03x05 - First Case, Second Base

Naughty thought.

How about we don't wait 12 minutes for our next kiss?

We would never see the end of the movie.

Oh.

Mm.

It's better if we stick to the schedule.

Sure.

Didn't hear you come in last night.

So I'm guessing it went well at Carly's.

The end of the movie was very predictable.

Not the question I was asking, but you still managed to answer it.

Carly touches me when we kiss.

You don't like her touching you?

- Oh, I I do.

- Oh.

But I prefer to touch only one thing at a time.

Have you told her you prefer to touch only one thing at a time?

In those exact words?

Oh!

Whatever it is, I'm definitely in.

My first lead surgery!

- Oh!

- Oh!

Shaun!

That is awesome!

I am going to rock it!

Oh, hells to the yeah you are!

Oh!

How you doing?

I'm good.

Thank you for helping me with the sea lions.

I'll never say no to a caper.

But I'd like to keep my mother's death between the two of us.

I just I can't deal with people's platitudes right now.

Okay, but that kinda suggests you're not good.

This is textbook denial.

It's only going to inhibit your grief process.

Denial is the first step in the grief process, so I'd say I'm right on track.

But thank you for your platitudes.

This is Curtis.

He decided to fix his chimney without a safety harness.

He has open bilateral tib-fib fractures.

They wanted $1,200 for a two-hour job.

And I can still do a Hurricane Grind.

It's a skateboard move that builds off a 180 Ollie.

I got great balance.

Pupils are slow to react.

Unfortunately, balance is less great after a few cocktails.

Not me.

Clean and sober six years, three months, and and 24 days.

Get him on IV antibiotics and to OR Level One.

And run a BAC.

I'm Dr.

Shaun Murphy.

Your surgeon.

Esophageal cancer is a serious condition.

However, you don't have any remote or metastatic disease and responded well to chemoradiation, so a resection of the esophagus should render you cancer-free.

You look awfully young.

I always say, the younger they are, the smarter they must be.

Oh, oh, yes.

We will pull the stomach up and attach it to the remains of your esophagus, keeping your GI system connected, so you will not need a permanent feeding tube.

My oncologist told me all this, but I refused to believe it that it was all gonna be okay until I heard it from my surgeon.

Oh!

I'm sorry, it's just I've been through a divorce and a career change and I finally bought my own cafe three days before I got my diagnosis.

And I thought it was a sign I was making a mistake.

But it was just the opposite.

I wasn't done.

Oh, I'm sorry I have to inform you of the risks of this procedure.

There is a 7% chance of heart and lung problems, a 12% chance of infection, a 0.

5% of death, among others.

Bring it, Dr.

Murphy.

Shaun got very lucky.

Landed the world's most genial patient for his first case.

- Nice.

- Of you.

You picked that patient for him I heard it was Park's chart before you stepped in.

Shaun's weakness is patient management.

You shouldn't be coddling him.

We challenge him too much, we lose him.

Murphy?

He perseveres.

He's annoyingly resilient.

I agree that some failures don't seem to faze him at all.

But it's his lifelong dream.

So, yes, I think we could lose him.

I'll tough-love his ass next week.

Okay, Curtis, we're good to go.

Curtis, my God.

Are you okay?

I'm thinking I should've gone with the contractor.

His thinking was impaired.

He had a blood alcohol level of .

09.

Your test must be wrong.

You were quite inebriated when you came in.

That's impossible.

Curtis doesn't drink.

We'll make a note of it in his chart.

We've got to get him to the O. R.

You play softball?

Uh, my junior year in high school, I had an ERA of 2. 95.

My wife's got an arm.

I can't believe you're my wife.

Till death do us part.

Yeah.

Oh, you found Wally.

You have a name for it?

Yeah, - he's my Walther PPK .

32; he and I go way back.

Is it loaded?

I mean, is this a problem?

'Cause I I just I keep it in my bedside table, in my gun safe combination 7-3-5-9.

