The Good Doctor – S07E08 – The Overview Effect | Transcript

Shaun, Jared and Charlie's young patient need his parents to agree on an important medical decision that could greatly improve his health however, his parents are unable to agree on the correct path which spurs the team to try and intervene on behalf of their patient.
The Good Doctor - S07E08 - The Overview Effect

The Good Doctor
Season 7 – Episode 8
Episode title:
The Overview Effect
Original air date:
May 7, 2024

Plot: Shaun, Jared and Charlie’s young patient need his parents to agree on an important medical decision that could greatly improve his health however, his parents are unable to agree on the correct path which spurs the team to try and intervene on behalf of their patient.

* * *

[gentle music]

Did he finish his…

What are you doing?

Steve has little vocalization, is fixated on ceiling fans, and makes eye contact less than 10%.

He’s a baby.

And as his daycare noted, he is not upset when his parents leave.

He’s a happy baby. That’s not a symptom.

Autistic children often demonstrate less attachment to significant…

Shaun, you know a sixmonthold cannot be diagnosed with autism.

Not definitively, but it is important to look for signs.

Which may not appear for another 18 months.

I would still like to consult a pediatric neurologist.

No. No matter what they say, you’ll still be looking for signs, you’ll still be trying to find out what’s wrong with him.

Not wrong. Just different.

You’re right. I’m sorry.

It’s just…

I don’t want to be evaluating him every time he smiles or he looks at a ceiling fan.

I just want to enjoy the magic of watching our baby experience the world.

Ignoring the possibility may help you feel better, but it will not help Steve.

I have to go to work. Goodbye.

[soft dramatic music]

Can you grab more diapers on the way home tonight?

And salsa for Taco Tuesday.

Chunky, not the smooth kind.


And can you skip your workout tomorrow morning?

It’s leg day.

We need to be at the courthouse at 8:00 a.m.


To get married.

Our attorney says a marriage license will expedite the adoption process.

We can carpool.

I don’t want to get married as an item on your todo list.

Actually, it’s on our needtodo list.

Okay, this is more than an administrative appointment.

It needs music, flowers, romance, something… special.

I’ll get you a boutonniere and a harmonica.

The other stuff we don’t have time for.

Then we should make time.

Just like I’m making time for leg day.

[door opens]


Did he swallow anything?


He… He has asthma, but his inhaler’s not helping.

Get a suprasternal view.

Holy cow, he has a third arm.

That’s his aburo.

His “little brother.”

You speak Yoruba?

My father’s Nigerian.

I only speak six words. Seven counting aburo.

They say his little arm is all that’s left of his ibeji.

His twin.


[monitor alarm beeping]

[gasping intensifies]

He’s too constricted to intubate.

Okay, bag mask ventilate. He needs a tracheostomy, stat!

[tense music]

[Jordan] Mason Landover, 41.

Severe neck, back, and extremity pain.

[Dr. Park] I’m gonna feel for tenderness along your spine.

Anything that could be causing this pain?

Well, I just spent eight months on the International Space Station.

Whoa. Like, space space?

Yeah, I’m a botanist.

Studying the effects of zero gravity on soybeans.

[Spanish accent] Selected from hundreds of others for the job.

[Dr. Park] That could explain the pain.

Returning to Earth’s gravity puts enormous stress on the joints.

It was worth it.

He can barely walk.

And he’s had a bunch of other health problems since coming back.

Palpate arms and legs for pain.

Low gravity decreases bone mass.

We should do a DEXA scan to assess how much he’s lost.




[Dom] Oh, my God. I’m so sorry.

Skip the bone scan. Let’s head right to the OR.

[breathing heavily]

[ethereal version of theme music playing]

[monitor alarm beeping]

[Shaun] Tracheostomy tube.

[beeping, alarm stops]

[Jared] And the bronchoscope is in.

Let’s find out what’s causing his breathing problems.

[Charlie] Have either of you seen a third arm before in person?

[Shaun] I have seen a third thumb, a third kidney, and a third nipple.

[Jared] Must be tough for the kid, living with that.

[Charlie] Not if he learns to embrace his differences.

[Shaun] Do you think we should get Steve tested for ASD?

[Charlie] Attempting a diagnosis at Steve’s age will likely lead to a misdiagnosis, and then you’ll likely be disappointed if you discover that your child is just typical.

