The Good Doctor – S04E05 – Fault – Transcript

Shaun questions his decision to give the new residents autonomy when one of his intern's misdiagnosis of a patient has dire consequences. Morgan and Park bond over failed relationships.
The Good Doctor - S04E05

Air date: November 30, 2020

It’s just a migraine.

Honey, until we’re completely sure…

Is the pain a tight band or pulsating?

Good question.

Pulsating, light bothers me, nausea. I get these all the time.

You said you didn’t feel a, uh…

What’d you call it? A…

An aura. I know, but…

Exactly how often do you get these symptoms? I just ask, since your boyfriend doesn’t seem to recognize them.

(CHUCKLES LIGHTLY)

(BOTH CHUCKLE)

Zane and I have only known each other for eight days.

It moved fast.

Ellie, did you feel your foot twitch?

No.

Positive Babinski.

What does that mean?

It’s not a migraine.

(THEME MUSIC PLAYING)


DR. REZNICK: Oh, that. I was performing due diligence on my new roommate, who might be a violent maniac, and look what I found in his closet.

It’s cute.

You moved in with two suitcases. You only have four pairs of underwear. How the hell did a parrot make the cut?

I’m a Parrothead. A Jimmy Buffett enthusiast.

The Margaritaville guy?

Well, he has other, far better songs, but yes, the Margaritaville guy. It brings me luck.

Scary to think what your life would be like without it.

Can I have it back?

It’s fun getting to know you better. Worth every damn bit of sacrifice.


(GROANS, WINCES)

I was demonstrating a torch lift this morning, and, bang.

“Ballet master.” You’re a dancer?

God, no. I’m like the CEO. At my age, I’d be the Betty White of the troupe.

Is she a dancer? I don’t know much about, uh, culture.

(CHUCKLES LIGHTLY) I assume I just sprained something, right?

Uh, we will need neuro and abdominal exams, X-rays for fractures, CBC for infection, cultures to rule out a spinal abscess…

You’re new, aren’t you?

Uh, it’s my second week here. It’s actually only my first day seeing patients.

Am I your first?

Yes. Sorry. But, yes.

Well… That’s impressive. Whoever’s supervising you must really trust you.

I’m not sure that’s true.


They won’t let me join their stupid gym because I had high blood pressure. How am I supposed to lower it if I can’t work out?

200 over 105. That is quite high.

I just told you it was high.

Are you a smoker?

Yeah. Pack or two a day. More if I feel crappy.

And… Do you have diabetes?

You’re reading those questions out of a book?

Yes.

Have you ever done this before?

I told you. You have to trust them.

I don’t.

Then act like you do. Go away.


JORDAN: Nothing more romantic than spending one of your first dates in an ER.

Well, stressful experiences release oxytocin. Same hormone that creates emotional bonds. This might actually cement their relationship.

(COMPUTER BEEPS)

Next to the hippocampus.

Is that a tooth?

Dermoid cyst. Cool.

She’s having a seizure.

Secure her airway. Push two milligrams Ativan.

(ELEVATOR BELL DINGS)

Thank you for trusting us enough…

Please report.

Uh, 58-year-old male dancer with back pain. I ruled out red flags like osteomyelitis and kidney infection, but I did find evidence of a mild L2 compression fracture with moderate wedging and evidence of impingement on the neural canal.

You want to start beta blockers?

Me? Yeah. I think my patient’s a stroke risk. BP’s 200 over 105.

It was the same at her gym earlier?

Can you raise your arms? Okay. Now try to squeeze my hands.

I just did all these tests with her. I thought you were gonna give me stuff to lower my blood pressure.

That would kill you. Now push against my hands.

If she’s in danger of having a stroke…

She’s not. She’s already having one. Smoking on estrogen put her at high risk. Loss of circadian blood pressure variation confirms it. Stick out your tongue.

We gotta get a CTA.

No. We’re treating with IV tPA.

Don’t we need to locate the clot?

We just did. Right deviation means a right vertebral artery occlusion. Oh. You can close your mouth now.


CLAIRE: Her seizure and coma were caused by a dermoid cyst. It’s a pocket of tissue with bits of teeth, hair, and fat. She likely got it before she was born.

What can you do?

