The Good Doctor

Your primary care doctor was right.

The mass is on the smaller side.

We'll confirm with the new images,

but it should be manageable with medication.

No surgery needed.

Well, my fiance will be so relieved.

He's been worried I'll look like Frankenstein in all our photos.

Also that I might die.

When's the big day?

June.

You've been dealing with wedding planning

on top of a pituitary tumor?

You deserve a medal.

Our medical record system, on the other hand,

it has you listed as female.

Probably because of the Pap smears.

Software clearly needs a trans update. Deep breath.

I'll fix it so everything is correct going forward.

Please confirm your gender and pronouns.

Male, he/him/his. Thanks for asking.

We're the ones with the messed-up software.

Your scans from this morning were just uploaded.

In less than two weeks, the tumor's doubled in size.

34-year-old female, Zara Norton.

Tachycardic and delirious.

Dr. Guerin, update vitals.

Dr. Wolke, draw blood for CBC and electrolytes.

Pupils are dilated, but reactive.

Ms. Norton, smells like you've had some marijuana?

Mmm-mmm. I just unloaded a shipment at the dispensary.

Test for THC and a full tox screen.

I am a peddler.

Run it.

BP's elevated, 180 over 115.

That could explain the delirium.

Ooh, that sound high. Better take my meds.

See, I never miss a... Oh, no.

Oh, no, that's not it.

BP's climbing, 210 over 120.

Enalaprilat, 1.25 milligrams, IV.

Ms. Norton, do you remember the name of your medication?

You can call me Zara.

See? It say right here on the...

Okay, forget about the meds. She is not taking any.

This is untreated chronic hypertension.

What if you're wrong? What if she's on a loop diuretic for her pressure?

This could cause renal failure.

She's heading into hypertensive crisis.

What if we try an angiotensin receptor blocker?

No drug interaction.

Angiotensin receptor blockers work too slowly.

I'm giving her the ACE inhibitor.

BP's going down.

Nice call.

Latest budget report.

Yeah, the PDF's sitting in my inbox.

I'm trying to ignore it.

And thus...

A sit-down visit?

Just checking in, see how you're doing.

Okay. You?

Me? I'm... recovering from the year,

like everybody else.

Pandemic, the surge.

You were here for every minute of every day.

It must have taken a toll.

It... comes with the territory.

You're not, uh, stressed or distracted?

I'm... tired.

Okay. Well, maybe you should take some time off.

No.

But thank you. I'm fine.

You don't seem fine.

Are there issues with my work performance?

No, you do great work.

Then I'm not sure why we're having this conversation.

Because I'm worried about you.

Because other people are worried about you.

There's no shame in struggling a little bit.

You know, what would be weird is

if you didn't struggle at all.

If you need to see someone, the hospital will cover the cost.

Great. You'll pay my bills.

And the damage to my reputation, who takes care of that?

I don't think that seeing a therapist

will affect your career.

Says the white guy.

Okay.

Privacy protections are there for a reason.

No one needs to know.

Thank you for checking in.

How you feeling? Good.

Be better when I understand what landed me up in here.

You had an acute hypertensive crisis.

Oh, I know my blood pressure's high.

I'm already on medication for it.

You probably wanna know what it is.

There's no medication.

We need to do an echocardiogram

to make sure your heart wasn't damaged in the crisis.

Fine by me.

Here's 10% discount

on any purchase over $50 or more at Z & B Naturals.

I'm Z. B is my partner Bill.

You're surrounded by pot all day, every day,

but you never touch the stuff?

How? Why?

It's just never been my thing.

Ah. There.

The name always trips me up.

Chlorthalidone.

That's for hypertension.

Yeah, bottle seems pretty full.

How long have you been on this?

About six months. Just refilled it.

Take it every day.

Smile.

Head tilt.

Now he smiles.

Burst of laughter.

Yeah.

Rio Gutierrez, 29,

pituitary mass went from manageable with meds

to likely surgery.

So, talking to the new radiology resident, huh?

I wanted Dr. D'Souza's opinion on an intriguing set of scans.

She is very talented.

You're crushing on her.

N... No.

I am not. I love Lea.

Well, those two things aren't mutually exclusive.

Mr. Gutierrez's blood has high levels of prolactin.

Prolactin is produced in the pituitary gland.

The tumor could be secreting it.

Or the tumor could be reacting to the high levels of hormones

being produced elsewhere in the body.

The patient is a transgender man.

Do an ultrasound.

Advance the probe until you see the cardiac chamber.

Maybe Zara has secondary hypertension

due to renal vascular disease.

She doesn't. Her creatinine is 1.2.

Her GFR is in normal range.

Well, that would make it unlikely, but not impossible.

It'd also explain why her prescribed hypertension meds weren't working

and why she got better when you gave her that ACE inhibitor.

Mmm. Simpler explanation, she's not taking her meds.

Valve looks normal.

Should I move on to the two-chamber view?

Yeah.

We have no reason to think that she's lying.

She seems to be telling the truth about her pot usage.

No THC in her blood or urine.

She couldn't possibly be lying about something else.

The left ventricle is thickened,

which is consistent with untreated hypertension.

Heart rate's climbing.

Cardiac output is dropping.

Stroke volume as well.

She's in cardiogenic shock.

Would you mind if I did an ultrasound on your abdomen?

For a brain tumor?

This is my fiance, Eli Simpson.

When I heard about the new scans,

I kind of stormed the castle.

My hero.

Your prolactin levels are very high,

which might be caused by the tumor,

unless another condition raised your prolactin,

encouraging more growth.

What condition boosts prolactin?

Do you think I'm pregnant?

He can't be. He's on testosterone.

Except for a few weeks last month.

I forgot to take my shot before our trip.

But there's no way that...

You're pregnant.

You went into cardiogenic shock

because your heart wasn't pumping adequately.

We did a minor procedure and installed an Impella pump,

but it's a short-term solution.

I do feel a little out of breath.

But that might be just 'cause of you, Dr. Andrews.

Ms. Norton, I'm a married man and your doctor.

You have a rare condition.

Certain parts of your heart muscle

have become abnormally thick.

So, this wall in between the chambers, that's the septum.

That's a normal one.

This is what yours looks like.

Oh, wow.

It's gonna require surgery.

We're gonna run a few more tests to determine the best approach.

Wait. You gonna be my surgeon, Dr. Andrews?

I sure will.

And y'all two gonna be with him?

Yeah.

My lucky day.

Three doctors of color taking care of me.

Doctors who won't talk down to me.