The Good Doctor – S05E02 – Piece of Cake | Transcript

Dr. Shaun Murphy and the team race to save a pregnant woman's baby and find her current situation as a convicted felon complicates it even more than they realize. Meanwhile, the hospital takes on some unexpected changes that the staff are not prepared for.
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The Good Doctor - S05E02 - Piece of Cake

Air date: October 4, 2021

The staff has to adjust to Salen and her company, Ethicure, taking over the hospital and treating patients as clients instead; desiring a change in his life, Glassman considers resigning and moving on to something else, but he eventually accepts a deal to continue working for Salen in exchange for her doubling the budget of his clinic. Andrews, Jordan and Mateo treat Madeline, a young woman who is diagnosed with terminal cancer. At Shaun’s suggestion and with Lim’s support, Mateo treats her with an experimental T-cell treatment while Andrews is removed from the case for his continuing disagreement with the treatment in front of Salen. Madeline struggles with the return of her birth mother who was forced to leave her behind years before and return to her home country. The two begin a reconciliation with Mateo’s encouragement, but Salen chastises Lim and Mateo for prioritizing Madeline’s case over their other “clients.” Morgan and Park treat Abby, a new mother who is in prison for murdering her first baby despite her claims of innocence. Park becomes convinced that Abby is innocent even after her new daughter, Maggie, develops the same symptoms of antifreeze poisoning that her son Troy had died of, while Morgan believes that she’s guilty. After an impromptu interrogation under anesthetic, Morgan changes her mind and helps Shaun and Park discover that the babies have a genetic metabolic disorder that was unknowingly exacerbated by Abby breastfeeding them. Maggie is saved while the doctors inform the authorities that Abby has been exonerated of murdering Troy. Shaun struggles with choosing a cake for his wedding while Lea struggles with installing an overly-complicated new system. Shaun eventually decides on a multi-tiered cake made out of all of the options while Lea convinces Salen to let her program the hospital a better system herself. However, some of the changes to the hospital ends up sending Shaun into a sensory overload at the end of the day.

* * *

Ethicure.

Devoted to an improved, accessible, for-profit, state-of-the-art healthcare experience.

An experience we curate via our Three Pillars of the Ethicure mission.

Pillar one, our hospital.

A new color palette designed to create a sense of well-being.

Cutting edge technologies.

Faster testing and imaging results.

And countless new surgical innovations.

Pillar two, our doctors.

We want you healthy and happy, so if you look under the table, you will find, custom fitness trackers, Ethicure scrubs, along with a few other goodies.

We’ll also be introducing new well-being incentives and protocols designed to encourage teamwork and mutual respect.

Bosses have first names, too.

Which leads us to pillar three.

At Ethicure, we do not treat patients.

We serve clients.

So we will be seeking their feedback at every stage of the Ethicure experience, because a happy client is a referring client.

My name is Salen.

Welcome to the Ethicure family.

I really want to break this.

Our jobs no longer depend on saving lives, but how many smiley faces get punched.

It’s cute.

Thank you!

She’s just incentivizing niceness.

You of all people do not want to be rated by how nice you are.

I can’t fake saving lives, but being nice?

Way easier to game.

It counts your steps, your pulse ox, monitors when you sleep, warns you when you’re stressed, and stores a thousand playlists.

If it vibrated, I’d marry it.

Jordan.

Ethicure knows where we are, what we’re listening to, how we’re sleeping, maybe even who we’re sleeping with.

It also tracks paranoia.

You’re fine with all of this?

I mean, it’s great if you are, but change is sometimes tricky for you.

I was concerned, but Ethicure’s changes seem reasonable and data-driven.

I think we should start by picking a cake.

You prioritized the cake, over the date, the venue, the caterer…

I like cake.

I’ve compiled a list of the most popular ones.

What is your favorite cake?

Whatever you think our guests will like.

There is no such thing as bad cake.

Whew. Take a good look.

You won’t be seeing much of me for a while.

I’ll be very busy turning a good program into a bad one.

Yeah.

Shaun.

Shaun.

Oh.

Love you.

She’s hemorrhaging.

Ultrasound to assess etiology.

Hanging blood and fluids, starting pressers.

The baby’s placenta is covering the cervix.

