The Good Doctor – S05E05 – Crazytown | Transcript

Dr. Park and Dr. Murphy treat an elderly Asian man brought to St. Bonaventure by his daughter after being the victim of a hate crime. In addition, Lea goes behind Shaun's back to help raise his negative patient satisfaction scores.
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The Good Doctor - S05E05 - Crazytown

Air date: November 1, 2021

Shaun, Jordan and Park treat Mr. Song, the victim of a hate crime who is diagnosed with a brain tumor; after learning that the surgery to remove it will result in permanent weakness, Mr. Song refuses treatment and Park and Jordan’s attempts to get him to change his mind with his daughter’s help fail. After Mr. Song’s condition worsens, Shaun’s blunt honesty convinces his daughter to approve the surgery against his wishes as his medical proxy; ninety-eight percent of the tumor is removed and Mr. Song is left with permanent weakness on his left side, but he accepts and respects his daughter’s decision. Lim and Asher treat Rosa, an ex-girlfriend of Mateo who is currently in Guatemala on a medical mission; Andrews later transfers Rosa to the county hospital, convinced that Lim is letting her emotions get in the way with Asher attempting to convince Lim not to risk her career for Mateo. Lim successfully operates on Rosa at the other hospital, but learns details about Mateo and Rosa’s failed relationship that mirror his sudden departure and ignoring of her calls; as a result, Lim leaves Mateo a voicemail breaking up with him. Morgan attempts to get Park to elevate himself in the eyes of the medical community, but Park is happy where he currently is and worries about the impact of Morgan’s own ambitions on their future together. Shaun goes tux shopping, but is ghosted by Glassman who is continuing his vacation. After discovering that he has the lowest approval rating in the department, Shaun attempts to improve his scores without success; Lea later secretly deletes several scathing reviews of Shaun, improving his rating. Salen asks Andrews out for dinner which he accepts.

* * *

Think of these not as a report card, but a window into the minds of your clients, their families and support persons, and also as a window into yourselves.

To see your greatest strengths and the areas where you have the greatest opportunity for growth.

First round of results is already in your inbox.

Regular updates to follow.

[CLEARS THROAT]

Third highest in the department.

Pretty good.

Second.

How’d you do?

Fine.

[SIGHS]

“Dr. Reznick cares deeply about people.”

“Sweet.” “Kind.”

[CHUCKLES]

“Thoughtful.”

What do I have to do to get that level of service?

Let me bill your insurance.

You have six comments.

Four “OKs.” Two “Goods.”

I have 46.

It’s hard to live in your long, sweet shadow.

I’ll give you some pointers. We could role play.

You could be the shirtless and eager-to-please doctor, and I’ll be the sexy-but-demanding patient with a nasty fungal infection.

Top five. Nice work.

Thank you.

But as Chief of Surgery, wouldn’t hurt to aim higher.

Speaking of which, where’s my numero uno?

Dr. Rendon. Top of the class.

Oh, he was called away on a medical mission in Guatemala.

It was urgent.

Huh.

Heroic.

When will he be back?

Should be just a few more days.

In the future, please let me know about any extended absences, hmm?

He can’t make our clients happy if he’s not in the country.

[CELL PHONE VIBRATING]

I have to go.

I had the lowest ranking in the entire surgical department.

I made five people “very uncomfortable.”

Seven patients said I talked weird, and one woman was “a little creeped out” by my manner.

The algorithm has some major blind spots.

I can make it better. I’ll talk to Salen.

No. The data reflects actual opinions.

I will learn how to make people feel comfortable and improve my scores.

[DOOR OPENS]

Rosa Castillo, 35, needs immediate bypass surgery for acute kidney failure.

She was treated for renal artery stenosis three years ago.

Looks like the stent failed.

Mm-hmm.

This imaging is barely readable. It’s from 1985.

Try Guatemala.

Mateo sent her here.

They don’t have the equipment for a bypass.

Ms. Castillo.

I am Dr. Lim. This is Dr. Wolke.

I heard so much about you.

The Chief. La Jefa.

Oh. Well, hopefully, we can have you in the O.R. in the next couple of hours.

We already have your medical history from Dr. Rendon, which helps.


Teo told me I would be in good hands here.

Uh, is that what all his patients call him back home?

