The Good Doctor S01E17
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00:00the timing was good I just got a job transfer Gretchen will start at a new
00:29school I'm gonna start a whole new life it's very exciting in college my dad majored in cheerleading
00:36that was a joke Gretchen's got a great sense of humor I'm laughing on the inside soon you'll
00:45be laughing on the outside too dr. Parker Mobius syndrome is a paralysis of the sixth and seventh
00:51pair of cranial nerves the seventh pair controls facial expression luckily in Gretchen's case we
00:57haven't found any limitation to the sixth pair I'm a lucky girl we'll be taking two slivers of
01:02muscle from your thighs along with their nerves and blood supply and transplanting them into your
01:06cheeks there'll be considerable recovery time before you'll be able to smile at will maybe
01:10three months so what do you say are you up for this can I sleep on it see what I have to live with
01:20nobody knows what I'm joking sorry dr. Andrews yes I am very up for this okay great so unless there
01:28any other questions you want to be a comedian people getting your jokes must be very important to you
01:37if you think it's worth the risk of dying during elective surgery
01:40I apologize for dr. Murphy he's still learning that silence is the right choice when you have
02:05nothing useful to offer we are required to have an honest risk-benefit discussion with our patients
02:12we are giving a lovely young girl a smile that's a simple equation well it's more than the smile or
02:17the jokes she can't express any emotions at all no one can tell if she's happy or sad or scared anything
02:27she's never had much of a social life ever since her mother died she's been completely withdrawn
02:34all I want to do is bring my baby girl back into the world don't worry mr. Melman we're gonna take
02:43great care of her all right Lucy has a post-op infection of unknown origin infusing 900 milligrams of
02:54clindamycin it's terrible isn't it yes it is have you been changing your dressing every day soaking it
03:01in clean warm water yes taking your antibiotics one pill three times a day that's no Lucy I know I gave
03:11you a script for antibiotics along with one for pain meds why haven't you been taking your antibiotics
03:14did you have a bad reaction to them I never filled my prescription I didn't think it was necessary
03:24until it got really bad and then I was two weeks to go myself and I didn't have anyone to pick it up
03:30for me okay mystery solved I'm sorry I know it was stupid very stupid
03:38okay hey Sean oh hello I haven't seen you in ages what's what's new I'm buying an apple I can see
04:04that here I'll get it for no thank you thank you Sean what else is new you didn't want to be friends
04:11yeah no I we we we we're colleagues you know where whatever we are we can still talk we should
04:20talk I have a new friend Kenny hey go thank you Debbie Kenny huh that's uh that's great do you have a
04:29new friend no okay thank you thank you we can talk you know we could talk about sports we could
04:39talk about weather we can talk about Debbie why would you want to talk about Debbie Debbie was flirting
04:44with you she was yes I noticed her exhibiting two typical signs not the trifecta no not the trifecta
04:53and one a typical I think she's just trying to be friendly she gave you an extra dollar and change
04:57and the fact that you didn't notice means you like her too
05:02maybe she's just bad at math
05:07my dad said that you're on the spectrum that's why you said that about people getting my jokes
05:20people always get my jokes and you're very lucky that was a joke I see what you did there
05:30yes they call me resting grudge face Sean the moron
05:42very witty I'm obviously quite smart I drew this to their attention I want a spectrum too
05:56somewhere between inscrutable unapproachable and actively scorned I don't want to be more
06:07approachable and I prefer people not reading my emotions they're mine but that's what you do with
06:15friends
06:24you really think the surgery is too risky possible complications include embolism hemorrhage
06:30collateral paralysis asymmetry brain damage and stroke it's also expensive and medically unnecessary
06:40okay look straight ahead
06:44there's a two-hour wait in the ER and what are we doing treating a woman because she willfully ignored
06:52doctors orders I know what a parasite looks like and it's not Lucy so this is the mom thing with you
06:57growing up with a whack mother means that you can identify any and all problem personalities and