The less invasive option is to put in a drain to release some pressure, treat with anti-seizure meds and steroids, then basically watch to see if the swelling goes down.

And the more invasive?

Surgical removal. But the cyst is deep inside and wrapped around major arteries, so it is more likely to fix the problem, but it carries risk of stroke or paralysis.

(SIGHS)

We need a decision quickly. Ellie’s sister is on the paperwork, but we haven’t been able to reach her. Do you know where the parents live or any other siblings?

He might still be on a business trip, but, uh… (SIGHS) you can try her husband.

If we can’t reduce the swelling, she will have permanent brain damage.

Is that him?

Brendan, we need you to make a decision.

Yeah, yeah. I’m… I’m not sure that I’m the right one to… I mean, right now, I hate her.

You don’t. You’re angry. You’re hurt. Because you love her.


(INAUDIBLE)

58-year-old male dancer with back pain. Moderate vertebral wedging and impingement on the neural canal.

Yes. I think an L2 compression fracture.

Prescribe anti-inflammatories, a brace, and PT, then discharge him.

Do you wanna re-check anything?

No.


(MONITOR BEEPING)

Remember to floss your brain after every meal, people.

CLAIRE: Aspirating.

Do you think we should be doing this? I know we have to legally, but maybe her husband isn’t the one who knows her best, knows what she wants.

Better than the guy who met her last weekend. Arachnoid knife.

Mmm, that guy, she’s in love with him. Apparently.

Well, maybe she loves them both.

Aren’t you a romantic! Watch for perforators.

I’ve been polyamorous for years. When I was monogamous, I was jealous, possessive, egotistical. Our patient wasn’t honest. That’s not cool. But other than that…

(INHALES DEEPLY)

Good margins all around. Let’s dry up the field and close her up.


I never would’ve guessed I was your first patient. Felt more like the fourth. By the way, did I detect an accent?

No. I mean, I had one, but I worked really hard to lose it. No one ever notices it anymore.

Eastern Europe?

Brooklyn. Williamsburg. I grew up Hasidic, speaking Yiddish. I left it a long time ago.

You left the… the religion?

The religion, the culture, my family.

Must not have been easy, growing up that way, knowing you were a doctor.

Excuse me?

My generation, you could get bashed. You could get thrown in jail. We had to learn codes, how to read each other. You should thank your lucky stars you get to live your life the way you want it.

I don’t know what you went through. Please don’t pretend to know what I went through. Sir?

My gut…

(GROANS)

Code blue!


The surgery seemed successful, but we need to monitor for seizures over the next 24 hours.

ENRIQUE: Is this high enough?

Um, a little to the left. No. To the right. Yeah.

You never said anything was wrong.

Can we have the room for a moment?

I’m sorry, but we really need to check…

You’re worried about talking in front of them? Embarrassing me?

I didn’t think anything was wrong. (SIGHS) When I met Zane, it made me realize something was missing. Or, at least, I think that’s what I’m feeling.

ENRIQUE: You mind tilting your chin up?

ELLIE: I’m sorry.

Why couldn’t you just talk to me? Or… Or leave me?

I don’t know.

Were you happy? With him? (SCOFFS) I guess I should go.

Brendan? Who are these people?

Ellie, do you know where you are?

Why am I in the hospital? (BREATHING SHAKILY)


SHAUN: Suprarenal aortic aneurysm. It ruptured as he was being discharged. Clamping aorta now.

How much blood is he down?

We suctioned out two liters and gave six units on the rapid infuser.

SHAUN: The aneurysm caused his back pain. Dr. Wolke missed it.

I did an abdominal exam.

Aneurysms are very hard to catch. Experienced doctors miss them all the time. Potts scissors.

The aneurysm is 6.5 centimeters. Dr. Wolke should have felt it.

It felt like normal musculature. I’m so sorry.

We’ll never know what you felt. There’s no way to know if you, or any doctor, for that matter, would have detected this.

I would have. He asked me if I wanted to double-check. If I had, I would’ve caught the aneurysm before the rupture.

Stop it.

He made a mistake.

He might have. But you did, too.

No. You told me to back off.

I didn’t tell you to abdicate responsibility. When a First Year asks if you want to re-check their work, your answer should always be “yes.” The fact they’re asking is a warning sign.

I didn’t know that.