[Jared] Approaching bifurcation.

There it is.

Constriction coming from outside the trachea.

[Shaun] Something very strange is going on inside Tayo’s chest.

[gentle music]


So, your recovery is going very nicely.

We can discharge you now.

Oh. Cool.

What’s next for you?


Like? Like, where are you gonna be living?

What are you gonna do for money?

Do you have any friends out there that can help you?

I’ll be okay.

Uh, I just need something for the pain.

I can give you Tylenol.

No, that’s not gonna be enough.

Hannah, you just had a very successful surgery.

Your neuro exam is completely normal now.

You don’t need anything stronger.

Yes, I do. I do.

You just want the oxy?

Yeah, because I’m in pain.

Because you’re an addict.

Thank you for everything.

Hold on. Hold on, Hannah. Hold on a second.

I’m just trying to help here.

[clicks tongue]

Are you hungry?

I could eat.


[monitor beeping]

[Dom] II can’t believe I broke his arm.

[Dr. Park] Not your fault.

He must have lost a lot of bone mass in space.

[Jordan] Do you and Morgan still need me to watch Eden tomorrow morning while you get married?

[Dr. Park] No. Because we’re not getting married tomorrow morning.

You can place the last screw.

[Jordan] I don’t know much about weddings, but it seems like agreeing on a date is a prerequisite.

[monitor alarm beeping]

[Dom] He’s in Vtach and hypotensive.

[Dr. Park] Push lidocaine.

He’s coding. Defibrillator pads.

150. Clear.

[paddles whine]

Charge to 200.

[paddles whine]


[alarm stops]

[Jordan] Normal sinus rhythm.

[Dom] Did I almost kill him?

[Dr. Park] No.

But we need to figure out what almost did.

[tense music]

Tayo doesn’t have asthma.

Because of his third arm, he has an unusually large blood vessel compressing his trachea and constricting his air flow.

We placed a tracheal stent to relieve the pressure, but that is a temporary fix.

We can’t remove the vessel because that supplies blood to both leftside arms.

But we can’t leave it as it is because he can’t breathe properly.

We need to remove one of his arms.

A bloodflow test will

We talked about this. His big arm should go.

We talked. We never agreed.

I want to remove the little arm.

The big arm can’t hold a pencil or squeeze a hand or

The little arm is not much better.

He doesn’t want to lose his little brother.

Without his big arm, do you know how odd he will look?

Okay. Stop talking.

We need to do a Doppler ultrasound to test the blood flow.

That is how we will choose.

[gentle music]

The echo showed he has a dilated heart chamber.

It’s causing arrhythmias.

We’ll have to implant a defibrillator.

Is this from being in space, too?

[Dr. Park] Most likely.

In zero gravity, the heart can weaken significantly.


Ana, I’m gonna be fine.

They warned me my body would change.

Not just your body.

Let’s talk about this later.

Mason’s been a totally different person

since his return.

I think something’s off with him mentally.

What’s off about wanting more time with you?

More time with me means I give up a dream fellowship in Buenos Aires,

so we can both stay here and take care of the children you now suddenly want?

Being up there made me realize what’s important.

Putting down roots, starting a family.

So, give me a brain scan.

Show her this isn’t just some tumor talking.

We need a medical reason.

Marital disputes don’t count.

Right now we need to implant the defibrillator.

[contemplative music]

[bell dings]

So, what’s your sport?

Your jacket. It’s yours, right?

Oh! Um, yeah. Uh, track.


Fourby. I ran anchor.

What’s your PR in the hundred?


12.2? That’s like scholarship speed.

UC Davis offered me a full ride.


It meant having to live in Davis.


Are you a big fan of track or something?

I used to be.

What about your folks? They live around here?

[sighs] You ask a lot of questions.

Okay, well, let me see if I can answer some of them.

You’re living on the street.

You’re panhandling or, worse, stealing,

and you have absolutely no one who can help you.

Well, I live in an ’04 Dodge Neon

with a really sweet rear spoiler.

I have a job at Goodwill, parttime.

And I probably have more friends than you do.

[chuckles] You’re probably right about that.

What about recovery?

I have it under control.

Well, yyou have to go to rehab. You know that, right?

