01x13 - Seven Reasons

- I was late!
- It's okay, sweetie. It's not your fault.

I just wanted to play one more game at Gary's.

Well, you did great.
You called right away.

- He looked dead.
- Daddy's not dead.

He's gonna be okay, right?

- He had a stroke.
- That's not possible!

Well, the CT confirmed a ruptured aneurysm.

We have to operate to clip the bleeding

and reduce intracranial pressure.

No, he had a stroke six years ago.

They put him on diltiazem.

We're gonna take good care of your dad.

Naja Modi... years old, suffered a burn to her left hand

as a result of a cooking accident.

Are Jared and I being punished?

This is not a very interesting case, is it?

Lesson one...

Don't suggest to the the head of surgery

that working with the head of surgery

is form of punishment.

Dr. Melendez is very unhappy with Jared

for how he got his job back.

And Dr. Melendez is unhappy with me for t-taking...

taking two days off.

I don't think he wants to talk about this, Shaun.

[MONITOR BEEPING RHYTHMICALLY]

[GROANS]

I was an idiot.

It's on the stove. Of course it's hot, right?

You wouldn't believe how often we see these types of accidents.

Well, there are a lot of idiots.

Okay, what do we need to do here, Murphy?

A superficial partial-thickness burn

should be managed conservatively.

Cleanse the area, debride with soft gauze,

and then cover with an antimicrobial

petroleum dressing.

All of which means,

this should heal with minimal scarring.

[GASPS]

Naja, are you having chest pain?

I think I'm having a heart attack.

It's hard to breathe.

Just relax if you can.

Put her on oxygen, a lead EKG,

and order a portable chest X-ray.

- Murphy, let's move. Come on.
- Her vitals are stable.

What the hell is going on here?

I don't know.

But it is interesting.

We've got a subarachnoid hemorrhage. Suction.

I need to isolate the aneurysm.

Poor kid.

Imagine finding your dad like that.

Well, that's exactly how I want to die.

[SIGHS]

If the dad doesn't make it,

the kid will always remember that moment...

be traumatized by it.

Because he loves him.

The idea of dying without anybody getting hurt...

There's nothing sadder than an empty waiting room.

Okay, what do you see?

A bulge on the anterior communicating artery.

Yeah, the ruptured aneurysm is compromising

blood flow to the frontal lobe.

Prep an millimeter standard clip.

Are you married?

Not anymore.

Turns out he had even worse judgment than I did.

Oh, speaking of creeps, you hear Coyle got transferred?

[CHUCKLES] I'm so glad they shut him down.

Well, yeah, I guess.

Just wish they'd spent the money on a Pediatric Trauma Pod.

They gave him a raise.

Clip.

The EKG confirmed

you weren't having a heart attack.

I-I wasn't faking.

- I wouldn't do that.
- We know.

The imaging also confirmed

that you have considerable lung inflammation.

Is it possible you inhaled smoke?

I guess I must have.

There was a minor grease fire.

- What happens now?
- You need a bronchoscopy.

We put a camera down your throat to see how much damage there is

and what we need to do to repair it.

But don't worry. You'll be sedated.

Please don't.

Oh, I'm... I'm sorry.

The test is absolutely necessary.

The test is fine.

But, um...

please don't touch me, except for medical purposes.

Yeah, of course.

That does not make sense.

A number of religions have rules about touching.

I don't quite get it, but...

That makes sense.

People shouldn't touch people

unless there's a very good reason.

Okay, then...

what doesn't make sense?

The grease fire.

The grease fire explains the whole thing...

the burn, the smoke.

She told us she forgot the stove was hot.

How can you forget something's hot

when it is on fire?

[SNICKERS] Shaun,

I'm sure we would have heard more of the story

if she hadn't suddenly thought she was having a heart attack.

Why didn't you fire him?

Because his story was different than yours.

And you believe his story?

I believe your story.

But you can't prove it.

And we simply can't make a policy

of believing every woman who files a complaint

against every man.

[SIGHS]

After a few thousand years of doing the opposite,

it wouldn't kill us to overcorrect.

And the fact that your boyfriend assaulted him

took away any leverage I had.

I did what I could.

I got him to take a position

where he has very little contact with staff, with patients...

outreach chair.

