Today is not Saturday.
Why did you make me pancakes?
They are fresh start pancakes.
Like the first day of school every year
when you get to wear a brand-new outfit.
Well, not everyone wore a new outfit.
But the rule in this house
is that when you start a new life event,
you get pancakes.
I... don't want a fresh start.
I want to stay in surgery.
I know.
And I am really proud of you
for handling it all so...
Doctors... please give me one more minute.
We have an associate pastor at the church,
but Clarence likes to write the sermons.
- Sorry. - Please.
Although this is important too.
The surgery consists of two steps...
first we fuse the spine to stabilize it,
and then we remove the tumor.
Because the cancer has spread to your lymph nodes,
you'll still have to follow up with chemo.
Clarence, are you in pain?
Quite a bit actually, but I'm fine.
Well, since what's causing your pain
is the tumor pushing against your spine,
the spinal fusion will ease pressure on your nerves
and should eliminate your pain.
Please, I, uh... I need this pain.
Can't you just do the second part and remove the tumor?
If we don't fuse the spine,
it'll make removing the tumor a lot more difficult.
More difficult, but it can be done?
It can. But I recommend against it.
Especially since there's no reason not to.
I did something...
...unforgivable.
This pain is my punishment.
Can I ask what you did that was so bad?
I killed someone.
Synced & corrected by -robtor- www.addic7ed.com
My sister and I were
coming home from climbing Mt. Whitney.
We're doing the State 50 climbs.
The numbness started during the climb?
First my hands, and then my feet.
- You have a headache? - Yeah.
High altitude causes headaches.
Dehydration compounds it.
From now on just... climb slower.
And drink more.
Tell them about the other thing.
Before leaving for the mountain,
I had this weird sensation like...
dread.
I couldn't shake it.
Well, when people describe a sense of impending doom,
it's usually anxiety.
No, it was like a premonition...
...that I was going to die.
- I'm sure it was... - Dr. Park will run a brain scan,
and we'll do some lab work.
Shaun.
Hello, Dr. Lever.
Carly is fine.
Welcome to pathology.
It is going to be great working with you.
What do you think?
I know it's a lot to take in.
It's kind of like your first time at Disneyland, right?
I've never been to Disneyland.
Let me give you a tour.
Cytopathology, forensics,
genomics, microbiology.
We get to identify organisms,
interpret cell morphology,
sequence genes.
Is that a D300e
pathogen antibacterial bioprinter?
It's new.
You're working on antibiotic resistance
in emerging microorganisms?
It's "we" now, Shaun.
Yes, we are.
Do you want to play with it?
Very much.
Go ahead.
It's kind of your job now.
We are the detectives.
Surgeons are just the beat cops.
Our best bet is to try to separate the tumor
from his cord, and then resect it.
Okay, this is insane.
You know how he "killed" a person?
He was counseling a parishioner who committed suicide.
That must have been traumatic.
Traumatic, yes. Murder, no.
Hey, I know it's stupid, but he has autonomy.
I didn't stay stupid. I said "insane."
You want to override his wishes because he's religious?
Something like 90% of Americans believe in God.
I'm one of them. Are we all mentally impaired?
Should you ignore us all if you don't like our choices?
Only those getting divine messages from their tumors.
- He's not crazy. - Okay, you're right.
He is just stupid. But don't we have a duty to educate him?
You're gonna talk him out of his religion?
No.
You told him the surgery was more dangerous this way.
I don't think he appreciated how much more dangerous.
Good idea.
He thinks he'll go to hell if he dies before he's forgiven.
Make sure he knows it can happen on the table.
An MRI for anxiety?
It does fly in the face of reducing
unnecessary medical tests.
When I was a resident,
I had a patient come through the E.R.
Female. 35 years old.
Slight cough. Slightly hypothyroid.
Normal vitals.
I labeled her a whiner because she kept insisting,
"I'm gonna die."
I sent her home.
And she died?
No. She kept coming back.
Over and over again.
We do this test, we prove there's nothing wrong with her,
we send her home reassured.
Damn.
The MRI showed a high grade meningioma.
An advanced tumor that grows in the tissue layers
that cover the brain.
Its features are consistent with it being malignant.
These tumors tend to be aggressive
and impossible to fully resect.
Um, so what... what can you do?
Palliative care,
symptom control with medications.