I tried quitting. It didn’t work for me.

Because you need rehab.

You can’t do this alone. No one can do this…

No… No one should have to do this on their own.

Thanks for the pancakes.

Whatever you thought was gonna happen, it’s not happening.

Sorry, what…

What the hell does that mean?


Wow, okay.


[somber music]

My daughter died of an overdose, okay?

[voice breaking] She thought she had it under control.

So, you know…

Her PR was 12.8, by the way.

I’m sorry.


My number’s on that card.

If you need a meal…

reach out.

[“Up Where We Belong” playing]

[Dr. Reznick] ♪♪ Love lift us up Where we belong ♪♪

♪♪ Where eagles cry ♪♪

♪♪ On a mountain high ♪♪

♪♪ Love lift us up Where we belong ♪♪

[whispering] What the hell are you doing?

♪♪ Far from the world below ♪♪

[whispering] I’m proposing, you idiot.

♪♪ Up where The clear winds blow ♪♪

Alex Park, will you marry me?

[cheers and applause]

You wanted music.

I wanted sincerity,

not the song that ruined Moulin Rouge! for me.

[sighs] Just say yes already.

You sure know how to make a girl feel special.

[music continues]

[feedback whistles]

[music stops]

This will show which arm has better blood flow.

That will help decide which one to amputate.

Are you feeling sad, Tayo?

Because you are losing an arm?

Dr. Murphy and I have a condition

that sometimes makes it hard for us to understand

what other people are feeling.

Can you tell us why you’re feeling sad?

My parents.

They fight a lot about my arm.

What school I should go to. Who I should play with.

I make them unhappy.

When parents fight about their child,

it’s their fault,

not the child’s.

[gentle music]

Does it say which one to cut off?

Not yet.

Which one would you choose?

It doesn’t matter.

No matter what I say, my parents will be upset.

[Dad] I know. I know.

Okay, but a doctor is just gonna want to run tests,

then they refer you to another doctor for more tests,

and we can’t afford that.

He needs help, Ethan, and we have no idea

No, what he needs is discipline.

I don’t need tests to tell me that.

[somber music]


[speaking indistinctly]

[gentle music]

[Dr. Park] Entering the right cardiac ventricle.

Leads placed.

Remove the sheaths and connect the defibrillator leads.

Doesn’t seem like a crazy ask,

wanting your wife to bend a bit.

[Jordan] But if they love each other, they’ll compromise.

Fluoro looks good.

[Dr. Park] Tough to compromise when one party is reasonable

and the other just isn’t.

[Jordan] Like when one party

does an amazing, romantic public proposal,

and the other one just leaves them hanging?

[Dr. Park] It wasn’t romantic.

It was transactional and manipulative,

and I’m proud I didn’t give in.

[Jordan] You’re a modernday Gandhi.

[monitor alarm beeping]

[Dr. Park] This is decerebrate posturing.

Something’s jacking up his intracranial pressure.

Push 75 grams mannitol.

[tense music]

[Jordan] Pupils nonreactive.

[nurse] Pushing.

[beeping, alarm stops]

[Jordan] He’s stabilizing.

[Dr. Park] This has nothing to do with his heart.

Looks like he’s getting his brain scan after all.

[contemplative music]

[machine whirs, thumps rhythmically]

[ethereal music]

[Jordan] Okay, we’re done.

[Mason] Can I just lie here for a second?

You all right?

Yeah, yeah.

It’s just… it’s ironic.

I was remembering…

looking at the most precious thing in the universe

and realizing exactly what I had to do with my life…

Get back to Ana.

Turns out the thing I thought would bring us closer together

is actually the thing that may break us up.

Uh, did you figure out what’s wrong with my head?

You have hydrocephalus…

excess fluid compressing your brain.

A delayed reaction to being in space.

We have to install a shunt to drain it

before it damages your brain.

The blood flow is 8% better in the little arm.

So we should amputate the big arm.

Should have done this years ago.

For only 8%?

If you are going to keep arguing,

we should move to where Tayo can’t see you.

He thinks he makes you unhappy.

And that makes him sad.

He said this to you?


[somber music]

Can we remove the big arm?


I will schedule the surgery for tomorrow.

Could the hydrocephalus explain his personality change?

No. Based on his postlanding test,

hydrocephalus is a recent issue.

