01x07 - 22 Steps

[SIREN WAILS IN DISTANCE]

[KEYBOARD TAPS]

Come on. Is the system down?

Worked fine for me.

[SIGHS] I don't have time for this.

How you doing?

The computer is not working.

That's not what I'm talking about.

I know. I'm fine.

A patient died because of something you did.

I think it's safe to say the one thing you are not is "fine."

I'm dealing.

How exactly are you dealing?

I'm getting back to work,

I have a diabetic toe to debride,

and I'm putting it behind me.

How do you do that... put it behind you?

By moving forward.

- I appreciate your concern.
- You're welcome.

I'm gonna make an appointment for you for grief counseling.

Dr. Mohan... She's an expert in dealing with hospital staff

who have experienced stressful events.

That's not necessary.

You agree you had a "stressful event"?

And while I am comforted by your commitment to move forward

by not looking back,

I still want you to see Dr. Mohan.

[INHALES SHARPLY]
If she says that you are fine,

then... and only then... can you go back to surgery.

- [KEYBOARD CLACKS]
- It's working now.

Just have to be patient.

[MONITOR BEEPING]

Heart rate .

Push another five milligrams of morphine and prep a nitro drip.

We need atropine on board stat.

What do you got for me?

[EXHALES SHARPLY ] An MI with severe bradycardia.

He's had aspirin, nitro,

and now we're trying to give him a real rate with atropine.

Cardiology see him?

He's got a broken pacemaker

and probably needs his coronary arteries cleared...

feels like a triple bypass, but you're the expert.

BNP is sky high.

What do you see?

[SIGHS] His ventricles are barely pumping.

He's had two massive prior MIs.

End stage heart failure.

His heart's way beyond repair.

What are our options?

He's years old.

His age is an absolute contraindication for transplant.

- He's dying.
- Well, he's not dead yet.

What else?

How about cardiac resynchronization?

That will get what's left of both ventricles

working together.

A biventricular pacer?

It should make him feel a little better

[SIGHS] in the few months he's got left.

[MONITOR BEEPING RAPIDLY]

His rate drops any lower, he'll arrest.

Claire, prep his jugular to float in a temporary pacemaker.

Shaun, call up to the cath lab

and have them get an estimate on how long it'll take

to get the bi-pacer in house.

Something wrong?

Um, not at all.

Just a little bit too much coffee this morning.

Let's go. Do it now.

[HEAVY BREATHING, GRUNTING]

Restraints, please!

I don't want to get stuck with a needle.

You're scaring him.

[YELLS]

You're scaring him.

NURSE: Haldol, five milligrams.

You're scaring him!

- Who are you?
- Dr. Shaun Murphy.

This patient is psychotic, Dr. Murphy.

He's not psychotic.

You don't like people touching you.

He's not psychotic. He's autistic.

SHAUN: You're being an excellent patient.

Okay. We're finished.

You're s-same as...

me.

Can we release his hands?

Dr. Murphy? His hands?

I'm here, son... Mom and Dad are here.

You can let go of his hands. He won't hurt you.

Wrong stop. Wrong stop.

Can someone tell me what happened?

Liam has a . centimeter laceration on his forehead,

probably from a fall.

The wound was infiltrated

with five milliliters of % lidocaine...

... single-interrupted
- Prolene sutures.

He will a small scar,

but no other long-term effects from this injury.

You're my son's doctor.

I am. Dr. Shaun Murphy... "Shaun" with a U.

Got lost... got lost, got lost, got lost, got lost!

- Yes, yes. Yes. But you're okay.
- Got lost. Got lost, got lost.

You won't be taking that bus again.

DON: This light is too bright.

These rooms make him anxious.
Can we take him home?

No.

Your son is jaundiced,

clenching his right abdominal muscles when touched

and febrile.

He should not go home.

[MONITOR BEEPING]

Why am I here?

Your pacemaker malfunctioned.

You had a heart attack.

I... I think I get that part.

[INHALES SHARPLY]

Your neighbor's gardener

saw you on the ground inside your house...

called , saved your life.

Well, I must remember to thank him.

How old are you?

Me?

I know how old I am.

I'm .

We have, uh, a biventricular pacer on its way,

and it's gonna make you feel a lot better.