I'm not gonna remember that.

I don't want to remember that.

If we're gonna live together, we're gonna need to make some compromises.

You nervous?

How badly are you freaking out?

I'm not badly freaking out.

I've assisted in six esophageal resections, all of which were free of complications.

So you're overdue for a blow-up.

Sorry.

I'm just a bit annoyed 'cause I had my hand on this case first, and now I'm third out of four, at best.

But I'm happy for you.

Really.

I'm happy for me, too.

She has extensive scar tissue.

And it's plastered her stomach to her anterior abdominal wall.

I told her she wouldn't need a permanent feeding tube.

But she will.

We've got to tell a budding chef she'll never eat again.

How will she react?

Don't know.

Badly.

But the specifics You should tell her.

She's your patient, it's your job.

I'm bad at patient communication.

If I make her very unhappy, she may not want me to do the surgery.

If you're not willing to take that risk, then you should hand the case over to Park.

No.

I don't want to hand the case over to Dr.

Park.

Park will tell Beth.

And, Shaun, it's still your surgery.

Drill.

Do you see his heart rhythm?

Rate controlled A-fib.

Wasn't on his record.

Ask his wife about it post-op.

Probably a symptom of binge drinking.

Which he'll lie to us about and she'll tell us she believes.

She's in denial?

You had surgery as a child.

As a baby.

I don't even remember it.

There's considerable scar tissue more than we'd typically expect to find.

Which has affected our surgical plan.

How?

Dr. Murphy will field that question.

No, Dr. Lim s-said Proceed, Dr. Murphy.

Somebody please tell me.

We can't move your stomach up, so you will need a feeding tube.

For the rest of your life.

The good news is that this surgery is simpler, so your recovery time will be shorter by three to five days.

Hey.

Do any of you own a gun?

Is there someone you'd like "taken care of"?

- Ah.

- I still have my service pistol.

I have a Sig P365.

Do any of you have, or have you ever had, issues about it with your significant others?

After our son was born, my wife suddenly hated having a firearm in the house.

And one night, I came home late to a PowerPoint presentation.

90 minutes of horrifying statistics.

Now it's in a locker at my gun range.

Lotta set up but I like that.

I had a boyfriend who felt very weird about me having a gun.

He wasn't big on logic, so I took the emotional approach.

Told him it's not for the firepower, it's for the confidence it gives me as a woman when I carry it.

I lived with a guy who had a gun.

Had to use the nuclear option.

It goes or he goes.

It worked they both went.

Well, that's just wonderful.

I heard your news.

It's pretty exciting.

I jumped seven times.

How's the anxiety level?

Why do people keep asking me that?

Everyone has doubts, Shaun.

I'm excited.

You can be excited.

And nervous.

Usually they go together.

Speaking of, uh, I'm sorry if I was a bit too assertive last night.

Lea said it must be tricky for you.

So now Lea is also privy to the intimacies of our intimacy?

- Great.

- Yes.

Oh.

Lea said to tell you that I prefer to touch only thing at a time.

Located upper esophageal sphincter.

You have a good tumor margin resecting above or below?

- Below.

- Mm-hmm.

Shaun gave the news to his patient after all.

Shaun did what I expected.

He upset her, but the news is upsetting.

She'll deal with it, he'll learn how to She wants him off the case.

- Shaun - No Shaun, I will find you another case.

This is my case.

I prepared for this case.

I don't want another case.

Dr.

Murphy You're learning, Shaun.

That's what you do at a teaching hospital.

I'm learning, too.

Going from attending to Chief of Surgery is a big deal.

Every day, every decision, every mistake I learn something.

So do you.

No, I don't.

I have a developmental disorder.

- Come with me.

- I'm waiting for my bus.

You can take a later one.

I'm sure I mentioned I was Chief?

Hi, Beth.

I'm sorry for what you're going through.

And Dr.

