The.Good.Doctor.S01E02
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00:00Take a break. Clear your head.
00:02You need a vacation.
00:04I'm gonna quit my job.
00:06I'm not looking forward to moving to Hershey, Pennsylvania.
00:10I don't want kids.
00:13Ever.
00:17I've just been fired for physically assaulting an employee.
00:21Go ahead, drop us an F.
00:24When will they wake up?
00:26They should've already.
00:30We were worried about you, Jenny.
00:48So glad you're back.
00:50I am gonna give you three words, try to remember them.
00:53Apple, ball, house.
00:56Can you count back from 100 by 7 for me?
00:59I'm going to Harvard, you know.
01:0593, 86, 79, 72, 65.
01:12And what city you're in?
01:14San Jose.
01:15And what were those three words?
01:17Apple, ball, house.
01:20Look out, Harvard.
01:23We'll be doing a lot more tests to know for sure, but your heart does sound better.
01:28Ask Katie.
01:31You woke up before her.
01:33So, too soon to tell.
01:35There's virtually no alpha or beta brain activity.
01:38You must've missed something during the separation surgery.
01:40We didn't.
01:41Katie's BP was steady, sats were fine, regional blood supplies were reconstructed.
01:45Just like Jenny, yet she's awake, Katie's in a coma.
01:48Katie's got the new sagittal graft.
01:50A problem with blood flow in that vein could cause a condition.
01:53An MR angiogram should tell us if the graft is open or not.
01:56Hello.
01:58I will proceed with the angiogram.
02:00Whoa.
02:01Murphy, you've been gone for two days.
02:03How about we start there?
02:05Okay.
02:06Just because you talk to the president doesn't qualify his permission.
02:10Okay.
02:11Yes.
02:12I will notify Dr. Melendez next time I go on a road trip with my girlfriend.
02:18Amazing.
02:19Road trip?
02:21Dr. Glassman said you were dealing with a personal crisis.
02:24That is true.
02:27Do you know the definition of personal crisis?
02:29Yes.
02:30A stage in a sequence of events at which the trend of all future events is determined.
02:36A death.
02:37An illness.
02:38Yes.
02:39No.
02:40Not a road trip.
02:42Okay.
02:44You and Dr. Brown get going on Katie's angiogram.
02:47Unless, of course, you have any personal emergencies to attend to.
02:50No.
02:51My crisis is over.
02:57Come in.
03:00Hey.
03:02How are the twins doing?
03:04Jenny's in recovery.
03:05Her numbers look good.
03:06She's talking.
03:07Katie not so good.
03:09We need to talk about Murphy.
03:12I told you he's on personal leave.
03:14Yeah, well, that's not what he said.
03:17You talked to him?
03:18Yes.
03:20In the surgical unit.
03:21Five minutes ago.
03:25There's the saginal vein graft we constructed for Katie.
03:28It's open with good flow.
03:31The graft is fine.
03:33Which means we still have no explanation for our coma.
03:37Going closer?
03:38In the middle cerebral vein, it has low flow out of the brain.
03:46You're thinking low flow out means low flow in?
03:48Yes.
03:49That is what I'm thinking.
03:51We should look at the arterial inflow phase.
03:56We'd like to look at the arterial inflow phase.
03:58Please.
04:01So what you do on your trip?
04:02Well, sometimes when we take a road trip, we're running away from something.
04:11I kissed Leah.
04:14And Dr. Glassman is mad at me.
04:17What's he mad at you about?
04:21It's almost entirely blocked.
04:23And there's a malformation in the circle of Willis.
04:27Katie is barely getting any blood to her brain.
04:31Excuse me.
04:32Sean, may I speak with you, please?
04:35Dr. Melendez, he was not angry.
04:37Oh, no.
04:38Sean, Dr. Melendez is angry with you.
04:40He's also angry with me.
04:43Why?
04:44Why?
04:45Because I lied to him for you.
04:48Why did you run away?
04:50I didn't run away.
04:52When you leave without notifying your attending,
04:54when you drop all of your responsibilities at this hospital,
04:58when you leave without telling anyone, including me,
05:02then you are running away.
