Shaun...
You need to give me your driver's license.
No, I don't.
Do you remember
- the memory test I gave you? - Vividly.
Yes. It demonstrated you have a deficit.
A deficit; you shouldn't be driving.
Dr. Blaize agreed.
Shaun, that test was supposed to be between us;
that's why I didn't want to do it at the hospital.
Yes, your doctor needs to be informed
of the results of all your medical tests.
Even tests that are done at home.
Shaun, I've been driving for like half a century.
I'm an excellent driver, okay?
I don't need to give you my driver's license.
Okay. Then I'll have to notify the DMV.
Dr. Glassman?
You're not gonna notify the DMV, Shaun.
Yes, I will notify the DMV.
Shaun, you will not notify the DMV.
Dr. Glassman,
if you don't give me your driver's license,
I will notify the DMV.
Dr. Glassman?
George Reynolds, 28,
sudden onset of arm and leg weakness,
right facial droop, and trouble speaking.
CT confirmed a middle cerebral artery embolism.
I booked us into interventional radiology.
When did you first notice your symptoms, George?
About, uh, four and a half hours ago.
Wait, what's wrong with me?
You may be having a stroke.
You're on monthly injections of Lupron?
For three months.
That may have caused this.
Do you have prostate cancer?
No. I-I was diagnosed with atypical hyperplasia.
That shouldn't have any effect on what we're gonna do now.
We're gonna take care of you, George.
Don't worry.
This is local anesthetic;
you'll feel a pinch.
Are you a real doctor?
I'm Dr. Shaun Murphy.
People ever call you Murph?
No.
I'm going to make a small incision
so we can insert the tube and re-inflate your lung.
What do they call you, Billy?
CraterHead, Volcano, ThreeEyes...
those are just the creative ones.
Hold tight. Here comes the tube...
You guys really know what you're doing.
Yes, we do.
We'll order an MRI for your lungs.
Then we will fix your fractured eye orbit;
that will require surgery.
What do you say we fix your forehead, too?
You could do that?
- I think so... - I don't think so.
It's a pre-existing condition,
and it's not medically necessary.
It shouldn't be approved.
...Captions by VITAC...
Synced & corrected by -robtor- www.addic7ed.com
The MCA clot is obstructing all distal flow.
Anti-androgens aren't indicated for hyperplasia...
He said atypical.
You think he's lying?
Maybe he's gender transitioning.
Aside from cancer, there aren't many other indications.
Let's focus on what we do know.
Feeding the catheter.
Suctioning the thrombus,
and he's recanalizing. Slowly retract.
Whatever his reasons are for taking anti-androgens,
hopefully there are options.
He either drops them or he's gonna keep having strokes.
The forehead repair would be expensive and cosmetic...
It's not about prettying him up;
it could give him a new life, friends,
maybe a few less beatings.
Stopping the beatings is the guards' job.
You really don't have any empathy for Billy?
Empathy is a bad reason to fight for someone.
If empathy makes me only want to help patients
who are from Wyoming or have ASD,
then that's very unfair
to all my neuro-typical patients from Idaho.
I need to take those drugs.
They caused your stroke.
We don't think you have hyperplasia.
If you tell us the real reason,
I'm sure there are other safer treatments...
No, there aren't!
If you're transitioning, there are alternatives...
I told you why I was taking the meds.
George, we are your doctors;
we need to know the truth.
We're not gonna tell anyone.
I'm not transitioning.
And I don't have hyperplasia.
I have problems...
with my sex drive.
I know it sounds stupid,
like why can't I just control myself
but...
It's all I think about.
It's all I can think about.
I can't work,
I can't socialize,
I can't have a life.
And those meds are the only thing
that makes it even remotely tolerable.
They'll kill you.
The residents have a betting pool
on who you're going to appoint.
As your replacement as Chief of Surgery,
the decision needs to be made with decorum and expediency.
I haven't quite gotten around to analyzing...
You've had little face time with your attendings
since you became president.
You need to correct that.
I've scheduled your announcement.
You've got two days.
- Where is he? - He's gone;
signed out AMA.
- I tried... - How long ago?
Five minutes...
Why are we in a hurry?
I was researching alternative meds for him.
Realized Lupron didn't make any sense.
Prescribing anti-androgens for sexual urges
is like hitting a mosquito with a mallet.
Unless they're deviant urges.
We might've just released a child molester.
Should we call the police?
We can't.
We have no evidence of a crime.
Lim's at 3 to 2,
Melendez is just behind at 2 to 1,
Cooperberg's 7 to 1,
and if Dartling, or anybody else comes in,
you can retire.
Andrews might bail on Melendez
when he finds out our patient bolted.
