Air date: October 25, 2021
Shaun, Andrews and Mateo treat Holly, a young girl whose father, Walt, has self-diagnosed her with visceral myopathy; after Walt proves to be right, Salen orders the team to treat him like a consulting physician, putting him at odds with Shaun who is dismissive and rude to him, eventually snapping at him. Andrews removes Shaun from the case as a result, but he acknowledges that Shaun was inappropriate but right. Although the team nearly has to remove most of Holly’s intestines, Shaun comes up with the solution of inserting a feeding tube into her colon to relieve the pressure, allowing Walt’s suggested treatment to work. Morgan and Park treat Gina, who desperately needs a lung transplant, and the two argue over whether or not to allow Gina’s estranged son Henry to act as a living donor against her wishes. Morgan later reveals that she has been taking hormone treatments in order to have her eggs frozen and expresses doubts about whether or not she’d be a good mother; although Park isn’t sure about her decision, he begins helping Morgan do the treatments. Shaun attempts to get Salen to remove the billboard and agrees to think it over for 48 hours and at Lea’s request, Glassman intervenes on the matter, agreeing to do some interviews in exchange for Salen removing it. Holly reveals that she was inspired to seek Shaun’s help from seeing the billboard, and Shaun agrees to let Salen keep it up if she fixes a flaw in his image. After Shaun changes his mind, Salen uses it as proof to Glassman that he doesn’t need to be coddled and is stronger for dealing with it by himself. Upon returning home, Glassman discovers that Lea has repaired the classic car that he has been working on and Glassman takes off on a trip.
* * *
It’s a nice photo.
I did not approve that billboard.
(SIGHS) Section 25 of your employment contract allows use of your image for publicity and marketing purposes.
I do not want to be the star of your ad campaign.
Are you ashamed of your ASD?
It’s amazing what you’ve accomplished.
Think of all the neurodiverse people you’ll inspire.
The billboard will inspire no one.
It is not fair to use my picture,
and it inverts my image.
My hair part is on the wrong side.
You’re emotional. I’m right.
Pick a random number between one and ten.
Did you pick seven?
I do not understand what you think that proves.
We’re not nearly as rational as we think…
Not in the way we see the world,
not in the way we think about the world.
I am constantly revisiting earlier decisions.
Then you should revisit your decision
to put up the billboard.
But you need to do the same.
Let’s take 48 hours, explore all sides of the issue.
Use reason, not emotion.
Then we’ll talk.
DR. ANDREWS: Representation’s important, Shaun.
Only 4% of doctors are Black.
I get my face out there whenever I can.
This isn’t representation.
It’s tokenism. Nah.
She’s not hiring more diverse doctors.
She’s just exploiting the ones who already work here.
“Did you know there are 26 cognitive biases and perceptual errors that affect the business community?”
It says doctors are especially susceptible to number 5… Anchoring Bias.
Initial impressions of a patient’s condition can make us ignore contrary evidence.
Dr. Murphy, there’s a new patient’s dad asking to see you.
And it’s more like demanding.
Oh, no. (SIGHS)
If you asked for me because I was on a billboard, that is not a good metric for picking a…
No, my metric is that you co-authored 23 papers, eight on pediatric surgeries, four on GI issues.
This is my girl, Holly.
Four years of puking, nausea, blood when she goes to the bathroom.
Now, I’m sure it’s visceral myopathy.
You’ve seen 19 doctors.
Have any diagnosed visceral myopathy?
They said inflammatory bowel, but it’s not.
She keeps getting sicker and sicker.
Hmm, your abdomen is distended.
Have you been vomiting?
Worse than ever.
This doesn’t seem to be a surgical case.
I’ll admit you to internal medicine…
I’ve done a lot of reading. It’s visceral…
Visceral myopathy doesn’t fit her symptoms well, and looking up diseases on the Internet is very unreliable.
Bowel is hypoactive.
She has a serious obstruction.
This has now become a surgical case.
You’ve had this cough for a month now?
Yeah, kept getting worse.
Last week, I had a little shortness of breath.
