The Good Doctor
Season 7 – Episode 10
Episode title: Goodbye
Original air date: May 21, 2024
Plot: As the doctors consider their futures, they work together to solve one of the most important cases of their careers.
* * *
[Lea] How long have you known?
[sighs] About a week or two.
My doctor found it on the yearly scan.
[Steven babbling]
Did they give you a sense of how long?
Three to six.
Years?
Months.
What’s your plan?
Is there a surgery or chemo?
No. This is my plan right here.
You. You’re it.
You’re the plan.
And you.
And that one.
And maybe some bowling.
I have to go to work.
Last time, you also said it was inoperable. Goodbye.
[door opens, closes]
He just took your medical file.
Yeah.
I’m so sorry, Glassy.
Me too.
[theme music playing]
Despite having you on vancomycin and ceftriaxone,
your postop infection is still progressing.
We’re waiting for the cultures to grow out,
but we suspect MRSA.
I’m thinking we debride the infected tissue,
then flush antibiotics directly into the wound
and put in drains.
Good call.
I’ll put it on the schedule,
and leave you two alone.
I guess we weren’t exactly subtle.
No.
You said you wanted more than a onenight stand.
I did.
But, uh,
how would we do that?
I don’t know.
But…
I would like to make it work.
Me too.
[chuckles]
[pager buzzes]
Oh, it’s Shaun. He wants me in the Residents’ Lounge, stat.
The patient is a 68yearold man
diagnosed with grade IV butterfly glioblastoma,
from the left frontotemporal lobe.
Do we have a full medical record?
Patient history?
Or a name?
Successful surgical resection for glioma five years ago,
followed by chemo and radiation.
And within the past year,
several minor strokes.
Glioma and strokes.
Are those Glassman’s?
His cancer’s back?
The patient’s identity isn’t medically relevant.
How is he? How are you, Shaun?
The patient’s identity isn’t medically relevant.
Shaun, did Dr. Glassman ask you to develop a treatment?
No, he didn’t. Otherwise, he’d be here.
The patient is reluctant to pursue treatment,
but the patient is also not aware of new developments.
You and Jordan go do Claire’s debridement.
I’m sorry, Shaun. I can’t.
Looking at the axial images with contrast…
How’s Claire?
Looks like MRSA. We’ve got her on vanc and ceftriaxone.
Rack ’em up.
Said the woman who hates the fact that there’s
a pool table in the president’s lounge
to a dying man?
Shaun?
He’s got a group brainstorming a treatment plan for you.
I’ll rejoin them if you want me to.
No.
Thank you.
Hey, look at the bright side.
When I’m gone, no more copresidency.
You can run this joint however you want.
I never wanted it in the first place.
Stop. You’re a natural.
Even if you are overly invested and too accessible…
In every other way, you’re amazing.
This sucks.
Shut up and rack ’em.
[Jared] No sign of any more devascularized tissue.
[Jordan] Proceeding with antibiotic irrigation.
Looked like you two were reconnecting last night.
[Jared] Yeah.
Did that… Does that bother you?
It caught me off guard a little.
You could have told me you two had unfinished business.
You’re with Perez.
Danny and I are texting a lot,
and, yes, I do hope and pray my future is with him.
That’s why I backed off and stopped flirting with you.
You and me, we’re friends.
Placing the drain.
Thing about friends is, no holding out.
I told you about me and Danny, you tell me
when your ex you’re not over is back in town.
I can close.
Deal.
To both.
I’ll go check on the cultures,
see which antibiotics are working.
Shaun, have you tried calling the Tisch Brain Tumor Center
or Cleveland Clinic about their inprogress GBM trials?
That is an excellent idea.
I’ll keep things rolling here.
Come on, guys, I need some energy, some enthusiasm.
Stop pitching the same idea. Start pitching any idea.
I ran out an hour ago.
How long are we supposed to keep doing this?
Until Shaun accepts what we already know.
That there is no treatment.
What do you got?
Nothing’s working.
Not a single antibiotic made a dent in Claire’s infection.
It’s not MRSA.
We cleared out all the infected tissue,
but initial cultures confirm you don’t have MRSA.
You have acinetobacter.
It’s resistant to everything.
One of the antibiotic combos slowed growth a little.