05:05Did this trip with this girl help?
05:09Yes.
05:10Yes, it did.
05:12Okay.
05:14How?
05:17I would like to give two weeks' notice.
05:24Mom, can you ask him to bring me some more ice chips?
05:35I'll get them, sweetie.
05:54I'll get a doctor.
05:55No.
05:56I'm just...
05:57When you leave...
05:58I'll get a doctor.
05:59No.
06:00I'll get a doctor.
06:19No.
06:21I'm just...
06:23When you left, there was no one here.
06:26For the first time in my life, I was alone.
06:32Sweetie.
06:33It felt cold.
06:39Well, sometimes it is cold.
06:43But you know what?
06:45Someday, you might find that you like it.
06:52Wrongful termination.
06:54Dr. Kalou assaulted an attending surgeon.
06:57I don't think you have strong legal footing here.
06:59There's more to the story.
07:05And I am sympathetic to Dr. Kalou,
07:09but his ends don't justify his means.
07:10Obviously, we can't tolerate staff members.
07:12And yet, you do.
07:13Please, read on.
07:14Okay.
07:14Okay.
07:14Okay.
07:14Okay.
07:24The middle cerebral has narrowed.
07:25It's less than two millimeters.
07:27You bypass the artery here and restore blood flow.
07:31Open her back up.
07:32She's just been through a massive operation.
07:34The brain tissue hasn't settled.
07:36Another could very well stroke Katie out.
07:38Other options.
07:42Intravascular.
07:42I don't see how an intravascular ultrasound gives us a better picture.
07:46I'm not imaging.
07:47He wants a stent in the middle cerebral artery in the angio lab.
07:50I like it.
07:51Stenting is usually reserved for the heart and the carotid.
07:54It's not the usual, but we are way past the usual.
07:56It would lower the danger of a stroke.
08:01Dr. Murphy, would you like to assist?
08:04Yes.
08:05Dr. Melendez, would you like to write me a letter of recommendation?
08:14You see the narrowing there?
08:16And the horizontal segment of the middle cerebral artery.
08:20Oh, yeah.
08:22I've heard about you.
08:24You're the one making the old guard nervous.
08:28Why would I make people nervous?
08:33If you had a gift.
08:35The surgeons judge themselves against their peers, and right now, you're winning.
08:42We're in position.
08:44Dr. Murphy, please inflate the balloon.
08:50Give us another squirt of contrast, and we should have good blood flow.
08:59Yes, the proximal end of the artery is dissecting.
09:02The balloon is damaging her artery.
09:03The reform is worsening.
09:04The stunt won't hold.
09:06She's going to stroke.
09:07I'm aborting.
09:08Okay.
09:17The reform is normalizing.
09:19We're right back where we started.
09:22Katie's brain is starving.
09:23I want to see Katie.
09:29I know she's in a coma.
09:31I still need to see her.
09:34I miss her.
09:35We can't risk contamination for either of you.
09:38She needs to know I'm there.
09:39We understand.
09:40You can't understand.
09:41You can't understand.
09:42No one can.
09:43We have always been there for each other, and now when she needs me most, I'm not there.
09:48You've just been through a 40-hour surgery.
09:51We need you to focus on your own healing.
09:53And what about her heart?
09:55We're going to do a cardiac catheterization test to see if her heart circulation has improved.
10:01Inject the contrast to evaluate the heart's blood supply.
10:05How's my soul looking?
10:07That's a different specialty.
10:12Katie says the eyes are the window to the soul.
10:16I say the eyes lie.
10:17It's the heart.
10:18Well then, so far your soul is looking good.
10:21Strong, unobstructed blood flow.
10:23The triculogram will tell us how the muscle function is doing.
10:37It's so quiet.
10:39Is everything okay?
10:42Ventricle's strained and dilated.
10:44We're hoping for some improvement post-separation, but it's barely pumping.
10:47It just doesn't make any sense.
10:49The separation was supposed to relieve the stress on Jenny's heart.
10:53Half the need, half the work.
10:55Jenny's heart is even sicker than it appeared.
