Previously on "The Good Doctor"...
- Hey! Stop!
- Danny!
Just promise me.
- What?
- No opioids.
He asked you not to do that.
He's tachycardic and hypertensive
because of the pain.
He's going into shock.
- He's not. He's praying.
- He's dying.
Forgive me.
I need to go back to Texas
with my family.
You made an error
in yesterday's craniotomy.
You closed with only eight sutures.
The size of the wound required 10.
We need to figure out why.
I've had a stroke.
Yes. A small one.
Dr. Glassman, please tell us
what the next step is.
Somebody please call security.
Shaun, you are out of line.
Answer.
It's, um...
You humiliated me in public
in my operating room
in front of my colleagues.
Do you have any idea how much that hurt?
I don't know what to do.
You can just leave me alone.
I don't think you should resign.
Because you don't
have to do it all alone.
You're the reason
I wake up in the morning,
so whatever there is to figure out,
all I want in the world is
for us to do it as a family.
I wanted to give you
a heads-up as a friend.
I've decided to resign.
Congratulations, Mom and Dad.
Look at what we made.
Do you think Dr. Glassman is coming?
This is from Dr. Glassman.
How did he know his name would be Steve?
Because he knows you.
Gloves.
Start the timer, please.
Good luck, babe. It's a doozy.
Good work.
I think that was your fastest yet.
Second-fastest.
is starting now.
I will log it into my app.
You sure you don't want to
get in a few extra snuggles
before you leave?
Oh, I had 10 minutes
of snuggles this morning.
Very nice.
I've also set up the app on your phone.
It will alert you when it's time
for Steve's nap, feeding, playtime...
Just in case I miss the
schedules posted on the fridge,
the bathroom, and in our bedroom.
Yes. And I will be able to
track it while I'm at work.
Steve and I will be fine.
Just enjoy your first day back.
We can finish reading the latest
Journal of Trauma
and Acute Care Surgery
when I get home.
After this, Steve should have at least
five minutes of tummy time.
Yesterday, he only logged 12 minutes,
which is three less than...
I love you.
Say hi to everyone for me.
Okay. I love you, too.
I will miss you both.
I don't know why you need three
protein powders, for your smoothies.
They do different things.
She's barely taken an ounce.
That's what the protein-powder
companies want you to believe.
- Are you holding her right?
- Yes.
She needs to be upright with
her head properly supported.
Good. And you mixed it enough?
The same as always.
She's not interested again.
And she seems lethargic.
I'll take her to get checked out.
Well, I'd like to come, too.
Sure. You can carry this.
- Good morning.
- How's Perez today?
Don't know.
It's almost 8:00 a.m.
It's been "today" for
a whole eight hours.
You two haven't texted each other yet?
We both decided we need space.
He's focused on his recovery.
I've got my life here.
I fully support that.
And your next chapter begins tonight.
You and me. Drinks, music,
questionable decisions.
You and Jerome finally got the surgery!
You're no longer joined at the hip?
Jerome is obsessed with some docuseries
about one of the many sports
that I don't care about.
Come on. It's been too long.
I've been busy. You've been...
mopey.
Fine. I agree to drinks and music,
but I'm definitely a "maybe"
on questionable decisions.
- Alright. We'll work up to it.
- Okay.
We're going out tonight for
drinks, starting a new chapter.
That's right. We're calling it
"Bad decisions with good friends."
We're definitely not calling it that.
Wanna join?
No, thank you.
Papa Murphy, welcome back.
Pictures of Steve.
I was just about to ask.
This way, I avoid the disruption
of pulling out my phone.
Look at that smile! Just like his mom!
He was pooping in that one.
Here he is... about to poop.
A theme develops.
Aww. He's got your eyes, Shaun.
I need to find Dr. Lim.
You may keep those.
I made enough for everyone.
Marcus sends greetings from Spain.
Oh, I thought he was at a
meditation retreat in Vietnam.
He was, and now he's walking
the Camino de Santiago.
How nice for him.
I'm two surgeons down with no
one to approve hiring a new one.