And it's a lousy assignment.

Sooner or later, he's gonna quit.

And get a job somewhere else.

If you have any better ideas...

I look forward to hearing them.

LIM: You're very lucky.

The aneurysm was in a small communicating artery.

We were able to restore blood flow

to the impacted brain areas.

He's gonna be okay.

Thank God.

Is this what life is gonna be like from now on?

A-Are these things just going to keep happening?

We're gonna keep him here for a few days,

do some follow-up testing,

make some adjustments to his medications.

Hopefully, we'll find out why this happened.

[CELLPHONE VIBRATES]

I have to go.

Another one?

Post-operative imaging showed a -millimeter aneurysm

in the basilar artery.

That size and location,

we're looking at a high risk of rupture.

He must have a genetic predisposition...

maybe a connective tissue disease?

All academic till we repair it.

MELENDEZ: Through the pharynx

and over to Grandmother's house we go.

There's the epiglottis and the vocal cords.

I know you're not happy that I sued the hospital.

But I'm not gonna apologize for that.

Makes it simple.

I did it because I want to be here.

I believe I can learn a lot from you,

even from your doghouse.

I just hope you give me a chance, sir.

[MONITOR BEEPS RHYTHMICALLY]

There's the carina.

Gonna pass into the mainstem bronchus of the left lung.

Is breaking up with your fiancée traumatic?

When I saw a woman get shot,

everyone told me it was traumatic

and that I should be going home.

Should you be going home?

Give me a mucosal brush for a cellular sample.

Loading it now.

How long does it take to get over a breakup

with the woman you love?

I'm seeing a lot of inflammation,

but no smoke damage.

That makes se-sense.

I thought we were doing this because she inhaled smoke.

She said she inhaled smoke.

I didn't believe her.

Whatever the cause, the inflammation

and the damage are real.

Let's get a mucosal biopsy.

I move down here, we...

Scope breached her bronchial wall.

She's hemorrhaging.

- This is bad.
- Prep the O.R.!

Type and cross two units of blood. We've gotta move!

We know there was a burn.

Was it something related to the grease fire,

or separate coincidental injury?

[MONITOR BEEPING RHYTHMICALLY]

You don't have a theory,

or are you refusing to talk to Jared?

MELENDEZ: I didn't answer because it doesn't matter

until we can repair this puncture

before bacteria passes through and spreads an infection.

That's true.

Cut this suture.

Let's approximate the edges with forceps.

Are you and Jared even now?

He made a mistake. So did you.

Exactly what mistake did I make?

This breach was your fault.

Is that traumatic?

I had breakfast by myself.

Where were you?

I'm sorry. Were we supposed to have breakfast this morning?

- I had an early consult.
- [LAUGHING]

Yes, we always have breakfast on Mondays.

- We do?
- Every Monday.

Every Monday.

Thank you.

Well, I guess our streak has been broken then, huh?

If someone punctures the bronchus

during a routine bronchoscopy, that's a mistake, right?

Well, I can't imagine how it wouldn't be.

Why? What did you do, Shaun?

I'm wondering if I need to report Dr. Melendez.

Dr. Melendez did that?

The protocol is very clear.

I need to report it.

But I've seen how Jared is being treated.

Will Dr. Melendez treat me badly if I report this?

He shouldn't, obviously.

But human nature being what...

Human nature?

Shaun, you know what?

You should make this decision for yourself.

In fact... In fact...

you should to make all your decisions yourself

from here on in.

That's what we agreed on, right?

Have you considered

an endovascular embolization procedure?

I have.

It's a little less risky,

but I haven't done as many,

so I'm not sure which way we're better off.

You want me to check the roster...

see if there's somebody available with more experience?

I would like to assist, but yes.

Okay, here we go.

No, he's not available.

So make him available.

I got a husband and father

who presented with two aneurysms in the last hours.

I'd rather not.

This particular surgeon was recently...

transferred.

[MUG THUDS ON TABLE]

Not a chance.

Coyle is the best available surgeon for the job.

Coyle should've been fired, and if he'd been fired,

- he wouldn't be available.
- [SIGHS]

And if he wasn't available,

you would be the best person for the job.

Our ultimate duty is to the patient.

No, it's not.