Probably just the ones who dated him.

[MONITOR BEEPING]

Bruising of the jaw, sublingual hematoma, most likely a parasymphyseal fracture.

It’s just a little bump. I’m fine.

You’re not fine, Dad.

How did it happen?

Ah, some kids were horsing around outside when I was opening up.

He runs a hardware shop. They attacked him.

It was an accident.

I fell off the sidewalk into someone’s side-view mirror.

Your jaw’s broken.

They pushed you off the sidewalk, told you to not get them sick.

They were just being stupid.

[SCOFFS] She’s so sensitive.

Checking for abnormal movement of the mandible or any malocclusion.

Okay, we need to file a report.

A report? Why would I…

[GASPING]

[ALARM BEEPING]

The fractured bone and tongue are sliding backwards, blocking his oropharynx.

We need to secure the airway, now!

[GASPING]

ANDREWS: Placing the last two-millimeter miniplate.

He must have been in a lot of pain.

PARK: [SIGHS] Good for you if you can stay positive after a hate crime.

Satisfactory occlusion and fragment reduction.

Doctors Allen and Murphy, let’s remove the temporary MMF.

SHAUN: Mr. Song and his daughter see the same situation very differently.

[ALARM BEEPING]

He’s bradycardic. Heart rate dropped to 35.

And hypotensive, 73 over 42.

Let’s dial back the sedation and opiates, push one milligram I.V. atropine.

ALARM STOPS, MONITOR BEEPING STEADILY…

Jordan: Maybe an adverse reaction to the anesthesia?

We need to figure out if there’s an underlying cardiac problem.

Get a post-op EKG, echo in recovery, and check for electrolytes.

SHAUN: And I need to figure out how to get a good review from both of them.

SALEN: How’s the water pressure?

Fine. I decreased output by 5%.

Saves 150 gallons a month, $17,000 annually.

Which, in three years and five months, will make up for what you’re about to spend operating on this new client, whom Dr. Rendon gifted us.

Mateo’s commitment to patients is the reason he’s numero uno in the department.

My concern isn’t Mateo.

You allowed him to fly in an uninsured patient without informing me.

Do I still have the autonomy to run my own department?

I hope you see yourself as more than just the head of one department.

You are a vital member of the Ethicure family.

[WATER RUNNING] We have to work together, all of us, or we will all… falter.

LEA: The colors on these are wild.

Mm-hmm.

That yellow would look great with your complexion.

Full-crested double gerbera daisies.

Mr. Song has sinus rhythm on his EKG.

Normal electrolytes, and no abnormalities on the echo.

Which rules out a lot, but not a P.E. or small cardiac contusion.

Get a CTA chest.

Gerberas produce excessive amounts of pollen, which can trigger migraines.

You don’t need to be here for this.

Text me.

Yeah.

Excellent point about the gerberas.

Lucky me, working with such a fabulous, knowledgeable couple.

Mm, gerberas are notoriously big pollen producers.

It’s an obvious point, not an excellent one.

You called Lea and me “fabulous.”

Are you using hyperbolic language to make us like you?

Mm, I think the language was pretty accurate, actually.

Hmm.

I’m trying to improve my own client satisfaction scores, which are poor.

You received 97% five-star reviews on Yelp.

Your methods must be very effective.

Are you using hyperbolic language to make us like you?

It’s all about appeasing and affirming.

Appease. Give the customers what they want.

And affirm. Make them feel that what they want is wise and good, which in your case, it is very much so.

LIM: Rotating everything medially to expose the renal vessels.

ANDREWS: I got three lap choles waiting for Dr. Rendon on Wednesday, little thank-you gift for letting us operate on his patient.

Well, might be Thursday before he’s back.

Sorry the humanitarian crisis is screwing up your schedule.

There’s a massive aneurysm cutting off blood flow.

There’s no way to get vascular control for reconstruction.

We might be able to do a bypass from the aorta or iliacs.

ASHER: There are several aneurysmal segments along the abdominal aorta.

This one’s abnormal, too.

All of her arteries are defective.

[ANDREWS SIGHS]

You should take me on a date tonight.

Okay. It’s a lecture on leadership in medicine by Dr. Chandra.

Recipient of two NIH grants.

That’s not a date. That’s homework.