The baby’s brachycardic. Mom needs C-section, STAT.

You’ll need to stay here.

Can’t let her out of my sight, Doctor.

She’s doing life for murdering her first baby.

I’m up there for two gallbladders.

Do you know I completed my residency?

Blame SurgiMatch.

I mean, I wouldn’t have put you on the schedule at all until you at least knew where the bathrooms were.

Oh, come on, guapa, look at all this stuff.

I’m a kid in a candy store and I’m starving to death.

Please don’t call me guapa at work.

Yes, Audrey.

Bosses have first names, too.

What do you think of her?

I’m not a fan of an algorithm telling me what to do.

This thing did a great job filling up my dance card for the next week.

She knows what I like.

Good to have you on board. Glad to be here.

Not all of our dance cards are full.

Mind if I tag along on your morning rounds, maybe show me where the bathrooms are?

Sure.

Let’s cha-cha.

I looked up her case.

Abby Clemmis was charged with poisoning her baby with antifreeze.

She pleaded not guilty and got pregnant again before the trial.

But when she was convicted, her boyfriend, like everybody else, stopped believing her.

Oh, boo-hoo.

Stay focused. You’re now being timed.

All part of the productivity metric.

Forget the timer. It takes as long as it takes.

I like knowing how long it takes.

It was probably postpartum depression.

Doesn’t make the baby any less dead.

But we might have a little sympathy.

Because women are helpless victims of our hormones?

Like people who should be treated rather than punished.

What’s your favorite cake?

Lea and I need to pick a cake for our wedding.

Angel food cake.

Packing peanuts have more flavor.

Anything with cream cheese frosting.

I’d eat dog poop with that on it.

Oh, please, uh, don’t let me distract you.

So, Salen, it’s great to see you again.

I loved how you kicked the tires on this place.

Nice due diligence.

What a beautiful sound.

Discharge them.

Uh, we have a 48-hour post-op monitoring policy.

And now we have a new policy.

As soon as they’re stable, you’ll discharge them, to make way for other clients in need.

This is Madeline, came in experiencing dizziness and severe nausea after running in a college track meet.

And winning the 100 meter.

Urine analysis and abdominal X-ray were normal.

I could try a G.I. cocktail to rule out gastritis.

Sit back here.

Any pain here?

I just set a state record.

It’s heat exhaustion and dehydration.

You sprint in full face?

I doubt my makeup could run faster than I do.

I ran track in college.

Mmm?

I found the makeup really helped.

You feel well enough to step up on the scanner?

Yeah.

Inset your hand here.

Scanning.

It even knows what you had for breakfast.

Perfusion’s good, pulses are strong.

Not surprisingly, you’re in top physical condition.

I told you, it’s just…

She’s hypoxic!

We need to suction and protect her airway.

Meggie, my baby…

She’s fine.

Seven pounds, three ounces, and, uh, the lungs of an opera singer.

Can I see her?

Just a peek through a window, anything…

That’s not possible.

We’re gonna start processing your discharge.

After we run a few more tests, just to be safe.

I know you’re feeling overwhelmed right now, and I’m sure you’ll be experiencing anxiety, sadness.

If you do suffer from postpartum depression, you’ll need to get help.

I sure didn’t have that with Troy.

Those were the most wonderful days of my life.

So, that means I’m either a victim or a monster.

Pick a side.

We stopped the bleeding, but your CT confirmed a lesion in your lung.

Which may be benign, but we have to do a biopsy to know for sure.

If I had a lesion in my lung, wouldn’t that be slowing me down?

The rest of your lung is healthy and compensating very well.

Any history of lung disease in your family?

I don’t know.

A medical history can help dictate diagnostic and treatment options.

Can we contact your family?

No, um… my parents are…

They’re…

Your mother’s here.

Are you okay, Madeline?

That’s not my mother.

My parents died two years ago.

I was a toddler when she gave me up for adoption, and then went back to Cameroon…

I didn’t give you up. I was deported.

I let you stay in America so you could have a better life.

Welcome back. I worked in Cameroon for a while.

Is it okay if Esther gives us some medical history?

Does anyone in your family have high blood pressure?

I do. Is that the problem?

I told her she had to watch what she eats.

She won’t listen to me.

And why should I?

I barely know you.

