Air date: September 27, 2021
During a routine tonsillectomy, Shaun, Park and Lim discover that a young boy Jordan has cervical cancer in his throat, which he got in utero from his single mother Sarah. While Jordan’s treatment can wait, Sarah needs an immediate radical hysterectomy. She refuses as she doesn’t have anyone to rely on, until Park convinces her to make amends with her estranged brother Nick. Lea, plagued by fears of disaster over her wedding to Shaun, plans their engagement party. The party turns disastrous when a depressed Glassman gives a drunken toast, admitting that his wife has left him. Shaun, realizing he cannot let Lea shoulder the burden alone, promises to work with her on the wedding plans. Mateo arrives in America after getting his charges dropped and pursues a romantic relationship with Lim. Mateo helps her to reduce complications with Sarah’s hysterectomy, and Lim offers him a job as an attending regardless of the hospital board’s wishes. Meanwhile, Andrews, Morgan, Jordan and Asher treat Salen Morrison, a clinic patient whose bizarre behavior hampers their efforts to treat her; they eventually realize that she is doing so deliberately. Meanwhile, Andrews exposes the blue fingertips due to Raynaud syndrome. Salen admits that she was playing up her scleroderma symptoms to test the staff at St. Bonaventure, having had a series of bad doctors in the past. Glassman later informs Lim that Salen has purchased the hospital.
* * *
Shaun Robert Murphy, do you take Lea Abigail Dilallo to be your wife…
[ORCHESTRAL MUSIC PLAYS]
…to live together…
[ORCHESTRAL MUSIC CONTINUES]
We got this.
To keep her in sickness and health, forsaking all others, for as long as you both shall live?
[CROWD MURMURS][WOMEN SCREAM]
We are not having an outdoor wedding.
I had a great time last night.
Want to go grab some breakfast?
[SIGHS] I got to get to the hospital.
I’m a surgeon.
[MATEO SPEAKS SPANISH]
[IN ENGLISH] You look beautiful as always.
One plus of only having video chats…
No morning breath.
I remember it being like a summer breeze.
What’s on your agenda for the day?
Ugh, budget hell.
Our department’s way in the red, so I don’t see a way to…
Perhaps I should let you go.
No, no. I was, uh…
Hoping for a little excitement this morning, but it looks like you’re out and about, so…
I can make myself available.
[KNOCK ON DOOR]
Just give me two minutes to make this go away, yeah?
I can go away, but not in two minutes.
So, my lawyer called me last night to tell me I’m no longer a wanted man, which, hopefully, only applies to law enforcement.
[THEME MUSIC PLAYING]
LIM: Nice exposure of the right tonsil.
Visibility can be tough with kids.
PARK: Someone’s in a good mood.
That’s your third compliment this morning.
Mateo flew up from Guatemala last night.
Oh, she’s in a good mood because she had sex.
Retract the superior pole.
Mateo can come to the engagement party this Saturday if he wants.
Also the wedding, depending on how long he is staying.
We don’t know when it will be, but I do know it will not be outdoors.
Incise the tonsillar pillar and dissect around the capsule.
Lea is making all of the arrangements because she wants it to be perfect, but all that matters to me is marrying Lea, and any day that happens will be a perfect day.
[CHUCKLES] Oh, that’s very sweet.
But planning a wedding’s a big undertaking.
Mia got pretty overwhelmed planning ours.
Better keep checking in.
Oh, there’s a firm, irregular mass in this tonsil.
Get that to pathology.
Some, uh, shortness of breath, occasional blurred vision and headaches, and this morning, my urine was foamy.
How many exam rooms in this clinic?
Three. Any blood in your urine?
A little. I love that blouse.
You take 20 milligrams of Ritalin L.A. a day?
For my ADHD.
Just three? I hardly had to wait at all.
JORDAN: Blurred vision and headaches can be side effects from Ritalin.
Would you be willing to stop your medication for a couple of days, see if they’re causing any of your symptoms?
I’ll refer any complaints about my behavior to you.
