02x05 - Carrots

[DOOR OPENS]

We should not live together.

That makes no sense.

I rented that apartment, and neither of us can afford it on our own.

It has a fireplace.

We shouldn't live together.

It has a fireplace.

Do you ever think about us being together... as a couple?

Sometimes.

I don't want that.

You don't want us to be a couple?

Or you don't want me thinking about us as a couple?

Neither.

If we get an apartment together, I feel like that's a signal that you and I might end up as boyfriend and girlfriend, and that's not going to happen.

You can't predict the future.

Feelings change.

I used to hate hugs, but now... sometimes I don't.

But I don't want my feelings to change.

I like being your friend, and romantic relationships a-are unpredictable.

So much can go wrong, especially when I am involved.

And if we live together, it's gonna be awkward.

You're bound to walk in on me when I'm naked or hear the weird s*x sounds I make with some out-of-work drummer or find me crying when that drummer dumps me,

even though I was totally gonna dump him.

[CLICKS TONGUE]

I was so unhappy when we weren't getting along.

You were, too, right?

Yes.

Anything that puts our friendship at risk isn't worth it to me.

Okay, Shaun?

Yes.

Our gallbladder removal's off.

Patient took an Ambien last night, woke up eating a roast chicken.

Let's check the consult list for something a little more interesting.

- See? Gallbladders are boring.
- You're a resident.

You don't get to call any surgery boring.

See?

This is interesting.

[ELEVATOR BELL DINGS]

Fizzy urine.

EMT: -year-old female, syncopal episode with persistent loss of consciousness.

On the ride, she went into PVT, rate of .

We shocked her back to normal sinus rhythm.

I'm starting to feel...

[EXHALES SHARPLY]

She's going back into PVT.

We need to shock her. Get her into a bay.

No. No.

- [CRACK]
- [WOMAN EXHALES SHARPLY]

That was cool, but you may have just cracked her sternum.

- Get her into bay .
- What happened?

- You're her husband?
- Yes.

Your wife is pretty frail.

Any idea what could have caused that?

She did.

She's anorexic.

- [DOOR OPENS]
- I'm Dr. Murphy. This is Dr. Park.

We're here about your urine.

How long has it been fizzy?

I hadn't even noticed. Is that a problem?

Ah, it can be a symptom of several conditions, many of them minor.

You're here for ortho, a scope on your right knee?

It's been sore.
I've been training for a race.

Joint pain plus fizzy urine.

You could have emphysematous cystitis, bladder cancer, kidney problems...

Those sound serious.
Should I call my husband?

Emphysematous cystitis is a treatable bladder infection.

Your symptoms could also be from a kidney stone or dehydration.

Could my issues be caused by...gastric bypass surgery?

It depends. When was it?

years ago.

I used to be pounds.

That's a lot.

Your surgery wouldn't cause those symptoms, but we need to do a cystoscopy to find out what did.

I'll cancel the ortho and get Lim to sign off.

Hey, wait. What...

So, what is a cystoscopy?

It's like a knee scope, except the camera goes up your pen1s.

You administered amiodarone?

Rhythm's normal.

That's good, right?

It's better than when you came in.

Your heart is failing as a result of a condition called mitral regurgitation.

One of your valves isn't closing all the way.

Blood keeps leaking back into your atrium.

That's why you fainted and why we need to repair that valve ASAP.

How long have you been anorexic?

I've had issues with food on and off since I was .

Mitral valve issues are a frequent complication of long-term malnutrition.

This bout started about a year ago... skipping meals, lying about eating, exercising excessively.

I don't know what else I can do.

I-I can't monitor her hours a day.

I'm not asking you to.

No, but you are starving yourself.

Mom.

Graham-y, come here.

What's he doing here?

[SIGHS] When I got home, I heard about the ambulance.

I made Cindy bring me here.

- [SIGHS]
- What's wrong with my mom?

She needs a surgery to repair a valve in her heart.

This heart thing, is, is that why she's so skinny?

SAM: Look, what matters, Graham, is that these doctors are gonna help your mom.

Okay?

You haven't moved your bowels.

Well, thank you, Shaun, for that announcement.

Saves me the trouble of tweeting.

The nurses already knew. They told me.