We’ll try that.
But mostly, we need your immune system to beat this thing.
Are you scared?
I heard about Glassman. How’s he holding up?
Better than the rest of us, I think.
At least, he’s acting like it.
Congratulations.
I assume they’ll offer you the presidency.
[scoffs]
Look,
it is a terrible way to get the offer,
but it is still a huge accomplishment.
[sighs] There’s another offer.
Chief of surgery at the hospital
where Clay’s doing his fellowship in Chicago.
I’d get to focus on surgery again,
be with Clay again.
But?
How did you know it was the right choice
to move to Guatemala?
It made me want to throw up.
[both chuckle]
It was so terrifying.
But in an exhilarating kind of way.
What?
You’re sweating.
[knock on door]
I’m looking for stuff to scavenge.
Oh, well, help yourself.
Just stay away from the scotch. I’m gonna need that.
Tell me about your bucket list.
Bucket list? Hmm.
[chuckles]
Crisscross the Serengeti with a backpack and a pitch tent.
Wrestle an alligator and win.
Or go bowling.
I didn’t take you for a Pin Prince.
A bowler?
I’m kind of a Strike Siren myself.
Park and I are in a league.
I wasn’t expecting that.
I know what I want.
When you were treating my rheumatoid arthritis,
there was this
one day when you were going over my
Xrays and blood work
and medical history,
all this stupid paperwork about me and my stupid hands,
and it all felt so overwhelming.
And then you gathered it up into this nice, neat pile,
and you paperclipped it together.
And all of a sudden, it felt manageable, like,
maybe I would be okay.
Also, I can use it to jimmy open
the filing cabinet in my office.
I can’t find the key.
Thank you.
I sense you’ve cracked it.
No, we’ve made no progress at all.
Shaun, we’ve been at this all day.
It’s only 3:15.
We’ve been at this for over seven hours,
with six people looking nonstop.
If there was a miracle cure to find,
I think we would’ve
I found something!
A maximal resection would debulk the tumor
down to a onecentimeter margin.
Minimally invasive techniques could be used.
You would only be in the hospital for one to two nights,
and overall recovery would be faster
because they wouldn’t be operating in the brain stem.
[Charlie] The surgery would be followed
by an experimental ultrasound therapy.
Thank you. An experimental ultrasound therapy,
breaking down the bloodbrain barrier
to increase chemo penetration, allowing for a lower dose.
There would still be some side effects,
but we could take more edibles together
and eat Mallomars. Mm.
It could give you as much as a year.
Maybe more, if you respond well.
[cellphone vibrates]
Claire is in septic shock. I have to go.
I will be back later to answer any questions.
[door opens, closes]
[Dr. Lim] Temp’s 103.
BP’s low, cardiac output is declining.
We could do another wound debridement.
It’s in her blood. The wound is not the biggest issue anymore.
But clearing it out allows her immune system
to focus its resources elsewhere.
Not enough. We could try a hyperbaric oxygen chamber.
[Claire] Guys.
We all know the answer.
You have to put me in a coma.
No.
We’re not there yet.
We are.
Shutting down your other metabolic demands
will allow your body to
focus on fighting the infection.
I know, once you put me under,
that may be…
But this is my best chance to beat this thing.
[sighs]
Hey.
Have you looked over the materials?
I highlighted relevant sections.
I have, and I appreciate
what you’re trying to do, Shaun.
Yes. It is a very good plan.
I’m not going to do it.
I don’t want to spend my remaining days sick and in pain.
I might not be able to talk normally.
I might not be able to walk normally.
I’ll have memory loss.
Oh, there is a less than 20% chance.
I don’t want to take that chance.
But it could give you more time.
A year, maybe,
and in and out of hospitals half the time.
Or, Shaun,
or I could do nothing
and have six good months.
I could spend those good months
with you and Lea
and Steve.
[timer ringing]
[timer ringing]
Please don’t touch anything.
Glassman rejected the plan.
His three concerns were impairment of motor and speech,
loss of memory, side effects of the chemo.
I just need to find ways to mitigate those risks.
You are just standing there.
You are here to tell me to stop working
on Dr. Glassman’s case.
No, Shaun.
It’s your choice.
[timer ringing]
The rocuronium will temporarily paralyze you
to make intubation easier.