You know the Overview Effect…

what many astronauts experience when they see Earth from space?

Is that a medical condition?

No, but it is a real phenomenon

that can change their priorities,

the way they want to live their lives.

And it can be wonderful.

Assuming they want their life to change.

I don’t.

We had a great thing.

Mason pursued his research, I pursued mine,

and we’d present at conferences all over the world.

We flew coach, we stayed at cheap, little hotels,

eating nothing but street food.

But we loved that life.

Seems like he’s ready for more.

I’ve waited years for this fellowship.

He knows how important it is to me.

And what was important to me used to be important to him.

You’ll find a middle ground.

I’m not so sure.

[contemplative music]

[Steve babbling]

[Dad] He’s just not making eye contact.

[Mom] He’s tired.

I read this thing in a magazine…

It’s a way to get kids to make eye contact.

What is it?

Shaun, look at me.


Hello? Look at me.


What are you doing?

Relax, It’s just water.

He hates it.

[Dad] Well, that’s the point, isn’t it?

It’s okay, Shaun. He didn’t mean it.


It’s okay, Shaun.

It’s okay.

We need to get a diagnosis from an expert in autism as soon as possible.

Any assessment before Steve is two is a waste of time.

I discovered a new study that uses fMRI imaging

to identify earlier predictors of autism.

We can’t subject Steve to that.

An fMRI is noninvasive and harmless.

Not for a baby. Steve would have to be sedated.

That is noninvasive and harmless.

No, Shaun, I’m not signing Steve up for any study.

Okay. I can do it.


This is not the kind of decision

you can make on your own.

Neither can you.

That’s why we have to compromise.

I want to get Steve tested.

You do not. How can we compromise?

I don’t know. I just… I just…

This… This doesn’t feel right to me.


I don’t know.

That is not a reason.

I will make an appointment for the study,

and if you think of a reason before that

No, Shaun!

We are not doing this!

You are being loud.

I am being loud because you’re not listening!

We’re not going to drug our baby…

Okay, sstop it.

Stop… Stop talking!

…and put him into a machine…


…just because you think that that is what we need to be…

Stop… Stop talking!

[breathing heavily]

I’m sorry.

I’m sorry. I…

[dramatic music]

After ligating nerves, arteries, and veins of the big arm,

we will amputate at the mid humerus.

[Jared] Maybe use some of the big arm’s skin for the closure?

Oh. That is a good idea.

Like Bust ‘Em Custom?

It was a show where they took two identical old cars

and stripped one to restore the other.

Ah, you’re into car restoration?

No. But my dad was.

Whenever I’d feel anxious,

he’d put it on and we’d watch it together.

My father was not supportive.

Mine was my biggest advocate.

Wouldn’t it be awesome if we could strip Tayo’s big arm

to restore his little arm to full capacity?

That would be awesome,

but the big arm has neurological deficits

and atrophied muscles, so…

[contemplative music]

I think we need to strip the other car!

I used a metaphor.

[quirky music]

[chuckles softly]



How did things end up with Hannah?

Oh, she was discharged yesterday.

I saw. Did she agree to any followup addiction treatment?

I even bought her pancakes, and I couldn’t get through.

You… You bought her breakfast?

More like brunch.

[sighs] You should stick with the medicine

and let social services do the rest.

I mean, there are rules for a reason.

[cell phone rings]

Where would Shaun be if I followed the rules?

Shaun wasn’t your patient.

Excuse me.

Yes, hello?

Okay. Where… Where are you? Are you okay?

Okay. I’ll be right there.

This new surgery is much more complicated.

There is a small chance that Tayo will be left with only one working arm.

Then that is not an option.

He said the risk is small.

But Tayo could end up worse off.

Or he could finally have a propersized arm that works.

That is what is important to you? How it looks.

That is not what

Stop arguing.

You should ask Tayo.

It is his life you are fighting about.

[gentle music]


You okay?

It was the crappiest car ever.

Why… [sniffles] would anyone…

[somber music]

Maybe it was that sweet rear spoiler.

[laughs, sobs]

Hey, I know aa shelter on Lexington.

It’s clean, it’s secure.

No, I have a friend I can stay with.

I just need a ride.

You were right.

And as humiliating as that was, I deserved it.