They also said you're no longer talking to your dead daughter.

Constipated, but no longer psychotic. A narrow win.

Your first defecation event is a vital part of the discharge criteria.

Event? What is this, the post-op decathlon,

- pooping, peeing, walking, talking?
- Yes.

You have to walk a full lap of the floor.

But you canceled physical therapy this morning.

Those nurses have big mouths.

I canceled because my leg is a little sore.

That could be phlebitis or a DVT or a...

Could also be an unsurprising complication from a surgeon poking around in my pons.

Every day in the hospital increases your risk of infection by . %.

You need to move your bowels, and we should walk right now.

I'll go very slow.

Shaun, is there any chance that you are needed elsewhere right now?

I-I have minutes until my patient's cystoscopy.

Good. Be early.

Urethra looks clean.

No lesions, no stones so far.

How do we check for obstructions or stones further up?

Contrast cystogram.

Since you found this patient, how about you do the honors?

You know this guy used to weigh pounds?

Thread the catheter further into the bladder.

That's a big drop. Good for him.

He did have gastric bypass.

That makes it less impressive?

- Now infuse the contrast.
- Well, yeah, it is the easy way, compared to just diet and exercise.

The contrast dye is dissipating.

It's supposed to.

You said he's training for a race.

Obviously, he turned his life around.

Still dissipating.

Bypass made it physically impossible for him to eat as much as he wanted.

It's gone. The contrast is gone.

- That makes no sense.
- Where did it go?

He probably has a fistula, a tunnel connecting his bladder to his intestine.

Air and bacteria moving the other direction caused bubbles in his urine.

Her liver and thyroid are normal, but her electrolytes are off.

Her albumin is at . .

She's severely malnourished.

She'll be totally vulnerable to post-op infections.

She needs this surgery to survive, but she may be too sick to survive the surgery.

MORGAN: In order to operate safely, we need to boost your caloric intake, optimize protein.

Can't you do that through my IV?

It's more efficient to pump a nutritional supplement directly into your stomach.

We use a tube running down from your nose.

I had an NG tube once.

It didn't work.

She couldn't tolerate it.

Because it's not really about food.

It's about control.

You've lived for decades with a condition that has killed more people than any other psychiatric illness.

You didn't just survive. You had a child.

Can you tell us how?

When I got pregnant, it was like this terrifying miracle.

And the thought of gaining all that weight, but...

I wanted him so much.

We both did.

Every meal, I would sit with pictures of his ultrasound,

I-imagining the food going directly to him.

Can you do that again?

Eat for Graham?

[EXHALES SHAKILY]

We've determined the fistula between your bladder and intestine was caused by Crohn's disease, an inflammatory intestinal condition.

Once we reverse your gastric bypass,

- you'll need...
- Wait. R-Reverse my bypass?

Are you sure?

Bypass surgery shortens the digestive tract.

People with Crohn's disease need every inch of intestine they have, or they risk critical, even fatal malnutrition.

Okay, but I don't want my husband to know, and he'll be here soon.

Well, we would never reveal anything without your permission, but Crohn's disease is going to require some major adjustments.

Well, I'll tell Spence about the Crohn's, and I'll tell him I'm having surgery... on my bladder.

Your husband doesn't know you had gastric bypass?

That would require him knowing I was obese to begin with.

That's not gonna happen.

Your husband must be very shallow.

Even if I don't disclose that I reversed your bypass, your scars might.

It requires a separate incision.

Well, tell him there was a complication.

Our obligation to protect your privacy doesn't include lying.

And you shouldn't have to go through this without him.

The single abdominal umbilical port.

We can repair Wade's fistula and reverse his bypass all through a single incision.

We can help deceive your husband.

- Oh, honey, I'm so sorry.
- That's okay, Spence.

- Got here... as soon as I could.
- It's all right.

And since my husband is surrounded by surgeons, what's the issue, what are you gonna do about it, and how often have you done it successfully?

How are you doing?

I'm fine.

[SIGHS]

Graham, would you mind filling this?

You've had one spoonful of tuna, ounces of apple sauce.

That's it?

Mom, if that's all I had, you'd never let me up from the table.

This is different. I... can't eat too quickly.

I don't believe you.

It's true.