- You agree he should have been fired.
- Of course.

Even if he was the best doctor in this hospital,

he should have been fired, right?

[SIGHS] Yes.

So some things have to matter more

than who is the most skilled.

If we forgive Coyle just because he's good at something,

what does he do next?

Either he matters or we matter.

Were you upset during the procedure?

Did Murphy tell you that I was "traumatized"?

You think that I might have almost killed a person

because you dumped me?

The fact that you're describing it as "me dumping you"

suggests that you are upset.

Look, I'm fine. You're fine.

Nobody's upset.

Great.

But you do understand

that I have to ask you these questions,

that I need a statement from you.

Yes.

Here's my statement...

"I wasn't distracted.

I didn't screw up."

You get all that?

[ELEVATOR BELL DINGS]

Your bronchus was punctured during the procedure,

but it's been repaired.

How? How could that happen?

Why did you lie?

You said that you inhaled smoke,

but there was no evidence of smoke.

So, what do you gain by lying to your doctors?

I wasn't lying.

I was just...

confused, I guess.

I was in a lot of pain,

and it was all happening so fast.

[GRUNTS]

My stomach!

Naja, what are you feeling?

It's really sore and... I feel like I'm going to...

[GASPING]

Can we get some help over here?!

Four milligrams of ondansetron.

[RETCHING]

Airway inflammation, abdominal pain, nausea.

We need a full blood panel and abdominal ultrasound.

[COUGHING, RETCHING]

The procedure will seal off the aneurysm,

but there will almost certainly be some brain damage...

anything from mild visual or speech disturbances

to significant paralysis.

But without the surgery, he'll die.

No. I-I won't consent to the operation.

There really isn't a lot of choice here.

Without the operation...

After his first stroke, it...

it took him so long to recover.

It was frustrating and painful for him.

But he did recover.

He made it clear he'd never want to live compromised.

[VOICE SHAKING] Excuse me.

Thank you for having breakfast with me.

My pleasure.

People lie a lot, don't they?

No, I-I meant it, Shaun.

I'm happy to spend time with you.

There are seven reasons that I've thought of.

There may even be more.

Do people ever lie without a reason?

No.

Reason number six. I think you just lied.

I think you just lied to avoid something.

You don't like this conversation.

Shaun, n... Shaun, I'm sorry.

I'm just... just a little distracted.

My aneurysm patient...

We're treating him with blood-pressure meds

to try and avoid a rupture.

You should do an endovascular embolization.

He doesn't want one.

It could leave him with brain damage.

- I thought he was unconscious.
- Yeah, he is.

His wife knows what he wants.

[CHUCKLES]

It's amazing. I just...

I don't think I'd be able to do that.

She's sacrificing her happiness, her future,

- just because she knows...
- She's lying.

She's lying.

It could be either reason number four or...

No, she's not lying, Shaun.
She loves him.

She doesn't love him.

You haven't even met her!

You haven't seen what she's like with him, with their son.

I'm not good at reading people.

- Well, I am, and...
- I think people-reading

embraces personal biases.

I think we should try to avoid biases.

Knowledge of human behavior

can help us make informed, intuitive decisions.

Mm, my way is better.

It's based on actions. She's lying.

All right.

If you love someone,

you'll do anything to prevent their death.

This... situation...

There seems to be a conflict of interest.

So I would like to bring in someone else from legal

to handle it.

Yeah, I agree.

You're an excellent lawyer, but...

But what?

Do you think this is my problem?

It's understandable.

hours ago, we were engaged.

And now, suddenly,

you're supposed to be investigating me?

Yes.

And doing crazy things,

like expecting you to give me complete answers

to appropriate questions.

You were trusting Murphy's judgment over mine.

His judgment about my demeanor.

Seriously?

I asked you a question.

You wanted me to screw up.

You did screw up.

So what?

So we just deal with it.

But if you can't even admit that you're not always perfect,

- then I...
- I am not perfect!

Clearly, I have made mistakes in my life.

But not this time.

That punctured bronchus was not my fault.

[MONITOR BEEPING RHYTHMICALLY]

The nurse says his vital signs are stable.

No change.

CLAIRE: That's good.

It's...

such a great sacrifice

to respect his wishes enough to let him go.

