|Transcripts - Forever Dreaming
|01x17 - Smile
|Page 1 of 1|
|Author:||bunniefuu [ 01/29/19 12:51 ]|
|Post subject:||01x17 - Smile|
♪ MAN: The timing was good.
I just got a job transfer, Gretchen will start at a new school...
We're gonna start a whole new life.
It's very exciting.
In college, my dad majored in cheerleading.
That was a joke.
Gretchen's got a great sense of humor.
I'm laughing on the inside.
Soon you'll be laughing on the outside, too.
- Dr. Park.
- [CLEARS THROAT]
Moebius Syndrome is a paralysis of the th and th pair of cranial nerves.
The th pair controls facial expression.
Luckily, in Gretchen's case, we haven't found any limitation to the th pair.
I'm a lucky girl.
We'll be taking two slivers of muscle from your thighs, along with their nerves and blood supply, and transplanting them into your cheeks.
There'll be considerable recovery time before you'll be able to smile at will...
maybe three months.
So, what do you say?
Are you up for this?
Can I sleep on it?
See what I have to live with?
Nobody knows when I'm joking.
Sorry, Dr. Andrews.
Yes, I am very up for this.
So unless there are any other questions...
SHAUN: Do you want to be a comedian?
People getting your jokes must be very important to you if you think it's worth the risk of dying during elective surgery.
I apologize for Dr. Murphy.
He's still learning that silence is the right choice when you have nothing useful to offer.
We are required to have an honest risk/benefit discussion with our patients.
We are giving a lovely young girl a smile.
That's a simple equation.
Well, it's more than the smile or the jokes.
She can't express any emotions at all.
No one can tell if she's happy or sad or scared...
She's never had much of a social life.
Ever since her mother died, she's been completely withdrawn.
♪ All I want to do is bring my baby girl back into the world.
Don't worry, Mr. Milman, we'll take great care of her, all right?
♪ Lucy has a post-op infection of unknown origin.
Infusing milligrams of clindamycin.
It's terrible, isn't it?
Yes, it is.
- Have you been changing your dressing?
- Every day.
- Soaking it in clean, warm water?
Taking your antibiotics...
one pill, three times a day?
- That's a no.
- [INDISTINCT ANNOUNCEMENT OVER P.A.]
Lucy, I know I gave you a scrip for antibiotics, along with one for pain meds.
Why haven't you been taking your antibiotics?
Did you have a bad reaction to them, or...?
I never filled my prescription.
I didn't think it was necessary until it got really bad, and then I was too weak to go myself, and I didn't have anyone to pick it up for me.
I know it was stupid.
I haven't seen you in ages.
I'm buying an apple.
I can see that.
- Here, I-I-I'll get it for you.
- No, thank you.
Thank you, Shaun.
What else is new?
You didn't want to be friends.
Um, yeah, no, I...
You know, we're...
Whatever we are, we can still talk...
We should talk.
I have a new friend.
Here you go.
- Thank you, Debbie.
- [REGISTER BEEPING]
That's, uh, that's great.
Do you have a new friend?
- Thank you.
We can talk.
You know, we can talk about sports, we can talk about weather, we can talk about...
Why would you want to talk about Debbie?
Debbie was flirting with you.
I noticed her exhibiting two typical signs.
- Not the trifecta, huh?
- No, no the trifecta, - and one atypical sign.
- I think she's just trying to be friendly.
She gave you an extra dollar in change.
And the fact that you didn't notice means you like her, too.
Maybe she's just bad at math.
My dad said that you're on the spectrum...
That's why you said that about people getting my jokes.
People always get my jokes.
Then you're very lucky.
That was a joke.
I see what you did there.
They call me "Resting Gretch Face." "Shaun the Moron." Not very witty...
I'm obviously quite smart.
I drew this to their attention.
I'm on a spectrum, too.
Somewhere between inscrutable, unapproachable, and...
I don't want to be more approachable, and I prefer people not reading my emotions...
That's what you do with friends.
You really think this surgery's too risky?
Possible complications include embolism, hemorrhage, collateral paralysis, asymmetry, brain damage, and stroke.
It's also expensive and medically unnecessary.
Okay, look straight ahead.
There's a two-hour wait in the E.R., and what are we doing?
Treating a woman because she willfully ignored doctors' orders.
I know what a "Parasite" looks like, and it's not Lucy.
So this is a Mom thing with you.
Growing up with a whack mother means that you can identify any and all problem personalities.
And that is the sole upside to my miserable childhood, - thank you.