07:02that is the sole upside to my miserable childhood well at least you had a mom mine died when I was
07:08six and dad instantly married a child-hating bitch with a buttload of debt Morgan I'm sorry I didn't tell
07:15you to get sympathy just that I know parasites too
07:17got your book first thing tomorrow morning dad what too soon it's you're nervous I get it if you
07:36have any more questions feel free I've changed my mind I'm not having the surgery
07:46Murphy
07:57hello
08:02Gretchen's father is very upset it seems you talked her out of the surgery
08:10no I didn't talk her out of it or talk her anywhere I just gave her the list of potential
08:16risks embolism hemorrhage collateral paralysis asymmetry brain damage and stroke stroke yes there
08:22there was a case in Brazil in 2004 and the patient suffered it seems that you don't believe that
08:30restoring this girl's smile is that important smiles are overvalued there are studies that support that and
08:37there are studies that don't when we smile we produce endorphins they make us happy they make other
08:43people happy when we see smiles our basal temporal lobes are activated and we duplicate what we see
08:49Murphy's smiles are contagious you see I feel good you feel good everybody likes smiles
08:59I don't in any case your smile wasn't sincere since it didn't demonstrate the Duchenne marker there
09:09was no involvement of the orbicularis oculi muscles around the eyes which means you didn't release endorphins
09:14you know if you can talk her out of a surgery she's wanted for years I'm pretty sure a conversation
09:21with someone objective can talk her back into it get Park come with keep quiet okay
09:29Dr. Kalou you remember me fish girl hi Seles hi yeah yes of course I do
09:44I hope it's okay that I requested you I'm glad you did how you doing that's what you're going to
09:52tell me I mean wearing the tilapia skins for five months getting really tired of being followed home
10:01by stray cats how's the pain compared to what it was nothing any any fever itchiness or swelling
10:12nope well it looks very good but how much longer um how do you feel about tomorrow
10:23seriously I never joke about tilapia
10:28what's the matter I I just wasn't expecting that I I'm afraid of how I'm going to look
10:44tomorrow I know dr. Murphy informed you about the risks of this surgery and some risks are
11:00significant and some just aren't this is as close to risk-free surgery as we can get it'll give you a
11:07smile it'll let you laugh no dr. Murphy didn't talk me out of it he inspired me he helped me realize
11:21that this could actually make me stronger I don't want to run from it anymore
11:27yeah she's lying she's a smart sarcastic young woman not exactly someone who's prone to
11:44inspirational stories why would she lie about changing her mind well when I was a cop I had a
11:48lot of people change their minds about testifying in court and it always came down to one of three
11:51reasons fear confusion where they were paid off she doesn't seem confused and I don't think she's
11:58afraid so Gretchen was paid off I admit the analogy isn't perfect it's close enough
12:05guess who's back in the ER you're happy so I'm guessing it's a non-compliant patient
12:21you misjudged Lucy she made an honest mistake forgetting her prescriptions you called her
12:27didn't you she didn't spontaneously remember you had to remind her is that a mom thing too
12:33Gretchen are you worried that your dad can't afford this surgery the insurance company is paying for
12:40it dad I know it isn't it's elective it's medically unnecessary no one can put a value on your smile
12:53not bullies not an insurance company not even Dr. Murphy in my opinion this surgery is medically necessary
13:02Gretchen sweetie my first memory of your mother was of her smiling at me from across the room
13:16and because of that smile we ended up with you and in my last memory of her is that radiance
13:27lighting up the world one last time
13:30I mean we never had much money but as long as I had that smile it didn't matter
13:40I love you dad
13:48and that's why I can't let you give up everything for this
13:54Lucy Callard I'm here
14:08Lucille Elizabeth Callard yes that's me Dr. Brown called me to pick up my prescriptions
14:18you're the victim of identity theft Lucy there's an imposter using your name and medical ID to get
14:31benefits did you have your purse stolen recently six weeks ago and you had your driver's license and
14:37credit cards replaced but not your health insurance card is this why the pharmacy refuses to fill my