Is it?

I will be back to prep you for surgery.

Liam has elevated bilirubin and liver enzymes,

a white cell count of .

Abdominal ultrasound shows dilatation of the bile ducts.

Sounds like ascending cholangitis...

can lead to sepsis

if the bacteria gain access to his blood.

Is he stable now?

Yes, his vital signs are stable.

Cause could be anything from cancer to diet, so...

Liam's parents have him on a special ketogenic diet.

High-fat diets can cause obstructive gallstones,

which could have set the whole thing off.

Do an ERCP to clear him.

After that, a few weeks of broad spectrum antibiotics

should take care of things.

[FOOTSTEPS DEPARTING]

SHAUN: I want your help.

[CLEARS THROAT] With what?

Endoscopic Retrograde Cholangio-Pancreatography.

ERCP? Why?

You've done those before, Shaun.

You're good with people who have autism.

Okay, Glen, let's get this, star... ted

Glen, you almost finished?

It's Dr. Kalu.

Glen?

Yeah, we have a code green.

Patient is Caucasian, male, pounds.

[BREATHING RAPIDLY]

Shaun, can you talk to him or something?

I can't push the Midazolam.

Four lights... four doors.

Yes. Lots of things.

and . , .

is the number of cabinet windows,

and is the number of handles.

[MONITOR BEEPING]

Hmm, the end title's CO is rising.

He needs oxygen.
He has respiratory depression.

It's a common reaction to Midazolam.

[BEEPING STEADIES]

CO is coming down.

- You can proceed, Claire.
- Thank you.

Have you been around a lot of other autistic people?

I've never met someone with autism.

Oh.

So, it must be nice to spend some time around Liam, then.

[SCOFFING] Why?

[NORMAL VOICE] Why would that be nice?

Okay.

There are no stones.

Where are the stones?

And there is scarring.

This has nothing to do with gallstones.

The entire biliary tree is so thick with scarring

we can't even get the camera through.

The differential diagnosis for biliary tree scarring includes

primary sclerosing cholangitis, liver failure,

secondary to primary biliary cirrhosis...

Yeah, Shaun, we can add a few cancers to that list as well...

It's a long and ugly one.

Find another way to figure out what it is.

We could do an MRI.

No, we couldn't.

It's not possible.

That's the first time I've ever heard you say that.

- Liam is stimming.
- Stimming?

The tics and spasms are a neurological response to stress.

If he's doing an MRI, there is stress...

if there is stress, he won't keep still,

if he wont' keep still, we can't do an MRI.

Therefore, it is impossible.

Maybe if you just keep talking to him like that,

he'll doze off and it'll all be simple.

Give him a mild sedative.

He didn't respond well to Midazolam during ERCP...

depresses his breathing.

His respiratory saturation can't be properly monitored inside...

I get it.

He could die in the MRI and we wouldn't know.

You're just gonna have to find a different way to calm him.

Okay. We'll do it.

Guess he has an idea.

[SCOFFS]

LOUDSPEAKER: We have a code green.

Patient is a Caucasian male, years of age.

Shaun, what are you doing?

Counting.

- Counting what?
- Hmm. Distance.

Why?

I want $ , .

You can get that by counting?

That's why you're alone and pacing in this room?

What do you want the money for?

- I want to buy a television.
- $ , for a television?

And . I am a surgeon. I get paychecks.

You're not a surgeon yet. You're a surgical resident.

Ah, there's a big difference in the paycheck there, pal.

I'm not a child, pal.

[SIGHS]

How 'bout $ , for a television?

No. The one I want is $ , , okay?

I know, but you have a budget.

- A budget.
- You... Uh, rent, food, bills to pay.

I should do my own budget.
I have an MRI to do.

These are live feeds... entrances, E.R., receiving dock.

If your patient had left, we would've seen it.

Then where'd he go?

A freight elevator, but we don't have cams in the freights,

and he doesn't pop back up.

So, we're dealing with an alien abduction here?

Sorry.

We don't have cams on the freight elevators

on levels one, four and five, and the basement.

And you got people looking on those floors?

We've covered four and five, and we're moving on to one.

[EXHALES SHARPLY]

[CELLPHONE CHIMES]

[CELLPHONE CLACKING]

[CELLPHONE CHIMES]

[DOORS OPEN]

- [EXHALES SHARPLY]
- Hey.