I need the Board to appoint
an Interim President, stat.
Just as long as it's not O'Brien.
They wouldn't.
I heard from a staffer
who covers Board Meetings
that his name's on the short list.
Ugh. Of the worst possible
candidates for the position.
Good morning! Pictures of Steve.
Aww.
You no longer have your cane.
Yeah. PT said I was ready.
I'm glad to have you back.
I would like to join your case.
He's adorable, Dr. Murphy. Welcome back.
Shaun, I'm thrilled to see you,
but I'm not sure this is the
case where you want to start
as a new dad.
It is an exciting
and challenging surgery.
Thank you for coming in
on such short notice.
Hello. I am Dr. Shaun Murphy,
attending surgeon
and father of a baby boy.
He is two weeks old, and
today is my first day back,
but that will not affect my
performance as your son's doctor.
Is it true there might be
a heart for Jack?
Yes, but the heart isn't available yet,
and we may not get it once it is.
We've been through this before.
Why isn't the heart available yet?
Well, the donor family is still
saying their goodbyes before
they turn off life support.
Jack is an excellent match
for the donor heart,
and his latest echo indicates
that his cardiomyopathy
and overall cardiac function
has worsened, so he should
be at the top of the list.
I just want to run some additional tests
to make sure he's otherwise healthy.
There is a problem.
There is a small scratch,
likely from his fingernails,
which has developed cellulitis
and an abscess.
If the infection spreads
and he spikes a fever,
Jack will be ineligible
for the transplant.
We have to lance
and debride it right away.
Morning.
Hi.
This is Steve, our son,
who is now two weeks old.
Steve, this is the grumpy man
who lives down the hall
and gave you your favorite blanket.
Shaun was very impressed
you guessed his first name.
Wanna take a s*ab at the middle?
Aaron.
I was lobbying pretty hard for Bowie,
because why not name your kid after
the coolest person who every lived?
But... Shaun insisted.
You should come over sometime.
You two both grunt a lot
and make strange faces.
I've got a lot going on, so...
We live next door.
You have nothing going on.
You're mad. And I get it.
But are you really gonna ignore
Shaun and Steve and me forever?
Is that the plan?
I'm not ignoring you.
And he's beautiful.
Congratulations.
I tried.
Any cyanosis while eating?
Maybe a hint of bluishness
on her lips last night.
I haven't noticed anything.
But given her prior surgery
and the Turner syndrome,
I thought we should...
The blood flow is reduced.
It looks like Eden's aortic stenosis
has progressed more rapidly
than we were expecting.
Can we put her on beta blockers?
We can try, but given how
dysplastic the valve is,
I don't think it will do much good.
You'll want to get more imaging, but...
I think Eden's gonna need
another surgery... very soon.
Cardiac MRI confirmed
severe narrowing of the valve,
obstruction, and left
ventricular dysfunction.
Eden needs a new aortic valve,
or her heart failure will get worse.
Are you thinking mechanical
or cryopreserved h*m*
for the replacement?
Mechanical valve for a neonate
needs to be built,
and it will require future surgeries
plus lifetime blood thinners.
Cryopreserved valves risk
degeneration down the line,
but it is a solid idea,
especially as part
of the Ross Procedure.
Possible complications?
Aortic insufficiency,
pulmonary stenosis.
We can take some time, discuss
the different options...
Do the Ross Procedure.
I'll have Asher get her prepped.
It's time to get off the sidelines.
I'm not sure what you're referring to.
Are you gonna throw me a ball?
You've run the hospital before.
You can handle a few more months.
I can, but why would I want to?
- That's a no?
- Yes.
Get ready for Interim President O'Brien.
They would never.
That's like Mao meets Basil Fawlty.
Wow. That's two obscure
and dated references.
They're never gonna move on O'Brien.
Well, apparently, he's on
the Board's short list.
Throw your hat in the ring,
he won't stand a chance.
My hat's gonna stay on my head,
but I'll handle it.
Okay, Jack.
You know that little bump
behind your ear?