Figured it was worth flying back.
From India. What brought you there?
Meaning of life. (LAUGHS)
I’m actually not kidding.
I was a bookkeeper for the city, and I just…
Needed something more.
I traveled the world until I found it.
Religion? Mmm, more like spirituality,
but through service and charity.
I live a very simple life.
Just try and do as much good as I can.
You know, I don’t feel too bad today.
Ugh, I hope I didn’t overreact.
You’re hardly moving any air in your left lung.
MAN: Depending on when you last had your carburetor rebuilt,
you will need to determine which parts need replacing.
Obviously, you’re going to be replacing
all of the seals and all of the needles.
SALEN: You haven’t been answering your phone.
…the damper and the float.
Once you’re happy with your choice…
Odd, seeing how it’s a foot away from you.
If you’re not, please look at my other…
Let’s talk about the press interviews
I scheduled for you.
That you scheduled for me.
You see the problem there?
In my experience, support from the old regime
is essential for a smooth transition.
We agreed I’d have yours.
What we agreed on was that I’d smile and nod.
What do you think an interview is?
Just a few nice thoughts about Ethicure, and you’re all done.
I don’t have a few nice thoughts,
but I can give you the thoughts I do have.
I’ve scripted them for you.
Thank you, but I’m gonna focus on things
that actually need my attention.
But thanks for stopping by.
(GARAGE DOOR WHIRS)
(CLAMPS CLIP, MONITOR BEEPING)
DR. ANDREWS: Both sides of the obstruction are clamped.
Dr. Rendon, please resect segmented bowel.
MATEO: GIA stapler.
I’m going to give you $10 to share with Dr. Rendon.
Divide however you like.
If he approves the split, I’ll pay you both after surgery.
Oh, okay. And if he doesn’t?
Then you both get nothing.
I’m gonna keep eight and give Mateo two.
Two dollars is better than nothing,
which is what you’ve ended up with.
There’s nothing irrational about trying to increase
the amount of fairness in the world.
Number 12 on Salen’s list. “Unfairness Aversion Bias.”
It isn’t a “bias.” Why reward greed?
Colon wall’s a little weak.
I’ll send samples to path.
But obstruction’s been cleared.
PARK: You have idiopathic pulmonary fibrosis.
Uh, your left lung is heavily scarred.
The right is functioning,
but it’s damaged, too.
(BREATHING HEAVILY) Can you fix this?
We can start you on medicine to help you breathe,
and we can list you for a lung transplant.
Um, how long do I have without the… The transplant?
A month or two. (GASPS)
Oh, I should tell my son.
You didn’t put him on your paperwork.
I haven’t seen him since I left.
He was… (CLEAR THROAT)
12 years old.
Number 6, “Pro-Innovation Bias.”
Salen may believe the billboard is good just because it’s new.
Okay. Hard to know what she believes, but fine.
Number 8. “Loss Aversion.”
People demand much more to give up an object
than they are willing to pay to acquire it.
She might be overestimating the negative impact
of losing the billboard.
How many of your points
end up supporting Salen’s point of view?
You might have misunderstood the assignment.
I don’t think it’s about proving her wrong.
She wants to see you re-examine your own assumptions.
Holly’s pathology results.
Her father was right.
Your oxygen saturation is decreasing faster than we expected.
I’m gonna increase the…
12-year-olds tend to grow.
I heard you got married. I saw photos online…
Why am I… Sorry, why am I here?
There’s something wrong with my lungs.
Are you dying?
You waited until you were dying to call me?
And, what? Forgive you? No.
Do you even feel bad about what you did?
For hurting you?
(VOICE BREAKING) Yes, of course.
I wanted to keep in touch with you.
You said it was too painful.
Are you blaming me now? No.
The transplant coordinator says there’s a potential match.
Why are you here?
Walt spent four years researching Holly’s illness,
outsmarted every doctor.
No high school degree, but slept five hours a night
while taking every pre-med course at a junior college.
My dad’s the best doctor I’ve seen.
What made you think it was visceral myopathy, Walt?
Well, I figured it out last week.