What's in the basement?

- [DOORS CLOSE]
- [CLEARS THROAT]

Pediatric patient lost a blanket...

I'm just gonna check lost and found.

That's nice of you.

While you're there,

you might want to check if they found your code green.

[DOORS OPEN]

[BREATHING HEAVILY]

Uh, this is Doctor...

This is Shaun.

I an hear you when you speak.

I was thinking about something.

There are steps from the ambulance to the E.R.

Please turn down the lights.
That helps calm him.

There are steps from the ambulance to the E.R.

There are steps from the ambulance to the E.R.

He has very long strides.

Yes.

There are steps from the ambulance to the E.R.

[WHIRRING]

There are steps from the elevator to room .

There are steps

from the elevator to room .

In room , there are steps to the sink...

steps to the sink.

CLAIRE: We're getting good images.

It's amazing how accomplished you are for someone with ASD.

Three steps to the window.

Three steps to...

[MECHANICAL BUZZING]

Three...

[BREATHING INTENSIFIES]

It's seven steps... It's seven steps to the door.

Liam, there are seven steps to the door.

You need to get him out.

Just a little more time.

- He's scared.
- It's okay to be scared.

We need to finish this.

Seven... You're doing wonderfully, honey.

Just breathe. Just breathe.

No, it's seven steps to the door.

[SCREAMS]

[HEAVY BREATHING CONTINUES]

[ELEVATOR CHIMES]

Glen?

Glen?

Glen?

[GLEN COUGHS]

Glen?

- [COUGHS]
- It's Dr. Kalu.

Let's get you upstairs.

Go away.

We're gonna get your new pacer in.

Don't you get it?

I broke my pacer on purpose.

I want to die.

With a new pacemaker, maybe you'll feel better.

So, I'll be cured?

Good as new?

Heh.

Well, it'll reduce your pain, and then hopefully...

You think this is the first time I've heard that?

It's always the "next best thing."

[COUGHS]

The truth is I'll just keep getting worse.

I know it, you know it.

Do you have any family you can talk to?

Brother's dead. I don't have a wife.

So, no, there's no one around to nag me into doing what you want.

We have great counseling services here.

[SIGHS] I'm in pain, ...

all the time.

Talk therapy gonna talk that away?

Let's get you upstairs.

You color's not good, and your lungs are crackling,

which means there's fluid building in...

I know my...

I know my rights.

I don't have to get treatment if I don't want it.

The minute I catch my breath, I'm gonna walk out of here,

so you can just leave.

I'm not leaving.

[EXHALES SHARPLY]

We can't treat it until we find the underlying cause.

How do you do that?

Surgically... It's called "exploratory laparoscopy."

We use a camera to navigate Liam's midsection.

There are significant risks...

perforation of an organ,

accidental spread seeding malignancy.

And you have to do this

because he can't stay still during an MRI?

You obviously know your son better than I do.

Do you think we should try again?

So, Shaun told me he's getting a TV...

inches, all the works.

Is he now?

It's just a TV.

It's not about a TV.

Why are you so worried about him?

He showed up late for work half a dozen times,

he calls me : in the morning

'cause he can't find a screwdriver,

and his superintendent wants to kick him out of his building.

- Did you show up?
- What?

At : in the morning when he called you

about a lost screwdriver,

did you show up?

He was frantic.

I didn't know what he was gonna do.

There are residents here,

and all of them show up late sometimes,

all of them make mistakes,

and hopefully, all of them learn.

If you want to worry about Shaun, fine.

But you fought to hire him because you know he can learn.

The question is, are you willing to let him?

Shaun?

I can see the pixelation.

- That's great. Listen...
- It's not great.

Mm, it's not good.

On a high-quality display,

the human eye at / cannot detect the pixels.

- [REMOTE CONTROL THUDS]
- You disappeared after the failed MRI.

I failed.

Yeah, see, I don't think it's about that.

You were hesitant with this kid even before that.

You asked me to do the ERCP.

Doctors don't have to like their patients, Claire.

- You don't like him?
- I don't know him.

Shaun, there's something else going on here.

- I know you know that.
- No. Nu... Nu-huh.