Once the tube is in, we’ll do a continuous propofol drip.
You ready?
[sniffles]
I forgot a med.
[breathes shakily]
I can’t say goodbye.
Just got you back.
I love you.
I…
I’m so sorry
we lost so much time.
Hey.
We needed that time to get back here.
We weren’t ready before.
We were too dumb.
[laughs]
We were so dumb.
[gasps softly]
But I did tell you that I think, one day,
we’d both be very happy.
I just didn’t realize it would be together.
I love you, too, Claire Browne.
[exhales]
And I really wish I could kiss you right now.
Where is Shaun?
Claire’s asking for you.
I am working on her case.
Currently, I’m working on Dr. Glassman’s,
but I will switch back in 3 minutes and 27 seconds.
She might not wake up, Shaun.
She wants to say goodbye.
I will find a way to save them both.
Oncolytic viruses have been used to infect
and destroy cancer cells, but the viruses won’t work
because Dr. Glassman’s tumor was previously EGFR negative…
Shaun.
…so there is no target for the virus to attach to,
but if I could find a different receptor
Shaun.
Your very good friend, who might die,
is asking for a few minutes of your time,
but you’re too busy ignoring the expressed wishes
of your other friend who’s dying.
I know you’re scared.
But you’re being a bad friend
when the people you love could really use a good one.
I know how to save Claire.
Hello. We can use viruses
to cure Claire’s bacterial infection.
Bacteriophages, to be precise.
They are viruses that attack and infiltrate
only bacteria, and then destroy them from the inside.
Every bacteriophage only infects certain kinds of bacteria.
All we need to do is find one
that will attack Claire’s infection.
There are billions of phages.
Are any of them known to work on acinetobacter?
No.
[Jordan] So, we’re searching
through a billion haystacks for one needle?
[Shaun] Not exactly.
Each phage can attack more than one kind of bacteria,
so it is more like searching a billion haystacks
for a million needles.
[Dom] And where are we supposed to find these
haystacks, or needles?
Bacteriophages. The metaphor is not helping.
We need to collect the phages,
as many as we can, as fast as we can.
[Charlie] Phage therapy is experimental.
We would need a compassionate use authorization from the FDA,
but they’ve
But that’s tomorrow’s problem.
Today, we’ve got to find the right phage.
According to the microbiology department
of the CDC, the most common sources
of bacteriophages are swamps,
farms, storm drains, and sewage plants.
I noticed her left forearm felt cold with a weak pulse.
Septic emboli?
Poor blood flow.
Already showing signs of ischemia.
We can do a thrombectomy,
try to remove the clot and slow progress of infection.
Her body’s putting a ton of resources into saving this arm,
which is taking energy away from saving her vital organs.
She can live without an arm.
[sighs]
Let’s try the thrombectomy first.
We need transport.
I have taken your concerns into account
and formed a new treatment plan.
I don’t want a new treatment plan, Shaun.
You don’t know. You haven’t looked.
We will do a fluorescenceguided
awake brain surgery with cortical stimulation.
Shaun, I appreciate that you’re doing this out of,
you know, love.
But sometimes when you love someone,
you don’t have to fight every fight.
You don’t have to persevere to the ends of the earth.
Sometimes, when you love someone,
you just, you know, take ’em bowling.
Six years ago, you didn’t give up,
and you got to see me get married.
You got to meet your grandson.
You got to save more lives.
You were wrong then,
and you are wrong now.
Shaun, look at me, please.
Listen to me. Look at me, please!
Is my tumor recurrent, yes or no?
Yes.
Is it aggressive? Is it even more aggressive?
There are better treatments now.
We just need to buy you some time.
I shouldn’t have told you.
[thud]
You are being selfish.
And you are a coward.
You could keep fighting and have more time with me
and with Lea and with Steve, but you are giving up.
You are giving up on all of us.
[breathes shakily]
If you are giving up on me…
then I have to give up on you.
[Dr. Lim] The thrombectomy didn’t fully clear the blood clot.
It’s obstructing blood flow,
and the arm is showing signs of necrosis.
I think we need to amputate.
Or we could try an open thrombectomy.
It’ll give us better access to the clot.
It’ll also risk seeding the infection to other places.
