This might be the first place
we've visited that feels right.
That's good.
But, Shaun, we really need to
talk about something
non-wedding related.
Oh, it's perfect.
Yes, and it is the only venue
available on our date
that meets all our criteria.
I'll stand at the altar.
You walk down the aisle.
Okay.
(FLOORBOARDS SQUEAKING)
(FLOORBOARDS SQUEAK)
(FLOORBOARDS SQUEAK)
The fireplace tile, is that original?
Uh, I have no idea.
Well, let's say it is.
If you want to up the curb appeal,
maybe a fresh coat of paint,
some landscaping...
"As-is" is just fine.
How soon can we sell the place?
We'll get multiple bids on day one.
Oh, great.
Hi, Aaron.
Shelly Carroll, Ethan Ray Realty.
Ilana Reeves, ex-wife.
We should drop off this agreement
with our deposit check tomorrow.
Once I explain the issue to the pastor,
I'm sure he will replace
the problematic floorboards.
Shaunie, there's something
I really need to tell you.
S-Stop!
(TIRES SQUEAL)
I'll call .
Hello, I'm Dr. Shaun Murphy.
Where are you hurt?
It's my hand.
Your fourth and fifth
fingers are broken.
If you have no other injuries...
Shaun! Over here!
(SIGHS)
(GASPS)
Hello, hi, I'm Dr. Shaun Murphy.
Are you injured?
My leg's trapped. (GASPING)
My chest hurts when I breathe.
How far along is your pregnancy?
Twenty-six weeks.
Do you think my baby's okay?
- I have no way of knowing...
- (GROANS)
...but you have tachycardia
and your jugular is distended,
which are signs of a cardiac tamponade.
If I don't drain it,
you'll die before the paramedics arrive.
(GASPING)
(THEME MUSIC PLAYING)
Synced & corrected by -robtor-
http://www.addic ed.com
Sorry about the mess.
Uh, Debbie talk you into a fresh start?
No, no.
Um, we didn't exactly work out.
Oh, I'm sorry.
Yeah, me, too.
But I am moving to
a small town in Montana,
which, hopefully, you know,
will be good for me.
Aaron, I need your help.
It's my husband, Sunil.
He's dying.
(GASPING)
LEA: What's your name?
Alma.
Alma. Hi, I'm Lea.
Is there anyone you need me to call?
Uh, um, no. My...
My boyfriend's out of town.
(SEAL POPS)
What are you gonna do with that?
A subxiphoid pericardiocentesis.
An echo-guided one would be better,
but I don't have a J-tipped wire,
or an echo machine.
Maybe we should wait for the paramedics.
Alma, you can trust him.
(ALMA MOANING)
(GASPING) My...
chest... is... exploding.
(TUBE CRUNCHES)
Okay, hold.
You are very lucky.
We usually don't drive to work this way.
(SIREN WAILING)
His diagnosis is Lewy Body Dementia.
Oh.
How long has he had the symptoms?
It began two years ago.
Insomnia, muscle weakness, agitation.
Recently,
he's started having bouts of confusion.
We found an experimental trial
that uses deep brain stimulation
to slow cognitive deterioration.
Would you look at it,
see if it's worth it?
There are so many more doctors
with more experience in
this field than I have.
Aaron, I... I need somebody
who's gonna give me the truth,
so we don't waste
what time we have left.
How many clients have been referred
for elective procedures from the clinic?
Forty-three.
Those satisfied clients
will lead to more.
And the automated intake
screens have cut labor costs by %.
But the nurses don't like it.
They think they're next.
Handle them right, they'll get over it.
If you have specific thoughts on that,
I'd love to hear them.
Maybe over lunch?
Morgan, you excel at
striking the right balance
between enthusiasm and obsequiousness.
Thank you.
- (LOCKER SHUTS)
- Instead of lunch,
how about you and Alex have
dinner with Marcus and me?
Marcus...
Marcus Andrews?
It'll be a hoot.
Twenty-three-year-old pregnant female,
blunt chest trauma from a car accident.
I performed a subxiphoid
pericardiocentesis
at the scene with a gas siphon.
Cool? Is the baby...
Fetal heart rate is normal,
no signs of distress.
Mother became hemodynamically
unstable en route.