Showing up at my track meets doesn’t make you a mother, Esther.

What about high cholesterol?

No.

In Cameroon, you don’t call elders by their first name.

Okay.

And you don’t show everyone all your goodies.

Your “parents” didn’t teach you respect.

Abby needs “a few more tests”?

You just don’t want to send her back to prison.

If she’d been getting decent healthcare, they would’ve caught the placenta previa long ago.

So if I can delay sending Abby back there, I will.

We’re discharging her as soon as possible.

Look at this.

Hypotonia?

She’s taking very little nutrition.

Maybe ultrasound her for a G.I. tract obstruction?

We could change the formula. She might just be a picky eater.

Good point. I’ll try that.

Right after the ultrasound.

Aaron.

Ooh, fishing flies.

Please don’t touch.

It’s harder than brain surgery.

Ow!

Your absence at the presentation this morning could be interpreted as a lack of support.

You think?

When we first met, you were a fake patient, and now you’re a hostile corporate raider.

This hostile corporate raider saved your hospital from being turned into condos.

I resign.

And I hate your new logo.

You’ve got a very loyal following, many of whom will be very opposed to this takeover.

You leaving could have a snowball effect.

My board of directors… and I think it’s important for you to stay on.

So you can draw on my expertise?

Or because you want a puppet?

Either way, you’ve got decent leverage.

Normally, I’d be offering stock options, salary incentives, definitely a larger office, but I suspect none of those will work.

So maybe, despite it being a money hole, I’ll just keep your clinic open.

How’s that?

Think about it.

Your baby’s not getting enough nutrition.

Her ultrasound was clear.

I think Meggie needs her mother’s milk.

Hey.

Hey, sweetie.

The biopsy confirmed the mass in your lung is malignant melanoma, stage four.

Your PET scan show it’s also in the lymph nodes of your neck, abdomen, and pelvis.

We’ll remove what we can and follow up with molecular and immunotherapies, but…

The prognosis isn’t good.

Even with all targeted treatments, you’re unlikely to live more than 12 months.

No.

I’m healthy. I’m strong.

I’m so sorry.

Pray, Madeline. We have to pray.

God will work through these doctors.

No!

I can’t be dying.

I’m going to nationals.

This can’t be right. It’s a mistake.

Stop praying!

Stop pretending like you care about me. You left me.

I do care. I love you…

No! My real mother loved me and accepted me.

I am your mother, and right now, you need…

No, I don’t need anything from you.

You’re nothing.

Please go away.

She’s vomiting. Cyanotic and O2 stats are plummeting.

She’s tachycardic.

Intubate.

CBC, BMP, stool sample, and echo.

And a tox screen for the mother.

What’s with the tox screen? The mother’s fine.

I didn’t change the baby’s formula.

I let Abby breastfeed her.

I’m wondering if there’s something in that breast milk that made the baby sick.

More likely it was antifreeze.

Right. She smuggled antifreeze into the hospital, from prison, under armed guard?

It’d be insane.

Like people who poison their babies.

We’ll be using a basic Ranked-Choice Vote.

It’s not as nuanced as the Kemeny-Young Method, which minimizes the sum of the Kendall Tau distances to the voters’ lists, but I decided that would be too confusing for you.

Intralesional injection?

Madeline’s melanoma is too widespread.

Only used for locoregional disease.

This carrot cake is amazing.

Mmm.

How about peptide vaccine?

Very high risk for immune attacks against normal tissue.

Ugh. Does anybody really like red velvet cake?

It reminds me of a dumb model, it’s delicious-looking but not worth the calories.

Mmm.

Complete lymph node dissection.

The lymphedema would be intolerable.

People die here, too, you know?

It’s my first day. I haven’t learned that yet.

Wait, there’s no way this thing knows I’m eating dessert, right?

I have been thinking about cake all day.

Oh, don’t let me interrupt you.

You already have.

And since you won’t be invited to my wedding, you don’t get a vote. Or cake.

You have an interesting affect.

Are you on the autism spectrum?

Please fill out your ballot.

I’m neuroatypical myself.

ADHD.

Mmm.

Okay.

You should look at Engineered T Cell therapy.

They’re all good.

That’s very unhelpful.

I’ve polled 12 people.