Your mother is suffering from severe malnutrition,

- and she's trying her best...
- I knew it.

You're too skinny.
That's why you're here.

That's probably why your heart's messed up,

- and you still won't eat.
- Graham, I am trying.

- How hard can it be to eat?
- I'm not feeling well.

Me and Dad are really worried about you.

- Don't you care?
- Of course I do, Graham.

- So much.
- Then do something.

Prove it.

You provoked that argument?

Yep, and I may have just saved our patient.

She requested an NG tube.

Understanding is nice. Calories are better.

He's screwing this up.
His husband's scared, and he just wants to know what's going on.

Nothing like marital advice from the divorced.

- You're divorced, too.
- And I'm not advising.

I'm not judging the health of a marriage based on a single secret, which is neither shocking nor a sign of its imminent demise.

What, truth in a marriage is overrated?

Well, it was in mine.
Not every single insight, opinion, or impulse needs to be shared.

Marriage sounds confusing.

No wonder you both failed at it.

How's it going in here?

Not as bad as I remember.

Does it hurt, Mom?

No, just a little awkward.

Makes it hard to talk.

[SWALLOWS] But I'm okay.

I am so proud of you.

[SIGHS]

Dr. Glassman hasn't defecated or done his physical therapy.

I am aware and yet unalarmed.

- Who are you?
- I'm Dr. Shaun Murphy.

Oh, right!

Your Dr. Glassman's... friend.

Please order him to do physical therapy and give him milligrams of ex-lax.

The ex-lax is a decent idea.

As for the physical therapy, of course, he's stalling.

Glassman's a proud man.
He ran this hospital.

He's reluctant to feel weak and vulnerable in front of people who used to work for him.

That doesn't make sense.

He is weak. He just had brain surgery.

Well, sensical or not, that's my take.

He'll walk eventually.

SHAUN: Every day in the hospital increases his risk of infection by . ...

Well, you tell him that, and maybe he'll hop right out of bed.

I did. It didn't work.

He didn't respond to the stick.

Try the carrot. Although, really, I would just advise...

[TABLET CHIMES]

Dr. Glassman doesn't like carrots.

What should I do with the stick?

It's a metaphor.

Uh, Glassman, appropriately, is the donkey.

The stick signifies punishment.

The carrot signifies... reward, but he is, he's recovering nicely, and your best bet is to just be patient with him.

[TABLET CHIMING]

So, I should use a reward to motivate Dr. Glassman to do physical therapy.

Actually... what I'm saying is that you should be patient and supportive...

[TABLET CHIMES]

...and please, please answer that.

Close the door.

[RETCHING]

We were headed to pre-op when he started projectile vomiting.

It's... green.

That could mean bile and a partial bowel obstruction.

- We need an NG tube.
- An obstruction?

Did the Crohn's cause that?

It's hard to know for sure.
NG tube, stat.

[GROANS]

You're doing great.

You should try and get some sleep.

I can't.

There's this voice in my head, and it won't be quiet.

It keeps telling me that this bag has grams of protein, grams of fat, , calories in total.

It just won't stop.

[SIGHS]

Try... to think of Graham and Sam.

I'm trying.

I'll get something to put over that.

[COUGHING, GAGGING]

Louisa, no!

- [GAGGING]
- No!

- [COUGHING]
- No!

[CRYING] I'm sorry.

I c... I just...

I can't stand it.

[BREATHING HEAVILY]

I got your deposit back.

Why?

Shaun, I told you that you and I can't live together.

No.

You told me we can't be boyfriend and girlfriend.

We can s-still be friends with benefits.

The benefit is... we would be living together.

I was clear.

- It's too complicated...
- You were.

We can't date or kiss or have s*x.

But I thought you wanted to be friends.

Yes. Of course.

- And spend time together.
- Right.

Then it's simple.

[DOOR SLAMS]

She begged us to reinsert the NG tube, then pulled it out again an hour later.

MORGAN: Do we try again with the tube and restraints?

Oh, we'd just be raising her risk of self-injury, pneumonia, a blood clot.

What about going back to solid food?

Anything less than , calories a day, and her malnutrition wouldn't be improving.

In fact, she'll keep losing weight.

We should go ahead with that valve repair now.