- Well, at least you had a mom.
Mine died when I was , and Dad instantly married a child-hating bitch with a butt-load of debt.
Morgan, I'm sorry.
I didn't tell you to get sympathy...
just that I know "Parasites," too.
[KNOCK ON DOOR, DOOR OPENS]
Got you booked first thing tomorrow morning.
I get it.
If you have any more questions, feel free.
I've changed my mind.
I'm not having the surgery.
Gretchen's father is very upset.
It seems you talked her out of the surgery.
No, I didn't talk her out of it or talk her anywhere.
I just gave her the list of potential risks.
Embolism, hemorrhage, collateral paralysis, - asymmetry, brain damage, and stroke.
Yes, there was a case in Brazil in , - and the patient suffer...
It seems that you don't believe that restoring this girl's smile is that important.
Smiles are overvalued.
There are studies that support that.
And there are studies that don't.
When we smile, we produce endorphins.
They make us happy.
They make other people happy.
When we see smiles, our basotemporal lobes are activated, and we duplicate what we see.
Murphy, smiles are contagious.
I feel good, you feel good...
Everybody likes smiles.
In any case, your smile wasn't sincere since it didn't demonstrate the Duchenne Marker...
There was no involvement of the orbicularis oculi muscles around the eyes, which means you didn't release endorphins.
You know, if you can talk her out of a surgery she's wanted for years, I'm pretty sure a conversation with someone objective can talk her back into it.
Get Park, come with, and keep quiet.
[KNOCK ON DOOR]
Yes, uh, of course I do.
I hope it's okay that I requested you.
I'm glad you did.
How are you doing?
Oh, that's what you're going to tell me.
I've been wearing the, uh, tilapia skins for five months.
I'm getting really tired of being followed home - by stray cats.
- [BOTH LAUGH]
How's the pain?
Compared to what it was?
any fever, itchiness, or swelling?
Well, it looks very good.
How much longer?
Um, how do you feel about tomorrow?
I never joke about tilapia.
What's the matter?
I-I just wasn't expecting that.
I'm afraid of how I'm going to look.
You're going to look beautiful.
I know Dr. Murphy informed you about the risks of this surgery, and some risks are significant and some just aren't.
This is as close to risk-free surgery as we can get.
It'll give you a smile, it'll let you laugh...
Murphy didn't talk me out of it.
He inspired me.
He helped me realize that this could actually make me stronger.
I don't want to run from it anymore.
Yeah, she's lying.
She's a smart, sarcastic young woman, not exactly someone who's prone to inspirational stories.
Why would she lie about changing her mind?
Well, when I was a cop, I had a lot of people change their minds about testifying in court, and it always came down to one of three reasons...
fear, confusion, or they were paid off.
She doesn't seem confused.
And I don't think she's afraid.
So Gretchen was paid off?
I admit the analogy isn't perfect.
It's close enough.
♪ Guess who's back in the E.R.
You're happy, so I'm guessing it's a noncompliant patient.
You misjudged Lucy.
She made an honest mistake forgetting her prescriptions.
You called her, didn't you?
She didn't spontaneously remember, you had to remind her.
Is that a Mom thing, too?
Gretchen, are you worried that your dad can't afford this surgery?
The insurance company is paying for it.
I know it isn't.
It's medically unnecessary.
No one can put a value on your smile...
not bullies, not an insurance company, not even Dr. Murphy.
In my opinion, this surgery's medically necessary.
my first memory of your mother was of her smiling at me from across the room.
And because of that smile, we ended up with you.
And my last memory of her is that radiance lighting up the world one last time.
I mean, we never had much money, but as long as I had that smile, it didn't matter.
I love you, Dad.
And that's why I can't let you give up everything for this.
LUCY: I'm here.
Um, Lucille Elizabeth Callard?
Yes, that's me.
A Dr. Browne called me to pick up my prescriptions?
MORGAN: You're the victim of identity theft, Lucy.
There's an imposter using your name and medical ID to get benefits.
Did you have your purse stolen recently?
Six weeks ago.
And you had your driver's license and credit cards replaced, but not your health-insurance card?
Is this why the pharmacy refuses to fill my prescriptions?
I'm on pain meds for post-herpetic neuralgia.
It's getting really bad.
Once the imposter filled her prescription for pain meds, the pharmacy must have thought - you were overfilling opiates.
It always flares up when I get upset.
Don't worry, Lucy, we'll get you your meds.
We're already treating "Lucy Callard." [SIGHS]
Nice game, Tony.
- Marcus, hey.