10:57Seems we couldn't see that because Katie's heart was doing all the work for Jenny's.
11:00What can we do to fix it?
11:02Give her a new heart.
11:03We're not going to find a donor match in time.
11:04Yes, we already have the perfect heart for Jenny.
11:08The sisters are monozygotic and therefore a genetic match.
11:13On the other hand, Katie is alive.
11:15She is GCS3.
11:16Her heart is still beating.
11:17Yes, but she is unresponsive.
11:19And I don't see a way to return blood flow to the brain.
11:22In all likelihood, Katie's not coming back.
11:25Yes, Katie very well may die, but we can't predict when that'll be.
11:28It could be today, could be 20 years from now.
11:30If Katie stays on the ventilator.
11:32That's not up to us.
11:33I know, but I also know that based on these scans, Jenny might not make it through the night.
11:40We need to propose this to the mother.
11:42There's no chance Katie will wake up.
11:58We can't say with 100% certainty, but from what we saw on Katie's brain scan, we have little reason for hope.
12:07But what we can say with certainty is that without Katie's heart, Jenny will die.
12:14Can we wait?
12:17Just a little?
12:18Maybe you'll know more.
12:18Maybe something will change.
12:20If we don't do anything, Jenny's heart will stop before the morning.
12:23How do you...
12:28Would it be painful?
12:36No.
12:37We simply power down Katie's ventilator.
12:40Once off-life support, she will peacefully pass.
12:43Do you want us to explain this to Jenny?
13:01I'm sure she'll want to be present.
13:03No.
13:03I put trust in them from an early age, thinking responsibility would build strength.
13:15I think it worked.
13:17But this...
13:19No.
13:22Jenny can't be part of this in any way.
13:24It'd destroy her.
13:25I'll tell her Katie died.
13:39Dr. Sean Murphy exhibits technical skills beyond his years.
13:44You wrote that.
13:45Yes.
13:46That's why he's saying my name at the bottom.
13:50You think Sean survives at another hospital?
13:52I didn't think he'd survive here.
13:56Without your endorsement, Sean isn't going anywhere.
14:01I may have my issues with him.
14:03But no matter how stupid an idea this may be,
14:05I'm not going to stop him from going after what he wants.
14:11There's another signature line next to mine.
14:13It's where the president of the hospital has to sign.
14:14A chief oncologist.
14:22This is before I came here.
14:24December at 14.
14:26Dr. Marshall shoved a scrub nurse during a post-op discussion of some sort.
14:30Do you remember that?
14:32I do.
14:32Your response was to settle with a nurse
14:34while Dr. Marshall was let off with a warning.
14:37There's another almost identical instance earlier in that year.
14:41In both cases, doctors in question were white.
14:45They were censured.
14:47Dr. Klee was fired.
14:49You think this was a racial matter?
14:52Do you think I'm racist?
14:55That I favor white people?
14:58Then why the leniency then and not now?
15:01They're stars that happen to be white.
15:08Doctors like Marshall allow St. Bonaventure to compete with other West Coast institutions.
15:14So that's our defense.
15:16We're not racist.
15:17We just allow our doctors to assault people as long as they bring in enough donors.
15:21They were reprimanded.
15:23And there were no further incidents.
15:25And how do you think all of this is going to play out in court?
15:27Settle.
15:32Settle.
15:37Okay.
15:42Hi.
15:45Floor?
15:47Floor.
15:51Sean asked Dr. Melendez for a letter of recommendation.
15:55Yeah.
15:57All I have to do is sign it and off he goes.
16:03I think he might think that you're mad at him.
16:16If you don't sign, it reinforces what he thinks.
16:20But if you do, it lets him know that you believe in him.
16:39Can I touch her?
16:40Of course.
16:41Goodbye, baby.
17:06Are you ready?
17:08Yes.
17:08Yes.
17:08Yes.
17:11Yes.
17:12Yes.
17:13Yes.
17:14Yes.
17:15Yes.
17:16Yes.
17:17Yes.
17:18Yes.
17:19Yes.
17:20Yes.
17:21Yes.
17:22Yes.
17:23Yes.
17:24Yes.