He has the same condition you have.

You have never met anyone with...

Do you like all people with psoriasis?

[SCOFFS] I don't have...

Yes, you do.

And you can never get rid of it.

Okay.

It's too bad you don't like him,

because I think he likes you.

Not only that, I think he looks up to you.

So you know how he thinks?

Well, not as much as you probably do.

What are you waiting for?

For you to pass out.

Judging by the size of your ankles...

[CLICKS TONGUE]

...that shouldn't be too long from now.

Then hopefully I can get you upstairs before you die.

Why do you give such a damn about what I do with my life?

I don't know, Glen.

Why'd you want to die so bad?

I've lived.

I've had decent jobs,

and I've had jobs that went nowhere.

[INHALES, EXHALES]

Had a good roof over my head,

and I've had that good roof taken away from me.

I loved a girl, and I got married.

The happiest years of my life...

then she died.

And now I'm alone

and in pain.

[CHUCKLES]

Feels like the end of the story.

I understand.

Yeah?

You've had some tough times, too, ?

Nobody understands what it's like

to be so good-looking and successful?

I was raised by nannies and housekeepers.

Oh, my God.

You're an ass.

Your point is you didn't suffer

because you were good-looking and smart...

you suffered because you were rich?

The only time I ever saw my parents was Christmas.

Seriously, the story continues?

They had this big party every year,

and wherever they were traveling they'd always fly home for it.

And I'd have to come home, too,

from whatever school they sent me off to.

When I was , I decided that I was fed up.

I was a man, done being their son.

[CHUCKLES]

And I was gonna tell them publicly,

tell all their friends what horrible people they were.

So I came home from school, and I knocked on the door,

and someone answered.

But it wasn't my parents.
It was a stranger.

Turns out they'd sold the house months ago.

They were gone.

I guess they were done with me, too.

[LIAM BREATHES HEAVILY]

To prep Liam for the laparoscopy,

we need to make four small incisions in his stomach.

I don't need to do it.

I-I don't need to do it.

- Liam, you do need to.
- I don't need to!

If you could just hold still for a second, Liam.

The... the bus driver lets me off.

I-I get lost...

You're safe now.

I get lost. I'm hungry.

I can't make food.

C-C-Can't do bath... Don't need to do it!

C-C-Can't do food... C-Can't put on clothes.

Can't do bus.

I took the bus.

I got off at the wrong stop,

and I got scared, but then I found my way.

[BREATHING CALMS]

I did an MRI, and a man got hurt.

I made a mistake.
I make a lot of mistakes.

You tried to walk.

You made a mistake.

But mistakes are good.
You should make more.

You're like me.

You have red eyes... uveitis.

Liam takes vitamins... Does Liam also take herbal supplements?

Kava root. Why?

He doesn't need the laparoscopic surgery.

I know what's wrong with him.

The red eyes... they're caused by an immune flare-up,

which can create the scarring that we're seeing

in his digestive system.

The solution requires us to go in

and remove damaged segments of the bowel piece by piece.

Us?

Yes, myself and my team.

Is Dr. Murphy on your team?

Of course.

Thank you for diagnosing our son.

Dr. Melendez, you have our permission to do the surgery,

but in no way will Dr. Murphy be in it.

Well, the parents... they won't budge.

They don't believe that anyone who has autism

is capable do doing surgery.

Well, clearly they're irrational...

I don't know... shallow-minded people.

Who cares? What's the difference?

You agree with them, right?

Do you agree with them?

It's my team... I don't want anybody telling me

who's supposed to be on my team, including the Board.

You're not answering my question.

- The question's moot.
- Moot? No, it's not.

If you agree with them, then the only issue

is somebody stepping on your poor, little toes.

Get over it and go save the kid.

If you don't agree,

if you think Shaun can handle surgery, then tell them that.

Tell them to go screw themselves.

Either they agree that Dr. Murphy belongs

in that room with you, or you can go find them

someplace else to do the surgery.

I was an -year-old with no one and no money.

So I worked three jobs and took out loans.

Still alive.

That's not a bad story, .

What happened with the parents?

I talk to them now, but...

they're not the people who got me here.

It was the people I didn't expect...

the ex-Marine at the shelter who got me my first job,

and this crazy artist girl

who convinced me to go after what I really wanted.