Foamy urine concerns me.
Could be kidney stones, so we should do a CT…
I see by your ID badges you’re both residents, but you seem to be more in charge.
Is that official, or are you just bossy?
Tell me if I’m asking too many questions.
You’re asking too many questions.
We’re gonna run some labs and do a CT of your kidneys.
Are you overwhelmed planning the wedding?
Because Park and Lim thought you might be overwhelmed.
Nope, not at all.
I’ve got it. It’s gonna be great.
[SIGHS] Oh, great.
That’s why they’re divorced.
I’m also great, because my tonsillectomy may have found something worse than an infection, which may be interesting… Or may still be very boring.
I won’t know for sure until the path results…
Maybe let me know once it’s definitely interesting?
This is a very small office.
Actually, it feels a lot larger when I’m the only one in it.
Who are you?
Are you really the president of the hospital?
Uh, it says so on the sign on your door.
Pretty small office for such a big title.
You used to be a neurosurgeon, but now you…
Actually, I still am.
You do both.
But do you identify more as a “doctor” or an executive?
Actually, I identify more as someone who wants to get back to work as soon as possible.
Salen… I’m sorry, Dr. Glassman. I’m so sorry.
We’ll be out of here right away.
Ms. Morrison, you can’t just wander off.
It’s time for your CT scan.
Ms. Morrison, please try to hold still.
You’re the one who wanted me off my meds.
Renal pelvis looks clean.
You sound disappointed.
Morgan made me a deal.
I do all the scut work.
If the patient needs anything surgical, she’ll put in a good word with the attending.
Even if there’s a kidney stone, I mean, surgery’s pretty unlikely.
But what’s that, on the right kidney?
That’s a significant hypodensity.
Could be a mass. She needs a kidney biopsy.
That is a legit ultrasound-guided procedure.
And it’s mine. All mine!
It’s still really bothering him.
We had to remove additional tissue because your son’s tonsils showed signs of cancerous cells.
Riley has cancer.
The margins were clear, which means that we were able to remove all the cancer.
His prognosis is excellent.
SHAUN: But right now, he’s not our main concern.
The cancer on your son’s tonsil is cervical cancer.
That makes no sense.
He got it from you.
He was exposed to your cancerous cells in the birth canal, which he likely inhaled.
Jackson may also have been exposed during birth.
We need to scan both you and…
NICK: Hey, boys.
How you feeling, Riley?
Hey, Uncle Nick.
Why are you here?
I texted Uncle Nick that Riley was sick.
SARAH: Everything is fine.
Thank you for the gift, but if you could please…
[SOFTLY] Sarah, I’m better.
All right? I swear.
And if you need anything, I can help.
Everything is gonna be fine.
It was very nice of Uncle Nick to visit, but he needs to leave.
NICK: I love you, guys.
I need to talk to you.
I’m sorry. I just…No. No, no, no.
You did nothing wrong, honey. Nothing at all.
The doctors and I…
We need to talk to you.
Imaging found an abnormal lesion in your kidney.
Now, it could be a benign growth, but given your symptoms, it could be renal-cell carcinoma.
We’ll need to biopsy the mass to be sure.
Who will be doing the procedure?
She’s an excellent surgical resident, right, Dr. Andrews?
And she’ll be under my supervision every step of the way.
If that’s acceptable to you, Ms. Morrison.
No eating or drinking anything besides water between now and when I do the procedure.
Why did you lie to your brother?
You said everything was fine.
He just never grew up.
When I decided to become a single mom, Nick wanted to help.
He got on great with the kids.
He also drank…
Like our dad.
One day about four years ago, I had a job interview and no sitter.
Nick insisted he’d help.
He took the boys to the beach…
And got drunk.
Started chattin’ up some girl, then turned around.
Boys were gone.
The cops found them about a mile down the beach.
That’s a good answer.
[ELEVATOR BELL DINGS]
DR. ANDREWS: Hey.
DR. GLASSMAN: Hey.
[ELEVATOR DOOR CLOSES]
I heard about you and Isabel.