17:25Yes.
17:26Yes.
17:27Yes.
17:28Yes.
17:29Yes.
17:30Yes.
17:31Yes.
17:32Yes.
17:33Yes.
17:34Yes.
17:35Yes.
17:36Yes.
17:37Yes.
17:38Yes.
17:39Yes.
17:40she's stabilizing
17:45I don't understand
17:48what's going on
17:51Katie's not ready to go
18:01she's breathing on her own
18:02which means Katie has normal brainstem function correct
18:05when a ventilator is removed
18:07life can continue
18:08it's rare but it could happen
18:09it doesn't change the prognosis for awakening
18:11off the ventilator with normal vitals
18:13suggests long-term vegetative state right
18:16yeah
18:17we just lost our remedy for Jenny's heart
18:20what about ECMO
18:22use the machine as a replacement for Jenny's heart
18:25buys us two weeks of life
18:27I don't like it
18:28ECMO requires blood thinners
18:31she just had brain surgery
18:32it would cause a catastrophic bleed
18:34ECMO and its complications may be our only avenue
18:37we can join them
18:39you want to put their heads back together
18:42not the heads
18:45the thighs
18:46the femoral vessels
18:47is it a funny idea
18:51I think it's funny that I didn't think of it
18:53the girl's blood is identical
18:54no need for anti-clotting meds
18:56so no possibility of a bleed
18:58as long as they're attached
18:59Katie's heart will beat for Jenny
19:01when Katie dies
19:02we sever the femoral connection
19:03and transplant Katie's heart
19:06into Jenny
19:06we just spent 40 hours separating them
19:11and now we want to put them back together
19:14you tried to kill Katie
19:17no
19:18you took her off life support
19:21what do you call that
19:24mercy
19:25not just for her
19:27you need a heart
19:28or you're going to die
19:30Katie's alive
19:33she was then
19:37and she's even more now
19:39Katie's alive in the sense that she has
19:42basic organ function
19:43but she has no higher cognitive brain activity
19:46she's surviving
19:47but she is not living
19:50hours ago
19:53you thought she'd die
19:56as soon as you pulled the plug
19:59you were wrong
20:04how do I know you're not wrong
20:06this time too
20:08the demand on Katie's heart
20:12is minimal in her resting state
20:14she can easily tolerate helping you
20:17I won't ask Katie
20:22to be my life support machine
20:25Dr. Andrews
20:51let's put the sisters in the same room overnight
20:58I don't think that Jenny sees herself as an individual yet
21:02you know I'm thinking the only thing that'll change Jenny's mind about the reattachment
21:07is Katie
21:08being close might help Jenny to see her as lifeless
21:11it could backfire
21:13and cement her feelings that she's killing her sister
21:16yeah possibly
21:17and then
21:20we're in the same position anyways
21:22okay
21:25do it
21:25okay
21:26well what about baseballs
21:33that this girl caught at a Giants game
21:35signed by Mr. Hunter Pence
21:36he didn't hit it
21:38but that doesn't matter
21:39so where's the sporting goods one
21:43there
21:44oh no that does not go in sporting goods
21:49it doesn't
21:50I'm applying to move my residency to Hershey, Pennsylvania
21:57really?
21:59yes
22:00Penn State Medical Center
22:02are you following me?
22:06I need to make sure you're not just doing this to stay close to me
22:15no
22:16Sean
22:18I want my own life
22:20I want a life that I control
22:23not Dr. Glassman
22:24Dr. Glassman is just trying to help you
22:26I don't want help
22:27but what if
22:31we need help
22:33how will I know if I stay
22:38too much stuff
22:44you have too much stuff
22:46we should book a trip
22:55maybe somewhere warm
22:59wow you are so slow
23:07you're only folding underwear
23:09underwear is easy
23:10mm-mm
23:11okay
23:13no you don't
23:15I don't mind
23:15fine
23:21let's go Presby
23:23I'm ready
23:25go
23:26you're the only good thing about my day
23:49Oh, my God.
24:19I couldn't sleep last night
24:49I couldn't even close my eyes until I could feel Katie's heart beat in my hand
25:07If I do this, at some point, Katie's heart will beat for me, right?
