They were reprimanded.
15:26And there were no further incidents.
15:28And how do you think all of this is going to play out in court?
15:35Settle.
15:40Okay.
15:45Hi.
15:49Floor?
15:50Floor.
15:55Sean asked Dr. Melendez for a letter of recommendation.
15:59Yeah.
16:01Well, I have to do a sign it and off he goes.
16:07I think he might think that you're mad at him.
16:20If you don't sign, it reinforces what he thinks.
16:24But if you do, it lets him know that you believe in him.
16:42Can I touch her?
16:44Of course.
16:58Goodbye, baby.
17:10Are you ready?
17:12Yes.
17:14Thanks.
17:24Thanks.
17:26Thanks.
17:27Thanks.
17:31Thanks.
17:31Thanks.
17:33Thanks.
17:38Thanks.
17:40Thanks.
17:42Thanks.
17:42Thanks.
17:47She's stabilizing
17:51I don't understand
17:53What's going on?
17:58Katie's not ready to go
18:05She's breathing on her own
18:06Which means Katie has normal brainstem function, correct?
18:09When a ventilator is removed, life can continue
18:12It's rare
18:12But it could happen
18:13It doesn't change the prognosis for awakening
18:15Off the ventilator with normal vitals
18:17Suggests long-term vegetative state, right?
18:20Yeah
18:22We just lost our remedy for Jenny's heart
18:25What about ECMO?
18:27Use the machine as a replacement for Jenny's heart
18:29Buys us two weeks of life
18:31I don't like it
18:33ECMO requires blood thinners
18:34She just had brain surgery
18:36It would cause a catastrophic bleed
18:38ECMO and its complications may be our only avenue
18:41We can join them
18:43You want to put their heads back together?
18:47Not the heads
18:49The thighs
18:50The femoral vessels
18:53Is it a funny idea?
18:55I think it's funny that I didn't think of it
18:57The girl's blood is identical
18:58No need for anti-clotting meds
19:00So no possibility of a bleed
19:02As long as they're attached, Katie's heart will beat for Jenny
19:05When Katie dies, we sever the femoral connection
19:07And transplant Katie's heart into Jenny
19:12We just spent 40 hours separating them
19:16And now we want to put them back together
19:19You tried to kill Katie?
19:22No
19:23You took her off life support
19:25What do you call that?
19:28Mercy
19:29Not just for her
19:30You need a heart
19:32Or you're going to die
19:36Katie's alive
19:40She was then
19:41And she's even more now
19:43Katie's alive in the sense that she has basic organ function
19:47But she has no higher cognitive brain activity
19:50She's surviving
19:52But she is not living
19:56Hours ago
19:58You thought she'd die
20:00As soon as you pulled the plug
20:06You were wrong
20:07How do I know you're not wrong?
20:10This time too
20:14The demand on Katie's heart is minimal in her resting state
20:18She can easily tolerate helping you
20:24I won't ask Katie
20:26To be my life support machine
20:54Dr. Andrews
20:59Let's put the sisters in the same room overnight
21:02I don't think that Jenny sees herself as an individual yet
21:06You know, I'm thinking the only thing that'll change Jenny's mind about the reattachment is Katie
21:11Being close might help Jenny to see her as lifeless
21:15Could backfire
21:17And cement her feelings that she's killing her sister
21:20Yeah, possibly
21:23And then we're in the same position anyways
21:28Okay, do it
21:29Okay
21:36Well, what about baseballs?
21:37Bet this girl caught at a Giants game signed by Mr. Hunter Pence
21:40He didn't hit it, but that doesn't matter
21:45So where is the sporting goods one?
21:47There
21:48Oh, no, that is not going sporting goods
21:52It doesn't?
21:58I'm applying to move my residency to Hershey, Pennsylvania
22:02Really?
22:03Yes, Penn State Medical Center
22:08Are you following me?
22:15I need to make sure you're not just doing this to stay close to me
22:19No
22:21Sean
22:23I want my own life
22:25I want a life that I control, not Dr. Glassman
22:28Dr. Glassman is just trying to help you
22:30I don't want help
22:34But what if we need help?
22:41How will I know if I stay?
22:47And too much stuff
22:48You have too much stuff
22:57You have too much stuff
23:01Maybe some more warm
23:08Wow, you are so slow
23:12You're only folding underwear
23:13Underwear is easy
23:16No, Neil, I don't want him
23:25Fine
23:26Let's go, Preston
23:28I'm ready
23:30Go
23:34Go
23:51You're the only good thing about my day
23:57Let's go
23:57I'm ready
23:58No
23:58Go
23:58Go
24:05Okay
24:13Go
24:14Go
24:14Go
24:14Go
24:14Go
24:20Amén.