Sorry to hear that.
Appreciate the sympathy.
No need for us to have a heart-to-heart.
I’ve been there.
Breakup’s a breakup. How different can they be?
I’m doing great.
Taking this cute dietician to Shaun and Lea’s party.
Or Annabelle or… Lydia.
You don’t remember her name?
I don’t know which one to take.
They’re all dieticians?
Two of them are.
[LAUGHING] I got to check my notes.
How you doing?
Good. Good. Really good.
Good. Really good.
[ELEVATOR BELL DINGS, DOOR OPENS]
[SOFTLY] I’m thinking of going on a diet.
This one or this one?
Wear whatever you want. I don’t care.
I’ve got work.
Oh, you do care.
Who are you on the phone with now? Caterer? Flowers?
I’m on hold with our cloud-backup people.
They’re just… Oh.
Um, three more trays of the bruschetta, two more chicken satay for Murphy/ Dilallo tomorrow night. Thank you.
This one or this one?
Number two. Morgan’s wearing green.
[KNOCK ON DOOR] Busy.
If you’re too busy to answer the door, I assume lunch is out of the question?
[GROANS] I ate at my desk half an hour ago.
The hospital’s bleeding more money than actual blood.
I’ll be quick.
I applied for a provisional California medical license.
My request was approved.
An old medical-school friend is a surgeon at San Francisco General.
Offered me a job.
As promised, very quick.
I’ll let you think.
No, I just didn’t know you were thinking of leaving Guatemala.
It is a bit fast, isn’t it?
If we’d met here, San Francisco would seem far away, right?
That is very true.
So if I take this job, we’ll just have to deal with being so far away from each other, am I right?
I’m glad you are no longer a fugitive from government authorities.
The PET scan shows increased metabolic activity in the mother’s uterus and the son’s trachea.
They both have cancer.
I’m doing a biopsy today.
Are you doing a biopsy today?
‘Cause I’m doing a biopsy today.
Not many second-year residents are doing biopsies today.
I’m not doing a biopsy today.
No. No, no.
The flowers need to be there by 5:00.
If it’s impossible, then why did you commit to that time two weeks ago?
Okay. I need to talk to my fiance.
He’s a lawyer, and he gets really worked up when businesses don’t honor their agreements.
It’s actually kind of a turn-on for him, making people pay, uh…
Oh. That’s great.
Yeah. Thank you so much.
SALEN: Was any of that true?
Either way, well done.
What kind of flowers are you getting?
Are you a patient?
I love gardenias.
What’s your P.U.E. ratio?
You’re not supposed to be in here. Uh…
Put down that sandwich!
Hi, Dr. Allen. Is it time for my biopsy?
I told you not to eat.
That tends to happen when I’m off my meds.
Please tell me that was going to be your first bite of that sandwich.
My first bite.
Of this half.
LIM: Your cancer appears to be primarily localized to the cervix and uterus.
You will need a radical hysterectomy.
If the cancer’s spread to the lymph nodes, you would also need those removed and post-radiation and possibly chemotherapy.
When was the last time you had a Pap smear?
Your cancer is quite advanced.
Most cervical cancers are detected early with regular Pap smears.
I’m a single mom.
Things sometimes fall through the cracks.
How’s my son?
Jackson has a tumor in his trachea.
There appears to be just one lesion, no lymph-node involvement or metastasis.
Surgery will hopefully be curative.
And how soon can you do that?
There’s no rush to do it. It’s slow-growing.
But there is a rush to do your surgery.
Waiting increases your risk of serious bowel injury and metastasis.
How long will my recovery take?
If all goes well…
Who will look after the boys?
I… I can’t afford a full-time sitter.
There’s no one that I can ask.
Jackson’s surgery should go first.
And once he’s better, you can do mine.
Jackson’s recovery won’t be quick either.
He may need to remain intubated while his trachea heals.
He won’t be able to eat.
We’ll need to put a tube in his belly.
You can help me in a month. Right now…
You help my son.
Are you okay?