25:14That's the plan
25:19Then wherever I go, she will always be with me
25:31Okay, I'll do it
25:42How are you doing, Jenny?
25:54I can't feel anything
25:56That would be the magic of local anesthetic
25:58Vessels are clamped
26:06Okay, doctor
26:06We're ready to proceed with the anastomotic grafts
26:10It's done, isn't it?
26:35I can tell
26:38Let's put both the girls' vitals next to each other, please
26:42Come on, now
26:50Give it a few cardiac cycles, too, chest
26:52How'd we do?
27:08You did great
27:09Why Hershey?
27:23Leah is moving there
27:26Well, they make good candy bars
27:32I don't like candy bars
27:35I love pancakes
27:37Well, they make those, too
27:39I brought you here because
27:48I thought this place
27:51Would provide a challenge for your abilities
27:55But I realized I really brought you here because I thought you needed me
28:02This is a now-signed letter of recommendation
28:19Bud
28:21I don't want you to go
28:24If you stay, I'll back off
28:30I'll let you make your own choices
28:33Your own mistakes
28:35I believe in you, Sean
28:56Their blood pressure dropped
29:11Five millimeters of mercury
29:15I like when you say there
29:18You're going to see some fluctuation
29:20BP drops five millimeters every complete cardiac circulation
29:23Shouldn't the fluctuation be inconsistent?
29:26Maybe Katie's heart isn't picking up the workload for Jenny is expected
29:29Jenny?
29:37Jenny?
29:44I'm right here, Katie
29:46Right next to you
29:49Take Murphy and get a shotgun workup on Katie
29:58I want everything
29:59EKG, EEG, and labs
30:01And an echo on Jenny
30:02Come on
30:06Come on
30:11Come on
30:15Come on
30:17Come on
30:19Katie has an awake algorithm on her EEG
30:28She's doing remarkably well
30:29We're still not entirely sure what caused Katie to regain consciousness
30:33Attaching them again could have redistributed flu into Jenny's system
30:36Possibly decreasing the swelling in Katie's brain
30:38Just don't know
30:40I know
30:42They need each other
30:45They always have
30:47The issue right now
30:50Has become Jenny and her heart
30:52When Katie was in a coma
30:54The metabolic demand on her heart was very low
30:56But now that she's alert and active
30:57There just isn't enough heart for both of them
30:59What does that mean?
31:01We're awaiting test results
31:02We're not sure how long Katie's heart
31:06Can tolerate the strain of supporting Jenny's circulation
31:09We'll closely monitor them
31:10The cardiac labs in that coast
31:12We need to find a donor heart for Jenny as soon as possible
31:16No
31:23No?
31:25I've had CEOs settle for half of what I just got for you
31:28I don't care about the money
31:29That's beautiful
31:30It's admirable
31:31Even
31:32But you see this is how it works
31:34Because we live in a civilized society
31:35They hurt you
31:37We hurt them
31:38By making them cut you a massive check
31:40I don't want them to hurt
31:42I want them to give me my job back
31:43A third of your job back
31:45Is by my calculation
31:46Almost nothing
31:48I'll pay you a third of this settlement
31:53What are you talking about?
31:54You'll be paying me more than you earn in a year
31:58I want my job back
31:59Lunch is on you
32:05Lunch is on me
32:08Are you moving to Pennsylvania to be with Leah?
32:17Does she know that?
32:20Leah knows I'm moving to Hershey
32:23Yeah, but does she know you're going there because she is going there?
32:28I'm not
32:29Leah makes me happy
32:36Leah's not the only one that can do that
32:43I'm gonna miss you
32:53You're BNP
32:55Jenny Kunkler's cardioprotein levels are
33:00I've never seen anything like it
33:01That's because
33:02The levels are for two hearts
33:05Not one
33:06Now Jenny is killing Katie
33:08What's going on?
33:13We gotta separate them now
33:14We're gonna lose them both
33:15We got the twins on the way
33:16Who's going to sit?