Which is why Melendez is now 4 to 1.
Pari-mutuel betting is very exciting.
Do you need empathy to be a good doctor?
No. I think it can interfere
with effective decision-making.
She's just saying that to avoid hurting your feelings,
thus making her fake point for real...
her empathy made her lie to you.
I think you just agreed with me
and insulted me at the same time.
I think empathy's very important...
Telling the cold hard truth even when it hurts,
sometimes is the most empathetic thing we can do.
Which is what I'm doing for Shaun right now.
You're welcome.
I have autism
which means I have a deficiency of mirror neurons,
which inhibits me from emotionally trading places
with people, which makes empathy very difficult.
Does that mean I can't be a good doctor?
No, it doesn't.
We all have our strengths and weaknesses, Shaun.
One of Claire's is making sure everyone feels validated.
The creep is back.
Is George having another stroke?
No.
Severe lacerations to the scrotum.
Did you give him anything for pain?
Morphine. Four milligrams. And I notified the cops;
I think it was a hate crime.
Yeah, I don't think so.
All right.
On my count.
One, two, three.
We'll take it from here.
I'll pack him and prep him.
You did this to yourself, didn't you?
I think I know what kind of urges you've been having.
I'm not a monster.
I never touched anyone...
any... child.
My sister and I were always best friends...
but then she had children.
If I can't keep taking the drugs...
...I had to do this.
Home surgery tends to not have
the results you're hoping for.
You did a lot of damage
but your testicles are unscathed.
Please... finish the job.
I say we do it; he's a pedophile.
No, he's not.
He just told us he was.
He has never acted on his urges,
and he's asking us to do something
to ensure he never does.
He is a decent person trying...
I'm confused.
What do you want to do with him?
Treat him like a patient with a diagnosis.
Put him on antidepressants,
refer him to a urologist, give him a psych eval.
Let the experts determine if he should have a castration.
Psych eval? Antidepressants?
When we refer people for counseling,
how often do they get cured?
I am looking to help him manage this dis...
And if they don't get cured, what happens?
They get more depressed, can't cope, quit jobs,
maybe kill themselves?
All bad, but not... rape-a-child bad.
So what are you going to do?
We can't ethically remove healthy organs
for crime prevention.
We don't amputate a kleptomaniac's hands
to prevent them from stealing.
Hands have many purposes;
the balls of a pedophile have but one.
Set up his referrals and patch him up.
How long you been in Foothills?
Nine months...
Time flies in Juvie.
Any visitors?
I don't have a granny bringing me cookies,
if that's what you mean.
This is why empathy is bad.
You're talking to our patient because you like him,
which is causing him to move,
which is affecting our imagery.
He's scared.
I'm talking to him to calm him down
which is improving our imagery.
The fact that I like him is beside the point.
You grow up in San Jose?
East Paly... but I got out of there as soon as I could...
I was 15.
Your parents still there?
Mom's gone...
dear old Dad is... terrible.
Siblings?
Little brother...
He's gone too...
Crappy dad. Lost his brother...
I mean, you really don't ha...
He's not scared.
He's short of breath
because his diaphragm is lacerated.
His stomach has passed through that tear
and is now in his chest.
Billy needs emergency surgery on his diaphragm.
The defect reaches all the way
from the center to the anterior costal margin.
So what do we need to do?
Divide the inferior pulmonary ligament
to bring the lung upwards.
Uh-huh. Mesh.
Whoever kicked him was wearing some serious footwear.
And they'll be waiting for him when he goes back.
Unless we help him.
Dr. Park wants to fix his forehead.
The Constitution guarantees prisoners
get the same care as everyone else.
Most non-prisoners can't afford cosmetic surgery.
He would be getting better care than everyone else.
Kid is smart and personable and puts up a great front.
But he's scared to death.
And he got 36 months for selling weed;
a crime that doesn't even exist anymore.
You think his life would be anything like this
if he didn't grow up with a massive dent in his head?
Sorry, I'm not convinced.
Is that because you don't have any empathy for Billy?
No. It's because I agree with you:
it's expensive, risky and unnecessary.
But empathy can be an invaluable motivator,
Dr. Murphy, that truly connects the physician
with their patient.
Is he still up there?
Yes he is.
We can't do the castration, George.
Not without the proper psychiatric clearance.
That'll take forever.
Just a few months.
A few months is forever.
Binge watch your favorite shows,
catch up on your reading.
You attracted to men, Dr. Reznick?
Yes. Adult men.
And if that were... reprehensible,
do you think you could stop?
You have no idea what it's like
to live with these thoughts.
I hate them,
and I hate myself for having them.
