- The most viral part of The Good Doctor.
- I am a surgeon!
- Feels weird saying viral,
'cause it has nothing to do with the virus,
but let's watch these episodes.
Let's get started.
Pee-woop!
- Hello Dr. Han.
You take the bus too?
- No, Shaun.
I just wanted to talk to you.
- That's one thick scarf!
It looks borderline uncomfortable.
- I spoke to the Residency Director of Pathology,
and we both agree you'll be a great fit there.
- Are they trying to get him away
from going into the surgical field,
and instead go into pathology?
I mean, there's value in that,
because there's less patient interaction,
but I feel like his skills in reading human behavior ...
Okay, maybe he is better as a pathologist (laughs).
- I am a surgical resident.
- As a pathology resident,
you'll touch cases and lives
across all the medical departments.
It's an opportunity for you to help patients
without having to deal with patients.
- He could also have a really good place
in interventional radiology, known as IR,
where there are procedures performed,
so you still have some patient interaction.
It's slightly surgical.
Something to consider, Shaun.
- I am a surgical resident.
- You were.
And you're gonna do great work in pathology.
- People switch residencies all the time,
and actually from surgery is a very common swap
to other fields.
Because surgery's unique, it's demanding,
and it doesn't mean that those people
aren't good doctors or they failed.
It's about finding the specialty that's right for you.
Lifestyle wise, skill wise, passion wise,
and initially when you start,
many people have the wrong impression
of what the field will ultimately be like.
- Through the generous support
of St. Bonaventure Foundation,
we've been able to transport Kenny and his mother
from their home in Mississippi.
We appreciate you allowing us to share your case
as an educational opportunity for our staff.
- The neurofibroma started as a small bump,
near the base of the spine.
- So a neurofibroma is usually a non-cancerous tumor,
meaning that it's not malignant, it's benign.
And the only time we really intervene with them
is if they start causing symptoms
due to their size or position.
Wow! Okay.
That's a very big size!
I'm curious to know if that's ever even been recorded.
I mean, that's like the size of a human,
and it's almost the shape of a liver,
which is kind of interesting.
- It encircled his abdomen,
and grew to over 100 pounds.
- But why did it grow to this size?
Why didn't anyone act on it?
- [Dr. Melendez] Blood supply becoming
so intertwined with the patient's,
it was deemed inoperable.
But we've been able to come up with
an innovative surgical plan
that will allow us to slowly peel the tumor
off the front and back of his torso, in one piece,
and give Kenny his life back.
- Now there are conditions called
neurofibromatosis type one,
where people can actually,
through a genetic mutation
with some of their protein genes,
actually have a bunch of different
neurofibromas throughout their body,
but I don't know that they have
one that can become that big.
I think it's more of a quantity versus a size.
- I am gonna need 60 units of type B positive
packed red blood cells held for OR.
- 60, hm?
You operating on a hemophiliac elephant?
- Our patient has a 200 pound neurofibroma.
- [Dr. Lever] Cool!
- [Dr. Browne] There's more blood in the tumor
than the patient,
so we're gonna have to follow
massive transfusion protocol.
- Those are the different types of neurofibromas,
by the way, that were popping up.
There's like spinal, there's muscular, there's dermal.
Dermal seems to be the more common type.
That's obviously not dermal.
- I could do some research on cell salvage techniques.
Cancer is a risk, but if-
- I'm sorry, Shaun.
Melendez has put together a pretty big team.
So, we have everything we need.
- I feel bad for Shaun,
but to some degree, she's right.
Because when you have too many cooks in the kitchen,
things get complicated.
Mistakes get made.
Too many people mixing around,
no one knows who's in charge.
Very very messy situation can arise.
- Shaun is being punished for mistakes
that Han thinks he might make in the future.
- He's not punishing him.
He just saved his ass.
- Okay, Kenny!
The MRA's gonna help us map the blood supply to the tumor.
- MRA is basically a form of MRI
that's looking at blood flow.
Through the dye put into the arterial system,
the blood vessels,
you'll be able to see where that blood goes,
and where it's distributed,
and where you can make safe incisions in.
- We should take a stand.
- Meaning what?
Stage a walkout.
- How much do one of these bad boys cost anyway?
- About 3 million.
But it's worthless unless you stop talking.
- Yeah, when you talk or move during an MRI,
you develop something known as
motion artifact on the scan,
where because there's a little bit of a delay
in between each image, you could actually see blurring,
and it becomes very difficult to make out
what you're looking at, and mistakes could be made.
- That's not good.
- It works for Jeff Bezos and Bill Belichick.
- I'm not talking about your leadership lecture,
I'm talking about this.
- It's such an extravagant image.
I've never seen anything like that.
- We expected the tumor to grow since the last scans,
but not to this extent.