She needs surgery for internal bleeding.
Okay, keep rolling. Keep rolling!
DR. GLASSMAN: We're gonna do
a couple of tests
to get a sense of your cognitive state,
and then we're gonna
throw you in the MRI,
the big donut, very loud,
to see if you're right for
the deep brain stimulation.
Any questions?
None.
What I know or don't know
about the medicine
will not change the outcome.
A patient who doesn't think
they know more than their doctors
is rare these days.
Implicit social contracts
are my field of study.
They're the agreements we make daily,
often without even realizing. (CHUCKLES)
But perhaps that's
a conversation for another...
Who are you?
Why are we here?
Sunil? Sunil?
Uh...
You're right where
you're supposed to be.
Take a deep breath.
Tell me their names.
Pavan.
Reema.
And little Raj.
Good.
Some spells pass a little
more quickly than others.
I... I think I'm okay now.
Sunil.
Hmm?
Do you remember why you're here?
Because I'm dying.
Let's get started with those tests.
DR. PARK: Sunil's MRI shows
no contraindication
to deep brain stimulation.
Initial labs look good.
He's a great candidate.
Is the coat hanging in my
closet your "good" blazer?
It's my only blazer, so, yes.
Get it dry-cleaned.
For our dinner with Andrews and Salen.
As intriguing as that pairing is,
dinner's a hard pass.
Not an option.
But compensation is fair.
We can finally binge The Wire.
Your first offer doesn't get
you off the couch, and...
Wait, Andrews and Salen?
Game respects game.
And sometimes sleeps with it.
Tickets for you and Kellan
to a UFC fight in Vegas.
Still no.
But save that thought for his birthday.
Salen and Andrews?
They may have one soul between them.
Any sign of motor weakness?
He's gonna have to
tolerate the head frame.
Here's the cervical spine MRI.
We could replicate
the DBS trial on site.
I'd be happy to coordinate.
Oh, that's very kind of you.
Are you sure you're gonna have time
while you overhaul my clinic
into an Ethicure profit center?
Oh, and by the way,
I'm gonna need my office back.
I hope you don't mind.
- Parathyroid looks off.
- Hmm.
DR. REZNICK: Is that an ectopic lesion?
He's had a history of renal stones.
I don't...
What were his calcium and PTH levels?
They were only mildly elevated.
Nothing that triggered for the workup.
What are you thinking?
I'm thinking this may not be
Lewy Body Dementia.
SHAUN: Repairing the
ventricular tear with Prolene sutures
JORDAN: No remaining
arterial or major bleeds.
Good. I'd prefer not to
have to open her belly.
I would like both of you
to wear socks to my wedding.
No shoes. Just socks.
Lea and I found a nearly perfect church,
but the floor squeaks.
Should make for
some interesting pictures.
JORDAN: No.
No way you are robbing me
of a chance to show off
my new Bruno Maglis.
Also, wet and stinky feet are
not in Lea's dream wedding.
That's... probably true.
Last suture is in.
Dr. Allen, how's the baby?
Heart rate is stable.
Okay. Next step,
get her down to imaging.
We need a surgical plan for
these pelvic fractures
before they cause any more bleeding.
Aaron! Aaron!
I didn't expect a miracle,
but thank you.
He's not out of the woods yet.
He still has a lesion.
Okay, hopefully benign,
hopefully removable.
- I heard you.
- Really?
Most people stop listening
after they hear the very bad news,
or, in this case, the very good news.
Okay, the nuclear study
this afternoon, I got it.
What happened with Debbie?
(SIGHS)
Why did my impulsive, whirlwind marriage
to a g*n-toting barista not work out?
Hmm.
- You're hurt.
- Do I look hurt?
I just saved a man.
I know how you hold onto things.
And I know how you try to fix things
and you try to fix everyone.
- I'm okay.
- Talk to me.
'Cause I doubt very much
you're talking to anybody else.
(SIGHS)
I was myself, and up close and personal,
Debbie didn't like what she saw.
She...
She said I was controlling and selfish.
Did you tell her she was right?
Well, yeah, 'cause she was.
It didn't help.
What's in Montana?
Pine trees and cowboy boots and
change for me.