We have to poke it with something sharp,
which will hurt, but we have to do it
so hopefully you can get a new heart.
But Mr. Snugglepuff is here
to keep you company.
Asher said the taco truck
added chorizo to the menu,
and it's bussin'.
The next late night,
we should share an order.
Not really my thing. Thanks.
The sheet papoose is secure.
Good. Dr. Kalu, cradle the baby.
Dr. Allen, sterilize
the area behind the ear.
Okay, baby, don't look.
His eyes are not yet able to
focus beyond 8 to 12 inches.
The abscess is pretty deep.
It may take a while to heal.
What about a wound vac?
We don't have one small enough.
It's okay.
Maggots.
How are those better than
just using antibiotics?
Maggots work faster to
clear necrotic debris
on account of the antimicrobial nature
of their saliva and
other digestive secretions.
It's safe to put those bugs on my baby?
- Larvae.
- These are medical maggots.
They've been specially disinfected.
It's completely safe.
I would use maggots on my son,
Steve, in this situation.
That is unlikely to happen,
but I hope the parallel
puts you at ease.
Go ahead.
Hm!
You want some coffee?
Or I have a stash of
protein bars in my office.
I'm fine, thanks.
But if you want something, go ahead.
What's your family here for?
A heart transplant, hopefully,
for our son, Jack.
How old is he?
Oh. My daughter, Eden, is 11 weeks.
She's having heart surgery right now.
Y'all will be in my prayers.
Is this Jack's first surgery?
He's had other procedures,
but this would be his first
open heart surgery.
If it happens.
When it happens, I recommend
Biafine cream for post-op.
It contains a natural compound
called trolamine.
It really helped with Eden's recovery.
How many surgeries
has your daughter had?
Uh, one. At seven weeks.
Hmm.
Eden and I are old hands.
You're two very resilient ladies.
I'm Kate Pierce.
This is my husband, Owen.
Morgan Reznick.
Alex Park.
Would you like to...
Yeah! You can do it! Come on.
Oh! There you go!
You got it! You got it!
You got it!
Hi, Daddy. How is it being back at work?
I just applied maggots to a baby
a few months older than Steve.
Is that Steve?
He is supposed to be asleep.
Mm. He's doing well
with tummy time.
And you mentioned yesterday
he was behind,
so I thought I'd add
a few extra minutes.
No, no.
Tummy time should not be
extended into his sleep window.
Did you not get the app alert?
You are seven minutes
into nap time.
Nope. I guess I missed it.
Delaying his nap could
make him overtired
or delay his next feeding.
The schedule is very important.
I know, Shaun, I know. It's just
a few extra minutes.
Eight minutes. That is not
a few. It is several.
Uh, I should go put Steve down.
Bye-bye.
Okay.
Oh.
We had to abort the procedure.
Eden has a bicuspid pulmonary valve.
There wasn't enough tissue
to attach it to the aorta.
And we observed leaking at the valve.
Her heart is failing
even faster than we thought.
I'm so sorry.
What's our next move?
Oh. The maggots worked!
Baby Jack's infection has cleared,
and the heart is on its way here.
Eden has two bad valves
and rapidly progressing heart failure.
We have one donor heart
and two babies who need it.
It's up to us to decide
which baby gets this heart.
Jack has been waiting for three months.
A transplant is his only option.
He could go on a V.A.D. until
another heart is available.
That could take months.
And a V.A.D. isn't a good option
for Jack because of the...
Morgan. Morgan.
You can't be here. Neither of you.
I can't be anywhere else,
so either someone should sedate me or...
Well, that can be arranged.
It's only a problem
that Park and I are here
if we influence your decision,
so don't let us.
I won't say a word.
Dr. Kalu?
Yeah, um...
as far as the V.A.D. for Jack,
he's underweight,
so a high risk of complications,
infections, bleeding, stroke.
It's not a great option
for Eden, either.
Eden can go on ECMO while we're waiting
for mechanical replacement valves.
ECMO has risks, especially for
a baby with Turner syndrome.
And the longer she's on it,
the greater the risk
of serious complications.