Holly started having trouble peeing, and…
That’s just one data point. It’s not enough.
And her mom died a couple of days after childbirth.
Complications from her bowel perforating.
And visceral myopathy is genetically based.
Treat Walt like a consulting physician.
Involve this man in all medical discussions.
Let him watch surgeries.
Hell, give him a fitness tracker.
SHAUN: Okay. (SIGHS)
Oh, he is not a doctor.
20 doctors dismissed me and my very valid questions
before I was diagnosed with scleroderma.
Good ideas are good ideas, no matter the source.
We should involve him after we talk among ourselves
like we do with all patients’ families.
I don’t see any advantage
other than further enshrining doctors’ elitism.
I don’t want to have to pull my punches
when discussing that girl’s possible outcomes.
He’s been through hell with her.
We can be honest with him.
And via our Twitter feed, we can share an inspiring story
of how a father’s expertise supplemented our doctors’…
He’s not an expert!
Just because we haven’t found his blind spots
doesn’t mean we won’t.
That’s Number 19… “Extrapolation Bias..”
But it also doesn’t mean you will.
(SIGHS) I do not like this at all.
It’s a direct order from our boss, so I plan to love it.
San Francisco General says organ procurement’s at 1:00.
Lung should be here by 4:00.
Great. Couple months, Gina’ll be back on her feet
and being a terrible mother again.
Are you defending this woman? I feel for her.
I feel for her son, too.
Because you’re all about empathy.
She has done a lot of good in her life.
Maybe she shouldn’t be condemned to the walk of atonement
for one mistake?
One mistake for 17 years.
So, moms should give up their whole lives for their kids?
Actually, yes. Dads, too.
Is that what you were doing when you ditched Kellan
to do your residency here?
I made plenty of mistakes
that I still feel guilty about.
But unlike this woman, I tried hard,
really hard, and stayed in my son’s life.
WALT: Thank you.
You’re the first doctors who’ve shown me any kind of…
We need to do a right hemicolectomy
with an ileotransverse anastomosis.
You want to throw away half her large intestine?
I agree it’s a bit drastic.
We go in using the interop biopsies as a map,
we’d resect the most damaged areas.
No, we just need to get her intestinal motility going again.
But if she experiences more obstruction…
I don’t want to rip out a large chunk of my girl’s bowels, okay?
Now, let’s just keep thinking about other ideas.
Is there a reason you’re snapping your fingers?
It helps me think.
It does not help me think at all,
and my thoughts are useful.
We could put her on Rituximab.
I’ve only heard it used for cancers
and autoimmune disorders.
But it’s been shown to increase motility in kids by 30%.
It’s an interesting idea.
SHAUN: It’s a bad idea.
She could have a severe infusion reaction,
cause more damage,
leading to a much more drastic surgery later.
Or it will alleviate her symptoms
without her having to compromise her entire life.
We’ll go with the Rituximab. What?
It’s a reasonable option.
No. My idea was better.
So was yours.
But the patient’s father is not going to approve
either of our ideas.
MOGAN: They found a cancerous lesion in the donor’s lung
Wake her up.
Your mother’s developing severe pulmonary hypertension.
In a few days, she’ll no longer be a transplant candidate.
And there’s no chance you’ll get a new donor before then?
Not realistically, no.
You could be the donor.
We could remove your mom’s bad lung and replace it with a lobe from your lungs.
A living donor lung transplant hasn’t been done in the US for a decade.
It’s done routinely in Japan, and it’s the only way to save her life.
And there’s a high risk of surgical complications.
You’ll have a lifetime of labored breathing,
pain, decreased endurance…
Only if things go wrong.
You’d be in great hands with Dr. Park.
I just… I need to think it over.
We put this in to help give you the medication.
It’s called a… A PICC line. I’ve had a few.
Must be tough being in hospitals all the time.
Being sick is tough, but I love skipping school.
I was the girl who always had to run off to the bathroom,
who threw up on her desk.
You can imagine what the other kids said.
Mmm, what did we say about those kids, baby?