It’s called retrograde memory loss. Luckily, it seems to have been temporary. She’s lucid again.

We’re running an MRI and lab tests to see what caused it.

Thank you for, uh, telling me. I know I’m just the…

You care.

Maybe things with Ellie and I weren’t always perfect, but…

It was exciting. When I was with her… Never felt that way before.

I took care of her when she was sick. I never strayed.

It wasn’t about the things we did. It was… It was about being with her.

She stuck by me when I needed her. Last year, I was… I was drinking way too much. It’s hard to imagine being without her.

I just can’t imagine being without her.


She’s stable. Q-hour neuro exams and monitor for signs of elevated ICP.

(“MARGARITAVILLE” RINGTONE PLAYING)

♪♪ Wastin’ away again in Margaritaville

I believe you’re getting a call, Dr. Park.

♪♪ Searchin’ for my lost shaker of salt ♪♪

(DECLINES CALL) You’re a Parrothead. Wear it proud.

Can we just agree to have some limits? Maybe not everything I own is fair game.

Mmm, no.

Perfect.

Trust me, it’ll be worth every damn bit of sacrifice. I’ve said that twice now.

You’ve said a lot of things twice. You have limited creativity.

Truth is, it wasn’t creative at all. It’s from Jimmy Buffett’s Cheeseburger In Paradise, one of his Big 8. So big, even I know it. You, sir, are no Parrothead.

Mia does woodwork as a side hustle. She made it for me on our first trip to Hawaii.

Lovely. Wait, no, that’s not right. “Pathetic”?

And do you toss away all mementos of past friends and jobs?

If a job cheated on me, I might wanna move on. When’s the last time you dated someone?

When’s the last time you acted like a human being?

So, years? Yeah, I definitely found the right word. See you at home.


You can’t sleep? You want some warm milk? My mother has, like, 18 prescriptions for this. Some of them are actual prescriptions.

I can sleep but need to figure out how to supervise better.

How many of these are you planning to read tonight?

Just the relevant sections of each.

Tech bros are always watching TED Talks on leadership. That could be quicker than those books. How about tomorrow, we have a date night?

Why would we need a date night if we’re in a relationship and living together?

Because it’ll be fun.

I’ll schedule date night for tomorrow.

Great. Think of something for us to do. There is one thing that helps most people sleep that my mother did not tell me about.

(TYPING)

What makes a great manager? Some say it’s all about planning. Others, charismatic leadership. A third group…


Your temporary memory loss was caused by some fat that leaked from your cyst. We can remove it via a craniotomy, but there is a real risk of more memory loss. Maybe permanently.

What will I lose?

The time prior to the surgery. Days, weeks, possibly months. But if we don’t operate soon, the risk of brain damage only grows.

(BREATHING SHAKILY) I can’t do it. I don’t even know what I want right now, but I do know that I don’t want the decision about my marriage forced on me by an operation. Please, find another answer.


You are not very good at your jobs, and I’m not very good at teaching you, so we are going to focus on one step at a time. You will master each skill separately. I’ve made a list of 400 skills. I didn’t have the time to finish it last night because…

Dr. Wolke, you will be focusing on physical exams. You’ll find a list of the seven post-op tests to be conducted on Carl. Dr. Jackson, you will find relevant seminars on conquering nerves in the workplace. What are good activities for a date?

Uh… What does she like?

Cars, coding, Zelda: Breath of the Wild, Sauvignon Blanc, Skittles, RuPaul’s Drag Race, camping…

I had a very romantic time camping in Big Sur.

This is for tonight.

I haven’t gone on many dates. But everyone loves movies.

Hmm.


Healing nicely. No redness or swelling. I’m gonna palpate around it now.

(BREATHING HEAVILY) Look, I need to apologize. For bringing up your personal life the other day.

No. You have nothing to apologize to me for.

So, what’s next on your list?

Checking for signs of infection inside your abdomen. Open your eyes wider. You have signs of jaundice. I think your liver’s failing.

(SIGHS)

SHAUN: The liver is being damaged by a new aneurysm.

How? A genetic predisposition or…

More likely, when we fixed the first one, we increased the pressure upstream.

Can we stent the celiac?

Anatomy’s too tricky.

Aortic to celiac bypass?

We’d just risk a new aneurysm forming upstream.