The cakes that got the most “loves” also got the most “hates,” and the only cake that no one hated is one that no one loved.

Why aren’t you working?

‘Cause I’m tasting cake.

Shaun, I… I have to tell you, I’m… I’m thinking of taking a break, of moving on.

On to fishing?

Maybe. Maybe not.

Uh, probably not. I don’t really like fishing.

I have no idea what I’m gonna do.

Are you sad about Debbie?

Yeah.

Yeah, I am. But you know what?

She wasn’t happy, so it’s probably for the best, and right now, I just think I want to take some time for myself.

You want to be alone?

I like people.

I just think I need to be around different people.

Different from me?

No. No.

I just think I need a big change, you know?

Well, there are plenty of changes here.

Yeah, none that I like, except maybe the iced coffee, surprisingly good for a cafeteria.

How are you coping?

I need you to help me pick the right cake.

Shaun, it’s your wedding.

Be selfish. Pick the cake that you like.

I’ve got no wife. I’ve got no kid.

I’m soon to have no job.

And I could get really depressed, but I’m not gonna do that.

I’m gonna embrace it. I’m gonna embrace freedom.

And for once in my life, I’m not gonna care about anything else.

I’m glad you have such a positive outlook.

You didn’t help with the cake.

We’ve scheduled your surgery, after which, we’ll start you on an aggressive course of molecular and immunotherapy.

So you’ll make me sicker first, and then I’ll die.

This could offer you several more months of healthy I…

Engineered T Cell therapy.

It’s an experimental treatment that teaches your immune system to fight the cancer.

Your body could cure itself.

You’re off my case.

The technology’s here.

The trial is available. Why not use it?

You were there to observe and learn, not diagnose and treat.

You’re not her doctor.

She doesn’t have specific mutations for most molecular therapies to work…

He offered her a treatment that wasn’t approved by me, you, or the FDA.

That’s a violation of protocol, not to mention, it…

The Wi-Fi’s good in here, right?

Just need to answer some e-mails.

Oh, please, continue your discussion.

Sorry for the overstep, Marcus, but I do feel T Cell therapy is a more effective option.

Well, Mateo, the trials were isolated, small sample, and not very encouraging.

Infection could kill her way before the cancer would.

And what about the patient? What does she want?

It was presented to her as a somewhat magical solution.

Sh…

I like magic.

Did you want to weigh in?

Oh, no. I’m… I’m not a doctor.

I do have two doctorates, though, neurotech and data science.

Not helpful. Right.

Give the client what she wants.

This is my case.

It doesn’t have to be.

Abby’s tox screen is clean.

Whatever the baby got, she didn’t get it from the mother.

At least not accidentally.

Sometimes, telling the guilty from the innocent is harder than you think.

It just got easier.

There are traces of antifreeze in the baby’s blood.

Doctor.

How’s Madeline?

The Chief of Surgery took over her case.

She’s in the very best of hands.

Can I see her?

I don’t think she’s ready.

I made a huge sacrifice when I left her in America.

I never thought she’d be so ungrateful.

Those people turned her against her culture, against me.

But that’s my fault.

I let her go.

You gave Madeline up out of love.

Don’t let regret blind you from seeing how wonderful she is.

And as for the people who made her that way?

Be grateful for all the sacrifices they made.

I used to be a lot like you.

If I was like you, Esther would love it.

Don’t let the white coat fool you.

I have some ink, too.

I just keep it covered at work.

My mother doesn’t like it, either.

My mom was a total hippie.

She didn’t care if I painted my face blue.

She just wanted me to be happy… no matter what else was going on.

Do you think she’d want you to go through this alone?

I’m here for another look.

You came home after I went to bed and left before I woke up.

It’s this re-programming.

It’s so frustrating, I may start punching things.

Make a list.

Of every single step that is required to complete your task and then cross off each…

Shaun, this isn’t about a heavy workload.

It’s about doing something that I know is a waste of time.

But you still need to do it, and this will solve your issue.

I don’t want a solution.

I don’t need a solution. I just want to vent.

Okay.

It is very difficult to find a cake that everyone likes.

Oh, I get it.

N-No. I don’t want to vent.

I just want a solution.

I wish I had one for you, Shaun, but I don’t.

Fresh out of solutions. The solution well is dry.