So, this medicine’s my dad’s idea, right?
But it’s not a good one.
I know it’s scary,
but we’ll get through this just like we always do.
You trust your dad.
It’ll work out.
But if it doesn’t,
it could kill you.
LEA: Key is to get the jets super clean.
You did clean them, right?
You saw the photo I sent you?
I actually saw the real thing. Mmm.
Yeah, he ran right to Salen.
Obviously, that didn’t go so well.
Otherwise, you wouldn’t be here
offering to help with my carburetor.
Yeah, they’re thinking it over.
I think she’s setting him up.
What does he think?
He thinks he can talk her into it.
Okay, perhaps he can.
Either way, he can’t keep asking his boss to bend to him.
What’s she gonna do, fire him?
She put him on a poster.
Will you… Will you just talk to him?
Feel him out.
See if I’m wrong.
He’ll be just fine.
But why are you still in town?
Work? Obviously not.
Seeing friends? Obviously not.
Mmm, you’d be in Tuscany, not your garage.
You’re here for Shaun.
So, why are you not helping him?
MOGAN: Maxed out on oxygen.
PARK: We’re gonna put you on BiPAP.
I’ll do the living donor transplant.
I’m going to give you a lobe of my lung.
Thank you, but no.
I’m not going to allow it.
I would never let you hurt yourself to help me.
Not after I… (INHALES DEEPLY)
I would rather die.
Now you care about me?
About my feelings?
I always did.
Then why did you leave me?
I hated myself.
First week I brought you home, I couldn’t get you to latch.
I couldn’t sleep. I was completely overwhelmed.
But that feeling…
It never went away.
And all the energy I should have used loving you…
I used trying to not to fall apart.
So, I finally just chose…
My own happiness. (SOBS)
But you were strong,
and (SIGHS) your father was a good man,
and I knew that he would love you in a way that I never…
I knew you would be okay.
You have no right to tell me that I’m okay.
Every day, I would walk home from school
praying that you’d be there.
And every day, a piece of me was destroyed when you weren’t.
I was a little boy who loved his mother…
(GASPS, MUTTERS INDISTINCTLY)
Who thought his mother didn’t love him back.
And now you tell me I was right?
(ALARMS BEEPING) (GASPING) Oh, I can’t…
Ooh… Florid respiratory failure.
(RETCHES) (ALARMS BEEPING)
She’s puking up blood!
Distended, firm, rebound tenderness.
Her bowel’s perforated. We gotta get her back to the OR.
I was wrong.
(BED FRAME CLANKS)
MOGAN: Your mom is on a ventilator,
and Dr. Park is placing her on ECMO.
It will oxygenate her blood
now that her lungs are no longer working.
Your mom is unconscious, and she has no living will.
By California law, you have power of attorney
over all her medical decisions.
He’s got a clear conflict of interest.
He wants the transplant… They want the same thing.
She said, and I quote, “I’m not gonna allow it.”
She’d rather die. You finding ambiguity in any of that?
Her priority was her son’s happiness, not her own.
Do the transplant.
So, you’re just gonna decide she was wrong
about what she wanted for herself? For her son?
Her proxy is. Her son is.
And you’d better hope this works.
Uh, we need to do Dr. Murphy’s plan from before.
The right hemicolectomy?
SHAUN: We missed our chance.
Now we have to do a full colectomy
and a resection of most of the small bowel.
It’s the only way to prevent another perforation
that would kill her.
But I read a case report where they’re using prokinetics
and…. And acetylcholinesterase inhibitors
to strengthen motility in kids.
That could help, but it wouldn’t be enough
to overcome the pressure from future obstructions.
We just reduce the pressure!
I mean, we can put, uh, tubes above and below. I’m not following.
Because it makes no sense. Shaun, let him talk.
Suctioning above and below
wouldn’t reduce the burden of a focal obstruction!
Don’t tell me what I’m getting wrong!
Help me find a way to do this!
Look, this is the affected part of the bowel.
Stop it. Stop it.
Please, stop it! Stop it!
Stop it! Stop it!