Maybe, but it solves the problem in front of us. He’ll die without an intervention.

He’ll probably die either way.

Let’s all take the time to research alternate solutions. If we can’t come up with something better in 24 hours, we proceed with the bypass.


She’s saying no for emotional reasons. So the answer isn’t medical. It’s emotional.

We think Zane should talk to Ellie.

No. I don’t want him anywhere near her.

To convince her to do the craniotomy. From you, it’s self-serving. From Zane…

Wait. If she doesn’t want it…

You said you can’t imagine life without her. If you meant that, you’d risk anything to keep her alive. Including her memories of you.


(CHUCKLES)

Well done, Shaunie. (SIGHS) I really needed this. The system update yesterday? Went bananas. I’ve been flooded with complaints. Total nightmare. How’s work? Did the videos help?

Yes.

Tell me more.

One of my patients developed a secondary aneurysm. Now I need to find a surgical fix by tomorrow. Otherwise, he will probably die. I brought Skittles.

Shouldn’t you be at the hospital?

Yes. After you go to bed, I plan to go back and do research.

Shaunie, go to the hospital.

No, we made this schedule.

Someone else needs you. More than I need you.

It’s a hospital. It’s filled with sick people.

But tomorrow, will someone need you to come up with a way to save their life?

Mmm, maybe. Probably not tomorrow. Okay.

Mmm-hmm. (SIGHS) I am canceling date night.

That’s rude.

Oh, well.

Then I should go to the hospital.

Mmm-hmm.


They’re prepping Ellie for surgery. Any last-minute questions?

What should I do?

Forgive her. Under the right circumstances, every human will stray. We’re not hardwired for monogamy.

I’m guessing you’re not married.

I’m not saying that it’s wrong to feel angry. She wasn’t honest with you. The alternative to forgiving her is losing someone that you love.

Then what? If she comes back to me just because she forgets him, (BREATHES DEEPLY) my marriage wouldn’t be honest.

I have an idea.


We could remove more proximal aorta and extend the graft.

And rebuild the celiac trunk with what?

Dacron?

Branches are too complex. This Lancet article on polymer materials doesn’t work. But thin-film nitinol?

(WHISPERING) Did we break him?

We have the material. It’s his veins.


Hey! Oh, I’m sorry. Did we reestablish personal boundaries? This morning’s presentation’s on who’s not moving on? Exhibit A. Canoodling on a very romantic hillside with…

With my gay best friend. Can you leave?

Exhibit B. A XXL Rob Gronkowski jersey. Just the latest fashion style from a woman who hates the Patriots? Or an ex-boyfriend’s…

Not an ex. I hooked up with Gronk. Seemed worth preserving.

Rob? Or one of his brothers? Props. I guess. Exhibit infinitum. Two ticket stubs to Quantum of Solace. Now, you once called Daniel Craig “James Blonde,” and yet, 11 years later, these were in your drawer, on top of an instruction manual for a 2019 cellphone, which means you dug them out within the last year. Why? I can only assume you are currently once again hooking up with the James Blonde fan.

How could you possible deduce…

I also read your e-mails. You’ve been sleeping with an ex without asking for any commitment.

It’s just sex. It’s not keeping me from anything.

What’s more likely to prevent someone from moving on? A parrot in a drawer or an ex in your bed?

I’m at least getting something hot from the situation. You’re just wallowing in failure. So, if your bag’s empty, I’m naked and have to go to the bathroom.


It’s called a Y-shaped vein graft. Your aorta is damaged from the aneurysm right where it branches off. We’re gonna find a vein in your leg that’s similar in size, cut it out, and use it to replace the damaged artery.

How bad is it?

This is an excellent solution.

If it works. What are the actual chances that it doesn’t, that I’m gonna die?

I don’t want to give a number.

(EXHALES)

I mean, I can’t. I literally can’t. There are too many factors. I can call in Dr. Murphy…

I don’t need to hear numbers. How bad is this?

Bad.

(EXHALES SHARPLY) Thank you. Whatever happens, you’re gonna be an incredible doctor. And I am honored to have been your first patient.

I screwed up. (BREATH TREMBLING) That first exam, I felt something. I should have known it was an aneurysm. We could have saved you before it got bad.

Why…

You were my first patient.