You coming or going?
-year-old girl with Moebius Syndrome...
your company denied coverage.
No respiratory issues, deformities, pain, she doesn't even drool.
She's fully functional.
She can't smile...
That's a function.
Marcus, I think it's wonderful you want to give this little girl her smile, but if we pay for everything wonderful, we'll go bankrupt, huh?
And then who are we helping?
We all know doctors cheat diagnoses to get coverage.
"Deviated septum" gets you a free nose job, "migraine" gets you Botox.
Do you really want me to play that game?
This isn't a game for me.
We're a reputable company with very high standards.
Very high bonuses that get even higher - with your denial rate.
I was gonna suggest we end this before we say something we'll regret, but I believe that just happened.
Gretchen's socially isolated, depressed, and that's only gonna get worse.
What if she slashes her wrists?
You'd prefer to cover that?
Are you threatening me with a teenage girl's suicide?
And God forbid something does happen to her, 'cause I'll make sure that this conversation's part of the permanent record.
Andrews said smiles are contagious, and I'm testing that hypothesis.
Well, I'm not sure your study will prove anything.
It might have something to do with the lack of the Duchenne Marker.
But here you go.
That wasn't a smile.
Sure it was.
I want to show you something.
♪ You need to follow me.
The impostor has poisoned the real Lucy's medical record.
We have to go through every medication, every notation, every test to determine whose is whose.
Doing that with zero tolerance for errors could take six months.
Well, the paperwork is our problem, not hers.
Not if the confusion results in a harmful treatment or incorrect diagnosis.
Well, we have to do something.
This woman is in serious pain.
So we treat her...
just be clever about it.
Shaun, I've already had two iced coffees...
- You flirted with Dr.
Oh, my God.
'Cause I have a new friend, and he needs one, too.
- I'm so sorry.
Look, Dr. Glassman, Debbie's facial proportions are close to optimal, okay...
vertical and .
- I'm so sorry.
- ...so you should find her attractive.
I-I'm so sorry.
And I think you're both Jewish.
Tribal commonality is highly conducive to social bonding.
Bullies can't put a value on your smile, nor can Dr. Murphy, but it seems the insurance company can.
They've agreed to pay $ , , about % of the entire cost.
I can cover the rest of that.
Oh, sweetie, please, let me do this for you.
That's the only way that we can treat you right now.
Go home and get some rest.
The records department will call you to sort all this out.
A year ago, I was playing tennis.
And then the shingles hit, and I was laid up for six weeks, and I've been on pain meds ever since.
I lost my job, my husband treats me like I'm an old lady, and my daughter thinks I'm too medicated to be around the new baby.
Maybe I'll be better off as "Jane Doe."
The imposter returns.
Lucy, can you squeeze my fingers?
- She's in septic shock.
Order a lactate level, blood cultures, and a broad-spectrum antibiotic.
I'll tell Melendez we've initiated Sepsis Protocol.
MORGAN: We should report her.
She's a criminal and a flight risk.
CLAIRE: And very, very sick.
We should put someone outside her door and arrest her when she's stable.
We don't report patients we find with drugs or non-violent people with guns.
We do report people who steal from us.
What would happen if people who needed our help thought they would be arrested?
If they thought they would be arrested for stealing an ID, maybe they wouldn't steal an ID.
I don't remember anything in the Hippocratic Oath about checking payor sources before treatment.
GLASSMAN: Strongly suggesting there was no health insurance in th century B.C., Greece.
We have a duty to treat, and we have the right to get paid.
But first things first.
Oh, God, I really do not want to be sued by either one of these women.
Maintain the pretense.
And as soon as she's stabilized, we're gonna press charges.
♪ ANDREWS: Dr. Park, pull the muscle, please.
We don't want any excess gathering in the suture line.
Okay, remove retractors.
♪ Are you sure you don't want something for the pain?
No, I'm good...
as long as you keep talking to me.
Especially if you share something, uh, very painful.
like the time I mistook my biology teacher for my girlfriend and picked her up in the hallway?
twirled her around three times before I realized my mistake.
That kind of painful?
You may have to dig even deeper than that.
the time I finally found myself in the perfect situation?
You know, work, friends, future...
something I never really had before.
Maybe that's why I screwed it up.
You're not responding to the antibiotics like we'd hoped...
You know, don't you?
When the real Lucy Callard showed up, it kind of gave you away.
Is there anyone we can contact?
Do you have any children?
But he'd be so ashamed of me.
Where is he?
first one in our family.
I had to choose between premiums and tuition.