Y-You always tell me to use my words and explain how I’m feeling, but I did that, and I think it only made you more upset.

You’re right. I’m sorry.

And… you have just solved my problem, so thank you.

Your baby’s still in critical condition, but we’re now treating her for ethylene glycol poisoning.

We found antifreeze in her blood.

We’re forwarding this information to the authorities.

You can’t let this happen.

Not again.

Don’t let Meggie die, please.

BP’s dropping, heart rate’s crashing.

Crash cart!

That’s an Ethicure smile.

She might have had a uterine tear in the wake of her C-section.

We’d see it on the ultrasound.

Ah.

Ah. Badges are gonna have bigger photos, so we need bigger smiles.

Coag profile and CBC rule out D.I.C.

Bowel perforation?

Park’s exposure was…

You can do better than that. Just…

Sunshine!

Next.

Park’s exposure was perfect, as were my sutures.

No perforations.

Now, just imagine you live somewhere perpetually warm and sunny.

Wait, you do.

Work with what you got.

Overdistended uterus and atony?

Consistent with time of onset, clinical history, and the fact that we can’t stop the bleeding.

Yeah, she needs a hysterectomy.

So she never gets pregnant again? Win-win.

Win.

She’s guilty, Park. And I’m gonna prove it.

How?

I’m gonna ask her.

Salen. Hi. Uh, I’m Lea.

We met in the server room a few days ago.

You were pretending to be a patient, which I feel was dishonest and manipulative

You don’t like me. Duly noted.

No, no, I just think it’s important for people to explain how they’re feeling.

I did judge you, but I have noticed positive things, like more efficient sharing of external EHRs and a streamlined system to fast-track hospital transfers.

So perhaps I was being too harsh… Are we going in a…

Just moved up to grudging respect.

And I hope this isn’t headed for fawning admiration.

No. The programming I’m working on is complicated, redundant, and, quite frankly, pointless.

I can design something much better.

How long have you been programming?

Four years. Ish.

You went to U Pitt, got your degree in three years, designed and built cars, desktops, and entire coding systems from the ground up.

And the ransomware attempt that you thwarted saved this place a fortune.

And I love that you don’t come from I.T. theory.

You obviously don’t come from sales, either, because you really don’t know how to pitch yourself.

Yeah.

But I’d love to hear about this better program.

You wanna grab a kombucha?

Yeah.

I-I would love that.

This anesthetic cocktail of Versed and Pentothal makes people tell the truth.

Abby? I have a few questions for you.

Not talking to you, you stone-hearted bitch.

It’s working.

Abby, do you know what happened to your babies?

They are sick.

Do you know why they got sick?

‘Cause I’m a bad mother?

Because you gave them antifreeze.

Because I couldn’t protect them.

Abby, did you kill your first baby?

I could never hurt my babies.

I’m their mommy.

These scrubs have very rough seams.

Do you think Audrey would have made a different decision if I hadn’t been in the room last night?

Do you?

I know she has a personal interest in Mateo’s success, because he’s her boyfriend.

And I think how he appears to me is important to that success, no?

Audrey is a highly principled professional and a great boss.

I like you.

You re-ran all the baby’s tests?

Using gas chromatography analysis.

In case we missed something.

Good call.

The baby’s still in critical condition.

If it is antifreeze, why isn’t she getting better?

I have no idea.

Same, same, same.

I’ve solved it.

We will stack all five varieties and serve a quadruple-tiered cake.

Yes, four. Not five.

Five flavors, four tiers, because Devil’s food and red velvet are actually both chocolate.

The only difference is one uses natural cocoa and the other uses Dutch-process cocoa, which is alkalized with potassium carbonate.

A very minor molecular difference.

They’re not the same.

A very minor molecular difference.

It’s not antifreeze.

It’s propionic acid, which appears identical to antifreeze on all tests except gas chromatography.

Propionic acid is made by the body, if that body happens to be afflicted with methylmalonic acidemia, which is a genetic condition.

Her first baby probably had it, too.

It was Abby’s breast milk, not because it contained a toxin, but because it contained proteins that triggered production of the acid.

She is innocent.

They said I might find you in here.

Something about the big doughnut I find very calming.

You’re here to accept my offer.

I used to be a pretty decent poker player.