The engagement party is off.
Another bad dream?
Another reminder that chaos follows me everywhere.
Is the wedding still on?
LIM: Stupid choice.
It’s not stupid to sacrifice yourself for your child.
It’s being a parent.
Call it whatever you want.
We can’t force her to do the surgery.
So we’re gonna have to do Jackson’s surgery first and hope for a smooth recovery.
Endoscopic mucosal tracheal resection.
If Jackson’s tumor was seeded via exposure during birth, which is a very reasonable assumption, then we can reasonably assume that it is localized.
Endoscopic resection should allow for a recovery of days instead of weeks.
Talk to the mother.
ASHER: We have rescheduled your kidney biopsy for 6:00 this evening.
Nothing to eat or drink between now and then.
Ms. Morrison, could you stop doing that while we’re talking?
This helps me relax.
I don’t care if you’re relaxed.
I care about the wandering, the eating, and the not listening.
Repeat what he just said.
You’ve rescheduled my biopsy for 6:00.
[SIGHS] Nothing to eat or drink until then.
Is your relationship primarily cooperative or competitive?
He said that because he doesn’t want to appear competitive in front…
Have you always had fat ankles?
ASHER: Only if the answer is “yes.”
If the answer is “no,” it’s a symptom.
SARAH: This endoscopic approach, it’s, um, not the normal surgery?
There is no normal surgery for removing cervical cancer from a child’s trachea.
SARAH: Is it just as safe?
It’s slightly more dangerous for Jackson, but much less dangerous for you.
We would need emergent ECMO, but we can prep for that, and his recovery should be shorter.
I’m sorry for giving a hard time with Uncle Nick.
I’m sorry for giving a hard time with cleaning up after dinner, fighting with Riley.
I know how much you do for us.
And I know after the surgery, you won’t be able to do all of those things.
I can help.
I love you.
[VOICE BREAKING] I love you, too.
And if anything ever happened to you…
Swollen ankles could indicate an infectious abscess, which could be the lesion we saw on her kidney imaging.
In which case, poking the mass with a biopsy needle is a terrible idea.
Could seed the infection.
So no biopsy.
You’ll be relieved to know that even if there was a biopsy, you wouldn’t be doing it.
Second-year residents who have to reschedule procedures because they allow their patients to wander off to eat sandwiches don’t get dibs.
Let’s recheck C.B.C., E.S.R., blood and urine cultures, and then start her on broad-spectrum antibiotics.
If her symptoms improve, then it’s an infection, which would be good news.
How cooperative you feeling right now?
PARK: You’re at the mass.
It has a wide base.
No easy way to loop my snare around it.
It has a major arterial feeder from his aorta.
We can’t remove it from this angle without risking a massive bleed.
It was a good idea that won’t work.
Abort the surgery.
You look amazing!
[LAUGHS] But wait.
You shouldn’t look amazing. The party’s canceled.
I do not accept that, not today.
I look amazing, and people need to see that.
And unless you caught Shaun cheating, no way you should be here sulking instead of having a party where I look amazing.
Did you catch Shaun cheating?
No! Of course not.
Are you worried about marrying Shaun?
No, not at all.
I just want this wedding to be perfect.
And the party was going to be a trial run.
It wasn’t going to be perfect.
It was going to be a disaster.
No. It just wasn’t going to be perfect.
The first time I got married…
I was all about it being spontaneous and romantic and fun.
The deejay was an hour late.
We ran out of booze, the food was cold, and, somehow, there were no napkins, not a single one.
It was a disaster, and so was the marriage.
So I-I really need to get this one right.
If you aren’t willing to risk little things going wrong, you’ll never get the chance to have the big things go right.
E-mail everyone and tell them the party’s back on.
Then I’m doing your hair.
PARK: If we avoid an abdominal incision, that’d reduce Sarah’s recovery time, which might convince her to let us do her procedure first.
There may be uterine adhesions to the bladder.
That makes a laparoscopic removal difficult.
You two, get changed.
Engagement party’s back on.
We are working on a case.