Starting the scan.

There’s a cocktail party after.

How about we spend our time doing that role playing you suggested?

You know, minus the fungus.

The infection was the whole motivation for my character.

Your guy’s heart is fine.

Make sure you break the good news.

Should bump up your scores a notch.

The tests show your heart function and anatomy are normal.

The episode during surgery was probably just a minor anesthesia reaction.

You should be good to go very soon.

[SIGHS] Thank you, Dr. Allen.

We can stop by the police station on the way home so you can make a statement.

I told you, no reports, no statements.

BP is 133 over 70.

Checking O2 sat.

Appa, these things are underreported.

Our relatives, our friends, our people are getting hurt out there.

[SIGHS] “Our people.”

It’s not us versus them.

That doesn’t help anyone.

You don’t think we’re seen as different?

You want to be seen as different.

You rub people’s faces in it.

That’s why you aren’t getting anywhere.

You don’t have a real job…

Community organizing is a real job.

I am lucky to have such fabulous, knowledgeable clients.

Emily, you’re right

about the importance of recognizing problems.

Mr. Song, it is wise to be concerned for your daughter’s professional future.

Please, Appa.

Go with me to make a statement.

It’s important.

Not to me.

You’re right.

Community organizing does not sound like a real job.

It’s a real job.

Heart rate dropped.

[ALARM BEEPING]

A-line shows a widened pulse pressure reading.

[BREATHING HEAVILY] Something is wrong… with my heart?

Respiration rate down, trending apneic.

Cushing’s Triad.

75 grams of mannitol.

Your heart is fine.

There’s something wrong with your brain.

It’s invaded the motor strip, left temporal, anterior corpus callosum.

Severe necrosis and edema, and no way to see where tumor ends and brain begins.

[SIGHS]

It’s inoperable.

I will definitely get a bad review.

I need more time to find a surgical solution.

[CELLPHONE CHIMES]

But we also need to leave for our tux fitting.

[CELLPHONE CHIMES]

We were able to bypass the renal artery using one of your veins.

But new imaging showed you have a condition called Fibromuscular Dysplasia.

It’s caused areas of stenosis and aneurysm in your heart, brain, and other major vessels.

We can give you medication to manage the underlying condition, but we’ll have to do another surgery to repair each of the aneurysms.

There are risks of stroke, or major hemorrhage.

But without it, it’s only a matter of time before one of these aneurysms ruptures.

[EXHALES SHAKILY]

Um, if anything goes wrong, can you please let Teo know?

He should be the one to tell my family.

I wouldn’t want them to hear it from a stranger.

Of course.

We could use intraoperative stimulated raman histology to determine tumor tissue versus normal.

PARK: Eh, if we resect normal tissue, we can’t put it back in.

Drape is perfect with your physique.

Intraoperative MRI guidance would help us achieve gross total resection.

And risk resecting eloquent cortex, with major deficits.

[SIGHS] You look like a little boy.

The shoulder sag is awful. Take it off.

That was neither appeasing nor affirming.

But your reviews are exceptional.

You can’t just tell people what they want to hear.

You’ve got to give them the cold, hard truth.

I always do that, and people don’t give me good reviews.

You have to follow it with a compliment, which now, thanks to your honesty, they’ll believe.

Very striking with those eyes.

I… do believe you.

GLASSMAN: Yeah, hey, Shaun.

Um, sorry for not replying.

You’re late for the tux fitting.

Oh, yeah, um…

I’m in Montana?

We need to reschedule your appointment.

When will you be back?

Well, I’m not so sure.

I’m heading towards a little town called Paradise, and I’m… I’m thinking of hunkering down there for a little while.

How about Wednesday, 12:00 p.m.?

Will you be done hunkering by then?

Sure. [SCOFFS] I’ll see what I can do.

[LIGHTS BUZZING]

You are confirmed. Goodbye.

We have to get back to the hospital and talk to Mr. Song.

With only chemo and radiation, you would die soon.

But I’ve found a way to remove the tumor using fluorescent light.

If we administer 5-ALA before surgery, the cancer cells will turn pink under the light.

Then we can resect those cells and leave healthy tissue unharmed.

You will likely have paralysis on your right side, but no cognitive or speech impairment.

[SIGHS]

No.