You're risking spinal damage,
paralysis... death.
If that's what God chooses, then that is his will.
If you have cancer because he wants you to have cancer,
why are you here? Getting treatment?
I'm here because I believe in science.
I am who I am because I believe in God.
So do you think all people who are sick
are being punished?
I mean, we have an eight-year-old down the hall
with bone cancer,
you want to go tell her God hates her?
I'm sure that girl is not suffering as a punishment.
She's suffering so others may have a chance
to show her mercy,
to show her compassion, so she can inspire.
I don't know His plan,
but I know it's not as simple as you would...
No. No, it's not simple.
Except for your pain.
His name was Michael.
His wife found his body.
You had no idea.
I knew he was depressed.
But you thought he was getting better.
I didn't take his call.
Because I was having a drink.
It'd been a long day dealing with the renovations,
and I was having a damn drink.
Hey, Shaun.
Hey, Carly.
I started Sadie Barnes on anti-seizure medication,
need you to run a peak phenytoin level.
The couriers must be happy that the surgeons
are doing their own specimen deliveries.
How you doing down here?
Carly says pathologists are the detectives,
surgeons are just the beat cops.
Shaun, are you happy here?
When did you give the patient her loading dose?
One hour ago. Hmm.
Shaun, if you're happy, that's great.
But if you're not,
you have to tell Han how you feel.
You need to show him you care
and that you believe in yourself.
Do you need this done STAT?
No. She's asymptomatic.
- It's just for seizure prevention. - Good.
Carly says that in pathology
you can take a break whenever you want.
I want to take a break now. I'm going for a walk.
He shouldn't be in pathology.
- He's a good surgical resident. - You're right.
- Then you'll move him back? - No.
You're wrong about that part. He should be in pathology.
- But he was a good surgical resident. - Then why...
Because he'll never be a good surgeon.
How do you think he'll do in three years
when no one's looking over his shoulder?
When he's looking over someone else's shoulder?
Supervising new residents, leading grand rounds,
advocating for vulnerable patients.
Do you see him doing any of that without a safety net?
We can help him get there.
Just because he wants to be a surgeon,
just because you want him to be a surgeon,
doesn't mean he gets to have that dream come true.
Has it occurred to you that maybe
we know Shaun better than you do?
Has it occurred to you that
that might be your problem?
That your view of him might be distorted because you like him?
Has it occurred to you
that maybe he's better off in pathology?
That maybe he'll even like it?
Do you care?
I thought you might.
We need better ventral exposure.
Drill off more of the pedicle and vertebral body.
Ligate the exiting nerve root.
We'll take it with the tumor for a wider margin.
I can't see it.
The tumor's causing the spinal cord
to be bowed up to us.
We need more exposure to get around and in front of it.
The vertebrae is too fragmented and displaced.
We can't get a complete resection
without stabilization.
He's tanking.
Probably spinal shock from tension on the cord.
We need to abort.
All right, on three. One, two, three.
You fixed me!
- No, no. - What happened to my pain?!
- Stop! - We didn't fix you.
There was a complication. We injected anesthetic.
It'll wear off.
We had to stop the surgery
before we could remove the tumor.
You went into shock.
We lost your heart rate and blood pressure.
We warned it would be a trickier surgery without the fusion.
Nothing has changed. The anesthetic will wear off,
the pain will come back, but worse.
When can you try again?
Try again? We failed.
There is no reason to think we will succeed
- next time unless we do the fusion... - But you know what the issues are,
- you learned... - Why haven't you?
Do think God wants you to die?
Please.
Try again.
Cyanide poisoning.
The cause of death on the Atlin case.
You know how I found it?
I smelled it... almonds.
Dr. Park's patient.
I flagged her eosinophil count...
it doesn't match up with the diagnosis
of advanced meningioma listed on the requisition.
Great. Nice work.
I'm going to talk to Dr. Lim about it.
Whoa there, Shaun. Hold up.
You don't need to do that.
The attendings are on the lookout for the flags.
- They'll run with it. - I want to run with it.
You've been on the receiving end... you know how it works.
How it works is I see something abnormal
and then I discuss it with the team,
and we plan how we'll fix it.
We run with it.
Shaun, once a test is done, we move on to the next one.
I'd like to... take a walk.
Are you going to walk to Dr. Lim
and discuss this case, Shaun?