Your fiancEe is working on a celebration of your future together.
Is someone going to die if you don’t figure this out tonight?
Not good enough. See you at the party.
Talk some sense into him.
We will solve this problem and then go to the party.
It won’t take very long. We are both quite clever.
[JAZZ MUSIC PLAYING]
[INDISTINCT CONVERSATIONS, LAUGHTER]
The food is happening, bubbly is flowing, flower arrangements are in position.
The deejay wouldn’t uncancel, so we’re streaming chill jazz on your phone.
Congratulations, Lea. Hi, Jordan.
So, where’s the man of the hour?
Shaun’s getting into his party duds as we speak.
Got to make sure he measures up to this beauty.
I got it. I know how to do Jackson’s surgery without cracking his chest.
I’ve seen journal articles that support it, and I need to pull them.
You go ahead. I’ll put everything together.
Are you lying about having a solution?
Is your future with Lea more important than this one case?
Then do you really want me to answer?
[JAZZ MUSIC CONTINUES]
Well, where’s Shaun? I’d like to toast the two of you.
[CELLPHONE RINGS] I’ve got to take this.
This is not a little thing.
Paging Dr. Shaun Murphy!
We are all so happy for you.
The first time Shaun mentioned Lea, she was the girl who borrowed his batteries.
I told him not to ask for them back, but clearly, it worked out.
These two have a love that can move…
What if we embolize the blood supply to the tumor and then do the endoscopic surgery?
If Shaun couldn’t figure this out, you really think you’re going to?
I was hoping you might help, you know, instead of just throwing insults.
Even if you come up with a brilliant idea, it still won’t work.
If medical logic was gonna persuade her, she’d have changed her mind already.
[JAZZ MUSIC CONTINUES]
[INDISTINCT CONVERSATIONS, LAUGHTER]
This is perfect.
Yes, it is.
Look, I know you don’t want me here.
I have something for you.
This is my 90-day chip.
I haven’t had a drink in 106 days, and…
Not my first time getting sober, but…
…I want to be the man I know I can be.
I want to be your brother again.
You keep it.
And whatever you all are going through, it’ll be here, just like I’ll be here for you…
And for the boys…
If you’ll let me.
[VOICE BREAKING] I’m… Glad you’re doing better.
But how do I know I can trust you?
No, you don’t.
Sarah, you need to trust someone.
♪♪ You’ve got me right where you want ♪♪
♪♪ I’ve got… ♪♪
You couldn’t decide, so you ended up with two dates?
I got Marie and Maria confused in my text threads and inadvertently double-dipped.
Well, it seems like it’s going okay so far.
Oh, yeah. They’re talking about moving on to a club…
They do have real chemistry.
[LAUGHS] How about a double?
♪♪ Tell me, tell me ♪♪
♪♪ Tell me what can I do ♪♪
That was SF General.
Once the hospital board found out that my original charges included assault, they decided I was too big of an insurance risk.
Maybe another hospital in the Bay Area.
Uh, I would like to, um… Make a toast.
[CHUCKLES] I have known Shaun since he was…
And, Shaun, I have never, ever seen you as happy as you are right now with Lea.
Well, not that you’ve always been happy.
There have been some ups and downs, a little bit like a roller coaster.
But you guys have managed it so well.
A whole lot better than I have.
Is that funny?
But here’s to many, many, many years of…
At least two, maybe three.
That was funny.
[CHUCKLING] I’m divorced, so that’s funny.
Yeah, but you’re married now, so let’s give it up for Shaun…
Debbie left me like two months ago, but that’s not the point. The point is…
You guys have built a-a platform and you’ve taken off.
I mean, who knows?
[SIGHS] That was fun last night.
You want to grab some breakfast?
I should get going.
[BELT BUCKLE JINGLING]
What’s on your mind, guapa?
Radical hysterectomy with lymph-node resection on a mom of two boys.
I’m just worried about incontinence and fistula post-procedure.
Can you preserve the superior vesical artery?
That will ensure blood supply to the distal ureter.