You must love your husband very much.

But...

there could be another explanation.

Either you love him enough to let him die...

or you hate him enough to let him die.

You don't know what you're talking about.

There's a doctor here who harassed me.

He made me feel vulnerable, worthless...

neither of which I am.

But he never hurt me.

I can't imagine how I would feel if he did,

what I would do,

what I would want to do to him.

What did your husband do to you?

He's a good father.

No, he's not.

A good father doesn't hurt a mother.

Payton loves him.

All the more reason...

No.

Payton doesn't know anything.
He never can.

I know you're afraid he'll come after you,

but there are people who can help.

Payton is better off with the memory of a loving father

than the truth.

Let him die.

Methanol is causing her abdominal pain.

She drank wood alcohol?

People drink whatever they can drink.

Well, she's Muslim... Wouldn't let me touch her.

Religious people aren't immune to hypocrisy.

There are other ways to explain the presence of methanol.

It's also produced by the liver

when the body is exposed to certain caustic chemicals.

If inhaled, caustic chemicals could also inflame the lungs.

And caustic chemicals also burn,

so it would explain all her symptoms.

Do you happen to have a list

of which caustic chemicals do all that?

Dimethyl sulfate...

It's used in the pharmaceutical industry.

- She's a school teacher.
- It's also used

in water treatment, industrial pesticides,

and chemical weapons.

She has no reason to be involved

with water treatment or industrial pesticides.

But she could be a school teacher

and a terrorist.

- So, what do we do?
- The surgery.

We don't have her consent.

Technically, the issue is we don't have his consent.

We go to his wife because we can't get his,

the assumption being that she's operating

in his best interests.

Pretty sure that's not happening here.

Go back to the wife, get her to change her mind,

or we'll take it to court.

Okay.

Hey, you look annoyed.

I'm annoyed we're sending him home

to keep abusing his wife.

She's a world-class liar.

I mean, for all we know, she wants her husband dead

so that she can run off with her Pilates instructor.

I'll get the consent.

Thank you.

[INDISTINCT SPEAKING OVER PA]

She refused initial treatment for methanol toxicity.

It's ethanol...

Because she's Muslim, she can't consume it.

SHAUN: She has alcohol in her system

but won't let us put alcohol in her system to treat it,

because she doesn't want alcohol in her system.

- We put her on fomepi...
- Dr. Murphy...

Is this part of your evidence that she's a terrorist?

Because she's Muslim?

There are billions of Muslims that aren't terrorists.

Is that part of your evidence that she's not?

I think she's a terrorist because it's the easiest way

to explain her symptoms and her lie.

Do you have a way?

She had an accident. It scared her.

Maybe we scare her.

Hell, maybe this whole place scares her.

There are a lot of reasons people don't tell the truth

other than criminal activity.

Six other reasons.

If a person comes in with a gunshot wound,

we have to report it.

Why don't we have to report

someone who might be making chemical weapons?

Because unfounded accusations can destroy people's lives.

What does it matter what people speculate

as long as the truth comes out?

Because people make up their minds

before the truth comes out.

Says the guy who played the race card

when he needed an advantage.

Even if you're right,

she's not making bombs while she's in our ICU.

Also, you're wrong. Now, keep me posted.

If she's not better in the next two hours,

I want to know.

We need you to consent to your husband's surgery.

I said "no."

There's a better way, Tessa.

Leave him.

Start a new life.

[VOICE BREAKING] I'm afraid.

I know.

But... this...

This isn't the answer.

[SIGHS] If you don't consent,

we'll take this to the court,

and we'll tell a judge what we know.

I told you those things in confidence.

You are not my patient. Your husband is.

[SCOFFS]

Two things will happen.

We will get the consent,

and Payton will find out the truth.

Tessa?

You are stronger than you think you are.

[MONITOR BEEPING RHYTHMICALLY]

Your methanol toxicity is abating...

The treatment's working.

Great.

Um... do you think that I'll be able to leave soon?

All of your symptoms are consistent

with exposure to dimethyl sulfate.

I... I've never heard of dimethyl...

Dimethyl sulfate is used to make chemical weapons.

[SCOFFS]

I didn't expect this from you.

I made a statement.

You're different.

I have autism.