I think we can improve her nutrition without force-feeding or IVs.

I found a small study where deep brain stimulation was used to treat anorexia.

You want to use brain surgery for a psychiatric disorder?

Surgical procedures have been effective for, uh, depression, OCD, addiction.

This surgery could reduce her anxiety around eating.

Once she's eating, her malnutrition will improve and reduce the risk of the valve repair.

It could also cause personality changes.

And this study covers six subjects with only % success.

Well, this could be Louisa's only shot at getting free of this illness.

And it was done in the UK.

DBS isn't FDA-approved for anorexia treatment here.

So, we call an IRB ethics hearing and argue emergent-use approval.

Which we shouldn't get off such little data.

Nice work digging this up, but it's not a real option.

Let's go talk to her about the valve surgery.

DEBBIE: Can I help you?

I'm looking for a carrot.

, , ...

No, uh, sorry, we don't have any carrot muffins.

How about a lemon-poppy, Shaun?

Hello, Debbie Wexler.

It's a metaphor for moving a donkey.

I need a carrot because I don't want to beat Dr. Glassman with a stick.

He likes blueberry muffins.

How's Aaron, Dr. Glassman recovering?

He moved his bowels this morning.

But he doesn't want to appear weak, so he hasn't done physical therapy.

I want that blueberry muffin, please.

It has visible blueberries.

You know, Aaron once told me that his absolute favorites were the chocolate chip ones.

Do you want one of those instead?

Yes, I want one of those instead.

[SIGHS]

Oh, hi, Dr. Park.

Um, I have a few questions about Wade's surgery.

[SIGHS] Sorry, I'm pretty busy.

Actually, I need to get going.

Uh, I'll walk with you.

I know Wade's surgery is this afternoon, but I've been researching treatments for Crohn's lesions.

What'd we do before the Internet?

I talked to two experts who felt that Wade should be put on REMICADE or Azathioprine before any surgical interventions.

Interesting recommendations, but considering they haven't seen your husband's chart...

Well, this doctor felt strongly that you should see how he responds to medication before...

Wade's care is completely appropriate for his condition.

But if his Crohn's lesions could be treated

- without cutting him open...
- That's not what we're treating.

Excuse me?

Go talk to your husband.

I brought you a chocolate chip muffin.

I love chocolate chip.

Thank you.

Where is it?

At the nurse's station.

- You can walk out to get it.
- Shaun, you see, here I thought you were doing something nice for me.

- I am.
- No, you're not.

You're manipulating.

My leg hurts, and I-I have a sore throat, and I don't feel like walking.

Dr. Blaize says you don't want to seem weak in front of people who used to work for you.

Dr. Blaize is wrong.

I don't want to walk because I don't want to walk.

And this is condescending, and it's insulting, and it's annoying.

Should I get you your muffin?

Well, that would be nice.

An orderly is eating it.

Mr. DeLeon, can I help you?

Uh... my wife's decided against the valve-repair surgery, at least until she's tried the deep brain stimulation for her anorexia.

Did Dr. Browne tell you that it's an experimental brain surgery, which could alter your wife's personality forever?

That's if we get the special approval required.

She's explained all the issues.

[KEYS JINGLE]

I got our apartment back.

I had to pay $ more as a deposit because someone else wanted it, but that's okay.

No, Shaun!

It has a fireplace.

Why aren't you listening to me?!

You're not listening to me!

I'll be okay running into you naked...or hearing s*x noises or seeing you cry over breakups with drummers.

I know that you think you can, but how can you be sure?

Because living with you will be good for me.

It makes me happy.

[SIGHS] You remember what you said, Shaun, that no one can predict the future and feelings can change?

What if I end up hurting you again?

I don't want to risk our friendship over an apartment.

Do you?

[EXHALES SHAKILY]

If we don't live together, you will have to buy your own batteries.

- We'll still see each other.
- That will be hard.

- I work a lot.
- We'll find a way. I know we will.

I need to go to work.

[KEYS JINGLE]

I'll stop on the way home and tell the manager we don't want the apartment.

No, I'll do it.

[KEYS JINGLE]

[KEYS THUD]

The subjects who responded in this study are all long-term sufferers with a target BMI of - , who actively pursued this treatment, much like our patient.