The valves may not get here in time.
Care to weigh in, Dr. Murphy?
Jack and Eden are equally
good matches to the donor heart
based on size and blood type.
Anything else?
It's okay, Shaun.
Without this heart...
Jack will die.
Eden may also die without it.
But she has other options.
They are risky, but they are options.
Jack should get the heart.
We'll put Eden on ECMO tonight.
And I'll contact Abbott about
getting the 15-millimeter valves ASAP.
Hey. I'm sorry.
Can we rain-check tonight?
I'm exhausted, and Jerome promised
that we could watch
a nice crime procedural.
Sometimes you need a case of the week.
Yeah.
Mm-hmm.
Mmm! My favorite!
One cheddar brisket with mild sauce
so little Steve's next meal
doesn't burn his mouth.
You are a treasure. I am starving.
Thank you.
Mm-hmm.
Poor Eden, having to go on ECMO.
And poor Morgan and Park.
It's... been a day.
And how are you holding up?
Without Perez?
Everything that happens,
at home or at work,
he's the first person I want to tell.
Mm-hmm.
And I can't.
Or I shouldn't.
I really miss him.
You can tell me everything.
If it's too surgical,
I may not understand it,
but I am excellent at nodding
and acting interested.
Mm!
I'm here for you. So is Asher.
What's going on? Tell me.
Babies are terrible at gossip.
Asher and I were supposed
to hang out tonight,
just the two of us.
Do you need to check on him?
No. If he smells me,
I'll never get out of there.
He'll settle back down.
So you and Asher had plans...
He blew me off... for Jerome...
because he had a hard day
on Eden's case, which I get,
but I had a hard day, too.
Mm-hmm.
Steve's not settling.
Well, he can wait a minute.
You had a hard day, too?
It... It just seems like
everybody has someone except...
Go.
I am so sorry. I-I will be right back.
I swear.
Mm.
You didn't have to do this, Shaun.
I am more thorough than
anyone else in this hospital.
Starting ECMO.
I just got an e-mail
from Gail on the Board.
I'm suddenly a top candidate
for Interim President?
You're welcome.
I don't want that job.
It's bet... better you than O'Brien.
You're a good manager, you're...
you're well-respected,
and, you know, as a diverse woman...
People aren't diverse.
I'm part of an underrepresented group.
Right. That.
Makes you an ideal candidate.
Look. Gail loved the idea.
I hate you. You're welcome.
Shh, shh, shh. Shh, shh, shh.
I am glad to see you, Steve,
but you are not supposed to be awake.
Yeah, I-I fell asleep
during his afternoon nap.
We didn't wake up until 4:30.
You need to set an alarm.
The schedule is very important.
I know. I know.
Tomorrow I am doing a heart transplant
on a 12-week-old baby.
Okay. You need sleep.
Yes, I do.
Go to bed. I'll handle Steve tonight.
I-I don't think I can.
Shh, it's okay. What about your
noise-canceling headphones?
I fall asleep on my side.
I cannot do that in those.
Maybe you could go spend
the night at Glassman's?
No.
What about your office?
Can you sleep there?
We can save them both with one heart.
It's called a Domino Transplant.
Jack's heart is failing,
but his valves are healthy,
so when Jack receives the donor heart,
we will use his valves to
replace Eden's damaged ones.
A fresh h*m* donor means
Eden won't need
multiple surgeries or blood thinners.
One heart could save both babies.
What are the chances of valve failure?
Minimal. Jack's valves
are very functional
despite his cardiomyopathy.
The odds of success are high.
It's the best option we have...
for Eden.
And for Jack?
We would have to be very careful
while removing his heart
so as not to damage his valves.
That would mean more time on bypass,
which means a greater risk
of bleeding or infection.
It's a lot to ask.
They can always say no.
What would you say?
You haven't eaten anything in 24 hours.
I'm fine.
No matter what they decide,
we'll get through this.
Don't.
What, try to help?
Yes, exactly.
It's pointless and annoying.
You know, I get that you don't
think of Eden as mine yet...
and that's why you haven't included me
in any of her medical decisions.