When you think you're alone, Glen, you're not.

All right.

All right?

Ready?

Two, three!

- No disturbing dreams?
- [LAUGHING ] After a -hour shift?

[NORMAL VOICE] From the moment my head hits the pillow

to the moment wake up, all I see is black.

Hm. How's your level of concentration?

Have you had any difficulty focusing?

I mean, I can do

the New York Times crossword puzzle in one sitting.

Sure, sometimes I wish I was more focused.

It's pretty normal, right?

Shaun's different.

He also has savant syndrome.

He has a remarkable memory.

He has autism, same as our son... same limitations.

DON: You saw what happened to our son in the MRI...

he knew he needed to lie still, but he couldn't.

Now, what happens if Dr. Murphy breaks down like that

while he's standing over my son at an operating table?

You know your son.

I know surgeons.

And after working with Dr. Murphy,

after challenging him in surgery and everywhere else...

probably more than he deserved...

I can tell you he has my complete confidence.


I'm sorry.

He doesn't have ours.

So, what do we do now?

I've contacted my colleague at St. Joseph's,

updated her on Liam's condition.

They have good people.

We can arrange for transportation

as soon as possible.

Where's my phone? Have you seen my phone?

Where's his second bag, the one with his medications?

I want...

I want...

What, honey?

He said I could do it.

I want Dr. Shaun.

Your pacemaker's here.

The techs are programming it as we speak.

The moment they're ready, we're gonna put it in.

[MONITOR BEEPING]

[EXHALES, COUGHS]

I told you my wife died.

The truth is s-she left me.

But I gave her good reason for that,

so I got what I deserved.

- We all make...
- But you didn't get what you deserved...

good parents who loved you.

They were lucky to have you, Jared.

You appear remarkably well-adjusted.

Thank you.

That's not a compliment.

That's my concern.

Well, I assume everyone responds differently.

The thing is everyone responds.

Strictly speaking,

you don't meet the criteria to be required to go into treatment

or take a leave of absence,

so I'm not gonna ground you.

You're a strong woman, Claire,

and that strength has undoubtedly played a major role

in getting you where you are.

But if you have suppressed feelings about this incident,

you need to find someone to share them with.

Because if not, they will eat you up

no matter how strong you are.

All right, Glen. Second ti...

Oh, come on.

[MONITOR BEEPING]

Thank you.

It should be a very interesting surgery.

I'm glad I'm participating.

- [BEEPING QUICKENS]
- [GROANS]

His pressure is bottoming out.

What's happening?

His bowel must have perforated.

He's going into septic shock.

This perforation could be anywhere.

What's the best way to access the entire bowel

as quickly as possible?

Full-length midline incision.

Good. Mark it.

And what do we do once we get in there?

Eviscerate the entire bowel

so we can check every inch for necrotic segments.

Okay, let's make the cut.

You gonna take it or not?

This is the Number L.

It's made of high carbon steel. It doesn't break.

That's correct, Dr. Murphy.

Time of incision... : P.M.

- [CELLPHONE VIBRATES]
- LOUDSPEAKER: We have a code green...

- patient is a Caucasian male,
- [CELLPHONE BEEPS]

years of age.

Where'd he go?

Yeah, on my way.

[CELLPHONE BEEPS]

I have a five-centimeter segment of proximal jejunum.

It's... sclerotic, but not perforated.

All right, mark it and move on.

Shaun, why are you just standing there?

We have feet of bowel to run.

Shaun, you need to get moving... unless you've found something.

I have...

- the perforation.
- Clamp it off...

I'll get in there with the enterotomy scissors

and remove the damaged segment.

I can't.

You can't? Why not?

It's a phlegmon.

You found a walled-off abscess?

It's large.

- Don't touch it.
- I already am.

If you move and that thing ruptures,

the pus will spread to his entire abdominal cavity...

this boy dies.

I know, that's why I'm not moving.

Claire, I need you to open it up gently.

I'm gonna evacuate the septic contents,

flush the cavity with antibiotics,

and then I'm gonna have you remove the capsule.

[MONITOR BEEPING RAPIDLY]

I didn't do anything.

That's the pressure tanking.

You need to finish what you're doing right now.