14:42prescriptions I'm on pain meds for post-herpetic neuralgia it's getting really bad once the
14:50imposter filled her prescription for pain meds the pharmacy must have thought you were overfilling
14:53opiates oh it always flares up when I get upset don't worry Lucy we'll get you your meds
15:00we can't already treating Lucy Callard
15:12nice game Tony hi Jim Marcus hey you coming or going neither 15 year old girl with mobius syndrome
15:25your company denied coverage no respiratory issues deformities pain she doesn't even drool she's
15:32fully functional she can't smile that's a function Marcus I think it's wonderful you want to give this
15:39little girl her smile but if we pay for everything wonderful we'll go bankrupt and then who are we
15:44hoping we all know doctors cheat diagnoses to get coverage deviated septum get your free nose job
15:49migraine get your Botox do you really want me to play that game this isn't a game for me we're a
15:56reputable company with very high standards very high bonuses to get even higher with your denial rate
16:01I was going to suggest we end this before we say something we'll regret but I believe that just
16:06happened Gretchen's socially isolated depressed and that's only going to get worse what if she slashes
16:12her wrist do you prefer to cover that are you threatening me with a teenage girl suicide and
16:16god forbid something does happen to her because I'll make sure that this conversation is part of
16:21the permanent record Dr. Andrews said smiles are contagious and I'm testing that hypothesis
16:39well I'm not sure your study will prove anything might have something to do with the lack of the
16:46Duchenne marker oh yes but here you go that wasn't a smile sure it was I want to show you something
17:01you need to follow me okay
17:15the imposter has poisoned the real Lucy's medical record we have to go through every medication every
17:22notation every test to determine who's is whose doing that with zero tolerance for errors could take
17:27six months well the paperwork is our problem not hers not if the confusion results in a harmful
17:31treatment or incorrect diagnosis well we have to do something this woman is in serious pain so we treat
17:37her just be clever about it Sean Sean I've already had two iced coffees
17:47hello Debbie you flirted with Dr. Glassman oh my god yes I have a new friend and he needs one too
17:56I'm so sorry look Dr. Glassman Debbie's facial proportions are close to optimal okay point three
18:02eight vertical and point four eight horizontal so you should find her attractive thank you Sean I'm so
18:09sorry and I think you're both Jewish tribal commonality is highly conducive to social bonding
18:25Shalom bullies can't put a value on your smile nor can Dr. Murphy but it seems the insurance company can
18:33they've agreed to pay forty three thousand seven hundred and fifty dollars about eighty five percent of the
18:38entire cost I can cover the rest of that I swear oh sweetie please let me do this for you
18:56okay okay
19:03Jane Doe that's the only way that we can treat you right now
19:07go home and get some rest the records department will call you to sort all this out
19:14a year ago I was playing tennis and then the shingles hit and I was laid up for six weeks
19:20and I've been on pain meds ever since I lost my job my husband treats me like I'm an old lady
19:26and my daughter thinks I'm too medicated to be around the new baby
19:33maybe I'll be better off as Jane Doe
19:43the imposter returns
19:45Lucy Lucy can you squeeze my fingers
19:57Lucy
19:59she's in septic shock order a lactate level blood cultures and a broad spectrum antibiotic
20:05I'll tell Melinda's we've initiated the sepsis protocol
20:07but we should report her she's a criminal and a flight risk and very very sick we should put
20:12someone outside her door and arrest her when she's stable we don't report patients we find with drugs
20:17or nonviolent people with guns we do report people who steal from us what would happen if people who
20:23needed her help thought they would be arrested if they thought they would be arrested for stealing
20:27an ID maybe they wouldn't steal an ID I don't remember anything in the Hippocratic
20:30cold about checking payer sources before treatment
20:33strongly suggesting there was no health insurance in fourth century bc greece
20:39we have a duty to treat
20:42and we have the right to get paid
20:45but first things first
20:47I really do not want to be sued by either one of these women
20:50maintain the pretense
20:57and as soon as she stabilized we're going to press charges