Is that all you’re thinking about?
It’s still swollen, but blood and urine cultures are negative.
Rules out infection.
Well, it rules out bacterial infection.
It could still be fungal or viral.
We’re better off with an endovascular renal biopsy.
Ms. Morrison, we’d like to insert a catheter through your jugular vein to your kidney.
That way, we can biopsy the mass safely.
Will you be doing it?
Dr. Wolke will be doing the honors, under my guidance.
Who’s the chief of surgery here?
Dr. Audrey Lim.
A woman. That’s fantastic.
Can I meet her?
She’s a little busy.
Dr. Murphy, can you identify the superior vesical arteries?
Salvage them. It will ensure blood supply to the distal ureter.
That will reduce the risk of incontinence or fistula.
It is, isn’t it?
SALEN: Dr. Lim!
Excuse me. Who are you?
And what are you doing in my operating room?
I’m Salen Morrison.
Dr. Andrews thinks I should have an endovascular kidney biopsy.
What do you think?
It’s absolutely the best next step.
But what about the possibility of…
Ms. Morrison, I don’t know anything about your case.
But if Dr. Andrews recommends you get a biopsy, then get a biopsy.
I have complete faith in him and all of my attendings.
Please page Dr. Andrews and have him come get his patient.
Oh, I feel…
What causes kidney lesions, shortness of breath, swollen ankles, and heart irregularities?
Early polycystic kidney disease?
ASHER: See, we’re just guessing. We need to sample the lesion.
Every time we get close to doing the biopsy on this woman, something… doc-blocks us.
It’s like she’s messing with us.
DR. ANDREWS: Whatever’s in her kidney is very real, and she didn’t intentionally make her heart rate go through the roof.
Look at her blood work.
She said she’d stop her meds, but her Ritalin level today is over double when she came in.
That could cause her heart irregularities.
She is messing with us.
You look great.
Yeah, Jackson’s asleep, but, um, he’s doing good.
Your surgery went well.
Your prognosis is good.
You’ll receive chemo-radiation treatment.
The radiation therapy includes both external beam…
I think she was talking to me.
Because you brought Nick.
Your brother is not perfect.
But sometimes, we need people who aren’t perfect.
You do that a lot.
[CHUCKLES] This is silly.
You must have patients all the time who screw up, don’t do what they’re told.
Do you accuse all of them of being liars?
I didn’t think you’re a liar.
I think you are insane.
There’s a lesion on your kidney, and you’re actively preventing us from finding out what it is.
Or she already knows.
Or at least she knows enough to put concealing makeup on her fingers.
To hide her Raynaud’s syndrome.
You have scleroderma?
JORDAN: So your kidney…
That’s a benign lesion, not a mass.
I got diagnosed seven years ago, after having symptoms for three years.
Lots of bad doctors out there.
I went off my scleroderma meds a couple weeks ago, see if you doctors were more of the same.
I was curious.
[SIGHS] How do I look?
You look like someone about to make a presentation to a hospital board.
I’m gonna go to my hotel room.
No, no. Don’t you dare.
Either the board is gonna make this a very good night or a very bad night.
But, either way, I want you here when I get home.
You know, we have been down an attending for over a year.
And I do know a very qualified candidate.
If the board gives me the money,
I’m gonna offer you a job.
And if they don’t, screw ’em.
I’m gonna offer you a job.
The party was a disaster.
Yeah, it was.
I screwed up.
Shaun, that was not your fault.
Oh, no, I know.
It wasn’t my fault at all. It was yours.
It was your party, your responsibility, but that’s the problem.
When things go wrong for us, they should go wrong for both of us.
So I’m going to help you plan our wedding.
When it goes terribly wrong, it will be both our faults.
And it’ll be because of the both of us when everything goes right.
What happened? The meeting’s over?
But my presentation… I haven’t had a chance…No one has.
There was only one item on the agenda.
The hospital is being purchased.
What? By who?
I’m looking forward to working with both of you.
[CLOSING THEME MUSIC PLAYING]