(SIGHS) I need you to do something for me. I need you to pray. You must know a prayer for the sick.

I’m not a believer anymore.

Neither am I. But… (SIGHS)

(PRAYING IN YIDDISH)


(MONITOR BEEPING)

Ellie, do you know these men?

Of course. Brendan. And… And are you a friend of Brendan’s?

(CHUCKLES SOFTLY) Something like that.

A lot has happened in the last week. So before you went under, the doctors made a video. It’s sort of, uh, a message from your old self to your new one.

(CHUCKLES)

Um… I just want you to know that I love you.

ENRIQUE ON PHONE: Tell me about the day you met.

(CHUCKLES) I was in the middle of an art exhibit in SoMa, and I noticed this guy, and he was looking at all the same paintings I had been looking at.


DR. LIM: Need another 6-0 loaded backhand for the arterial stump.

(MONITOR BEEPING STEADILY)

Graft is secure.

Take off the Satinsky clamp. Good perfusion to his lower body.

(ALARM BEEPING) JORDAN: Heart rate’s spiking.

There’s no ST elevations.

(MONITOR BEEPING RAPIDLY)

BP’s tanking. Did he thrombose the graft?

Distal anastomosis is pulsatile. But there is blood pooling in the left lower quadrant.

The right, too.

He’s bleeding everywhere but the graft.

ASHER: It’s DIC.

Send a stat ROTEM and coag profile…

(ALARM BLARING)

Start compression, give epinephrine, and get the defib.

Set it to 120. 120.

(DEFIBRILLATOR WHIRS) Clear.

(DEFIBRILLATOR THUMPS)

Compressions.

(BREATHING HEAVILY)

No response. Go to monophasic at 360.

(DEFIBRILLATOR WHIRS) Clear.

(DEFIBRILLATOR THUMPS)

(EKG FLATLINING)

(FLATLINE CONTINUES)

Why aren’t you shocking again?

He’s in asystole. Dr. Lim?

(DEFIBRILLATOR THUMPS)

(FLATLINE CONTINUES)

(BREATHING HEAVILY)

Dr. Wolke. He’s dead.

(BREATHING HEAVILY)

DR. LIM: Time of death, 7:23 p.m.

(EKG SWITCHES OFF)

(BREATH TREMBLING)

Take as much time as you need.

(BREATHING HEAVILY)


I was in love with him. All those moments I had, meeting at the gallery, the conversations… I don’t remember any of them. But they were real. And they brought up feelings. Ones I don’t remember having for a really long time. But all they made me think of was you, Brendan. Hearing how I met Zane just reminded me how you and I met at Chelsey’s party, and you showed up in that ugly bomber jacket. And Zane taking me to the hospital reminded me how you nursed me for months when I broke my femur in Aspen. And the whole time… I just couldn’t stop thinking about how much I must have hurt you. And I… I don’t know if you can forgive me. But I love you. And I… I want to come home.

Well, you’re wrong. That bomber jacket was really cool.

(LAUGHS)

(SNIFFLES)

(CRYING)


He died. I tried stepping back. I tried brainstorming. And he died. I don’t know what people are thinking or feeling. I can’t communicate what I need. And more patients will die.

You don’t think your ASD had anything to do with your patient’s death, do you? Because it didn’t.

It did. Asher wasn’t sure about his abdominal exam. I should have known that.

Shaun, you’re gonna do most things better than anyone else, and there are days when you’re gonna fail, like everyone else. Today might be one of those days.

So… What do you do then?

(SIGHS DEEPLY) You go home, you be with the people you love. You take comfort in that, and then you wake up tomorrow and start all over again.

(SIGHS DEEPLY)


You can go home.

I just don’t wanna be alone right now.


(SIGHS)

I opened a Bumble account today.

Mmm. I swiped right three times today.

Gronk’s jersey didn’t have a tag in the back.

It’s symbolic. You have any idea how much the real one will be worth one day?

Fair enough.

♪ Wastin’ away again in Margaritaville ♪

♪ Searchin’ for my lost shaker of salt ♪

♪ Some people claim that there’s a woman to blame ♪

♪ But I know ♪

♪ It’s my own damn fault ♪

♪ Damn fault ♪


I’m glad you’re here with me.

So am I.

(CLOSING THEME MUSIC PLAYING)

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