We could start a heparin drip,
see if it’ll give us better blood flow.
The arm is taking resources
the rest of her body desperately needs.
Her creatinine and LFTs are trending up.
Her liver and her kidney are starting to fail.
Putting off amputation any longer,
it risks her life.
She wouldn’t be a surgeon anymore.
She loves her job and is very good at it.
I know.
But what she loves
is the young girl in Guatemala who walked half a day
to the hospital with a broken ankle.
And the old man who just lost his wife of 52 years
and needed someone to hold his hand.
And the firstyear surgical resident
who was different,
but she saw something special in him.
Claire loves people,
and she will find a way to take care of people,
no matter what.
And I think, if she was here right now,
listening to all of this, she would tell us
to take her damn arm
and trust that she will find a way forward,
because she…
she always has.
Prep the OR.
I thought you could use some baby snuggles.
[chuckles]
You have no idea.
[Lea] Mm.
Come here.
Come here. I gotcha.
I gotcha.
Hi.
Hi. I gotcha. I gotcha.
[sighs] I said no to
Shaun’s plan twice.
I thought he’d be ready to
accept this eventually.
Well, “eventually” probably means more than 48 hours.
[sighs]
I spent a couple of decades trying to prepare him
for when I
wasn’t going to be around anymore.
Apparently, that wasn’t enough.
Glassy…
I love you.
You are the firstwisest
and secondsmartest person I know,
but if you think you haven’t done enough for Shaun,
then I am sorry, but you are a ginormous idiot.
Look at who you’re holding.
That baby is here because of what you did.
I’m here because of what you did.
You saw who he was, who he could be.
You saved his life, and he knows it.
He will come around…
eventually.
Hi.
He doesn’t have a whole lot of time.
[monitor beeps, respirator hissing]
[Dr. Lim] 10blade.
We’ve concluded our tour of the most disgusting barns
in Northern California.
I have received hundreds of phages from the CDC.
Charlie and Dom are on their way with 87.
Have any showed promise so far?
None whatsoever.
Shaun, uh, can I talk to you?
I have samples to test.
Uh, it’s important.
We’ll keep gathering.
I know of a slaughterhouse nearby.
[Dr. Park] You know of a slaughterhouse?
[Dr. Reznick] Mmhmm.
You can’t shut Glassman out.
I presented him with two plans.
He doesn’t want them. That’s his choice.
His choice is wrong.
No, it isn’t, Shaun.
I know how hard it is for you to accept.
I know you don’t want to face any of this,
but Glassman is dying, Shaun.
And all this work you’ve been doing to try to save him
is really for you.
You need a new plan.
A plan to say goodbye.
Right now, you can’t make yourself feel okay
about Glassman’s decision, and that is okay.
You don’t have to.
But…
he is going to die,
and if you are not with him for his final days,
you will regret it for the rest of your life.
So…
you need to plan
for your final days with your father.
You are a very good friend.
I should have come earlier.
I am sorry.
Goodbye, Claire.
[Charlie] We’ve got it!
We’ve got it!
The bacteriophage?
Yes!
The right bacteriophage?
I said, “We’ve got it.” What else would I have meant?
Ohye!
I told you. I was not wrong.
I was not wrong to not say goodbye.
I will see you very soon.
You have the data. It’s in the green folders.
Stress the time frame,
the bacterial lysis times were very striking,
and there were low levels of endotoxins.
Oh, also, uh, her amputated arm isn’t strictly relevant,
but because we’re applying for a compassionate use,
anything that’ll make her appear
more sympathetic will be helpful.
We can appeal.
But the whole point of a compassionate use
is to allow people with no other option.
They can take risks.
I am so angry.
Are you not angry?
Go back to the hospital
and prep Claire for the bacteriophage treatment.
Are you going to…
I don’t know. I need to think.
Are you okay, Shaun?
Is Claire going to be okay? Why did you text us?
I texted you
because when I have important news,
you two are the people I need to share it with.
On the day the copper pipes
in the old building smelled like burnt food…
my brother taught me
that just because you love somebody doesn’t mean
you get to love them forever.
But I was okay
because I had you, Dr. Glassman.
And on the day that…
On the day that you go to heaven…
I will have Lea.
I will have little Steve.