But I am taking this seriously.

In World War I,

my greatgrandfather survived a winter in the trenches.

He met this lovely French farm woman.

They fell in love.

When they were married, my greatgrandmother gave him this ring.

And now I want to give it to you.

[gentle music]

Will you marry me?

For real.

I’m not gonna do the whole knee thing again.

Yes. I will.

[romantic music]

There’s an inscription here.

Something like “MF… DR”?

I didn’t notice.

Marie Francois and Daniel Reznick. That’s incredible.

It would be, except that it actually says “Bunny Hearts Irv.”

And let me rephrase…

No, I won’t.

I spent my lunch hour at a pawnshop so you could feel romantic about your second marriage.

Well, maybe if my first marriage had been a bit more romantic, I wouldn’t need a second one.

Oh! [groans]

I’m sleeping in the guest room tonight.

I sleep better without you anyway!

I could lose my big arm too?

Unlikely, but possible.

Your mother and I fight far too much.

But it is because we both care so much about you.

More than anything else in the world.

But I know it makes you sad, and that breaks my heart.

I am sorry, Tayo.

What do you want to do?


You’re a big boy.

We want to hear what you think.

I don’t want to say goodbye to my little brother.

But I know he’ll understand.

[gentle music]

The shunt procedure went very well.

How are you feeling?


Uh, where… where’s Ana?

DDid she “shay”… sshe “shay”…


[tense music]

Pupils are blown.

Pressure’s back up, pumping. OR now.

[indistinct conversations]


No, no, no, no.

You know what? There are housingfirst shelters you don’t even have to be clean before you I know a guy who got stabbed in one of them.

Right, like no one’s ever gonna get stabbed here.

My friend is waiting for me. I wasn’t lying about that.

I really appreciate all you did.

You’re a good person.

[somber music]

[Maddie] Daddy, please! What are you doing?

[locks door]

[banging on door]

I can’t believe you’re doing this.

I hate you!

[banging on door]

Hey, hey, hey, hey. Hannah?

Hey. Look…

I have aa very comfortable couch in my living room.

Nobody’s using it.

What do you think?

[somber music]

Good morning.


I wasn’t lying about the couch, was I?

You were not.



Unnecessary, but…

The key is adding the chips by hand after the batter’s already on the grill.

That way, there’s no weird clumps of chocolate.

I like to pay my own way.

Uh, there’s a guy at work who said he’ll rent me a room in his house.

I’m checking it out today.

You know what?

I can get you a bed in the St. Bons rehab unit.

When I tried to quit, it was the worst week of my life.


Well, you can always stay here until you get back on your feet.

I don’t feel good putting you out.

It wouldn’t put me out. You just…

Couch is right there.

You can earn your keep in pancakes.

I guess I could stay one more night.

I’ll even restock the chocolate chips.

[gentle music]

Is he okay?

When he was in space, his brain shifted due to the microgravity, and now it’s shifting back and blocking the flow of the shunt.

And we need to remove a piece of the skull to relieve the pressure.

Could he die?

This is a risky surgery.

But it’s our best shot.

We need your consent.

Thank you.

[elevator bell dings]

Oh, God, and then I lost it, and then Shaun lost it.

Now he’s totally dug in, but there’s no way I’m gonna let Steve do this study, but he’s being so unreasonable.

Why are you so worried about this study?

It’s way too early for Steve to be tested.

And no matter what happens, it’ll label him.

And that’s what you’re worried about, being labeled?

Once that happens, he’ll be seen as different.

By whom?

By everyone.

Since when are you so concerned about everyone?

Since I became a mom? I don’t know. I…

How can I not?

You’re a new parent. That’s scary.

But how often do we make the right decision when we’re scared?

[“Sky on Fire” by Mehro playing]

♪♪ Light the sky ♪♪

♪♪ On fire ♪♪

♪♪ Who could’ve known? ♪♪

[Shaun] Isolating the median, ulnar, and radial nerves of the small arm.

Beginning side nerve transfer.

[saw blade whirring]

Goodbye, little brother.


I might have been a little tough on you yesterday.

Tough I don’t mind.

It’s the ethics lecture I can do without.

I just… II know you want to do right by her.

It’s fine. You were trying to help.

I get it.


Do you think you’ll ever hear from her again?