Additionally, DBS surgery requires lighter sedation and places less strain on her system than an open-chest procedure.

You're referring to the valve repair recommended by Dr. Melendez?

Yes.

I propose delaying that surgery by a couple weeks, which would be well worth it in terms of reduction of risk if the DBS is successful.

Excellent presentation, Dr. Browne.

Very thorough.

Agreed, though I do have concerns about approving this procedure based on the small subject pool.

But I'll confer with...

There is, uh, one more person I want you to hear from, the patient.

This is an IRB, not a therapy session.

Actually, patients who had the opportunity to air their concerns are eight times less likely to sue their hospital.

You paged me?

You can step out. Dr. Park's got this.

Grab the sheet.


[INHALES DEEPLY]

You talked to Wade's husband.

Maybe we should discuss this later.

I can patch him up while tearing you down.

You violated our patient's confidentiality.

I told him what we weren't treating.

That's not a violation.

And their marriage is better off for having his secrets out in the open.

That'd be meaningful if you were a marriage counselor instead of a surgical resident. Whatever lie blew up your marriage won't be undone if Wade tells the truth.

[ARM CRACKS]

I was just trying to help our patient.

[SIGHS] Our former patient.

Wade's demanding a transfer to another hospital.

I have tried cognitive behavioral therapy, food psychodynamic therapy,

[VOICE BREAKING] family therapy, in-patient treatment, out-patient treatment, anti-depressants, NG tubes, TPN.

And yet, here I am, dying.

Killing myself.

And I can't stop on my own.

Please...

help me... to stop.

Are you aware DBS has been known to cause personality changes?

In your case, the electrode would be at the nucleus accumbens...

Dr. Browne explained all of the risks.

It's important we know that you understand.

The nucleus accumbens plays a role in maternal attachment, delivering dopamine when moms interact with their children.

Now, what if in trying to overcome your eating disorder...you lose the ability to feel love for your son?

[NORMAL VOICE]
My son is everything to me.

For that past year, he has been watching me starve myself to death.

I'll risk anything to keep him from seeing me succeed.

Thank you, Ms. DeLeon.

We'll need a few minutes to talk.

You kept it a secret because you think I'm shallow.

- I said the same thing.
- I kept it a secret because of "friendly fatties."

Any news on my transfer?

San Francisco General should have a bed tomorrow.

Come on. It's a joke.

- A joke?!
- I'm here to clamp your nasogastric tube.

About a couple we've known for years?

We were at their wedding, and yet you treat them

- like a punch line.
- This used to be green.

- Now it's brown.
- You're the one who lied.

If I'd known you were offended...

The point is, is that's why I didn't tell you.

SHAUN: Red and green makes brown.

Your bowel is bleeding.

You need surgery now!
Page Dr. Park and Dr. Lim!

He has a strangulated bowel.

- Spence.
- It's gonna be okay.

We need to open up an O.R. now!

By a margin of -to- , this Internal Review Board has decided in favor of allowing this procedure.

- Nicely done.
- CLAIRE: Thank you.

Hope the surgery goes well.

Use the mm gold stapler.

The truth coming out didn't help Wade's marriage.

PARK: Hopefully, with some time.

Secrets are corrosive.

Wade should've been honest from the start.

Maybe Wade thought Spencer would feel the same way you did about his bypass, that he lost weight the easy way.

Okay.

It's time.

[WOMAN SPEAKING INDISTINCTLY OVER P.A. SYSTEM]

Graham-y.

You are... the highlight of my life.

You know that, right?

Yeah. I love you, too.

I love you more than any person on the planet ever loved any other person on the planet.

I-I know.

GRAHAM: Mom, you're gonna be okay, right?

Of course, baby.

Of course.

We'll see you guys in a few hours.

I love you.

The chocolate chip muffin didn't work.

The donkey won't walk.

I told you that Glassman's probably embarrassed.

No. He's not.

I asked him, and he said you were wrong.

Doesn't mean I'm actually wrong.

[BREATHING SHAKILY]

He needs help recovering.

I'm trying to help, but it's not working.

He got angry at me.

Dr. Glassman is your patient.

You need to fix his lack of mobility.

This is your problem.