Not that I need that...
or disagree with any of your choices...
Is pissing me off another
attempt to distract me?
I'm not trying to pick a fight.
I just want you to know
that I love that girl
like she's my own, and...
I'm as scared as you are.
And I wish you'd let me
help you because...
we're in this together.
That's it.
And I really don't want you to pass out,
so please eat or drink something.
If our baby can save your
baby's life, we'd be honored.
"I'll love you forever,
I'll like you for always.
As long as I'm living,
my baby you'll be."
Oh, my God. What a tear-jerker.
We need to find one of
Daddy's medical journals.
Reminder...
nap time in five minutes.
How do I un-sync the baby app
from our speaker?
Oh, no. You should not do that.
I set it up so you can
remember the schedule.
When it's just me and Steve
home during the day,
I like to be a little bit more...
flexible, go with the flow.
I'll just... I'll just unplug it.
It has a battery
in case of power outages.
Lea, when I'm at work,
I like knowing what
you and Steve are doing.
It makes me feel like I am
still a part of his day.
And when Steve gets off
his sleep schedule,
I have to go sleep at the hospital,
and I miss you both even more.
Aw, we missed you, too.
How did you sleep?
Not well. But I came up
with a very good idea
to save both babies.
I have to go prep for my surgery
now. I love you.
Dr. Lim, we have a meeting to review...
One minute, Shaun.
Gail, of course, diversity
and representation
should be considered, but given this is
an interim position,
I think the top priority is
finding someone who can hit
the ground running from day one.
And that means someone
who's done it before.
He's too modest to sing his own praises,
but I think he's the obvious choice.
Hmm. Compelling argument.
- Thank you.
- Oh.
And seniors are also
an underrepresented group.
Dr. Murphy and I will start
with Jack in OR 1.
Asher, you'll be with Eden
next door getting her ready.
Allen and Kalu, you two
will receive the donor heart
and prep it for transplant.
Then Dr. Lim and I will
put Jack on bypass
and start cooling him to 25 degrees.
Given his age and underlying
medical condition,
he should not be on bypass
for longer than two hours.
Putting in Jack's new heart
will take about 90 minutes.
That leaves us half an hour
to remove the old one.
While Shaun is transplanting
the new heart,
I will be excising Jack's valves.
We have zero room for error.
Prep your patients.
Exciting case...
Yep.
We're saving two babies at once,
and your commentary is "yep"?
- I was agreeing with you.
- With as few words as possible,
which you've been doing
for the last two weeks.
If you have a problem with me,
just tell me.
Okay.
Okay. I have a problem with you and
how you handled Perez's case.
- That's completely stupid.
- You just said I should tell you.
I didn't say I would agree with you.
You overrode our patient's wishes,
- and Perez is gone because of it.
- Perez is alive because of it.
You don't know what would have
happened if you'd listened to him.
You made the decision
you thought was best.
Didn't matter what anyone else wanted.
I'm sorry, but you don't get to do that
and not deal with the consequences.
The consequences?
I lost someone I care about a lot,
and I miss him every day.
I'm really trying hard to focus
on the good things in my life,
the job I love,
the friends I thought I had...
But it feels like everyone is
moving on, and I'm just alone.
Spare yourself the burden
of punishing me.
Get her prepped, draped,
and under anesthesia.
I'll see you in 30 minutes, hopefully.
I had an extra set.
You don't have to be Catholic.
They can just be a reminder
that you're not alone.
Thank you.
There is a lot of
scar tissue to dissect through.
The cardiomyopathy has caused
Jack's heart to enlarge
and adhere to his chest wall.
This will take longer than planned
in order to preserve the valves.
We inspected the mitral valve.
The atrial septum is intact.
The heart looks good.
Dr. Allen, connect the pulmonary veins
to prep the left atrial cuff.
Dr. Kalu, you're with us.
Okay. Increase flows
and cool to 25 degrees.
Start the clock.
Come on, Peanut.
We went with the flow,
but now it's nap time.