24:48Amén.
24:49No podía dormir la noche la noche.
24:53No podía incluso cerrar mis ojos hasta...
25:00...puedo sentir el corazón de la cabeza en mi mano.
25:10Si hago esto...
25:13...a algún momento...
25:15...Cati su corazón irá para mí, ¿verdad?
25:21Es el plan.
25:31Entonces, wherever I go, she will always be with me.
25:44Ok, I'll do it.
25:56¿Cómo estás?
25:57¿Cómo estás, Jenny?
25:58No puedo sentir nada.
26:00Eso sería la magia de locales.
26:08Vestos están clandos.
26:10Ok, doctor.
26:11Vamos a proceder con los anastomotos.
26:25...
26:38...
26:39...
26:39...
26:41...
26:44Let's put both the girls' vitals next to each other, please.
26:53Come on, now.
26:54Give it a few cardiac cycles, too, Chess.
27:09How do we do?
27:11You did great.
27:22Why Hershey?
27:27Leah is moving there.
27:33Well, they make good candy bars.
27:37Don't like candy bars. I love pancakes.
27:42Why'd they make those, too?
27:51I brought you here because I thought this place would provide a challenge for your abilities.
28:01But I realized I really brought you here because I thought you needed me.
28:19This is a now-signed letter of recommendation.
28:26Bud, I don't want you to go.
28:32If you stay, I'll back off. I'll let you make your own choices, your own mistakes.
28:57I believe in you, Sean.
29:01I believe in you, Sean.
29:12They're blood pressure dropped.
29:16Five millimeters of mercury.
29:20I like when you say there.
29:22You're gonna see some fluctuation.
29:24BP drops five millimeters every complete cardiac circulation.
29:27Shouldn't the fluctuation be inconsistent?
29:30Maybe Katie's heart isn't picking up the workload for Jenny is expected.
29:34Jenny?
29:41Jenny?
29:48I'm right here, Katie.
29:52Right next to you.
30:00Take Murphy and get a shotgun workup on Katie.
30:02I want everything.
30:03EKG, EEG, and labs, and an echo on Jenny.
30:29Katie has an awake algorithm on her EEG.
30:31She's doing remarkably well.
30:34We're still not entirely sure what caused Katie to regain consciousness.
30:37Attaching them again could have redistributed fluid into Jenny's system,
30:40possibly decreasing the swelling in Katie's brain.
30:43I just don't know.
30:45I know.
30:48They need each other.
30:50They always have.
30:53The issue right now has become Jenny and her heart.
30:57When Katie was in a coma, the metabolic demand on her heart was very low,
31:00but now that she's alert and active, there just isn't enough heart for both of them.
31:03What does that mean?
31:05We're awaiting test results.
31:08We're not sure how long Katie's heart can tolerate the strain of supporting Jenny's circulation.
31:13We'll closely monitor them.
31:15Cardiac labs and echoes.
31:17We need to find a donor heart for Jenny as soon as possible.
31:27No.
31:28No?
31:29I've had CEOs settle for half of what I just got for you.
31:32I don't care about the money.
31:33That's beautiful.
31:34It's admirable, even.
31:36But you see, this is how it works, because we live in a civilized society.
31:40They hurt you, we hurt them by making them cut you a massive check.
31:44I don't want them to hurt.
31:46I want them to give me my job back.
31:47A third of your job back is, by my calculation, almost nothing.
31:55I'll pay you a third of this settlement.
31:57What are you talking about?
31:59You'll be paying me more than you earn in a year.
32:02I want my job back.
32:08Lunch is on you.
32:10Lunch is on me.
32:15Are you moving to Pennsylvania to be with Leah?
32:21Does she know that?
32:24Leah knows I'm moving to Hershey.
32:27Yeah, but does she know you're going there because she is going there?
32:32I'm not.
32:39Leah makes me happy.
32:45Leah's not the only one that can do that.
32:52I'm going to miss you.
32:58You're BNP.
33:01Look, Jenny Kunkler's cardioprotein levels are, I've never seen anything like it.
33:06That's because the levels are for two hearts, not one.
33:10Now Jenny is killing Katie.
33:16What's going on?
33:17We've got to separate them now, we're going to lose them both.
33:19We've got the twins on the way.
33:20Which means it.
33:26Jail's going to do a local on the fly.
