The Good Doctor

Previously on "The Good Doctor"...

Coming back to California and moving in with you...

it's been harder than I anticipated.

Hershey meant everything to me, Shaun.

I took the biggest chance of my life going back there.

And then it just went away.

Deep brain stimulation

was used to treat anorexia.

You want to use brain surgery for a psychiatric disorder?

DBS isn't FDA-approved for anorexia treatment here.

It's not a real option.

My wife's decided against the valve-repair surgery,

at least until she's tried the deep brain stimulation.

You won't be a part of the surgery.

Or any of my surgeries.

You went around me, directly to the patient.

You're booting me off your service?

Oh, he's... very affectionate.

Ooh. Yeah.

Cats are smart and independent.

I don't think my first pet

should be something I'm allergic to.

Oh.

Did you know constrictors don't crush their prey?

They induce arterial circulatory collapse.

He looks like a Hubert.

The pH should be maintained within a range of 7.1 to 7.3.

And we're supposed to add 3 drops of Klor-out

to neutralize the tap water.

Don't worry, Hubert.

Daddy just shows his love in a different way.

Mnh-mnh, no.

You don't come by for a month, and then you think

a store-bought pie is gonna make it all right?

It's from the Farmer's Market.

- Uh-huh. - Mm-hmm.

Fine. Hand it over.

Bring it in.

- Hey. - Thanks for coming.

How is she?

Why didn't you tell me things were getting so bad?

- I would have come. - You're busy.

I will always make time for you, Kay.

Good, 'cause you're not leaving

until the three of us finish a bottle of Merlot.

Did you call that oncologist

doing the new ovarian cancer PARP-I trial?

The intake doctor said I don't have the right tumor markers.

Then you need to go back to your hos...

My... My team put me on hospice last week.

Do you want a dose of morphine?

No. I got it.

Just give it a minute to pass.

Her doctors keep upping the dosage,

but it's not helping anymore.

- Nothing is. - Ohh.

... Captions by VITAC ...

Hey, um...

Um, my college roommate was diagnosed

with stage 4 ovarian cancer a year ago.

She's had six cycles of Carbo-Taxol

without cyto-reductive surgery due to widespread disease.

They stopped chemo when she stopped responding.

She has a month at most.

Wow. I'm so sorry to hear that, Claire.

As am I.

And I assume you're not here just seeking sympathy.

I have reviewed her scans and she can't be cured,

but this metastatic lesion extending through her diaphragm

is causing most of her pain.

Her surgeon has ruled out removing it

due to vascular complexity.

But I think laparoscopic debulking is possible.

Difficult, but possible.

I know you're upset with me,

but sh-she's my friend and she's in pain.

I need your help.

I'll take a look at her today.

Thank you.

We need a surgeon over here!

He fell down the stairs at a construction site

while holding a nail gun.

Portable head X-ray, stat. Any other injuries?

Nah. Just yank it off and slap a Band-Aid.

- Any weakness? - No.

All right. On my count.

One, two, three.

Let's get you that Band-Aid.

We could have done that for free at home

with a pair of vise grips.

You don't pay for our equipment.

You pay for me to tell you that he got lucky.

It's superficial.

His pressure's dropping.

- You feeling faint? - A little banged up.

All right, something else is going on.

Let's log-roll him.

What's wrong with my brother?

I see a puncture wound in his flank.

There's a nail in his abdomen, too.

Let's get him up to the O.R.

How bad is the pain?

Maybe a six.

She's lying.

She, uh, hides it well,

but she's in terrible pain all the time.

But Claire said you're not out of options

until Dr. Melendez says you are.

So, am I?

I think we can make things a little easier for you.

How soon?

Dr. Park and I will do it today.

What about Claire?

I came here because of her.

Dr. Park is excellent.

You're in very capable hands.

When my doctors gave up on me, Claire found a way.

I trust her. I won't do this surgery without her.

Dr. Park and Dr. Browne will prep you for surgery.

Now try that again.

Show me.

Straight. Straight.

Straight. Yeah.

Oh, almost.

And pull back up.

That's good.

Thank you.

The nail completely ruptured the kidney.

Renal hilum's blown, too.

4-0 on a driver.

This isn't working. Clamp the renal vessels.

He's gonna have to live without it.

Expose the other kidney,

make sure it's got that new-car smell.

The adrenal gland is low-lying.

You won't find the left kidney there.

You expect her to find it on the right?

No. The most likely reason

for the gland to be lower is unilateral renal agenesis.

He was born with one kidney.

Is that the vena cava?

There's so much tumor in there,

it's hard to tell what anything is.

I need to free this segment without nicking that vein or...

Park, pull on that fragment very carefully.

Got it.

All right. Claire, I need you to tilt...

Exactly.

The tumor's invaded the vessel wall.

I think you got it.

Why isn't there tumor tissue penetrating her diaphragm?

Hmm.

The CT scan showed...

The segment we removed was displacing the diaphragm upward,

giving the appearance of chest infiltration.

If the cancer's just in her abdomen,

she could be a candidate for HIPEC treatment.

Treatment?

Not pain relief?

We may be able to give her a little more time.

It's called HIPEC surgery.

I'd remove as much tumor as possible,

and then we'd infuse your abdomen

with a chemotherapy solution for 90 minutes.

It could give you another six months.

It comes with a big risk.

This is a major operation, and your body's frail.

You could die on the table.

Uh... I-I want more time.

But her pain is finally manageable.

I-I'm afraid to press our luck anymore.

The thought of gambling away your last few weeks

terrifies me, too, but this wasn't luck.

Dr. Melendez has proved that despite all of the challenges

of your cancer, he can safely navigate inside your abdomen.

I think it's worth putting your trust in him again.

Okay.

We'll start with a complete PET-CT scan

so we can plan our approach.

He has extensive vein thrombosis.

There's a clear segment we can use

for an AV dialysis graft.

It's short, but we can attach it to the brachial artery...

Ohh.

Hello, Lea.

I'm sorry, but I can't talk right...

There's a problem with Hubert.

Oh, okay.

Yeah. The pH is exactly 7.2,

temp's 73, everything is perfect.

Perfect.

He looks bored.

Bored?

He can't be bored.

He's a fish.

He's just floating there with nothing to do.

I thought you were working today.

I was... from home.

Now I'm procrastinating with Hubert.

You should work.