I’ve always taken care of myself.

Without this procedure, you’d have a year at most.

I’d better make it count, then.

No surgery.

Chicken pepian, from the place down the street.

Mateo says it reminds him of home.

Funny. When he was “home,” his favorite food was pizza.

[BOTH CHUCKLE]

You’re very kind.

I’m not sure I would be this nice to the ex-girlfriend of my current boyfriend.

Mateo told you about us?

No, but you’re his type.

Beautiful. Smarter than he is.

And Dr. Wolke let something slip.

Ah.

I can’t quite picture Teo here.

Everything is very nice.

And shiny.

Mm.

Did you meet here?

No.

We met in Guatemala.

And then he decided to move.

[CHUCKLES]

It was a little…

Romantic?

Crazy.

[CHUCKLES] Yes.

He moves fast when he knows what he wants.

We were practically living together by our third date.

Were you together a long time?

Six months, maybe less.

Long enough for me to start imagining what our kids would be like.

But then there was a war in Congo or an earthquake in Haiti.

Someone, somewhere needed him.

But I am glad he’s found a place to settle down.

I wasn’t sure that would ever happen for him.

You left me. At the party?

I was tired and bored. I went home.

Without saying goodbye.

I was about to introduce you to Dr. Chandra.

I didn’t ask you to do that.

And I didn’t ask you to tell that guy from Stanford that I’ve done over 50 robotic surgeries, or give that research fellow my ABSITE scores.

It’s calling mingling.

Felt more like being pimped out.

What can I say? You’re a stud.

I’m fine. I’m good. My scores are average, and it’s driving you crazy.

You’re not average, but you shy away from the spotlight.

You’re a hot Korean martial artist surgeon, and your face isn’t on a poster.

Why do you think that is?

I just want you to reach your full potential.

I mean, don’t you want that for yourself?

ASHER: Rough night?

Not really.

Oh.

You know, when I don’t sleep well, it’s usually anxiety about work or why some hot guy isn’t texting me back, or, oh, he sent his ex-girlfriend to me for help.

I was up late prepping for this surgery.

Yeah. Me, too.

I have moisturizer in my bag, just, if you want it.

Where is she?

Rosa was stable, so I transferred her to County Hospital this morning.

She’s my patient, and I’m your boss.

This is the right call for our department.

She’ll get the care she needs, and as a non-profit…

Their team has far less experience with this kind of surgery.

I know this patient is important to Mateo, and he’s important to you, but we cannot allocate our limited resources based on personal feelings.

Oh, this has nothing to do with Mateo.

You are risking a woman’s life so you can crawl further up Salen’s ass.

I’m protecting this department, which is actually your job.

Pedes just hired three new nurses.

I got approval for a portable X-ray.

When’s the last time Salen approved one of your requests?

This is a hospital, not a swap meet.

It’s her hospital.

I’m contacting County.

You can’t bring her back here.

I know.

What about a limited temporal lobe resection?

Lower the risk of future brain herniation?

Good for preserving motor function, but he’d likely lose speech.

Why is my dad still here?

He isn’t telling me anything.

Emily, the break room is for surgical residents only.

Your presence is not only prohibited, it is unwelcome.

You’re distracting us from trying to change your dad’s mind and save his life.

That sweater is very striking with your eyes.

You should talk to him.

So he can tell me everything’s fine?

He needs you.

I used to be a cop.

In part to try and please my dad.

He was all about being tough.

He always had this, uh, wall up, you know?

He came over with nothing.

Didn’t know the language.

He got by on very little for a long time.

It took a while for me to realize it, but being tough was just… a survival strategy.

My dad came here when he was 19 and went “from a socket wrench and a couple bolts to Number One Convenience Hardware in the Bay, no problem.”

I get that he’s strong because he had to be.

And I get that it helps him to deny how the world sees us as “other.”

But when you do that, it can make people who are struggling feel messed-up and…

Alone.

Maybe he’s protecting you not because he thinks you’re weak but because he’d rather take on the world all by himself than see you get hurt.

Your dad’s a fighter, Emily.

But so are you.

And he needs you to fight for him right now.

Why haven’t you told your daughter what you’re going through?

When she was a little girl, she’d help out at the shop.