Murphy's phrasing was unfortunate.

But there's been no deceit or negligence.

He's an excellent surgeon who has my full confidence in the O. R.

And if you don't trust him, you don't trust me.

So, I would recommend you have your surgery at a different hospital.

I can make arrangements.

However, if you reconsider, we can proceed as scheduled first thing tomorrow morning.

If you don't want people to know your mother died, stop acting like someone whose mother died.

I'm gonna move on to the second stage of grief anger.

I'm not acting depressed.

No, you're acting bitchy.

But you're not a bitch, so that looks weird on you, and people are gonna know something's up.

So, do you want me happier or sadder?

Let me know, because I'm really looking for your approval.

Bitchy You really think this guy's still on the wagon?

Just because he's a drunk doesn't mean he's not sick.

But all you can see is an addict married to an enabler, so all roads lead to rum.

C'mon, that was cute.

No IV wall motion abnormalities.

No valvular disease or dysfunction.

Ruling out any structural cause for the arrhythmia.

You win.

Congratulations.

- Hey!

- Hey.

How was your day?

Good, good.

Pensive.

I was thinking about your gun and why you need it - Oh, Aaron, I I don't - No, no, no.

I was an idiot and a guy, I get it.

You walking alone in a garage late at night, you walking alone on the street late at night Or getting into my own car, or even my own house.

Exactly.

That's why I got you a surprise.

- Yeah?

- Right outside the back door.

We have exactly 10 seconds to punch in the code before S. E. A. L. Team Six arrives. 7-3-5-9.

Every door, every window, every vent over 36 inches.

This is your security fob.

Works in all 48 contiguous states and Canada.

You have no idea how much extra comfort this is gonna give me.

Actually, I was hoping it would be your primary source of comfort.

You were thinking that this would mean I would give up my gun?

That's exactly what I was thinking.

Well, the first rule of security systems is redundancy.

By that logic, we should get a tank for the garage.

Aaron, it shouldn't matter why I want a gun whether it's because it makes me feel more secure, or it was a memento of my dad's or just because it's fun to shoot.

All that matters is I'm a grown-up, and I'm responsible, and I want it.

You're ruining Shaun.

Maybe you got him over the hump of patient management, but what about surgical management?

Taking charge of the O. R. , keeping lines of communication open, everyone cooperating.

You're throwing him into the deep end, and that's unfair to him.

Unless you plan to scrub in as a lifeguard.

He'll be fine.

You handpicked his surgical team?

You're ruining him.

The tests prove his arrhythmia is associated with excessive ethanol consumption.

But there's no permanent damage and his rhythm will return to normal in the absence of any further drinking.

We met when we were 15.

I was first clarinet, he was second.

We were at a band festival in Anaheim when he found out his parents died in a plane crash.

We grieved together and fell in love.

Then he started drinking.

It wasn't until I threatened to leave that he finally woke up.

The day he received his two-year recovery chip was the day we got married.

The day he vowed to me, and a church full of our family and friends, that he would never drink again.

Our marriage is built on his sobriety.

I believe him.

Teal, we ran the BAC three times, and the results were consistent.

I believe in my husband.

I have to.

His BP is dropping.

Temp is normal.

Check for causes of shock.

Upper GI bleed need stat hematocrits and transfuse blood.

Surgery's the easy-peasy part.

You wanted this, enjoy it.

I can't.

If I get distracted, if I get upset If you do, Andrews has your back.

If Dr.

Andrews has to take over, then I have failed.

I have failed, and I have endangered a patient's life, and if I'm no good at the easy-peasy part, then what part am I good at?

What do we do when we get all nutty like this?

Blow out the candles.

How many do you need?

Three.

Hey.

I was looking for you.

Big day, huh?

How are your nerves holding up?

I'm not nervous.

Of course you're nervous.

Everybody's nervous.

It just means that you care.