Who knows?

[bell dings]

[somber music]



Can… Can I have a kiss?

That was quite a thing we had the other day.

When you raise your voice, it makes me very upset.

I know.

We both got pretty emotional.

But I’ve been thinking.

And I don’t think it was about you or the study or even about us disagreeing, not really.

It was about me.

A child on the spectrum has so… so many different needs than a neurotypical child that I… that I got scared.

I’m scared I might not be up to it as a mom.

That doesn’t make sense.

You are a very good mother, and you are very supportive of me.

That’s the thing about being scared.

It doesn’t always make sense.

Anyway, if you’d like, we can try the study.

I would like to make an appointment.

Thank you.

[gentle music]

[“Blow Your Mind” playing]

♪♪ Down by the delta Not too far from here ♪♪

♪♪ Can’t wait to show you ♪♪

♪♪ Hurry up, can’t you hear? ♪♪

♪♪ The rhythm is calling And it came without a warning ♪♪

♪♪ Can’t help How it makes you feel ♪♪

♪♪ You’re better off knowing That I’ll be about showing ♪♪

♪♪ You’ll swear That it ain’t real ♪♪

♪♪ This right here Gonna blow your mind… ♪♪




What, what? What? No! No! No!

[crying] Hannah.

Hannah, Hannah.

♪♪ Whoohoo ♪♪

♪♪ Whoo ♪♪

♪♪ Gonna blow your mind Uhhuh ♪♪

♪♪ Whoohoo ♪♪

♪♪ Whoo ♪♪

♪♪ This right here’s Gonna blow your mind ♪♪

[Dr. Park] Welcome back, Mason.

Pupils reactive.

Am I gonna be okay?

I wouldn’t go into orbit again, but if you stick to Earth, you should be fine.




You remember that horrible hotel in Dar es Salaam?

Every time they flushed upstairs, our ceiling leaked.


You took the shower curtain and tented it over our bed.

Said we were having a campout.

[both chuckle]

When I thought you were dying, I had my own Overview Effect.

A world without you would be so cold.

So empty.

I don’t need to take that fellowship in Buenos Aires.

But I’m not sure about the kids.

Maybe we can start with a puppy.

No, no. WWe’re going to Bueno Aires.

II’ll take a sabbatical.

And the puppy.

[both laugh]

[gentle music]

Thank you, Dr. Murphy, for your advice.

When you snapped at us to stop fighting.

Simple, direct, and very wise.

It is very good advice.

[serene music]


You OD’d.

In my house.

Must have been fentanyl in those pills.

I’m sorry.

You have any idea how lucky you are?

That I happened to come home when I did, that I happened to have naloxone in the house, that there wasn’t more fentanyl in those damn pills?

This can’t happen again.

I’ll go.

No, no, no.

That’s not what I meant.

I’m gonna write you a prescription of oxycodone.


I can deal with you being an addict.

I can’t deal with you being dead.

You can stay here until we figure out a way to get you better.

I’m gonna give you each pill on a schedule.

No more scores on the street.

Can’t you get in trouble?

You let me worry about that.

[“Burning Stars” by Mimicking Birds playing]

[guitar music]

♪♪ So, see, it seems We’ve settled down ♪♪

♪♪ Quite a bit From the energy we once had ♪♪

♪♪ Oh, believe me We’ve settled down ♪♪

♪♪ Way down ♪♪

♪♪ Way down, way down… ♪♪

How is he ever gonna be a man if he can’t even look me in the eye?

He’s just a little boy.

[Dad] Yeah, and he’s gonna stay that way if you keep coddling him.

It’s mint chip.

[Dad] At least I’m doing something!

[guitar music]

♪♪ And all we are Is burning stars ♪♪

♪♪ Shining brightly ♪♪

♪♪ Making sure You don’t float too far ♪♪

♪♪ I’ll keep an eye on you If you keep one on me… ♪♪

Would you like to get some ice cream?


♪♪ And then what happens We’ll see ♪♪



♪♪ Shining brightly ♪♪

♪♪ Making sure You don’t float too far ♪♪

♪♪ I’ll keep an eye on you If you keep one on me ♪♪

♪♪ And then what happens We’ll see ♪♪

♪♪ And then what happens We’ll see ♪♪

[closing theme music playing]


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