Come on. Settle.
Oh.
Ohh! We were so close, Peanut.
I need to transect the aorta,
but there are thick adhesions
where it meets the valve.
You now only have an hour and 14
minutes to put the new heart in.
The annulus is at the tip
of my dissection.
If I nick that,
the aortic valve is useless.
Anterior retraction.
We're running out of time.
Jack's transplant is at serious risk.
Metz.
Dr. Murphy, you need to
abort this procedure.
Shaun, ECMO is still an option for Eden.
- You need to abort...
- Got it!
The valves are good.
Ready for the donor heart.
- How is she?
- Ready to go.
Vitals are great.
Open her chest and start her on bypass
while I recover the valves.
Scalpel. How do the valves look?
A little bigger than
we measured on imaging.
Makes the anastomosis challenging.
But it can still work?
It has to.
Hm.
Feeding time starting
in five minutes.
Shh.
It's not seating perfectly.
Let's try a purse string suture.
Got it. Saline.
There's a paravalvular leak
at the aortic.
How about pledgeted sutures?
In an infant this small,
that could cause stenosis.
We try again.
It's been almost two and a half hours.
We need to get him off bypass.
The aortic anastomosis is complete.
Unclamp the aorta and start rewarming.
Now what?
We wait... and hope
his heart starts b*ating.
It's been almost three hours.
Do you think something's wrong?
The sutures are holding.
Now the little thing just has to b*at.
Start warming her up.
Decrease the flows.
We need to shock him.
Clear!
Again.
The surgeries were successful.
Both your babies are doing very well,
and you can see them soon.
Thank you.
Thank you.
You saved our daughter.
You are welcome.
I miss my baby.
I'm going home now.
Alright. Let me just jump in the shower.
And then I'm good to go.
Go home to your man.
It's okay.
Bless you. Tomorrow?
Mm-hmm.
You're right. This chorizo is...
What'd you call it?
Bussin'.
Right. Definitely bussin'.
I thought we could share an order.
Tell me you didn't forget the hot sauce.
- Hello.
- Hm...
Why is Steve awake?
You look terrible.
Thank you.
Steve has been fed, burped, changed,
and woken from his haphazard nap
by a speaker reminder.
How's Eden?
Very good. And Jack's transplant
was successful.
Mm.
Parenting can be very hard.
Mm-hmm.
Yeah. I've noticed.
There are many hard choices
about what works best.
People want different things.
I will try to...
...make room for your way.
The schedule is important,
but I will un-sync the app
from the speaker.
I put it out on the fire escape.
Thank you.
I really appreciate it.
But the only room I need
right now is the bedroom.
- Okay.
- Good night.
I'm borrowing your
noise-canceling headphones.
I love you both.
Are you kidding me?
You recommended me?!
I was just following your example.
See? You're a natural leader.
I'm old. I'm worn out and I'm old.
- You're wise.
- I remember rotary phones.
You're vital. You're experienced.
You're the most respected doctor
in this hospital.
Aaron, you have institutional knowledge
and a... and a natural,
unexplainable gravitas.
Will you please stop being
an idiot and just take the job?
Stop being selfish and stubborn.
How am I being selfish? I'm...
Oh, you're together.
That saves me a stop.
Your recommendations presented the Board
with a very difficult choice.
So we didn't...
choose.
You two are the new
Interim Co-Presidents
of St. Bonaventure Hospital.
Congratulations!
This is not the schedule, Steve.
Mommy needs to sleep.
Daddy needs to sleep.
You need to sleep.
Please?
Please. We are both very tired.
Please. We are both very tired.
Hey.
I don't know what to do.
I can't go inside because
Lea needs to sleep.
I've always been able
to get him down before.
Sometimes babies just need to cry.
Hey. Um...
why don't I take him?
Get some sleep.
It's okay. Just get some rest.
I will just take a short nap.
Take as long as you need.
Hey.
Hey. I got you.
Hey. Hey. Hey, hey, hey, hey, hey.
I got you. Huh. I got you.
I'm Grandpa...
in case you were wondering.