Blood vessels that I thought we'd be able to
quickly cauterize, are now thicker than my thumb.
- Thick blood vessels are problematic
because as soon as you make an incision
to cut out the tumor, you get massive bleeding.
And because this tumor created a lot of neovascularization,
where it literally released these factors
called endothelial growth factors,
it created its own blood supply.
Fat, tumors, they all behave in this very unique way,
where they actually start sucking life from you.
That is why many of our patients
who are advanced in their cancer staging,
actually look cachectic,
where they look so skinny and worn down.
Really, the cancer starts taking away the calories.
It starts using the calories for its own growth.
It redirects blood towards the tumors.
- It's impossible to remove the tumor
without causing you to bleed to death.
- No!
I don't care how risky it is.
- But then if it continues to grow, he's also gonna die.
You have to make a decision here.
- Kenny, as long as your heart remains healthy,
you basically will be too.
- Whoa! How can you make that prediction?
If this thing starts growing
and is growing at the speed where he's like,
in just a few days,
the blood vessels became thicker than my thumb.
What's gonna happen in a matter of years?
In five years, this thing could be three times the size
of any other human,
at which point he will start suffering those ill effects.
- I don't wanna be treated!
I wanna be cured!
I want my life back!
I always thought all I had to do was get enough money
or find the right doctors.
But if you're telling me there's no hope-
- I've never seen in a hospital,
where a patient has to cry,
and advocates so hard for their case
that it will then change the doctor's mind.
Like, it feels like the medical necessity
should change the doctor's mind,
not whether or not the patient becomes emotional.
- She's always trying to one up us!
Morgan!
She's not staying late because she wants to do research.
She's staying late so that Han can see she's staying late.
- That's just who she is. Don't take it personal.
My dad's a TaeKwonDo grandmaster,
coached me growing up.
He always used to say, "Only you can beat you."
- I did TaeKwonDo for eight years.
Certainly other people could have beat me, besides me.
But you know, I tried.
- You'd think if you're selling boba,
you'd have straws wide enough
to get the balls through the damn thing.
- I can't believe you drink that stuff.
It's like putting gummy bears in a drink.
- Is she gonna try and clot the blood vessels?
- I got an idea!
If we embolize the larger blood vessels to the tumor
before surgery, we can-
- I just don't understand
why they didn't think about this before.
Why is she having to boba brainstorm here?
I'm not a surgeon, and yet I figured this out.
- This should reduce hemorrhaging during surgery,
and allow us to excise the tumor without you bleeding out.
- I also don't understand why they can't embolize the tumor.
If they're embolizing and destroying the blood vessels
to the tumor, that can actually cause the tumor to necrose,
at which point it would start getting smaller, and fade,
and then you could operate on it.
I don't understand why you have to do it in this order.
- [Dr. Melendez] Just need to get a few more branches
off the aorta and we're done.
- [Dr. Han] Well done, Dr. Browne.
- This feels like it's the easiest decision to have made!
Why did Dr. Browne,
like, every other doctor should be ashamed of themselves.
- [Dr. Melendez] What's his estimated blood loss?
- [Dr. Reznick] About eight and a half liters.
- That's a lot.
There's only like four to five in a human.
- The entire human body typically only has
five and a half liters of blood.
- Thanks Shaun!
For fact-checking me in real time!
- [Dr. Han] Let's get 30 more units on deck for PRBC.
- He's like, "You said, four to five.
It's actually five to six. Ass-"
(bleep)
- [Dr. Melendez] Add cryo fresh frozen plasma
and platelets to that.
- So the unique thing is you see those pads.
We frequently use those for dabbing
and getting control of bleeders,
but we count those very meticulously
when we bring them out,
and then when we put them back.
There have been many instances
of them being left inside patients.
- [Dr. Browne] He's crashing!
- [Nurse] He's ventilating fine!
- [Dr. Han] We've got no immediate
blood loss or hemorrhaging.
- [Dr. Reznick] It looks like distributive shock.
- [Dr. Melendez] I need stat labs
and initiate shock resuscitation.
- For some reason, he's having fluid go into
different spaces throughout his body,
causing a low blood pressure.
But if you give more fluids,
essentially you create more demand on his heart,
more fluid entering his lungs,
and creating a bigger problem.
- [Dr. Reznick] He's got a high white count,
and what looks to be a systemic pro-inflammatory
cytokine release.
- [Dr. Melendez] Cutting off the blood supply to the tumor
is causing post-embolization syndrome.
- [Dr. Han] I need intra-arterial lidocaine,
130 milligrams of methylprednisolone,
and start antibiotics.
- [Dr. Park] Should we be trying
to reverse the embolization?
Restore blood flow to the tumor?