I don't know what to do.

I don't know how to help him.

- Being sick is hard.
- [BREATHING HEAVILY]

Being around sick people is hard.

We want to help.

We all struggle with what to do.

- Your obsession...
- Okay.

More than a muffin or a bowel movement or a walk around the ward, what Glassman needs is someone to be there for him.

A patient, supportive friend.

I know the perfect person.

[INHALES DEEPLY]

Mm.

CLAIRE: Hey, there.

How are you feeling?

I'm okay.

I feel like...

I want something to eat.

I'm hungry.

All right, buddy.

Let's get you home.

- Get you a decent night's sleep.
- [SIGHS]

See you in the morning.

I'll get you some food.

Are you sure you're all right?

Yeah.

I just...

I wonder if that hug felt different for him.

Did it for you?

[INDISTINCT CONVERSATIONS]

Your husband's surgery went well.

He's in recovery now.

I think he's awake.

Thank you.

Wade told me where to find these.

This is him before bypass?

He said that seeing these would help me understand why he never told me.

Which...

I said was ridiculous.

Is he gonna end up like this again?

It's possible.

[SCOFFS]

I wish I didn't know that.

[KNOCK ON DOOR]

Yeah?

Debbie, hi.

Oh, um...

Shaun thought you could use a visit.

- Huh.
- Oh, and, uh, and another muffin.

Thank you. I wish I'd known you were coming.

I would've slipped into something a little less comfortable.

You look... good.

- Uh-huh. [CHUCKLES]
- Yeah, well...

Unlikely, but thank you.

I am... sorry that I've been...out of touch.

- Well, I had a brain tumor.
- Mm.

Understandable. We both dropped the ball.

[SIGHS]

Okay.

- Here we go.
- What's happening?

- We're taking a walk.
- Oh, no, no, thank you.

- Oh, yes, we are. Yeah, mm-hmm.
- No, my leg hurts a... Ow, ow.

Which is exactly why you need to take a walk.

Wow. You're really good at this.

You sure you haven't done this before?

Well...

I spent a little time as a nurse.

- [CHUCKLES]
- [CHUCKLES]

I always liked the night shift.

Everything gets really quiet.

It's almost... It's almost peaceful.

Just came from Louisa's room.

She's eating.

That's great news.

Yeah.

Hopefully we'll be able to do the valve repair in a couple weeks.

I hope you're right.

But you won't be a part of the surgery.

Or any of my surgeries.

You went around me, directly to the patient.

I had a good idea that you didn't take seriously.

I considered it, and then I decided against taking it to the patient.

And yet, I managed to get Aoki and Andrews to sign off at the IRB.

You didn't get Andrews.

You voted for me?

You made a strong case.

But you're, you're booting me off your service?

Disagree with me all you want.

I expect my residents to.

I expect them to argue passionately for their position.

And I expect them to then accept my decision.

Even when you're wrong?

I can't run my team any other way.

You know what was insane, was the Torpedo Roadster.

With the Purpleheart trim?

Ah, and the lizard-skin interior.

My neighbor in Wyoming had a Silver Arrow.

Oh, I'd love to drive one just once.

[CONVERSATION FADING]

Good job. You got him walking.

Debbie Wexler did it.

She's a better carrot than I am.

She's a better friend.

PARK: Hey, it's me.

Yeah, just making sure the check got there okay.

Great, great.

Hey, I have a question... about Phil.

I know, I know. He's long gone.

I was actually wondering... what do you think would've happened if I hadn't seen you two together?

I found my next apartment.

Okay.

It's has a fireplace... and natural lighting...

No. N-N-No.

...and a really great roommate who's also a friend.

He works a lot, so might be hard to see him otherwise.

I'm talking about you, Shaun.

I don't want to risk anything hurting our friendship.

If you say you can handle living together, I trust you.

W-We're... going to be roommates?

[EXHALES SHAKILY] Oh...

I-It has a fireplace.

Yes, it does.

Oh!

We're going to be roommates!

We're gonna be roommates! [LAUGHS]

- Okay!
- Yes.

- Okay!
- Yes!

- [SQUEALING]
- We're gonna be roommates!

- Oh, y...
- [LAUGHS]

- Yes!
- [LAUGHS]