Being nervous means I feel inadequate and unprepared, and if I am either of those things, it doesn't matter whether I care or not.

You are more than adequate, and you're very prepared.

You remind me of a a young surgeon I knew once.

The day he got his first lead, he was thrilled, but he was a mess, trying to remember a million things, imagining a million things that could go wrong.

But then he remembered the birth process, how moms are asked to pick a focal point, - let everything filter through that.

- Hmm.

So, he chose the color orange to focus on.

This is the cap that he focused on, and he got through it with flying colors.

Maybe it'll help.

Why do you have the young surgeon's cap?

I was being coy.

The young surgeon was me.

Konnichiwa.

That's Japanese for hello.

Konnichiwa.

I have surgery in 42 minutes.

Which is why I'm here, to wish you luck.

I don't need luck.

Everyone needs luck.

That was a good luck kiss.

How can a kiss give you So was that.

I am feeling a bit lucky.

You know the thing that Lea told you to tell me?

Yes.

That was actually great advice.

It's important that we tell each other exactly what we like and what we don't.

I also don't like pickles, sirens, anything wool I was thinking more in the romantic area.

And right now, we are not going to touch lips anymore.

Because there's something else I want you to touch.

So, what do you think?

You don't have any lumps.

Win-win.

Lab and imaging tests rule out Crohn's, gastroenteritis, C-diff colitis, and even H pylori.

Leaving bleeding ulcers.

Caused by alcohol abuse.

He needs to be on a proton pump inhibitor and octreotide to prevent any further blood loss.

No.

He loves you.

That's why he hasn't been honest.

Doesn't make it right, but it's that same love that kept you together through everything.

And it'll get you through this, too.

He's telling the truth.

We'll run more tests.

Your faith in your husband is impressive.

But it may have just killed him.

Ten blade, please.

Located lower end of esophageal lesion.

Linear cutting stapler.

Resecting the esophagus from the stomach I'm now at the upper end of the lesion.

Hemoclips.


Dr. Murphy?

No.

No What's the matter?

No, no, no Shaun, what are you seeing?

Can't can't do this!

What what can't you do?

- No!

- Don't No.

No!

No!

No!

No!

- Dr.

Murphy!

- No!!

Dr.

Murphy!!

Go, go!

Page Dr.

Lim.

Keep her stable.

No.

No.

No.

Yur No.

No.

No.

- Yur - What happened?

- No, no, no.

- He lost it, walked out mid-procedure.

Yuri Yu Yuri kucho saiken.

Shaun?

Yur Yuri Yur Okay, Park, take over the surgery.

Y No!

Dr.

Park.

Y - No.

- He obviously can't.

I don't think he lost it.

He was in complete charge of that room.

I don't think this is a meltdown.

He said he can't do it.

He said, "Can't do it.

" Maybe he meant we can't do it.

I think he's seeing something We have a patient open on the table.

Shaun, you have to tell us what you're seeing.

It's okay, Shaun.

Breathe.

That's it.

Now slowly.

What are you thinking?

When Okay.

When I examined the upper portion When I examined the upper portion, there was a much larger area of tumor-free esophagus than anticipated That's correct, but not nearly enough to reach the stomach.

But there is enough to accept a jejunum free flap, using a portion of the small intestine to replace the resected esophagus.

We don't do jejunum free flaps.

They do in Japan.

They do in Japan.

I've been studying their technique Yuri kucho saiken.

They have had great success.

It would mean Beth wouldn't need a feeding tube.

But it is v-very complex.

It's too complex for you to lead.

So you'll lose your case.

Yes I haven't done a transposition graft like that before.

Think you can walk us through it?

Yes.

I'll scrub in.

Stomach is perfect.

Check the duodenum.

The only way Teal will accept the treatment is if we give her no room for denial.

Did you really believe what you said?

That their love is enough to get them through this?

Such BS, the belief that love is enough.

Even worse, it's corollary that a lack of love is the real problem.