In Montana, no one knows me,
and I have no history,
and no one has any expectations of me.
You've done this before. After Maddie.
That's not fair.
I know.
But my therapist would say you're
"pulling a geographic."
Has your therapist met me?
I have to go prepare
for Sunil's procedure.
The safest path is external fixation.
We'd use a metal frame to
stabilize the fractured bones
until your baby
is ready to be delivered.
You'd need three weeks of bed rest,
and you'll likely develop
debilitating arthritis.
There's a significant chance
you will never
have full mobility ever again, bu...
I have grad school. A job. This baby.
- That can't be the only option.
- No, it's not.
I was going to tell you,
if we do a C-section now,
we could do an internal fixation,
which would greatly improve your chances
of walking without assistance.
Though it does increase
the risk of complications
associated with premature birth.
So I either never walk right again,
or I jeopardize my baby's life?
Yes.
You have to decide.
My boyfriend,
at first, he didn't
want to keep our girl.
But then he came around to it.
We said that we'd figure it outogether.
Then he signs up for
this month-long research trip
off the Gulf of Alaska, and here I am.
I can't choose between
myself or my baby.
No, you have to choose.
I can't.
Dr. Glassman, I'm glad you're back.
Lea and I have a problem.
I heard.
The floor squeaks.
At the church?
(SIGHS)
Is that it?
No. I also have a patient who
won't decide on a surgical plan.
Have you talked to Lea?
She is no doctor.
No, I don't mean about the patient.
(SIGHS) Shaun, I am not gonna be around.
I'm... I'm moving.
I'm selling my house, and I'm moving...
(CHUCKLES)
...to Montana.
Oh.
Will you still be my best man?
Yeah, of course.
Then you should give me your advice.
Shaun, you don't need my advice.
Sometimes I do.
You don't like to give it to me anymore.
Lea and you are partners now.
You can... You can talk to her,
and Lea has a whole lot of
stuff she's gotta talk to you about.
And you'll work it out, without me.
(MACHINE WHIRS)
Sharks tickets.
Doesn't being together mean that
we have an unspoken agreement
that when I need a date, you're it?
No.
(COMPUTER WARBLES)
The lesion has an irregular shape,
and it's extending into
the carotid sheath.
It's a malignant carcinoma,
and it's invasive.
Hey, I thought you were working late.
I am going back, but first,
you and I need to make a decision
about the church and the squeaky floor
and something else entirely.
Dr. Glassman said you have
things you need to tell me.
Uh, I didn't go on a business
trip a couple weeks ago.
I went to Montana to find Glassman
and convince him to come home.
Because I was really worried about you.
What were you worried about?
There have been so many
changes at the hospital,
and I know that's been hard for...
- Not because of my...
- I know.
Not because of your ASD, but because
change is hard.
And then your patient reviews,
and I knew you were
struggling with them.
I was, but then I improved
my interaction techniques,
and my scores went up.
(SIGHS)
That's not what happened, Shaun.
I omitted some of the patient reviews.
Just the ones where
people said really mean stuff.
That's why your scores went up.
I told you I didn't want you to.
I know. I'm so sorry.
I just got so worried,
and I wanted to protect you.
And I thought, if I could
just help you, I...
What you did was very wrong.
I know.
I am truly so sorry.
No.
Your apology is not accepted.
(DOOR OPENS, CLOSES)
The lesion in your neck is cancerous,
and it has grown very quickly.
I am suggesting a non-surgical approach,
one with targeted therapies
and radiation.
It should give you a few more good years
before debilitating symptoms set in.
I'm very sorry.
There's no way of removing it?
It's attached to the carotid artery.
It's too dangerous.
Um...
Thank you, Aaron.
That's more than we hoped for
when we came to you.
I was here all night with Dr. Allen.
We have not come up with
a better surgical solution.
Your choices from yesterday
remain the same.
How is she?
Normal fetal movement.
Heart rate is .
That's good.
Mm.
(MONITOR BEEPING)
I talked to Matt.
He's making his way back,
but it'll be a couple of days.
He says whatever I decide to do,
he will support it.
Which isn't really helpful right now.
No, it's not.
You need to make a decision.
(SIGHS)
He shouldn't have gone,
but we needed the money,
and it was a great opportunity.