You've experienced bigotry.

Yes.

Have... people refused to serve you?

Have you seen people

change their flight

because of you?

[VOICE BREAKING]
Have people cursed you out

before you've opened your mouth?

I'm not prejudiced.

I have evidence.

Nobody's prejudiced.

Everybody has evidence.

And I'm always brown.


[SCOFFS]

Maybe you're not so different.

[INHALES SHARPLY]

You're sweating.

Perspiration is a sign of dishonesty.

[BREATHING SHAKILY]

[GASPS]

My chest.

Chest pain can be brought on by anxiety.

[MONITOR BEEPING RAPIDLY]

Oh, but this time, you are having a heart attack.

EKG, stat!

The endothelial lining had moderate inflammation

that appeared acute,

and there was evidence of mucosal edema.

I made no extraordinary motions,

nor did I apply any unnecessary force.

And yet, the bronchus was punctured.

Which is a risk, albeit a small one,

with this kind of procedure.

- Well...
- [PEN CLICKS]

thank you.

I appreciate the thoroughness
of your answers.

- Not sure I understood it all...
- [CHUCKLES]

...but I think I've got what I need.

I probably shouldn't say anything,

but I know you and Ms. Preston

are going through something right now.

That really wasn't relevant.

Oh, I-I know. I know. It's just...

I know she'll get through it, but...

it's good you're handling it better.

It's one thing to be distracted while drafting a contract

and a whole other thing entirely doing what you do.

[FOOTSTEPS DEPART]

[DOOR CLOSES]

Inject dye.

Injecting dye.

[MONITOR BEEPING RHYTHMICALLY]

Hanging a left at the vertebral artery.

Okay, withdrawing the guide wire.

Inserting the platinum matrix.

[MONITOR CONTINUES]

You know, sometimes,you do the right thing

and things get a little better.

And sometimes, things still suck.

Entering the aneurysm.

Okay.

[MONITOR BEEPING RAPIDLY]

- Blood pressure's spiking.
- Wait, why?

There's no rupture, no bleeding,

- no stroke.
- [SIGHS]

If his BP goes up any higher, he will have a stroke.

[SIGHS] I'm terminating the procedure.

Push milligrams of labetalol, stat.

We need to stabilize him before we can retry the procedure,

which means we need to figure out what we missed.

This wasn't our fault.

His BP was stable going in.

He's been on calcium-channel blockers

- for the last six years.
- Well, we missed something.

BP doesn't skyrocket for no reason.

Run a full work-up.

Why would a -year-old with no risk factors

have a heart attack?

Hmm.

Her heart is burning.

Burning?

From the caustic chemical!

- Murphy.
- It's going through her system.

Unlike thermal burns,

chemical burns get worse over time.

And it also explains the punctured bronchus.

The caustic chemical thinned the bronchial walls.

You did not make a mistake.

That's not the only explanation.

But I'll shut up now.

You think you have a good idea,

but you're going to shut yourself up?

It could be caused by an infection

from bacteria that leaked as a result of the puncture.

The treatments are iametrically opposed...

antibiotics if it's infection,

steroids if it's inflammation.

If she needs antibiotics and she needs steroids instead,

it will suppress her immune system,

causing the infection to flourish and kill her.

If she needs steroids

and we give her antibiotics, then...

I get it.

- We'd better be right.
- Yes.

Sir, I think we should bring another senior attending in

- to consult on this decision.
- Why?

Because if Shaun's right, you're exonerated.

And if I'm right, you may have made the mistake

that could kill this woman.

You don't think I can be objective?

I think you're incredibly professional...

Shut up, Jared.

It is possible that I screwed up.

Let's put her on broadspectrum antibiotics.

You're wrong.

Making a decision

on the assumption you made a mistake

is a mistake.

You're very arrogant.

It helps you be a great surgeon.

Fortunately, I don't need your approval.

[DOOR CLOSES]

We've determined what the underlying problem was.

What caused your husband's aneurysm to rupture

and why his blood pressure spiked in the O.R.

According to his labs,he hasn't been taking his meds.

As far as I know, he has.

I mean, that's just not like him.

We don't think it's like him, either.

You think I had something to do with this?

That I, what, threw his meds away?

He'd just order more.