If only they had someone in their life who had enough faith in them, had enough love for them, they could've pulled through.

It's wrong and it's mean.

What's that?

Flush the area.

There's our bleed.

But it's not coming from an ulcer It's coming from a tumor.

It's obstructing his digestive tract.

I'm paging Melendez to the O. R.

- Okay.

- Actually, I'm I'm gonna need an extra shot.

Rough day?

Had to help out in the E. R. with an eight-year-old boy who was accidentally shot by his sister.

He'll survive, but with brain damage.

That's horrible.

Yes, it is.

And quite coincidental.

Like so many other coincidences.

You know how many kids are shot every day in this country?

You know you're three times more likely to be shot if you have access to guns than if you don't?

Here's another fact one in four women are victims of violence at the hands of their intimate partner.

No, no, no.

I'm not afraid of you.

This isn't about you.

Did something happen?

'Cause if it did, I want to know about it.

You figure something horrible must have happened to drive me to such an irrational, fear-driven choice?

I'm sorry.

Hi.

The ends of the harvested jejunum have been matched for caliber size for the attachment sites.

You should begin proximal attachment at the neck incision, using layer-to-layer technique on the esophagus and microvascular anastomosis of the vessels.

You wanted to know when Dr.

Semler was heading to O. R. #3.

Dr. Park, scrub out and join Semler.

I-if it's all right, I'd rather stay here.

You're needed where you're needed.

Tumor is free.

Bag it, tag it, and get it to Path.

Do you smell that?

Smells like a distillery.

But we know he couldn't have touched a drop for at least 24 hours.

Final stitch is yours.

It's completely symbolic, but symbols can be powerful.

Easy-peasy.

You had something called Auto-Brewery Syndrome.

The tumor we found was blocking your intestinal tract.

So carbs weren't being digested, they were being trapped and fermented.

Your stomach was actually creating its own alcohol.

You were drunk, but not from drinking.

With the removal of the tumor which was benign you're all good.

And the arrhythmia's gone, too.

I never doubted you.

Her faith in you saved your life.

Thank you.

I was so pissed when Lim kicked me out until I found Semler had an appendectomy waiting for me.

Got my first lead after all.

I'm happy for you.

Really.

I'm happy for me, too.

You earned it.

And you'll get your chance again soon, Shaun.

So that's it?

All's well that ends well?

Your surgeon walked out on his case.

That's your takeaway?

That he failed?

A chef can eat.

Well, as a diagnostician, he did something wonderful, but as a surgeon?

Yes, he failed.

We don't work alone, Marcus.

Every time we have a good outcome, it's because everyone in the room did something right.

Shaun came up with the idea, Park got it out of him, I approved the surgery, and you?

The only reason Shaun is working here is because you believed in him.

Yay, team.

Are you still having a gun fight?

Oh, yeah.

Second day of my marriage and we are at an impasse.

Tried the logical approach, I tried the emotional approach, no compromise.

Only thing left is the nuclear option, which really sucks.

The thought of having a gun in my house makes me sick Has Debbie let you touch her breast?

What?

Has Debbie let you touch her breast?

Yeah.

Then you shouldn't worry about anything else.

I was wrong this time.

But 99.

9% of cases, I would be right.

If if someone acts like an addict, lies like an addict, smells like an addict, then they are an addict.

And just because we stumbled across the one ridiculously fluky exception, that isn't going to change my attitude moving forward.

I respect you, Claire.

Might even go as far as to say I like you.

And I know you're angry right now.

At your mother.

The world.

Yourself.

Eventually, that'll go away.

Or at least some of it will.

But until then, giving up on that 0.

1% means giving up on something else.

Hope.

Hope killed my mother.

We need to talk.

About the 800-pound gun in the room.

I'm working on my compromise skills.

Okay.

Looks like your first lead surgery went well.

I didn't have a first lead surgery.

Yes.

It went very well.

Can I check your other breast?