33:28On my count, three, two, one.
33:35I can't do this.
33:37You'll die.
33:39I'm gonna do it.
33:40No.
33:41Estamos juntos.
33:43Como siempre hemos sido.
33:46Como siempre hemos sido.
33:46Como siempre hemos sido.
33:54Es Jenny, en V-Pib.
33:56Pusión milagros.
33:57Prepar el ambu bag.
33:59Murphys, start chest compressors.
34:10No.
34:10No.
34:37It's Jitney.
34:40Her heart had nothing left to give.
34:46Katie?
34:48She's stable.
34:50Her vitals are good, but...
34:52We have an issue that we need your help with.
34:55Okay.
34:56Um, Katie won't allow us to separate her from Jenny.
35:01If she doesn't acquiesce, Katie will clot and die.
35:04Sorry.
35:07Bring 10,000 units on board.
35:17We'll clear out and give you some privacy.
35:31Baby.
35:37We have to let her go.
35:40I won't let them separate us.
35:43I never wanted to do this.
35:47I used to say we were made this way for a reason.
35:54I won't let them.
35:55I won't let them do this.
35:57Even if it kills me.
36:01I want you to look at your sister.
36:06Look at her.
36:19I can't lose both of my daughters.
36:45I'll try to use.
36:47Evening.
36:48I, uh, checked out the twins file.
36:50It's an amazing case.
36:51To be clear, Jared, I don't want you here.
36:55What we presented to Miss Preston was the truth.
36:58I understand that.
37:00And those problem doctors and the ways we police ourselves
37:03will be dealt with.
37:04Should have been dealt with a long time ago,
37:05but you stepped over a line.
37:07I fought for my job.
37:08You compromised your integrity.
37:11The incident with that jerk coil had nothing to do with black or white,
37:15but that's what you and your lawyer sold for leverage.
37:17And when you misrepresent racism for something it's not...
37:24...sets us two steps back.
37:32She's ready.
37:42Jared, you're on suction.
37:49Nails.
37:59Nails.
38:20You've been fighting the memory...
38:23Gone fishing.
38:25Store's closed.
38:27I spoke to Claire.
38:30I know how it feels.
38:31Be by yourself in the rain.
38:34We all need someone to stay.
38:42We all need someone to stay.
38:47Hear the falling lonely crier.
38:51Are you fixing me up?
38:54Will you show me hope?
38:56The end of the day you were helpless.
39:00Can you keep me close?
39:02Can you love me most?
39:05Hey.
39:07I wanna break up.
39:13Why?
39:14¿Por qué?
39:17Porque yo amo.
39:20No hay razón para romperse con alguien.
39:23Quiero que hay todo en tu vida.
39:27Que incluye hijos.
39:30Te dije que yo iba a querer no tener hijos.
39:33Te voy a regretar esa decisión un día.
39:36No, no.
39:36Sí, te voy.
39:38Te voy a pensar que no lo haré.
39:42Así lo que?
39:44Sí, todos tenemos desgracia.
39:45Yo quería tocar tercer base para los astros.
39:48No, no es así.
39:49Es un sueño de niño.
39:50Este es tu vida.
39:51Este es mi vida.
39:53Y es más desgracia para ser desentado por ti.
39:56De tener mi corazón rompido.
40:01Y tú vas a ser un padre grande.
40:20No, no, no.
40:25No, no.
40:26No, no.
40:30No, no.
40:38No, no.
40:42No, no.
40:42No, no.
40:43No, no.
40:43No, no.
40:44You've never been to Hershey.
40:46Leah's there.
40:54Can I put my arms around you?
41:11Are you a good doctor?
41:15I guess when I think of you, I think you are.
41:19You were alone left out in the cold
41:23Clinging to the ruined and you're broken home
41:27In the falling and lonely cry out
41:31Will you fix me up?
41:34Will you show me hope?
41:36The end of the day and we're helpless
41:40Can you keep me close to me?
41:42Remember, I said borrow.
41:44I know how it feels
41:47Being by yourself in the rain
41:50We all need someone to stay
41:58We all need someone to stay
42:02Hear the falling and lonely cry out
42:07Will you fix me up?
42:10Will you show me hope?
42:12The end of the day and we're helpless
42:15Can you keep me close?
42:18Can you love me most?
42:20Can you love me most?
42:23Will you see me?
42:25Can you see me?
42:28Can you see me come on?
42:41Can you see me through my eyes
42:41Will you ride your hand
43:09Gracias por ver el video.
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