That's not what we do here.
We investigate, report, and then we move on.
Are you gonna be able to do that...
move on?
I don't know.
But I will try very hard.
Next time.
Dr. Browne.
Is this about a patient?
No.
Come in.
I've heard a lot about you...
I'm aware you stood up to a supervisor.
Is that what's happening now?
Um, I put together a list of cases
which Dr. Murphy contributed to.
Uniquely.
You're a loyal friend.
I've specified the ideas he had...
ideas that no one else around here could have...
Do you think I hate him?
No.
But I think
you might be biased against him
because of his condition.
So he doesn't have communication issues?
- I'm wrong about that? - No. But he...
If he had the flu, I would tell him to stay home
until he got better.
He has autism...
I could tell him to stay home until he gets better.
Instead I found a place for him to help us,
to save lives.
And you should know
I have rather mixed feelings about loyalty.
All righty. There you go.
Hello.
Aaron.
It's good to see you.
Yeah. The feeling is mutual.
Can I have one of those?
- The chocolate chip muffin? - Yes, please.
Special occasion?
- Yes. - Yeah?
As of today, I am no longer injecting toxins into my body.
Except, of course, with chocolate chips.
Oh, you're done with chemo? Wow.
That's amazing.
Congratulations. Thank you.
I was thinking of going out tonight and celebrating
what may be very good news.
If you're free, my treat.
I... I'm sorry, Aaron.
I have a-another commitment.
Oh. Um, tomorrow then?
This week is really crazy.
You know what? I am not doing chemo
every night next week, so I am free
every single night, so...
Aaron, I'm seeing someone.
I'm sorry.
Nothing to be sorry about.
It was good to see you.
Keep an extra close eye on blood pressure and heart rate.
I have extra fluid, vasopressors,
and inotropes ready.
Why no God?
You follow in the tradition that you're handed.
My family wasn't religious. We never went to church.
I was there every Sunday.
8:00 a.m. for Catholic mass.
My parents eventually got tired of all the rules
and turned Lutheran.
They found that dull and went back to Catholic.
That's my tradition.
What do you think it'll be like when you die?
Probably like it was before I was born.
A whole lot of nothing.
We're there.
Where we were when everything went wrong last time.
We need to remove the tumor without putting any pressure
on his cord at all, or he'll be back in spinal shock.
And we need more tumor release from the vertebral body.
Extend your osteotomies proximal and distal.
Good.
I think I got a free plane...
Retract it from the cord a little more.
- I got it. - Now, when you remove it
careful not to morselize it.
Can you hold that up?
Dr. Reznick, give me a measurement.
Max length is 4.5.
Get a pre-op scan up.
That says the tumor's eight centimeters.
How does a tumor shrink from 8 centimeters
to 4.5 without radiation in two weeks?
It doesn't.
Why the page, Shaun? And why are you in radiology?
We rely on flags.
You have to count on the ordering physician
seeing it while you move on to something else.
- Okay. And...? - I don't agree
with Sadie Barnes' diagnosis,
and I think her tumor should be biopsied.
- Shaun, I... - Dr. Han wanted me away from patients.
Patients are not allowed in the viewing room.
So I'm not doing anything wrong.
Two radiologists said
it was a malignant meningioma
in the insular region and encasing the MCA vessels.
That's exactly where it is.
And her clinical picture matches perfectly...
arm and leg numbness.
The tumor attachment to the dura is slightly anomalous.
And the insular region is slightly atypical, too.
What differential diagnoses are you proposing?
I need to speak to the patient.
Should I ask Dr. Han for permission?
Shaun, I...
...will bring your concern about the scan
to the head of radiology.
But approaching Dr. Han? Don't do that.
Now, I already talked to him about your reassignment.
I don't know if it'll make any difference...
If I were Claire, would you let me approach Dr. Han
about something that concerned me?
Yes. I probably would.
Hmm.
Is that because Claire doesn't make mistakes
when she's communicating?
Yes.
Then do you think Dr. Han made the right decision
by sending me to pathology?
No.
The lymph nodes have shrunk, too.
This is a PET scan from two weeks ago.
Enlarged and cancerous.
Today...
...they've all regressed.
Spontaneous regression has been reported
in melanomas, renal cell carcinomas,
neuroblastomas, and some types of blood cancers.