You developed a tell.

How much am I increasing the clinic budget?

Double.

If that’s what it costs to keep you engaged.

Oh, no. No. You don’t have enough money for that.

The clinic can run perfectly fine without me.

So can everything else in this place.

I plan on taking my role as puppet very seriously.

So what do I get for my money?

Exactly what you asked for… my support.

I plan on smiling and nodding through this transition, and nary a negative word will cross my lips.

That’s a much more passive interpretation of “support” than I had in mind.

Mmm. I’m not the only one with a tell.

Welcome to the Ethicure family.

We got all of the tumor.

And based on the T Cell response to your tumor cells, we’re very optimistic.

The day I gave you away, I put you in the prettiest pink dress and tied bows in your hair.

I stared at you, trying to memorize every curve of your little face.

I started to cry, but you, you, my strong petite fille, wiped the tears from my face.

“Don’t cry, Maman. Don’t cry.”

I gave my heart away that day, and over time, I grew to hate the people who took it, who took you.

But without their love and their sacrifice, you wouldn’t be the amazing girl that you are, and I love them for that.

Maybe where I come from has a little bit to do with how great I am.

Maybe we can be friends.

Work our way up to… Famille.

I would like that very much.

Tell me about your maman.

It wasn’t antifreeze making your baby sick.

She has a metabolic disorder, which we’re treating her for now.

Meggie’s gonna be just fine.

We think Troy had the same thing.

You were a victim.

We’ve let the authorities know that, too.

I’m sorry, Abby.

Congratulations.

I hear the results of your procedure were very promising.

You two make quite a team.

Thanks.

Do you have an office?

Maybe.

I remember my assistant saying something about that.

Uh, do you know what happened with Bernice Fisher and Derrick Bell?

Your surgeries from yesterday.

I rescheduled them when I took over Madeline’s case.

Did you schedule Derrick at San Jose General?

Because that’s where he’s being treated now.

And what about, uh, Stanley Ferlin, Kelly Jarnigan, and Thelma Sewell?

Those are my consults, and I’m seeing them all tomorrow.

Wonderful. Except Kelly was awaiting cancer biopsy results.

Twenty-four hours is a lifetime to put that off.

So you’re comparing scheduling issues to saving a young woman’s life?

All of our clients’ experiences matter, Mateo.

I understand your license is provisional.

Who you writing the article with?

I mean, T Cell therapy on melanoma, it’s kind of a big deal.

But, you know, I got to assist on two appies, a chole, and a hip replacement, so… there.

Not a lot of steps.

I just hit 11,000.

Mmm. That’s impressive.

Mmm-hmm.

‘Course it’s no 22,378.

It doesn’t measure steps.

It measures how many times you move your wrist in rhythmic motion.

So you log a quarter-mile anytime you have some “me time”?

I haven’t had any time for that, either.

Mmm.

I just strapped it to a dialysis pump.

That’s clever.

Mmm.

It’s also cheating.

It’s only cheating if the rules have merit.

Vive la revolution.

Regrets are for when you make a mistake, not for when you do the right thing.

I can handle Dr. Andrews.

After we took his case, made him look bad?

Andrews is gonna “supervise” the hell out of you.

I’m not worried.

You know why?

Because, guapa,

I get to see you every day, and that makes everything wonderful.

I solved our cake problem.

We serve them all?

Kinda brilliant, Shaunie.

I am quite proud of myself.

I solved my problem, too.

I pitched my program idea to Salen, and she loved it.

Mmm…

This soap is different.

And I’m proud of you, too.

You’ve done an amazing job with all these new changes, especially those scrubs, which you look super cute in.

What? No. They’re itchy.

We’ll wash them, try some unscented fabric softener.

Okay, this soap won’t come off.

Okay, no rush.

Paper towels?

Oh. I think they got rid of them for sanitary reasons.

No! No.

No.

No. S-Stop it. No. Okay.

Okay, Sha… Oh.

No.

Stop it.

I-I can’t, Shaun. Breathe.

Stop it. No, please stop it.

It’ll be okay. If you just step away from it…

No. Please. S-Stop it!

Yeah. It’s okay.

Shaun?

Stop it! Stop it!

Stop it! Stop it! Stop it!

You’re gonna be okay. Shaun.

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