Your son is very lucky to have such a loving mother.
I just wish you got your antibiotics when you got your pain meds.
I didn't get either medication.
Are you sure?
Because the real Lucy was having problems with the pharmacy.
I didn't want to risk using the card again.
Is she okay?
Maybe it's time to move on...
take the lesson with you, find new friends.
I went to Denver for an interview last week.
Take a look.
Hey, trust me.
The kid, college...
it's just a convenient sob story.
Why would she lie if she may be dying?
Here's what we don't know about fake Lucy...
whether her story is true.
Here's what we do
She's a liar who just found out she's busted.
Speaking of lies, that shingles virus that the real Lucy had last year?
According to Dr.
Spindler at Santa Clara General, she had it the year before, too, and according to Dr.
Millhouse at SF Muni, the year before that.
She wasn't denied the pain meds because of our imposter.
She was denied because she is a garden-variety addict.
Park says the surgery went well.
It's been too long.
She should be breathing on her own by now.
Even after prolonged anesthesia, it should only take to minutes.
♪ Is she okay?
She should have protective airway reflexes, motor activity, and a return of consciousness.
♪ I need to page Dr.
What's going on?
♪ Gretchen's glucose is within normal limits and her electrolytes are also normal.
And we've ruled out hyper and hypothermia.
It doesn't leave much.
What about hypoxia?
Uh, she maintained normal oxygen, as well as end tidal CO throughout the entire case, and we've given reversal agents...
which we will repeat.
Do you feel bad?
♪ It's okay.
You told them it was close to risk-free.
They knew there were risks, and I told them, too.
Get a CT.
Rule out clots, hematoma, bleeding, and stroke.
♪ [MONITOR BEEPING RAPIDLY]
WBCs and lactate are rising, O sat and MAP are falling.
The Sepsis Protocol isn't working.
Multiple Organ Dysfunction Syndrome.
Another antibiotic, ah, continue crystalloids, - increase her vasopressors?
- Low-dose steroids?
Give 'em all at try, and intubate her and insert a swan.
And, yes, I understand this is out of our own pocket.
♪ [DOOR OPENS]
Um, do anything exciting for Purim?
you know, the usual.
Ate a little matzah, and celebrated our "Exodus from slavery"...
which I think is Passover and not Purim.
The truth of the matter is, I'm only half Jewish, so only half the knowledge.
The truth is I-I'm not Jewish at all.
Yeah, my first husband was.
So I guess we have our lack of Jewishness in common.
You know what, Debbie?
I think I-I should get going.
Well, it was...
it was nice, uh, finally meeting you, officially.
[TIRES SCREECH IN DISTANCE, CLATTERING]
Oh, no, look at that!
A D, one of the most perfect Mercedes ever just got a little less perfect.
I beg to differ.
If you're looking for perfection, you look no further than the SE.
Cabriolet or coupe?
an all-time classic.
Well, an owner of a SL Gullwing might argue otherwise.
Can I get you another coffee?
Iced, large, black.
- That's it.
- I know.
♪ That's a little bit unsettling, Murphy.
Why are you studying the current of ions during electrolysis?
Uh, it's not the chemical kind of transference.
It's the doctor-patient kind.
I'm dealing with a personal situation.
I don't think the Internet is very helpful for solving personal situations.
But I can't exactly ask Claire for her advice, and I barely know Park, and Morgan...
Morgan would be bad.
I'm a person.
Yeah, of course, Shaun.
I'd, uh, I'd love your advice.
Uh, so I think Celez, my burn patient, has feelings for me, and I...
may have feelings for her, too.
♪ But there's a good chance her feelings aren't real, and if they are
real, then they may not be permanent.
♪ Uh, you know, it's kind of textbook transference...
she's grateful and she's vulnerable.
♪ And all I've ever known in my life is unrequited love...
from Claire and from my parents.
And that makes me vulnerable, too.
♪ [PEN CLICKS]
♪ You should call in sick.
Lea says calling in sick is all you need to gain superior wisdom and knowledge.
She was right.
The CT showed no abnormalities, and the reversal agents have been repeated without effect.
So what else could it be?
Anoxic brain injury, a complication of anesthesia.
♪ Unfortunately, we believe...
your daughter is brain dead.
♪ [MONITOR BEEPING]
All for a smile...
I made her think she wasn't good enough the way she was.
I should've listened to you.
There's just no predicting how individuals will react to anesthesia.
You just walked out on that man.
The last thing a grieving family member needs is to see their doctor tap out.