But if you emptied his capsules and filled them with sugar...

or, even better, salt...

It would end your nightmare.

I was willing to let him die,

but I could never...

If I were strong enough to kill him...

Is there a chance your son knows more

than you think he does?

[MONITOR BEEPING]

Her heart rate's .

That's in the normal range.

But it was . It should be going down.

All her other signs are normal.

You were right.
This is the proper treatment.

.

[MONITOR QUICKENS]

I'm switching her to steroids.

If we give her steroids,

it will suppress her immune system,

causing the infection to flourish...

I'm going to push milligrams of methylprednisolone.

...and she'll die.

This is on me.

I know.

We switched her to methylprednisolone.

It's working.

You were wrong.

Yeah, I got that.

Just about the treatment choice.

- You didn't do anything wrong in the O.R.
- Don't kiss my ass.

Jared saved her life.

If he hadn't acted so quickly, she would've died,

and that would've been your fault.

Yes, it would've.

You should thank him.

Thank you, Dr. Kalu.

Hey.

Can I help you?

I'm Dr. Shaun Murphy.

You're my new neighbor, number .

Yeah, cool.

Uh, you wanna come in for a beer?

No.

Nice work.

You, too.

You can have the honors.

[SIGHS]

This is the first time I'm not looking forward

to telling the family it went well.

You're going to be fine.

The treatment worked?

The second one did. The first one almost killed you.

The fact that you're alive right now is evidence

that you were working with dimethyl sulfate.

You're a terrorist, aren't you?

My brother works for a drug company.

They use dimethyl sulfate to make one of their medications.

He stole some for me.

So you could make a chemical weapon.

So I could make perfume.

Smell that.

It's... beautiful.

But very stupid.

Yeah.

Especially since my brother would get fired

if anyone ever found out.

You believe her?

Protecting someone...

reason number three.

So... we good?

Thing is, I'm not sure it really matters.

I've been told I can only have three residents next year.

That's great.

Not really.

Because of Coyle's transfer, I have to take on his.

Reznick?

[LAUGHS] She's a pain.

Pain can be a hell of motivator.

Good luck.

You were right.

And I think you were right that I wanted you to be wrong.

And I'm sorry.

You were right, too.

I kept telling myself that I'm fine, but...

it's been hard.

Got me second-guessing myself,

maybe affecting my judgment.

I don't know.

If we're hurting so bad, maybe we made a mistake.

No.

It just means that what we had mattered.

Doesn't mean that it was right.

I've also been thinking that...

arrogance does make me a better surgeon.

But it's not gonna make me a better husband.

I'm sorry.

Kristin?

Hey, I'm Claire.

Hi.

Thanks.

Um,

I am doing some research on Dr. Coyle...

on the women who worked with him and then quit.

I got another offer at SF Muni.

I was harassed by Dr. Coyle.

And I think you were, too.

[SIGHS]

Doing the right thing can make things a little better...

especially if we do it together.

[SPEAKS INDISTINCTLY]

I have a new neighbor.

Hmm. So, Lea's really gone, huh?

So, can we have breakfast tomorrow?

I'd love to, Shaun, but...

[CLEARS THROAT]

we, um...

We talked about this, right?

I-I said that I would

back off if you stayed, right?

More space, less "fathering."

I don't need a father.

I hate fathers.

- Right, so...
- I need a friend.

Shaun, I-I am someone who can't help

but give advice, you know?

I don't know if I can not do that.

So you think I can change and you can't?

I think that we have a certain kind of relationship.

And we can call it something different if we want,

but we can't magically make it different.

You said that you wanted space.

You said that you needed space.

I-I think you should be my friend.

[PATRICK WATSON'S "BROKEN" PLAYS]

Shaun...

Okay.

Shaun?

♪ Do you feel a little broken? ♪

♪ Do you feel a little broken? ♪

♪ Do you feel a little broken? ♪

♪ Do you feel a little bro-o-ken? ♪

♪ Memories come and they go ♪

♪ You just learn to let go ♪

♪ Sometimes, sometimes, you wanna, wanna go back ♪

What are you smelling right now?

Pine trees.

♪ Do you feel a little broken? ♪

Mmm.

♪ Do you feel a little broken? ♪