But I can't stop them...
and I'm afraid of what I could do.
We will start the process immediately.
In the meantime, we'll transfuse you,
get you on antibiotics...
No. I'm refusing treatment.
No transfusion. No antibiotics. No repair.
Let 'em rot.
We have something in common.
Neither of us has a driver's license.
How do you feel about not having a driver's license?
I'm pissed, Shaun.
You feel pissed.
Yes, I feel pissed. I feel very pissed
because something important was taken away from me.
And by a friend.
You feel very pissed
because something important was taken away from you...
and by a friend.
And parroting everything I say isn't helping.
I'm finding commonality, Dr. Glassman,
and inquiring about your emotional state,
and actively listening by restating your responses.
"External corroboration enhances our sense of self-worth."
Okay.
The day after I got my driver's license,
you want to know what I did?
I went out and bought a 1963 Galaxie, Midnight Blue.
1,255 bucks;
every penny I earned for the past three years
working in a gas station.
How do you think that made me feel?
You liked it?
No, Shaun. I loved it.
You want to know why?
Because a car to a sixteen-year-old kid
means independence,
which means he can go wherever he wants
whenever he wants.
And that doesn't change with age, Shaun;
in fact, it means even more.
When you took my license, that's what you took from me.
I don't expect you to understand.
So you don't have to pretend.
Hey. Is Andrews stalking you?
- Yeah. - It's annoying.
We need to stand together and tell him to back off.
I'm not telling the president he's annoying.
He's infringing on our autonomy
and inhibiting the free flow of ideas,
both of which affect our ability
to deliver the best patient care.
That sounds slightly better.
Okay. I'm in.
- Are you? - No. Of course not.
The last thing I'm gonna do right now is confront him;
I'm the front-runner.
Not according to Vegas;
I'm three to two.
Guess they don't know that you have double my mortality rate.
I'm a trauma surgeon;
you're comparing apples to asshats.
I resent being called an apple.
The diaphragm repair went very well.
And we've scheduled your orbital fracture repair.
We'll get you some stronger pain meds for the recovery.
When are you gonna fix my forehead,
make me all John Legend?
I tried, Billy.
I'm sorry.
I wasn't really getting my hopes up anyway.
My dad taught me that.
He'd say, "You know what, Billy?"
And he'd just punch me in the face.
At least, I think that was the lesson
he was trying to impart.
That's what happened to your forehead?
He was a big A's fan.
Watched every game with a bat in his hand.
August 14th, 2008,
they lost in the 12th inning...
Infection's setting in but his testicles
still show good flow on the Doppler.
- Pain meds? - He won't take them.
Thinks they'll knock him out
and we'll step in and repair them.
I hate this.
Me too.
I'm going to be a good driver.
I got every answer correct on the written test.
Except one
but that was because it was improperly worded.
I told the DMV they need to rewrite it and...
they said they'd take it under advisement.
Great.
Let's go.
Okay... let's close our eyes...
And take some nice, deep breaths...
And how about a little guided imagery,
to evoke positive visualizations?
Okay.
Let's picture the parking lot...
the cars around us...
the yellow steel thingy at the entrance of the parking lot
that could really do a lot of damage...
A bollard.
The speed bump that is 15 feet from the corner
with the stop sign that someone put a "Hate" sticker on
so it says "Stop Hate,"
which is right in front of the Jiff-E Mart,
which says it's open "8 til Late, 24/7,"
which can't be true beca...
That's great, Shaun.
Super amount of visualization.
And now that we're feeling comfortable
about our surroundings,
we can put the car into drive,
ease our foot off the brake...
Very nice...
We can open our eyes now, Shaun.
What we're doing is cruel.
I'm open to all options, Dr. Browne.
I'm gonna have to ask you to give us some privacy.
Really?
You want to throw the president of the hospital
out of a medical discussion?
You're infringing on my autonomy
and inhibiting the free flow of ideas,
both of which affect my ability
to deliver the best patient care.
Dr. Melendez.
There are many drivers
not following the rules of the road.
They fail to signal, check their blind spots...
display a red flag when the load extends
more than four feet past the tail lamp.
You're right, Shaun, it's a mad world.
But there's nothing you can do about them;
you just got to focus on you.
Yes, let's focus on me.
Yes.
Let's take the next right.
You can drive in the bike lane
when you're this close to the turn, Shaun.
No, I can't.
It's a broken line.
That was the improperly worded question...
whether it's broken or solid,
you can't enter the bike lane
this distance from the intersection.
I told them that it...
Okay, Shaun. You don't have to go so slow.
She's in the lane;
she's not supposed to be in the lane.
It's a violation carrying a fine...