In a sarcoma that's metastasized?
No. But if it happened in those others, why not?
Because none of them make sense.
When I read about disappearing cancer, I always think
some doctor missed something, forgot something,
screwed up something.
The theory is that the body somehow triggers
an immune response against the cancer.
Something somehow lights a fuse.
The theory says the fuse is lit by an infection.
His lab work proves he hasn't had one.
At this point, the most credible explanation is...
Are you gonna use the "m" word?
You seriously can't say it?
Only when referencing the 1980 U.S. hockey team.
Keep testing. Anything you can think of.
Molecular markers, T-cells, PD-L1.
We'll need permission from the patient.
Which raises another issue...
what are we gonna do next, medically?
He was supposed to start chemo next week.
No, it'll wipe out his immune system,
which may be what's actually killing his cancer.
If we don't know what's making him better,
we don't know what to stop, what to start.
So we do nothing?
Just trust God to fix him?
We trust whatever is currently
fixing him to keep fixing him.
If he took a Tylenol yesterday at 8:00,
he takes a Tylenol today at 8:00.
Monitor him. Closely. Scans constantly.
Hello, Dr. Glassman.
Hi. Thank you for coming.
He has been doing this for two hours.
Shaun.
What are you up to?
Alphabetizing our canned goods
and checking all the expiration dates.
Well, somebody's got to do it.
Is something wrong?
No.
- Okay. - Okay. I think
Dr. Lim's patient's diagnosis is wrong,
but I can't prove it without information,
and I'm not allowed to talk to patients.
Shaun.
I want to run with things.
I want to fix people.
Can you help me become a surgical resident again?
No. I can't, Shaun.
- I'm not president... - Yes.
I'm not the president of the hospital
anymore, Shaun.
And even... even if I was...
...it's irrelevant.
You have to stand up for yourself.
And you know what? If you can't,
then the new Head of Surgery, the Chief, he's right.
Now, I can go tell him he's wrong.
It won't do any good.
Or you can go show him.
I'm doing research concerning Sadie Barnes.
She's asleep.
Perfect. I'm not allowed to speak with her.
I'm looking for her sister Jess.
I haven't seen her. Sorry.
What are you doing?
Can you explain why, instead of remaining in pathology
as directed, you were in a patient's room,
going through her purse?
I didn't speak to her. She was asleep.
Dr. Murphy, any reticence I had
about removing you from surgery just vanished.
You shouldn't be in contact with patients.
Or their families. Or anything they own.
Do you understand, or am I gonna be forced to fire you?
Sadie's social media says that
she finances her climbing travel
by working as a freelance food critic.
She reviewed a Japanese restaurant that used to have
a Restaurant Grading System Score of "A,"
but then it dropped to a "C," which corresponds
to very bad food safety practices.
Bad sushi can lead to worms, but it usually doesn't
because stomach acid almost always kills fish parasites.
But not if someone is taking an acid blocker,
which 60 million Americans are.
I saw a bottle in her purse.
Sadie could have sparganosis
with an encapsulated worm that is mimicking a meningioma.
That's a good idea.
Excellent. I'll tell the patient.
I will tell the patient.
I'll tell her we're doing a biopsy
to confirm the initial diagnosis.
- But we're... - It will tell us
if the initial diagnosis is correct.
Your theory is a real long shot.
It would be irresponsible to get her hopes up.
- Hmm. - The surgery went well.
We were able to extract the entire tumor
without complication.
Thank you.
When can we start chemo?
There are a few follow-up tests we want to run first.
And we want to retake your history.
Make sure we have a proper list
of all medications you've been taking.
You want to take his history? After the surgery?
What's going on? What are you not telling us?
- What went wrong? - Nothing.
The fact is, the surgery went...
better than we'd hoped.
Your cancer seems to be...
going away on its own.
We'll run our tests.
We're confident that there is a medical explanation.
Oh, Clarence.
- Hi. - Hi, Aaron.
Um, what I...
What I told you earlier, that I'm seeing someone...
I'm not.
I mean, I-I-I had one date,
- but it wasn't, you know... - Okay.
We're... We're just... We're not a good match.
That's what I wanted to tell you.
That's not true, you know.
You know, that's not true.
You like me. A lot.
And I like you even more than that.
So what is this?
You know, I'd really rather not get into it.