- So this is kind of similar to what happens
when a patient loses circulation
to let's say an injured limb.
If after a while, the body part starts dying,
and then you re-perfuse the dying portion,
the body comes in, you get massive inflammatory response,
you get massive electrolyte imbalances,
and it can actually kill the person
when you remove the thing that's crushing them.
So, re-perfusing a dead or damaged organ
can actually be quite problematic.
And this is essentially what's happening
with this tumor right now.
- [Dr. Melendez] Page Dr. Murphy.
- [Dr. Han] No, do not page Dr. Murphy.
I get it, you like him,
but we don't have time for an audition.
- [Dr. Melendez] I'm trying to save my patient's life.
My patient. Which means it's my call.
- [Dr. Han] I am also trying to save your patient's life,
so I'm urging you to stop wasting time.
Now we've cut away almost half.
That's all we can do right now.
So let's remove it, and give him a chance to live
and fight another day.
- Why can't you do both?
You can walk and chew gum at the same time,
can't you, surgeons?
Call Shaun, and then continue on with the procedure!
- If you clamp the aorta,
it could lower the blood flow to the tumor
enough to slow the release of the cytokines.
- [Dr. Han] Clamping the aorta will kill the intestines,
kidneys, and legs.
- Maybe you could do a bypass.
- [Dr. Browne] Not if we release the clamp every 10 minutes.
Give it just enough blood to stop the cytokines,
but not so much that he bleeds to death.
- Oh, I don't know.
This sounds awful. (laughs)
(bleep)
Remember, when you're clamping off the aorta,
you're also clamping off all the blood flow
to the lower portion of the body,
which includes vital organs.
- [Dr. Han] Thank you for the consult, Dr. Murphy.
- I don't know if that's good advice!
- [Dr. Melendez] Care to do the honors?
- [Dr. Han] Let's take it up!
- They made this procedure,
I mean, it's complicated.
Granted, all the intricacies of the size of the tumor,
the blood flow,
but they made it sound way more complicated
than it actually was.
It's a tumor.
You clamp off the arteries,
you cut them, you move on with your life.
Like, I don't understand what the issue is here.
- You're still gonna need some skin and soft tissue grafts,
but the hard part's done.
- Your prognosis is excellent.
- Thank y'all so much.
What, am I taking this thing home in a glass bottle?
Y'all got something that big?
(woman laughs)
- He's just being a smart ass.
- I'm surprised he's that lucid after his surgery.
Usually patients are really groggy,
especially after that huge amount of blood loss.
- I am not leaving your office until you reinstate me.
- What are you doing, Shaun?
Do you think ordering me to do something
will change my mind?
- I am a surgeon.
- And the viral meme was born!
- I am a surgeon!
I am a surgeon!
I am! I am a surgeon!
I am a surgeon, Dr. Han!
I am a surgeon!
(auto tuned version)
I am a surgeon.
(indistinct sounds)
I am a surgeon!
(metallic clang)
I am a surgeon!
Dr. Han! I am a surgeon!
(Bring Me The Horizon "Can You Feel My Heart" plays)
(bleep)
- Now, part of reading social cues,
which is something those who are diagnosed with autism
struggle with at times,
is inability to read contextual cues,
which oftentimes actually help us
learn to manage our emotions better.
That's why a lot of times,
children who are diagnosed late,
or not diagnosed with the correct condition,
can actually develop behavioral issues,
because they don't have the checks and balances
that their classmates or peers might have,
because they are able to read contextual cues.
They are able to use social guidance
to keep ourselves in check.
That's not to say what others think about us
is always right,
but we as humans have evolved to think alongside the group,
to use group ideology,
to use others' actions to guide our own.
And when you're not able to read social cues,
that makes the process a lot more difficult,
especially when dealing with difficult moments
like traumatic ones,
maybe even as traumatic as this.
- Dr. Murphy may not communicate like you do.
He may not communicate like I do.
But make no mistake, he does communicate.
And he inspires.
- But I didn't fire Dr. Murphy because he doesn't inspire.
I fired him because he was irrational,
unprofessional, couldn't calm down.
He couldn't control himself.
- I mean, it's kind of fair feedback.
Like, I can't even hate on the guy.
- Just as you have the power to fire someone
under your supervision, so do I.
- You're gonna fire me to save Dr. Murphy?
- That's mad drastic!
Just be like, "Yo, we wanna keep the guy.
Can you bring him back?
Can we mediate the situation?"
You don't have to fire him!
So did he get fired?
- [Sam] Yeah.
Shaun gets rehired.
(Dr. Mike laughs)
- I feel like Shaun has trouble falling asleep,
but here are evidence-based ways
of how to fall asleep faster.
Click here to check that out.
And as always, stay happy and healthy.
(chill beats music)