But mostly, I feel like it was
a reason for him to be somewhere else.
He says one thing but
does something different.
How do you know if he loves you?
He does.
But someone can love you
and still let you down.
That doesn't seem right.
No.
No, it doesn't.
Knowing what to expect
of others is difficult.
People can be very unreliable.
That's why I always
wanted to be a doctor.
Science and biology and
medicine are very reliable.
I like that.
She's relying on me.
(SIGHS)
I need to do what's best for my baby.
Go ahead with the external fixation.
How would you rate the new
self-serve, self-pay system?
Four stars.
Not five?
I prefer to be stingy
with my top rating.
(QUIETLY) Last night was a five.
So it was even better than
a convenient way to buy a smoothie?
Hey, what are you doing Thursday night?
I invited Morgan and Alex
to have dinner with us.
A double date?
I didn't realize we were going public.
We're both consenting adults.
What's to hide?
As the boss, you are free
to do what you like.
As a partner,
that's not the way it works.
I'm sorry.
I should have asked you
before I told anyone.
Marcus, you're smart and funny
and almost too good-looking,
and your socks don't just
match your sweaters,
- they elevate your whole aesthetic.
- (CHUCKLES)
And I told Morgan because
I'm excited about you.
About us.
(WHISPERING) I'll make the reservation.
There's a surgical solution
here, isn't there?
No, no, no. Not a safe one.
But you've built your career
on doing surgeries
that most doctors think
are too dangerous.
Yeah, because, to quote you,
I am an insufferable egomaniac.
But that's who we came to see,
and now I'm getting some surgeon
who's gonna run off to Montana
in the guise of becoming
a decent human being?
Okay, uh, criticize me,
yell at me if you like.
- I understand you're upset.
- All those late nights
where you were tackling
the most impossible cases,
exhausting every possible angle.
You come alive in surgery,
more than you did in...
There are other surgeons.
There are other hospitals.
I have done everything I know
how to do to help you and Sunil.
I am sorry if that's not enough.
I think you're scared.
Of what?
Failing.
Of failing me again.
Yeah, I wish that were true.
(CELLPHONE CHIMES)
(SIGHS) It's Sunil.
I need to get out of here. (PANTING)
Don't you see what's happening?
Sunil, Sunil.
Wait, wait, wait, wait. Sunil, Sunil.
Stand by with a sedative.
Ahead of you. Just trying to get close.
You're right where you're
supposed to be, honey.
Take a deep breath.
All right, tell me...
tell me their names.
Tell... Tell me their... Tell me the...
I don't know you!
Whoa, whoa, whoa, whoa, whoa, whoa!
(GASPS)
- You got him?
- I got him. I got him. I got him.
Oh...
- (GROANS)
- I got him. I got him.
Are you hurt?
I'm okay.
My patient chose to prioritize her baby.
We did the external fixation.
She's resting comfortably, and
you need to correct my scores.
I can't restore the data.
You are very smart.
You can figure out a way.
Shaun, I apologize,
but I... I can't undo what's been done.
Lea, the scores reflect my work and me.
No, it didn't.
The algorithm ignored
what's best in you.
No, it should be the same for everyone.
The data has to be corrected.
I can't, Shaun. I'm sorry.
Then you need to tell Salen.
That's a terrible idea.
There is no other option.
Shaun, I could lose my job.
You broke the rules.
Maybe you should get fired.
I'm fine, really.
Humor me.
Pupil response is normal.
(DRAWER SLIDES)
I'm sorry about before.
I was so frustrated.
I... I appreciate everything
that you've done.
You owe us nothing,
and you've gone out of your way to help.
Here's some Naproxen.
It'll help with the pain and soreness.
(VOICE BREAKING)
I don't blame you anymore.
- For Maddie...
- No, p...
No, don't. Please stop.
Don't do that. I need you to hear this.
For a long time, I did blame you.
I could barely look at
a picture of Maddie
without being reminded
about how angry I was,
and how angry I was at you
trying to replace her with Shaun.
Shaun wasn't meant to replace Maddie.
My God.
Nobody can.
Becoming a part of Sunil's
family has brought me peace.
They're my whole world.
And I'm so glad you found Shaun.