And on the day the carousel smelled like oil,
the carousel you used to go to with Maddie,
I told you I would go there
and think of you after you’re gone, and I will.
But I want to go before then too.
I will go there with you.
And I will go bowling. I will go bowling with you.
I will make a plan. But I can’t today because…
Because on the day you stood up for me, I met Claire.
And she believed me.
And I spoke to people in this room,
and I told them I want to save people
so they can become adults
and have children and love those children.
[voice breaking] But I don’t…
I don’t need to save everyone.
I just need to save Claire.
[breathes shakily]
The FDA did not approve her treatment.
But I am going to give it to her anyway.
And then I won’t be a doctor anymore.
And that’s okay.
No. No.
No, Shaun, that’s not okay.
Thank you.
I am Dr. Shaun Murphy.
I am Chief of Surgery
at San Jose Saint Bonaventure Hospital.
I have autism spectrum disorder,
which is part of the reason that I remember the names
of all 1,524 people whose lives I’ve helped save.
There were a lot of people
who did not want me to be a surgeon
at Saint Bonaventure Hospital, or anywhere,
because I was different.
I couldn’t make eye contact.
I didn’t know how to lie. I made people uncomfortable.
But someone believed in me.
Dr. Aaron Glassman…
was my friend.
♪♪ There is no Rhyme or reason why ♪♪
I love you, Dr. Glassman.
I love you more, Dr. Murphy.
♪♪ Being known ♪♪
♪♪ I carry with me A part of us ♪♪
♪♪ There’s nothing I could do Or have ever done ♪♪
♪♪ To bring me closer To being known ♪♪
[Eileen] But you don’t even speak Ukrainian.
They have translators, Mom.
[breathes shakily]
I’m proud of you.
Thanks.
♪♪ This is the place We’re all hiding ♪♪
♪♪ Getting closer To being known ♪♪
♪♪ The one we all long to be ♪♪
♪♪ The why it’s so hard To sleep ♪♪
♪♪ The heart, it becomes fire ♪♪
♪♪ The soul It becomes the sea ♪♪
♪♪ When we are known ♪♪
♪♪ Closer, fire ♪♪
♪♪ Burning, brighter ♪♪
♪♪ Feels like the first time ♪♪
♪♪ The first kiss, desire ♪♪
♪♪ Closer, fire ♪♪
♪♪ Burning, brighter ♪♪
We have to go.
♪♪ The first kiss, desire ♪♪
♪♪ When we are known ♪♪
[remote clicks]
Dr. Claire Browne
is my friend.
Hello.
Dr. Glassman and I saved her life.
Dr. Glassman saved over 4,000 lives.
He would say less, but I give him credit
for all the lives that I have saved,
because he taught me
a mnemonic for remembering
the effects of organophosphate poisoning,
and he taught me that
if you just palm grip the needle driver,
you will get way more maneuverability, and force control.
And he taught me…
that when you touch one life,
you don’t just touch one life.
You touch every life that that life touches.
Dr. Glassman said many wise things. Yes.
And over the years, I have tried to write them down.
“Think about what people can do,
not about what people can’t do.”
“Hear what I have to say,
and then decide if it’s bad advice.”
“Questions are good.”
“Leads to awareness and understanding.”
“And, who knows, maybe even acceptance.”
And when he wanted the board to hire me, he said,
“We will be a better hospital for hiring him.”
“We will be better people for hiring him.”
And then he slammed the desk with his hand,
because that is how you communicate
that you really mean what you are saying.
[soft laughter]
He always knew people were looking to him,
that they might take lessons from him.
And if they did,
he always wanted that lesson to be…
“Don’t be an ass.”
[laughter]
“Don’t be an ass.”
It’s not always easy.
Together, we planned,
and six months after he died,
I started…
the Dr. Aaron Glassman Foundation
for Neurodiversity in Medicine,
which is today run by myself and Dr. Claire Browne,
and has affiliations with 17 hospitals
and 32 medical schools.
I wanted to help people
and save lives.
And I wanted to make a lot of money
so that I could buy a television.
But because of Dr. Glassman,
I have much more than that.
I have many friends.
And I have a family.
And I have two televisions.
♪♪ Leaves are changing So am I ♪♪
[closing theme music playing]