[CLEARS THROAT]

Let's go, Claire. Come on.

Clamp.

Uh, you guys check left.

[SIGHS]

Hey. Hey. Come on.

Stop.

Come on, Glen.

You can do this.

I don't want to...

Just don't want to.

Please leave me alone.

Once I get my strength back, I'll climb up and jump.

I can't let you do that.

[EXHALES SHARPLY]

When this temporary pacer fails,

which it will,

your heart may stop and you die suddenly.

But more likely, Glen,

you slip back into that slow rhythm,

your chest is racked with excruciating pain

and your lungs start to fill with fluid,

and slowly you suffocate.

Eh, give it a rest, .

Just get me a DNR and a cab.

You can't help me.

Yes, I can.

[DOOR OPENS]

It was a difficult procedure.

We removed a total of two feet of...

Is he okay?

He will be okay.

[SIGHS]

Thank you.

[LAUGHS]

Thank you, thank you.

I-I'm sorry. We're... We just...

He's our son.

You shouldn't feel bad.

You did what you thought was best for Liam.

You love Liam.

I didn't have that from my parents.

It also means I didn't have to take kava root,

so I didn't get

hypereosinophilic gastroenteritis.

Are you gonna get in trouble for this?

[SCOFFS]

You're worried about me now?

You signed the DNR.

All I'm doing is sitting with you.

♪ When they say your father's name ♪

[MONITOR BEEPING RAPIDLY]

♪ They're talkin' 'bout a boat ♪

♪ They're not talkin' 'bout him ♪

♪ 'Cause they can't trust you as far ♪

Are you feeling any anxiety?

No.

Pain?

Some.

Would you like a dose of morphine to help with that?

♪ But back then the ship seemed sunk ♪

♪ I couldn't sleep when I wasn't drunk ♪

♪ I couldn't sleep when I wasn't drunk ♪

♪ But now a bad idea

♪ Has cut you in two

♪ Darlin', I just don't know ♪

Thank you.

♪ Darlin', I just don't know ♪

♪ Some things you just let go ♪

♪ Some things you just let go ♪

♪ Ooh

♪ Ooh

Find your guy?

I did.

Put in the biventricular?

♪ Light will lead the way to set you free ♪

How long did it take to get access to the coronary sinus?

♪ I'm only looking for a little peace ♪

I didn't do the surgery.

I didn't put the pacer in. He, um...

he didn't want it.

He was a good guy.

♪ And when the night falls

♪ Oh, call on me

- ♪ Just don't forget to show me ♪
- I lost a patient, too.

♪ some mercy ♪

Want to talk about it?

♪ Ooh, say you're mine

I do.

♪ Ooh, take me higher

Your surgery went well.

You should be able to get up and move around in two weeks

once we're sure the antibiotics have cleared your infection.

Hear that?

It won't be too long until we can go home.

You did great, honey.

The lights.

♪ Ooh, ooh, shine a light ♪

Are the lights okay?

♪ Oh, shine a light on me

Do you want them dimmed?

♪ Ooh, shine a light on, shine a light on me ♪

They're... okay.

♪ 'Cause I was lost at sea ♪

♪ While the waves were dragging me underneath ♪

♪ Who-o-a ♪

♪ Shine a light on, shine a light on me ♪

You'll love the software.

It makes it very easy to budget.

And the best part, it links directly to the bank,

and... get rid of the ball!

He was the first quarterback picked in ,

but his stats outside the pocket are only % completed passes.

Their backup QB is at % under pressure.

Absolutely.

- He's wasted potential on the bench.
- Yes.

Anyway, the link to the bank will help make automatic...

- Oh! [LAUGHS]
- Oh!

Did you see that?

He pinned it against his helmet... even with the PI!

I want to go to the Super Bowl.

Okay, see, that's exactly the kind of thing

you have to think about before you buy.

Tickets are very expensive.

- Oh, hoo-hoo-hoo!
- [LAUGHS]

You know... You know what? You should go.

I should go. We should go.

Okay.

Excuse me. [CHUCKLES]

Uh, it's almost closing time, so...

I'd like to buy this TV.

...stay as long as you like.

[TVS PLAY INDISTINCTLY]

[TVS PLAY INDISTINCTLY]