[CHUCKLES]

Make a mess, more like, disappear in the middle of stocking fasteners.

I’d find her hiding behind the counter.

Someone said something mean, made her feel bad.

That’s… That’s the world.

I sell hammers to people who hate me.

I get their money, they get their hammers.

I kept my head down, built a life for our family, for her.

So, when I’d see her upset, I’d tell her, “Hey, forget that guy.

Focus on the next customer.”

I don’t want her to hurt.

I need to be strong for her.

Mr. Song, the best way to show your daughter what strength is…

Tell her what you’re going through.

She’s not the little girl hiding behind the counter anymore.

[KNOCK ON DOOR]

Mm.

I heard you’re doing Rosa’s surgery at County.

I would like to assist.

You don’t have any surgical privileges at County.

And unless you want to piss off the CEO, you shouldn’t do it anyway.

Maybe you shouldn’t, either.

You don’t know when Dr. Rendon is coming back, do you?

Before I got into this program, I had heard so much about you, how you were smart and talented and tough and fair.

And at first, I was like, “Oh, my God. Stop. I get it.”

But…

But I didn’t.

Until I met you.

Everyone who works for you is a better doctor because of it.

And I would hate to see you put everything you’ve worked for on the line for someone who isn’t willing to do the same for you.

Thank you.

Don’t ever give me advice again.

Whatever you and Jordan said has improved the situation.

How did you do it?

I just affirmed where Emily was coming from and… helped her see where her dad was coming from, too.

That’s what I tried to do, and it made them both angry.

There’s some shared experiences.

Because you’re both Asian.

American, yeah.

Both second generation, similar fathers.

You’re both outsiders.

Yeah. I guess that’s, uh…

Um, my dad told me about the tumor.

Did you convince him to accept the surgery?

The thought of losing him terrifies me.

But he needs my support now.

Which means supporting his decision.

Thank you for helping me see that.

I was wrong.

What you and Jordan said has made the situation worse.

SHAUN: My clients are finally in agreement with each other.

But against me.

I’m sorry, Shaun.

I love the tuxes, but where’s Glassman?

Oh, he is “hunkering down” in Paradise.

Dr. Park, Emily, and I are all outsiders, but I failed to connect with her, and Dr. Park succeeded.

To connect with people, I need them to like me, which they do not.

I need new strategies.

Shaun, I know you grew up not feeling accepted, you didn’t have many friends…

No. I did not have any friends.

Maybe the scores are bringing up some of those old, painful feelings?

The scores are providing useful data to help me track my progress.

Many people like you. Why do you think that is?

Shaun, obsessing over whether or not people like you is a guaranteed trip to Crazytown.

That is very easy to say when you are likeable.

You’re an amazing doctor, which any functioning, decent algorithm should recognize.

If I just talked to Salen, I…

No. I don’t want you to do that.

It might be simpler.

Do you think I can’t improve my scores?

Of course not.

I know you can.

[CELLPHONE VIBRATING]

Mm. I have to go.

[ALARM BEEPING]

PARK: Securing the airway.

Give another two milligrams Lorazepam.

What’s happening?

The seizures and brain herniation will only get worse as the tumor grows.

All we can do now is keep him in a medically induced coma.

Until the tumor kills him.

Without waking up first?

There’s nothing you can do?

You are his medical proxy.

Now, your dad rejected surgery when he thought he still had time.

It’s possible he’d make a different choice now.

He made it clear he didn’t want to live weakened in any way.

He’d hate me for choosing the surgery for him.

I can’t.

That is a very bad, very irrational decision.

It doesn’t matter if your father hates you.

Being liked doesn’t matter, and worrying about that is a guaranteed trip to Crazytown.

What matters is saving your dad’s life.

Your watch is a very nice shade of orange.

Teo’s lucky to have you.

I told him he better not screw this one up.

You talked to him?

Mm. Earlier today.

Only for a minute.

He said he’ll be back soon.

Hopefully.

The nurse will come by in a couple minutes to take you to the O.R.

[VOICEMAIL BEEPS]

Hello, Dr. Glassman, you haven’t accepted the calendar invite for the rescheduled tux fitting.

Should I send another one?

Also, in attempting to improve my performance with my clients, I have not many progress, even though…

EMILY: Dr. Murphy?

You were right.