(CHUCKLES)
You're right, I am scared.
(CLEARS THROAT)
If I operate on Sunil and he d*ed,
I'd be responsible for you
losing someone you love.
Again.
(SNIFFS, SIGHS)
I'll take another look at the imaging.
I can't promise anything.
Who knows, maybe this egomaniac
can come up with something.
- (ALMA GROANS)
- (MONITOR BEEPING RAPIDLY)
She's having severe abdominal pain.
BP's over . She's hypotensive.
There's uterine bleeding
from a placental abruption.
It's a delayed reaction to the crash.
Her choice was moot.
Okay, page Dr. Lim to the OR
for an emergency C-section.
♪
We're ready.
- I love you.
- I love you, too.
(GURNEY RAIL CLICKS)
DR. REZNICK: Hey.
What are those for?
I know how mad you were
when these disappeared
from the vending machine.
Salen's health-conscious revamp
- was not a victimless crime.
- (BAG OPENS)
I drove minutes to a gas
station to get those for you.
This is the bribe?
No, it's just chips.
And a declaration
that I will respect
the boundaries you've set.
You don't have to do dinner.
I'll survive.
I assume Salen will be
picking up the check?
I don't love your ambitious streak,
but I do love you.
I'll be your arm candy for the night.
(CRUNCHES)
DR. LIM: How long until we
have access to start the C-section?
JORDAN: A few more seconds.
BP's over . Heart rate .
Fetal tones?
Present, but we saw D-cells on
the tracing. The baby is stressed.
Once the baby is out,
we will immediately begin
an in-fix pedicle screw rod fixation.
She'll walk fine.
We'll need a two and
a half millimeter drill bit
and titanium screws.
We're clear. ChloraPrep and scalpel.
DR. PARK: BP and heart rate stable.
Carcinoma's in the cross hairs.
"Be quick, but don't hurry,"
as John Wooden used to say.
Starting resection.
Suction.
That's a lot of bleeding.
Yeah, well,
we're poking around the carotid.
It's to be expected.
How's he doing?
BP's over .
(MONITOR CHIRPING)
Do you see any vascular
feeders you can clip?
No.
Tumor has completely invaded the artery.
We're gonna have to move fast.
Mother's BP is still dropping.
over .
Hang another two units.
Extending uterine incision.
Okay, here she comes.
(GRUNTS)
Dr. Murphy, Dr. Allen,
- deliver the placenta.
- (BABY CRYING)
Check for uterine bleeding
before beginning internal fixation.
- (MONITOR BEEPING RAPIDLY)
- Dr. Lim, Apgar's three.
The baby's in distress.
She's not oxygenating.
We need to intubate.
Dr. Murphy, with me.
Get a blood gas.
Bagging % oxygen.
(DEVICE WARBLES)
Baby is acidotic with a pH of seven.
No improvement in vitals or oxygen sat.
Check the tube's positioning.
ET tube is in the correct position.
Equal breath sounds on both sides.
This doesn't make any sense.
The baby has a congenital heart defect.
The patent ductus arteriosus is closing.
That is causing hypoxia.
We need to open the duct
and oxygenate her blood.
Call the pharmacy for PGE, stat.
(CAP CLATTERS)
Start the PGE at . .
DR. PARK: BP's over .
DR. GLASSMAN: Tumor's hypervascular.
I can't see a damn thing.
There's too much blood.
Should we stop the bleeding
and abort the resection?
(MONITOR BEEPING RAPIDLY)
No.
Tubing... clear plastic surgical tubing.
(MONITOR BEEPING RAPIDLY)
Baby isn't pinking up.
PGE is in. IV looks good.
(MONITOR CHIRPING)
V-tach. Starting compressions.
What if it's not a heart defect?
We're gonna occlude the carotid,
blocking the blood until we
can cut the damn thing out.
He'll stroke out.
DR. GLASSMAN: That's
what the plastic tube is for.
I'm gonna build a shunt bypass,
keep the blood flowing to the brain.
(ECHOING) Suction.
Apply the clamp.
Dissecting scissors.
(SIGHS)
Ugly little thing.
Okay. Stand by with the patch.
(SIGHS) Let's clean it up.
No obvious metabolic disorder.
No evidence of head
trauma or pneumothorax.