21:03Dr. Park
21:05on the muscle please we don't want any excess gathering in the suture line
21:08thank you okay remove retractors
21:20ready
21:28you sure you don't want something for the pain
21:30no no I'm kidding
21:32as long as you keep talking to me
21:33especially if you share something uh very painful painful
21:40okay
21:43like the time I mistook my biology teacher for my girlfriend and picked her up in the hallway
21:50yeah twirled around three times before I realized my mistake
21:54that kind of painful
21:57you may have to dig even deeper than that
21:59how about
22:07the time I finally found myself in the perfect situation
22:11you know work friends future something I never really had before
22:21maybe that's why I screwed it up
22:23you're not responding to the antibiotics like we'd hoped
22:31Lucy
22:33you know don't you
22:36when the real Lucy Keller showed up it kind of gave you a room
22:42is there anyone we can contact
22:45do you have any children
22:48a son
22:50but he'd be so ashamed of me
22:53where is he
22:53college
22:55first one in our family
22:58I had to choose between premiums and tuition
23:03your son is very lucky to have such a loving mother
23:09I just wish you got your antibiotics when you got your payments
23:13I didn't get either medication
23:16are you sure
23:18because the real Lucy was having problems with the pharmacy
23:20I didn't want to risk using the card again
23:24is she okay
23:32maybe it's time to move on
23:34take the lesson with you
23:37find new friends
23:38I went to Denver for an interview last week
23:42and
23:46and we're done
23:50really
23:52take a look
23:52take a look
23:55hey
23:56trust me
24:04see
24:05beautiful
24:06the kid
24:15college
24:15college
24:16it's just a convenient sob story
24:17why would she lie
24:18she may be dying
24:22here's what we don't know about fake Lucy
24:24whether her story is true
24:25here's what we do know
24:26she's a liar who just found out she's busted
24:29speaking of lies
24:32that shingles virus that the real Lucy had last year
24:34according to Dr. Spindler at Santa Clara General she had it the year before too
24:38and according to Dr. Milhouse at SF Muny the year before that
24:44she wasn't denied the payments because of her imposter she was denied
24:48because she is a garden variety addict
24:51well played sir
24:51Dr. Park says the surgery went well
25:05it's been too long
25:07what has
25:08she should be breathing on her own by now even after prolonged anesthesia it should only take 60 to 90 minutes
25:21is she okay
25:23she should have protective airway reflexes motor activity and a return of consciousness
25:31we need to pitch Dr. Andrew's stat
25:33well what's going on
25:35something bad
25:43Gretchen's glucose is within normal limits and her electrolytes are also normal
25:48and we've ruled out hyper and hypothermia
25:50doesn't leave much what about hypoxia
25:52she maintained normal oxygen as well as end tidal co2 throughout the entire case and we've given
25:56a reversal agents
25:58which we will repeat
26:01do you feel bad
26:05it's okay
26:07you told them it was close to risk-free they knew there were risks and i told them too
26:14get a ct rule out clots hematoma bleeding and stroke
26:20it's okay
26:32wbc's and lactate arising o2 satin map are falling the sepsis protocol isn't working multiple organ
26:37dysfunction syndrome medications add another antibiotic uh continue crystalloids increase your
26:43vasopressors low-dose steroids give them all a try an intubator and insert a swan and yes i understand
26:49this is out of our own pocket
26:51uh
26:53uh
27:03um
27:05Um, do anything exciting for Purim?
27:10Purim? Uh, no.
27:12Yeah, you know, the usual.
27:14Ate a little matzah
27:17and celebrated our exodus from slavery,
27:21which I think is Passover and not Purim.
27:25Truth of the matter is, I'm only half-Jewish,
27:29so only half the knowledge.
27:32The truth is, I'm not Jewish at all.
27:36Ah. Yeah.
27:38Yeah, my first husband was.
27:41So I guess we have our lack of Jewishness in common.
27:48You know what, Debbie? I think I should get going.
27:51Okay.
27:53Well, it was nice, uh, finally meeting you officially.
27:57Same.
27:59Oh, no, look at that.
28:04A 1975 300D,
28:08one of the most perfect Mercedes ever,
28:10just got a little less perfect.
28:12I beg to differ. If you are looking for perfection,
28:14you look no further than the 1967 280 SE.
28:17Cabriolet or coupe?
28:19The coupe, an all-time classic.
28:20Well, an owner of a 300 SL Gullwing
28:23might argue otherwise.
28:26The Gullwing?
28:28Yeah.