Nothing matters except saving my dad.

Do the surgery.

Ignore the part about not making progress, but please respond about the calendar invite.

[CELLPHONE BEEPS]

We got over 98% of the tumor, and your prognosis is very good.

As expected, we weren’t able to preserve full motor strength in your left arm and leg.

Who…

I told them to.

Appa, I couldn’t stand to lose you.

I know you may never forgive me or speak to me again, but at least I know you’re still here on the planet with me.

That decision… took a lot of strength.

Good thing my daughter’s so tough.

Wonder where I got that from.

Everything went well.

I was able to repair each of the aneurysms.

We should have you home in a week, maybe less.

Thank you.

Yeah.

How did it end, between you and Mateo?

It’s none of my business. [CHUCKLES]

You don’t have to answer that if you don’t want to.

He would go on medical missions all the time, sometimes with no notice.

I would wake up and find a little gift, like a book or a bottle of wine, and a sweet note.

After a few days, or weeks, he would come back, and everything would be good.

And then one time, he didn’t.

I waited for a long time.

Too long.

Thank you.

You want to get some dinner?

I make a fairly average lasagna.

Ah, I have to finish this proposal for Dr. Chandra’s lab.

Unless you want to work on it together.

I’m good.

You know, the… day I handed in my badge, my dad told me I was weak.

And then he didn’t say anything else to me for a year.

I was only able to do it because of him.

I’d watched him make tough choices my whole life.

It cost me a lot to get here, but I’m finally in a good place.

I love my work and… my pain-in-the-ass girlfriend.

I don’t know if that’s “reaching my full potential,” but I’m happy.

And I fought too hard for that to let anyone tell me it’s not enough.

Even the person who makes me the happiest.

I’ll eat the lasagna.

[EXHALES SHARPLY]

[SIGHS] I need to know at some point “good” is gonna be good enough.

For you. For us.

[EXHALES SHARPLY]

I’m ambitious. That doesn’t mean I’m broken.

I think you’re unhappy.

As long as I’ve known you, you’ve been reaching for the next rung of the ladder.

Will it ever be enough?

[CELLPHONE CLICKING]

GLASSMAN: Hi. You haven’t reached Aaron Glassman.

So I’ll call you back. Sometime.

[VOICEMAIL BEEPS]

Hi. It’s Lea. Call me back.

And call Shaun. He needs you.

[CELLPHONE THUDS]

[SIGHS]

Did transferring that young woman make you feel crappy?

It was the right call.

Yeah.

Pretty crappy.

A few years ago, a colleague made me take one of those online tests that tells you if you’re a sociopath.

Mm.

Oh.

[CHUCKLES]

I’m not.

[BOTH CHUCKLE]

I’m just committed.

Allowing feelings to influence business decisions leads to…

Bad decisions.

Yes. Exactly.

You think like somebody who knows how to be in charge.

So why aren’t you anymore?

I made a good call. The board made a bad one.

Would you like to have dinner? With me.

Before you answer, you should know that going out with me will not benefit you professionally in any way.

Or personally, maybe.

Who’s to say?

And turning me down will have no repercussions.

Feelings do not influence business.

I can sign something to that effect.

[SIGHS]

I’d love to have dinner with you.

Excellent.

Do you like shawarma?

I know the best shawarma place.

Oh, I love their chicken, but I hear their lamb is also very good, though I don’t eat lamb anymore.

It makes me sad.

[SIGHS]

[CELLPHONE CLICKING]

[CELLPHONE BEEPS]

AUTOMATED FEMALE VOICE: You have reached the voicemail box of…

MATEO: Dr. Mateo Rendon.

AUTOMATED FEMALE VOICE: Please record your message.

[VOICEMAIL BEEPS]

Hi. It’s me.

If you’re coming back for work, I’ll see you Thursday.

If you’re coming back for me… [VOICE BREAKING] don’t.

SHAUN: Ranunculus.

They have very low pollen, and the colors are also…”wild.”

These are Delano Yellow.

Gorgeous, allergen-free, they’re perfect, Shaun.

Yes, we are celebrating my success.

I received a new batch of scores, and they are elevated 2.3 points.

That’s great.

Yes. It is.

My efforts to improve my performance have been effective after all.

And no one said I was weird.

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