33:16JL's gonna do a local on the fly
33:24On my count
33:26Three
33:26Two
33:27One
33:28I can't do this
33:33You'll die
33:34I'm gonna do it
33:36No
33:37We're in this together
33:39The way we've always been
33:41The way we were meant to be
33:43It's Jenny
33:51She's in V-fib
33:52Push a milligram up and up
33:53Right now
33:53Prepping ambu bag
33:54Murphy, start chest compressors
33:57The way we're meant to be
34:27It's Jenny
34:34Her heart had nothing left to give
34:38Katie?
34:44She's stable
34:45Her vitals are good
34:47But
34:48We have an issue that we need your help with
34:50Okay
34:52Um
34:53Katie won't allow us to separate her from Jenny
34:56If she doesn't acquiesce
34:59Katie will clot and die
35:00Bring 10,000 units on board
35:05We'll clear out
35:15And give you some privacy
35:16Baby
35:27Baby
35:27We have to let her go
35:35I won't let them separate us
35:38I never wanted to do this
35:42I used to say
35:44We were made this way for a reason
35:47I won't let them do this
35:52And if it kills me
35:54I want you to look at your sister
36:00Look at her
36:01Look at her
36:03I can't lose both of my daughters
36:18I'll try to use
36:28Evening
36:30I'll try to use evening. I checked out the Twins file. It's an amazing case. To be clear, Jared, I don't want you here.
36:51What we presented to Miss Preston was the truth. I understand that.
36:55And those problem doctors and the ways we police ourselves will be dealt with, should have been dealt with a long time ago, but you stepped over a line.
37:03I fought for my job.
37:04You compromised your integrity.
37:07The incident with that jerk coil had nothing to do with black or white, but that's what you and your lawyers sold for leverage.
37:13And when you misrepresent racism for something it's not, it sets us two steps back.
37:25She's ready.
37:38Jared, you're on suction.
37:46Nails.
37:47You were alone, left out in the cold, clinging to the run of your broken heart.
37:59Too lost and hurting, to carry your load.
38:04We all need someone to hold.
38:07You've been fighting the memory.
38:19Gone fishing.
38:22Store's closed.
38:23I spoke to Claire.
38:24I know how it feels.
38:27Been by yourself in the rain.
38:30We all need someone to stay.
38:34We all need someone to stay.
38:43In the falling lonely crying.
38:47You're fixing me up.
38:50Will you show me hope?
38:52The end of the day we're helpless.
38:56Can you keep me close?
38:58Can you love me most?
39:01Hey.
39:02Hey.
39:04I want to break up.
39:10Why?
39:13Because I love you.
39:16I don't have a reason to break up with somebody.
39:19I want you to have everything in your life.
39:23Which includes kids.
39:25I told you I was willing to not have kids.
39:29You're going to regret that decision one day.
39:32I won't.
39:32Yes, you will.
39:34You're just too decent to think it, but you will.
39:38So what?
39:40We all have regrets.
39:41I wanted to play third base for the Astros.
39:44It's not the same.
39:45That is a child's dream.
39:46This is your life.
39:47This is my life.
39:49And it would be more devastating to be resented by you.
39:52Than to have my heart broken.
39:57And you are going to be a great dad.
40:03Sean.
40:06I wanted to give you something.
40:21I'm letting you borrow it.
40:29Bring it when you come visit.
40:32Okay.
40:34Promise?
40:36You're gonna come visit, right?
40:38I promise.
40:39I like Hershey.
40:41You've never been to Hershey.
40:42Leah's there.
40:51Can I put my arms around you?
41:08Are you a good doctor?
41:11Because when I think of you, I think you are.
41:21I know we may be broken home, in the falling and lonely cry out, will you fix me up, will you show me hope, the end of the day and the helpless, can you keep me close, can you keep me close, can you keep me, I know how it feels, be by yourself in the rain, we all need someone to stay.
41:51We all need someone to stay.
41:59Can I find a lonely cry out, will you fix me up, will you show me hope, the end of the day and the helpless, can you keep me close, can you keep me close, can you keep me close, be by yourself in the rain, you just keep me close, can you keep me close, can you keep me close, can you keep me close.