I am trying to help your daughter!
Dr. Murphy, you need to leave.
No, I do not need to leave. He does!
He made us give her Rituximab, and it made her sicker!
Why are you even here? You are not a doctor!
Get out of here now, Shaun.
Dr. Murphy was inappropriate, but he was right.
Let me be the one to tell her.
We could hand-suture with a running 4-0 prolene.
No, we need interrupted sutures for the cartilaginous portion.
Okay. End-to-end anastomosis.
Bronchial sizes don’t match up.
Fine. Telescoping technique.
No. Why not?
I don’t know. I just…
Don’t like it.
What are you doing?
I’m obviously feeling some pressure
to make sure the transplant comes off safely, and…
Yes, that’s the only thing you’ve been doing that makes sense.
Everything else on this case, you’ve been unfair, emotional.
I’m sorry. This…
This has nothing to do with you.
I… I don’t… Just shut up.
I’ve… I’ve been emotional because…
I’m hormonal, and I’m hormonal
I’ve been sneaking off
and injecting my butt
with insane amounts of HCG and Gonal-F,
which is making me feel like a total lunatic.
You’ve been freezing your eggs.
Why didn’t you tell me?
(SCOFFS) Like an icebreaker?
(SNIFFS) “I know we just got together.
“Guess what, I’m two months into egg retrieval”?
I’m not even, uh…
I’m not even sure I want kids, or…
Whether I’d even be a decent mom.
I’m certainly not the most unselfish person.
And, uh, who’s to say
I’d make better choices than Gina?
Who knows if anyone would ever defend me?
I should go.
(SIGHS) How you doing?
I have been put on a billboard and kicked off a case.
Yeah, well, I spoke with Dr. Andrews,
and there’s not gonna be a note in your file
or anything like that.
What about this other stuff?
Yes, Salen gave me 48 hours.
I’m going to talk to her tomorrow morning.
What are you gonna say?
I have 30 bullet points.
(SIGHS) Maybe we should talk these through?
Maybe narrow them down a little?
I know I was right about that girl’s treatment.
But nothing I said convinced her father.
I just made him mad. She just got sicker.
I know I’m right that this billboard is a mistake.
But I think I won’t be able to convince Salen, either.
I keep knowing I’m right,
but I can’t change anyone’s mind.
GLASSMAN: Excuse me, fellas.
Sorry, guys. Can we have the room for just one minute?
There is no justification, none,
for exposing an employee’s personal medical records.
Take the billboard down.
It’s noisy. Makes people talk.
Yeah, about how awful it is.
It’s also possibly illegal.
Why are you coddling Shaun?
Nobody made accommodations for my ADHD.
That was hard,
but it made me stronger, smarter, more resourceful.
We have different problems and different strengths,
but I know if you keep patronizing him,
That is very impressive.
Apparently, your attention issues give you the power
to see into the souls of people you’ve barely met.
I’ve known Shaun for 15 years.
You’re like a dad to him,
but sometimes, parents make the wrong choices
when it comes to their kids, despite loving them.
Or maybe because they love them.
I’ll tell you what… I’ll do the interviews.
And when Shaun comes to see you,
you’ll make him believe that he convinced you,
and you’ll do what he wants you to do.
Your bowel got sicker real fast.
And… And that’s why you had the perforation.
So now we gotta remove your large intestine
and most of your small one.
So, I’ll have to have that bag attached to me?
Like, my whole life?
There’s improvements every year in ostomy care.
But I can still eat, like, normally, right?
I won’t need that IV nutrition thing?
Baby, that… that’s not clear yet.
No, my dad’s wrong. Tell him he’s wrong.
I’m so sorry, Holly.
You promised me. (SNIFFLES)
You said you’d fix this. I know.
You said to trust you.
I know I did.
But I failed.
I’m so sorry.
HOLLY: I thought you’d be different.
That’s why I asked for you.
You did not ask for me.
Your father did, and that was because…
He had like six doctors that he liked,
but I saw the billboard and said it had to be you.
Because you were different,
like me, and you’d think different.
And we needed that.