Okay, Shaun, don't worry about what she's doing...
No.
Shaun, you have to pull into the bike lane...
Don't worry about what she's doing...
You can't just stop.
Shaun, you can't just stop...
Shaun!
George is screaming in agony
and we are doing nothing.
Except hiding behind ethical red tape.
Ethical red tape is there to protect people like him
from making permanent regrettable mistakes.
I'm glad we're not using it to cover our asses
the day before the new Chief of Surgery is announced.
Let me sign off on the documentation.
I'll note his scrotum is already beyond repair
and surgical castration is our only option.
- I vote yes. - No.
I'm not gonna let anyone falsify medical records.
Not for pain. Not for a pedophile.
Once his testes are actually beyond repair,
we will castrate him.
So we're just gonna leave him there screaming;
keeping his entire unit awake?
Move him.
I'd like a clean dissection through the periosteal planes
so I can slip the MEDPOR mesh over the fracture.
Why do I prefer MEDPOR mesh?
It allows fibrovascular ingrowth
and integration of the patient's tissue.
Prisoner surgeries are approved
for psychological reasons all the time.
Tattoo removal,
gender reassignments include breast implants;
hell if he had a crappy smile
we could justify dental work as needed
for proper mastication...
You sent a few kids to Juvie?
More than a few.
You feel guilty.
Think that's maybe clouding your judgment?
Maybe.
You're afraid of ruffling Andrews' feathers
this close to decision day.
Think that's maybe clouding yours?
We could give Billy a breast implant.
We could insert it
over his split thickness frontal bone defect;
it would only require a tiny incision at his eyebrow.
Now you're in favor of this?
I was against it because it was too expensive
and unnecessary and risky
but if we do it now,
it won't require any additional surgery.
And it'd be very economical.
He did give us verbal consent when he was first admitted.
Keep him under.
Get what we need, Dr. Murphy.
Ready or not...
Tell Melendez to meet us in the O.R.
Showing signs of ischemia;
we have a strong medical case for removing.
Dr. Lim. You a castration fan?
Right now, I am.
- Andrews told me he's backing off. - Great.
Because you presented him with a very good argument.
My argument. Which you regurgitated to him
right after you said you wouldn't back me up.
Call that leadership?
Yes I do.
You presented me with a very good argument
but you didn't have the guts to take it to Andrews on your own.
One more reason I don't want to work under you.
You don't want this promotion so that you can improve the hospital,
you want it for the pretty title.
You're an adrenaline junky;
you won't last 2 weeks liaising with board members.
There's a long and dusty trail
littered with people who have underestimated me.
We're ready to go.
Curved tissue scissors, please.
His systolic is 68. And look at this.
He's septic.
He's going into D.I.C.
Rerun his labs,
have platelets, plasma and cryo ready.
If he starts bleeding, he'll die.
I reduced the volume from 80 cc's to 35.
Have the odds changed in the last 24 hours?
- Little. - Where am I at?
Six to one.
I'll put 100 on me.
He's becoming severely bradycardic.
The pressure on his orbit caused a retrobulbar hematoma.
If we don't relieve it now, he'll arrest.
Forceps and scissors.
Just lost his pulse; pushing atropine.
Set up a temporary transcutaneous pacemaker.
If we inject the orbital muscle with local anesthetic
we might be able to fatigue the reflex.
Do it.
Starting CPR.
I hope that's a look of resolve.
Melendez stood up to me in front of his residents.
I did the same thing to O'Connell when I was his age.
What about Lim?
She has the kind of focus that took me years to develop.
And Cooperberg, he reminds me of me when I was...
Marcus. You were good.
But no one's gonna be as good as you think you were.
One of your weaknesses was decision-making.
I trust you've gotten past that since I made you president.
Continuing compressions until I have capture on the pacemaker.
Pacing pads are in position.
Stopping CPR.
Injecting lidocaine.
I have set the rate to 80.
Increase the ventricular by two milliamps.
Increase by two more.
Blood pressure is responding, 102/68.
Keep those pacer settings
and let's get back to the main event.
Both his PT and PTT are coming back down,
his systolic is stable at 110, and no ectopy on the monitor.
His D.I.C. score is back under four.
He's stabilized.
Ball's in your court.
Dr. Melendez?
Effects of low testosterone on cardiovascular function
and sepsis?
Possible acute vascular response,
circulatory collapse...
And what about on D.I.C.?
Increased risk of clots and stroke.
George's body can't tolerate
any loss of testosterone right now.
We want to save his life, we have to save his testicles.
Sutures.
I know how to get you to drive.
I can't drive.
Driving is just like surgery.