Maybe she's still under anesthesia.
It was one of the anesthetics Gretchen was administered.
- Now, what if she has a Plasma Cholinesterase Deficiency?
It'd mean her body couldn't break down that specific drug.
Complete deficiency is extremely rare.
I've never personally seen it, and I don't know anyone who has.
Yeah, but if she does have it, she's just gonna wake up.
♪ Should I tell the father?
No, not yet.
No way we're letting him grieve twice.
♪ Your labs are not improving.
Your organs are shutting down.
You're running out of time.
♪ I'd like to stop calling you "Lucy." ♪ You're welcome...
♪ [MONITOR BEEPING]
What are you doing?
It's mediated by the nasociliary branch of the ophthalmic branch.
♪ What does it mean?
It means we were wrong.
She's gonna be just fine.
Thank you, Doctor.
Thank you, Dr. Murphy.
♪ [DOOR OPENS, CLOSES]
Honey, you're gonna be okay.
You're gonna be just fine.
I was drawing a bath, and I leaned over to turn it off, and I dropped the pill bottle, and before I could fish it out...
All the pills were ruined.
So you need a refill.
My pain has made me so clumsy.
Lucy, you're a liar and a cheat and an addict.
We know about the frequent prescriptions, the multiple doctors, and the ever-recurring shingles.
You have a serious medical problem.
Let me help you.
♪ Three months?
But we might be able to give you a pretty good idea of what you're gonna look like.
PARK: Those things by your ears are neuro-stimulators.
When we activate them, instant smile.
It's your mother's smile.
She seemed like a good template.
♪ There is no Duchenne Marker.
Her smile is not real.
♪ Thank you.
But all the other ones are.
All the other ones are.
I spoke with Jim Ransler, who made it very clear that we owe him big time for this.
Don't worry, Marcus, I can handle him.
I'm very impressed.
It was all very presidential of you.
You really went above and beyond.
Yes, I did.
I thought I was saving her life...
instead, I nearly ended it.
This is the brilliant Dr. Murphy.
He'll be assuming your care from here on, though I don't expect you'll need much.
♪ I understand.
I don't think you do.
You see, doctors aren't allowed to date their patients.
What are you doing tomorrow?
Uh, I'm calling in sick.
♪ I think you may still have some friends here.
♪ [MONITOR BEEPING]
♪ I guess there is one upside to all this.
If she hadn't bought the stolen insurance card, the real Lucy wouldn't be in rehab right now.
I told her what she needed to hear to get help.
Trust me, I get it...
too soft, people take advantage of you.
But with your badass upbringing, no one messes with you.
You have way more street cred than, say, someone whose mom's a Johns Hopkins cardiologist, whose dad's a pathologist, and whose parents have been happily married for years.
Coming from privilege...
Must be really hard to overcome.
[MONITOR BEEPING RAPIDLY]
- I'll call a code.
There's nothing left to save.
Time of death, : P.M.
I'll notify her son.
♪ ♪ Oh, oh, oh ♪
♪ We're gonna show you that we're tough ♪
♪ We're gonna show you that we're tough ♪
♪ Knock us down, we'll get back up ♪ ♪
♪ Yeah, we're gonna show you what we've got ♪ ♪
Um, my homies decided to pop by and, uh, play some Texas Hold'em, so I'm gonna have to take a rain check on that pizza night.
You got a inch flat-screen, too.
I borrowed yours.
Makes no sense for us both to have one, right?
Plus homies got to watch March Madness.
- Oh, um, sorry, amigo.
It's four-player Texas Hold'em.
- I don't like poker anyway.
- Hey, Shaun.
♪ Look, you're a great guy, um, but you got a few, [INHALES SHARPLY]
like, quirks, you know?
It doesn't really...
jive with this kind of face time.
You get what I'm saying, right?
♪ Oh, oh, oh ♪
I love you, man.
♪ Oh, oh, oh ♪
I once drove a SL...
a SL Gullwing.
On the road?
For feet at the Concours d'Elegance.
Oh, in Pebble Beach...
That's just as cool.
The car show...
You know it?
Of course, yeah.
This year, they're featuring a Rollston Coachwork display.
Including the Mercedes SS?
- I don't know.
But we should find out.
Do you want to go?
Yeah, no, I...
thought that I should make that my first response before I accepted.
Can I get you anything else?
No, thank you.
We'll just take the doorstop.
Well, you can bring the doorstop.
The thing that...
that t-tells you how much to pay, the...
Could you call a...
Can you call an ambulance, please?
- Thank you.
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