We’ve cleared the omentum covering.
Let’s proceed to prep for the excision.
I was wrong about the billboard.
That’s good, right?
No, it’s not.
When I saw it, I thought it was dumb
and my ASD would inspire no one, but it did.
It inspired the very first patient I saw,
and if I wasn’t being rational about that,
maybe I wasn’t rational about this case.
Maybe my emotions got in the way.
I shot him down. I wasn’t open.
I’m sure you were fair. No, I wasn’t.
When? The whole time.
I yelled at him.
I… I yelled at him
when he was talking about the pressure in her colon.
It made no sense. He did not know how it worked.
Well, if it made no sense, then… It must have made sense.
He’s very smart.
He must have been thinking of something. Something that…
ANDREWS: I’m going to begin the excision of the large intestine.
(BANGS ON GLASS) What the hell?
Have you ligated any critical vessels? Hey!
We were just about to. (SIGHS) That is good.
You need to insert a PC tube to the colon.
A feeding tube? She can’t absorb nutrients.
Not to feed her. As an outflow mechanism.
Pressure valve for emergencies,.
It’ll keep her GI tract viable.
What about the muscle weakness?
It’s what Walt said.
We use the prokinetics and acetylcholinesterase inhibitors
to increase contractility and movement.
ANDREWS: Walt, I’d like to revise the surgical plan
and invite Dr. Murphy to scrub in.
Yes, to both.
No bleeding, no bruising, no signs of infection.
(SIGHS) Oh, thank you so much. Both of you.
We wouldn’t have gotten here without you.
Dr. Murphy, don’t you think my dad would make a great doctor?
Mm, I’m not sure.
He had some very good ideas, but also some bad ones.
He is a very good father, though.
One of the best I have met.
Hey, careful. The sutures.
Oh, what happened?
I didn’t want you to die.
I have to make this up to you.
I’ll move to California. I’ll do whatever…
You’ll never be happy.
I don’t deserve to be happy.
You shouldn’t love me.
When you left us…
…I really acted out.
I would fight with Dad all the time.
But he would remind me that…
He was gonna love me
no matter who I was or what I did.
Because he was my dad.
I’m gonna love you like that.
Because you’re my mom.
My baby boy.
Yes, uh, well, um… uh, indeed.
I am, uh, using my custom fitness tracker because healthy doctors make healthy…clients.
Are we gonna be talking about paint?
Can you ask me an– a-another question?
Yeah… Yeah, well, d– uh, different kind of d-doctor, different kind of hospital.
That one? When did you see “that one”?
Really? Um, you know what?
We’re gonna have to do this, uh, another time.
We had a deal, didn’t we? Didn’t we have a deal?
What was supposed to happen was,
you were supposed to take down the billboard.
Did you forget? Calm down.
I’m not gonna calm down!
You don’t treat Shaun like this.
Shaun’s the one who asked me to keep the billboard up.
I don’t believe that.
(CLICK, TAPPING KEYS)
“Dear Salen, I have changed my mind about the billboard.
It can stay up.”
“As long as you fix the image so my hair part is on the correct side.”
Haven’t had a chance to do that yet.
He handled this on his own without you.
And he’s better off because of it.
The truth is, I’m not young.
And I never would have chosen to be a dad again.
But I also didn’t choose to fall in love with you.
So, now I’ll do what it takes to make this relationship work, whatever you decide to do.
I-I-I plan to with, uh, caring, with…
Prove it right now.
And you wouldn’t just be a decent mom. You’d be a great one, because…
Not now, please.
SHAUN: Maybe I was wrong.
Maybe I don’t need them to fix my hair.
Nah, it does look a little off.
♪ Oh, there’s something in my mind that’s killing me ♪
♪ There’s something that this life’s not giving me ♪
♪ Would you say ♪
♪ There’s something in my mind that’s killing me ♪
♪ There’s something that this life’s not giving me ♪
♪ Would you say ♪
♪ Oh, we don’t know if we leave, will we make it home ♪
♪ But we all know, if there’s hope, then we’ll be okay ♪