Say you're driving down the street
and suddenly, somebody steps off the sidewalk,
right in front of you.
Things like that must happen
when you're deep inside someone's belly.
That doesn't make any sense.
It's an analogy, Shaun.
I need you to work with me just a little bit.
Give me.
Okay.
It would be something unexpected,
out of our control,
from an aberrant source, and very bad.
It would be analogous to an arterial bleed.
How about if a truck stalls out, crippling traffic?
A thrombus impeding blood flow, so we divert.
A thrombus, exactly.
What if you're just cruising along
and a car comes out of nowhere and goes racing by?
A tachyarrhythmia.
- Yes! Shaun, you got this. - Yes.
So let's get you driving that hooptie.
I've got this, Albert.
We did the surgery;
your circulatory and clotting systems
were shutting down.
But removing your testicles would have put you
at greater risk by reducing your...
You would have died.
I've set you up with a psychiatrist and a urologist.
They'll screen you, get you cleared,
and then we can do this the right way.
George, we can get this done.
You just cannot try this again.
I get it.
I do it your way, or it just doesn't happen.
It's just another intersection, Shaun,
just like the last one and just like the next one...
The last intersection isn't where everyone honked at me
and made me freeze...
That was a different day, with different drivers
and a different Shaun behind the wheel,
because today, this Shaun has a plan
for this intersection, which is...
...I am going to dissect it.
Damn right you are.
And today, you're gonna turn right
which you will do by...
Determining laterality.
And waiting until I can legally enter the bike lane.
Somebody just made a turn...
Shaun!
Everybody okay?
You were wrong.
You were wrong, Lea.
I can't drive.
Shaun, I thought I had it figured out.
I can't drive.
I...
Surgery is mechanical.
Mechanics are predictable.
Driving is subject to human foibles
which means there are limitless possibilities.
You're right. My metaphor sucked.
It sucked very much.
Because...
becoming a surgeon is about way more than operating.
You had to learn about interacting
with teachers, co-workers, patients, bosses.
Cooperating with them, communicating with them...
I am very bad at communicating.
Shaun, you became a surgeon;
one of the hardest things that anyone can do.
And you proved that just because something is hard,
doesn't mean you can't do it.
And look what you just did.
I just hit a trash can.
Exactly; a trash can instead of an oncoming car
or a pedestrian.
You did great, Shaun.
That soccer ball was a dropped Metzenbaum.
I know, right?
When I accidentally drop an instrument in the O.R.,
I react quickly to minimize damage.
- Yes. - Yes.
I dropped a Metzenbaum.
I can drive this hooptie.
Window's about to close.
$10 will get you $20 on Melendez;
$10 will get you $1,000 if you want to bet on me.
Hey, everybody.
I can't be prouder of all of you.
We have grown into a preeminent surgical department,
which has been recognized with the official designation
of Surgical Center of Excellence.
It's now more important than ever
that we maintain our high standards.
And so, while there are many worthy candidates,
I've decided...
to retain the title myself.
Thank you.
Thank you!
Yes!
Y...
You...
You did it. You...
You really did it.
It was his idea.
Murph? You...
We inserted a small breast implant
to fill in the depression
and create a more aesthetically pleasing contour.
Breast implant?
Yes.
You saved my life.
It was a mistake.
It caused an oculocardiac reflex
and you almost died.
It was a mistake.
George?
Why didn't his monitor alarm go off?
He was stable; I disconnected it so he could use the restroom.
- I didn't... - Morgan! He's gone!
George!
I was never gonna confront Andrews.
I was playing you.
But damn if you didn't actually make it work.
It didn't work for anybody.
He played us both. He set us against each other.
I think you were right.
Even if you were just bluffing,
we need to stand together.
Where was that wisdom two days ago?
Still in the bottle.
Hey. How'd you come up with that idea?
You mentioned breast implants and I thought...
Of his forehead.
We were operating on his eye,
his forehead was covered.
Why were you thinking of it?
You care about him;
you were worried about his problem.
You empathized with him.
My idea almost killed him.
No it didn't.
I found these in Billy's drawer.
Three days of pain meds.
He was cheeking them to build up a stash.
He wasn't exaggerating.
You saved his life, Shaun.
This isn't the way this should have ended...
But I'm not so sure the world is a worse place
than it was a couple hours ago.
You almost look comfortable behind the wheel.
This seat has excellent lumbar support.
But I am still very nervous.
I can drive a car.
I can see that.
Lea taught me using a very bad analogy.
Nothing works like a bad analogy.
He's getting pretty good;
won't be long before he gets his operator's.
Your next radiation appointment is in 45 minutes.
Ow.
Thank you.