28:29Can I get you another coffee?
28:32Yeah.
28:34Iced, large, black.
28:36That's it.
28:37I know.
28:38Okay.
28:55That's a little bit unsettling, Murphy.
28:57Oh.
28:58Okay.
28:59Oh.
29:00Why are you studying the current of ions during electrolysis?
29:04Uh, it's not the chemical kind of transference.
29:07It's the doctor-patient kind.
29:09I'm dealing with a personal situation.
29:11I don't think the internet is very helpful for solving personal situations.
29:22True.
29:24But I can't exactly ask Claire for her advice,
29:26and I barely know Park and Morgan...
29:28Morgan would be bad.
29:30Very bad.
29:36I'm a person.
29:39Yeah.
29:40No.
29:41No, yeah.
29:42Of course, Sean.
29:43I'd, uh...
29:44I'd love your advice.
29:45Okay.
29:46Uh, so I think Seles, my burn patient, has feelings for me.
29:52And I may have feelings for her, too.
29:57But there's a good chance her feelings aren't real.
30:00And if they are real, then they may not be permanent.
30:04You know, it's kind of textbook transference.
30:09She's grateful and she's vulnerable.
30:14And all I've ever known in my life is unrequited love.
30:23From Claire and...
30:25from my parents.
30:26from my parents.
30:29And that makes me vulnerable, too.
30:42You should call in sick.
30:43Uh...
30:44Uh...
30:47Leah says calling in sick is all you need
30:50to gain superior wisdom and knowledge.
30:53She was right.
30:54The CT showed no abnormalities and the reversal agents
31:08have been repeated without effect.
31:12So what else could it be?
31:13A knock-sick brain injury.
31:15A complication of anesthesia.
31:17Unfortunately, we believe your daughter is brain dead.
31:28What?
31:40All for a smile.
31:42I made her think she wasn't good enough the way she was.
31:49I should have listened to you.
31:51Yes.
31:53There's just no predicting how individuals will react to anesthesia.
32:06Park, you just walked out on that man.
32:08The last thing a grieving family member needs is to see their doctor tap out.
32:12Maybe...
32:13she's still under anesthesia.
32:17Cessinolcholine is one of the anesthetics Gretchen was administered.
32:21Huh?
32:22Now, what if she has a plasma cholinesterase deficiency?
32:25It'd mean her body couldn't break down that specific drug.
32:27Complete deficiency is extremely rare.
32:29I've never personally seen it and I don't know anyone who has.
32:32Yeah, but if she does have it, she's just gonna wake up.
32:35Should I tell her father?
32:36No.
32:37Not yet.
32:38No way we're letting him grieve twice.
32:40Your labs are not improving.
32:41Your organs are shutting down.
32:43You're running out of time.
32:44I'd like to stop calling you, Lucy.
32:45I'd like to stop calling you, Lucy.
32:49Hey,
32:56.
32:59Listen.
33:00I'm calling you Lucy.
33:20You're welcome, Beatrice.
33:31What are you doing?
33:33Corneal reflex.
33:38It's mediated by the nasociliary branch of the ophthalmic branch.
33:50What does it mean?
33:52It means we were wrong.
33:54She's gonna be just fine.
34:00Thank you, Doctor.
34:07Thank you, Dr. Murphy.
34:08I was drawing a bath, and I leaned over to turn it off, and I dropped the pill bottle. And before I could fish it out...
34:13All the pills were ruined, so you need a refill?
34:15My pain has made me so clumsy.
34:17Lucy, you're a liar. And a cheat. And an addict.
34:21We know about the frequent prescriptions, the multiple prescriptions, the multiple prescriptions, the multiple prescriptions, and the multiple prescriptions.
34:29I was drawing a bath, and I leaned over to turn it off, and I dropped the pill bottle. And before I could fish it out...
34:32Lucy, you're a liar. And a cheat. And an addict.
34:40We know about the frequent prescriptions, the multiple doctors, and the ever-recurring shingles.
34:48You have a serious medical problem.
34:53Let me help you.
34:54Three months?
35:03Hopefully.
35:05But we might be able to give you a pretty good idea of what you're gonna look like.