- You came to my house... - To tell you what I told you,
- which I just told you. - Okay, you came here to be honest,
and you're only gonna be honest halfway?
- You're not timid. - No.
Okay. Then what?
The last time I was here,
we were headed upstairs...
Yes, we were.
You fell.
Yes, I did.
I tried to help you, and you pushed me away.
I was embarrassed.
You were sick.
- You needed help. - And I'm not sick anymore.
Maybe. And I want to go and celebrate.
With you. Specifically with you.
'Cause we have fun.
You... You make... You make me laugh.
You make me feel good.
I like being with you.
Sounds horrible.
But bad things are gonna happen.
Aaron, I-it can't just be about having fun together.
One of us is gonna get sick,
one of us is gonna need to be taken care of...
Wait, wait, wait. I just want to go out
and have a nice dinner with you.
Not to run away to Reno, find a priest in an Elvis suit.
What are we gonna do, Aaron?
Just drive to a hill with a view and neck till prom?
And then I'm gonna come home and hope you call?
Yeah, uh, you know, I just came to apologize.
I'm sorry.
And I'm really glad...
I'm... I'm glad you're finished with chemo.
And...
...you're gonna... you're gonna beat this thing.
Your immunoglobulins are normal.
Everything is normal.
We can't find a scientific explanation.
Our prayers... It's a miracle.
Miracle or not,
it seems we're on the same page now.
There is no reason not to do the spinal fusion
to eliminate your pain.
Do more tests.
- Clarence. - There are no more tests.
T-T-There must be. There must be an explanation.
Redo your tests. Find new tests.
"Let all bitterness and wrath
and anger and clamor and slander
be put away from you."
Ephesians 4:31.
I didn't take you for a believer.
I'm not, anymore.
I'm not sure you are either.
God speaks directly to Noah,
Moses, Job, and Solomon.
And now apparently he has singled out
Pastor Clarence of San Jose
to join the ranks of the prophets.
I'm sorry, but unless there is a burning bush
it is narcissistic to think that God
has made you his personal project.
God speaks to every one of us,
- you just have to listen. - You are not listening.
People get cancer all the time.
Often that results in pain.
Those things are not unique.
What is unique
is having an aggressive metastatic cancer
start to disappear without any rational explanation.
The issue isn't God.
You have to forgive yourself.
What I did...
Cannot be undone.
But your pain can.
Clarence.
Your pain...
Your pain does no one any good.
Okay.
Osteotome and mallet.
You lied when you said you never went to church.
What happened?
I didn't want to have this conversation
is what happened. I'm not judging.
My brother took a year off school
to travel and came back a non-believer.
So ask him.
Was it freeing,
or did you feel empty?
Hand me the first polyaxial pedicle screw.
It was like losing a loved one.
The moment of truth.
Follow me.
Our initial diagnosis was wrong.
You don't have a meningioma.
You have a worm in your brain.
And while that sounds fairly gross,
it is completely curable.
So, the sense of doom, it was... it was wrong?
- It saved your life. - As did Dr. Murphy.
This is the pathologist who noticed
an abnormality in one of your tests.
That led us to this discovery.
Can I give you a hug, too, Dr. Murphy?
No.
You and your sister will be free to conquer
whichever of the remaining 50 peaks you choose
as soon as my team surgically removes the worm.
- Thank you. - Oh! Of course.
There are not a lot of doctors who would have made the leap
that you made today, Shaun.
Good work.
Yes, it was excellent work.
Most people would say "thank you,"
but technically that's not an incorrect response.
Hmm.
Have a good evening. You've earned it.
I don't want to go on walks.
I don't want to move on from cases
after the tests are done.
I do not want to be a pathologist.
Dr. Han, you need to make me a surgical resident again.
I appreciate you telling me that.
I was wondering whether you had it in you
to advocate for yourself.
But the truth is, Shaun,
what you did today,
it proved I'm right.
Your skills are tremendous.
Your weaknesses...
equally significant.
You could be a great pathologist.
Just think of all the Sadies out there,
waiting for you to save them.
Dr. Browne, Dr. Reznick.
The surgery went well. Your spine is stable.
I'm scared.
There may still be some residual pain as you heal, but...
No, I...
I keep wondering,
what if I disobeyed God?
You have to have faith.
But you lost yours.
I didn't have a miracle to help me through the dark times.