No mucus plug in ET tube.
No transient tachypnea in the newborn.
The PGE is the right dosage...
What?
Oh.
Shaun, what?
It's expired.
(EXHALES SHARPLY)
Call the pharmacy.
We need more PGE,
but from a different lot.
The PGE is expired. We need...
The pharmacy says
we don't have another lot.
Our entire supply is expired.
Prep for catheterization.
We might be able to keep
the PDA open with a stent.
Stop!
Alprostadil!
We need to run PGE at . micrograms.
Tell the pharmacist to mix
vials of micrograms of Alprostadil
with milliliters of saline solution.
Mix vials of
micrograms of Alprostadil.
He says that's the wrong medication.
Where are you going?
It'll be faster if I do it myself.
(DOOR OPENS)
♪ ♪
Uh, you know this is
for erectile dysfunction?
Yes.
Alprostadil is the same drug as PGE
but in a different concentration.
We need to run the IV at
. milliliters per minute.
That will give the baby .
micrograms per kilogram per minute.
Pushing . .
(MONITOR BEEPING RAPIDLY)
(FLATLINING)
Restarting compressions.
(MONITOR BEEPS)
Mucous membrane's still blue.
Oxygen saturation's not registering.
We just need to give it more time.
Hold compressions.
(FLATLINE)
Pulse not palpable.
No, push . of the solution.
Restarting compressions.
(MONITOR BEEPING RAPIDLY)
- Dr. Murphy.
- No.
Push . .
Dr. Murphy, the baby is flatlining.
- No.
- There's nothing more we can do.
- No, I can save her!
- Shaun.
(FLATLINE)
(BREATHING SHAKILY)
(BEEPING STOPS)
Time of death, : .
Sunil's recovering very nicely.
Just, no exercise or, you know,
strenuous activity
for the next six weeks.
Thank you.
Don't go to Montana.
You still need Shaun.
He makes you better.
Hang up.
I need to call you back.
We just lost a baby,
because this hospital wasn't prepared.
The medication we needed was expired.
All of it. No back-up batch.
Did the money you saved
pay for your water wall?
(EXHALES SHARPLY) In my years here,
nothing like this has
ever been allowed to happen.
This hospital's priorities...
your priorities
are upside down, and today,
that k*lled someone.
(SIGHS) How's the mother?
Recovering.
She won't be conscious for a few hours.
I'll make sure and have a
grief counselor standing by.
And call your lawyers, too.
When she finds out that her baby d*ed
because of expired meds...
Dr. Lim, until we've done a thorough M&M
and identified what changes
need to be made,
discretion is in
everyone's best interest.
Are you suggesting
we not tell her the truth?
I'm suggesting we all have exposure.
You, the residents.
Audrey,
this is a tragic day.
But we cannot allow a single event
to derail everything we do here.
Salen made cuts.
We're... We're behind on inventory.
(STAMMERS) It just...
It... it fell through the cracks.
Expired.
(BOTTLE SHATTERS)
Expired.
Expired!
Expired!
They're all useless!
- Shaun.
- No!
- Shaun, stop, stop, stop, stop!
- They're all... No!
- It wasn't your... It wasn't your fault!
- N-N... Please! Please! No!
- There's nothing you could have done!
- No, you lied to me!
I can't trust you!
And I can't marry you.
- (BREATHING HEAVILY)
- (PAPER CRUMPLES)
Shaun. Shaun!
(HYPERVENTILATING)
You're hyperventilating.
Hey, hey, hey, hey.
Look at me. Look at me.
Look at me.
Take a deep breath now, okay?
Take a deep breath.
- (BREATHING SLOWER)
- There you go.
You can talk to me.
Dr. Glassman,
you... you are a...
An awful best man
and a terrible mentor.
You said you would never
abandon me, but that's a lie.
A lie.
That is a lie!
Why is everyone lying to me? Why?
You should have been
running the hospital!
If you had, the baby
would not have d*ed!
(SOBBING)
Okay.
(GRUNTS)
I'm here. I'm here.
Shaun.
I'm right here.
(SOBBING)
I'm right here. I got you.
I got you.
I got you. I got you.
(SOBBING ECHOING)
I got you. I'm right here.