35:09Those things by your ears are neurostimulators. When we activate them, instant smile.
35:14Sound good?
35:18Dr. Murphy?
35:24It's your mother's smile.
35:34She seemed like a good template.
35:39There is no Duchenne marker. Her smile is not real.
35:54All the other ones are.
36:01All the other ones are.
36:03I spoke with Jim Ransler. He made it very clear that we all went big time for this.
36:10Don't worry, Marcus. I can handle him.
36:13I'm very impressed.
36:15It was all very...presidential of you. You really went above and beyond.
36:19Yes, I did.
36:22I thought I was saving her life. Instead, I nearly ended it.
36:28Celeste.
36:30Hi.
36:32This is the brilliant Dr. Murphy.
36:34He'll be assuming your care from here on.
36:36Though I don't expect you'll need much.
36:39I understand.
36:41I don't think you do.
36:45You see, doctors aren't allowed to date their patients.
36:52What are you doing tomorrow?
36:55I'm calling in sick.
36:56I'm calling in sick.
37:03I think you may still have some friends here.
37:19I guess there is one upside to all this.
37:22If she hadn't bought the stolen insurance card, the real Lucy wouldn't be in rehab right now.
37:31That was surprisingly nice.
37:33I told her what she needed to hear to get help.
37:36Trust me, I get it.
37:39Too soft, people take advantage of you.
37:41With your badass upbringing, no one messes with you.
37:45Upsides everywhere.
37:47I mean, you have way more straight cred than, say, someone whose mom's a Johns Hopkins cardiologist,
37:55whose dad's a pathologist, and whose parents have been happily married for 37 years.
38:02Coming from privilege. Zero respect.
38:07Must be really hard to overcome.
38:10I'll call the code.
38:14No.
38:16There's nothing left to save.
38:31Time of death, 8.14pm.
38:39I'll notify her son.
38:40I'll notify her son.
38:46We're gonna show you that we're tough.
38:48We're gonna show you that we're tough.
38:50We're gonna show you that we're tough.
38:54We're gonna show you that we're tough.
39:01Knock us down, we'll get back up.
39:05You know, we're gonna show you that we're tough.
39:09Knock us down, we'll get back up.
39:15Yeah, we're gonna show you what we've got
39:38Oh, hey, um, my homies decided to pop by and play some Texas Hold'em,
39:43so I'm gonna have to take a rain check on that pizza knife.
39:46You got a 70-inch flat screen, too?
39:49Uh, no. I borrowed yours.
39:53Makes a lot of sense for us both to have one, right?
39:56Plus, homies, gotta watch March Madness.
39:59Okay.
40:00Oh, um, sorry, amigo. It's four-player Texas Hold'em.
40:04I don't like poker, anyway.
40:07Hey, Sean. Look, you're a great guy.
40:11Um, but you got a few, like, quirks, you know?
40:18And that...
40:21It doesn't really jive with this kind of face time.
40:26You get what I'm saying, right?
40:29I love you, man.
40:34I once drove a 300 SL thank you. A 300 SL gullwing.
40:39On the road?
40:54No, but 200 feet at the Corps d'Elegance.
40:58Oh, in Pebble Beach. That's just as cool.
41:00The car show. You know it.
41:01Of course, yeah.
41:03This year, they're featuring a Ralston coach work display.
41:07Including the Mercedes SS?
41:09I don't know.
41:10Ah!
41:11But we should find out.
41:13Wanna go?
41:15I couldn't.
41:17Yeah, no, I...
41:19Why?
41:20No reason.
41:22No reason.
41:23I just...
41:24I just...
41:25Thought that I should make that my first response before I accept it.
41:33Can I get you anything else?
41:35No, thank you.
41:36We'll just take the doorstop.
41:38I'm sorry.
41:43Um...
41:44Well, you can bring the doorstop.
41:50Aaron?
41:52Sorry.
41:53Um...
41:55The thing...
41:59The thing, the thing, the thing that tells you how much to pay.
42:02The doorstop.
42:03The doorstop.
42:11Could you call that?
42:12Can you call the ambulance, please?
42:13Mm-hmm.