The Good Doctor

We should not live together.

That makes no sense.

I rented that apartment,

and neither of us can afford it on our own.

It has a fireplace.

We shouldn't live together.

It has a fireplace.

Do you ever think about us

being together...

as a couple?

Sometimes.

I don't want that.

You don't want us to be a couple?

Or you don't want me thinking about us as a couple?

Neither.

If we get an apartment together,

I feel like that's a signal

that you and I might end up as boyfriend and girlfriend,

and that's not going to happen.

You can't predict the future.

Feelings change.

I used to hate hugs, but now...

sometimes I don't.

But I don't want my feelings to change.

I like being your friend,

and romantic relationships a-are unpredictable.

So much can go wrong, especially when I am involved.

And if we live together, it's gonna be awkward.

You're bound to walk in on me when I'm naked

or hear the weird sex sounds I make

with some out-of-work drummer

or find me crying when that drummer dumps me,

even though I was totally gonna dump him.

I was so unhappy

when we weren't getting along.

You were, too, right?

Yes.

Anything that puts our friendship at risk

isn't worth it to me.

Okay, Shaun?

Yes.

Our gallbladder removal's off.

Patient took an Ambien last night,

woke up eating a roast chicken.

Let's check the consult list

for something a little more interesting.

- See? Gallbladders are boring. - You're a resident.

You don't get to call any surgery boring.

See?

This is interesting.

Fizzy urine.

42-year-old female, syncopal episode

with persistent loss of consciousness.

On the ride, she went into PVT, rate of 180.

We shocked her back to normal sinus rhythm.

I'm starting to feel...

She's going back into PVT.

We need to shock her. Get her into a bay.

No. No.

- (CRACK) - (WOMAN EXHALES SHARPLY)

That was cool, but you may have just cracked her sternum.

- Get her into bay 2. - What happened?

- You're her husband? - Yes.

Your wife is pretty frail.

Any idea what could have caused that?

She did.

She's anorexic.

Improved By: FidelPerez Sub Upload Date: October 30, 2018

- (DOOR OPENS) - I'm Dr. Murphy. This is Dr. Park.

We're here about your urine.

How long has it been fizzy?

I hadn't even noticed. Is that a problem?

Ah, it can be a symptom of several conditions,

many of them minor.

You're here for ortho, a scope on your right knee?

It's been sore. I've been training for a race.

Joint pain plus fizzy urine.

You could have emphysematous cystitis,

bladder cancer, kidney problems,

Those sound serious. Should I call my husband?

Emphysematous cystitis is a treatable bladder infection.

Your symptoms could also be from a kidney stone

or dehydration.

Could my issues be caused by...

gastric bypass surgery?

It depends. When was it?

15 years ago.

I used to be 377 pounds.

That's a lot.

Your surgery wouldn't cause those symptoms,

but we need to do a cystoscopy to find out what did.

I'll cancel the ortho and get Lim to sign off.

Hey, wait. What,

So, what is a cystoscopy?

It's like a knee scope,

except the camera goes up your penis.

You administered amiodarone?

Rhythm's normal.

That's good, right?

It's better than when you came in.

Your heart is failing

as a result of a condition called mitral regurgitation.

One of your valves isn't closing all the way.

Blood keeps leaking back into your atrium.

That's why you fainted

and why we need to repair that valve ASAP.

How long have you been anorexic?

I've had issues with food

on and off since I was 14.

Mitral valve issues are a frequent complication

of long-term malnutrition.

This bout started about a year ago...

skipping meals, lying about eating,

exercising excessively.

I don't know what else I can do.

I-I can't monitor her 24 hours a day.

I'm not asking you to.

No, but you are starving yourself.

Mom.

Graham-y, come here.

What's he doing here?

When I got home, I heard about the ambulance.

I made Cindy bring me here.

- (SIGHS) - What's wrong with my mom?

She needs a surgery to repair a valve in her heart.

This heart thing, is, is that why she's so skinny?

Look, what matters, Graham,

is that these doctors are gonna help your mom.

Okay?

You haven't moved your bowels.

Well, thank you, Shaun, for that announcement.

Saves me the trouble of tweeting.

The nurses already knew. They told me.

They also said

you're no longer talking to your dead daughter.

Constipated, but no longer psychotic. A narrow win.

Your first defecation event

is a vital part of the discharge criteria.

Event? What is this, the post-op decathlon,

- pooping, peeing, walking, talking? - Yes.

You have to walk a full lap of the floor.

But you canceled physical therapy this morning.

Those nurses have big mouths.

I canceled because my leg is a little sore.

That could be phlebitis

or a DVT or a,

Could also be an unsurprising complication

from a surgeon poking around in my pons.

Every day in the hospital

increases your risk of infection by 1.37%.

You need to move your bowels, and we should walk right now.

I'll go very slow.

Shaun, is there any chance

that you are needed elsewhere right now?

I-I have 8 minutes

until my patient's cystoscopy.

Good. Be early.

Urethra looks clean.

No lesions, no stones so far.

How do we check for obstructions or stones further up?

Contrast cystogram.

Since you found this patient,

how about you do the honors?

You know this guy used to weigh 370 pounds?

Thread the catheter further into the bladder.

That's a big drop. Good for him.

He did have gastric bypass.

That makes it less impressive?

- Now infuse the contrast. - Well, yeah,

it is the easy way, compared to just diet and exercise.

The contrast dye is dissipating.

It's supposed to.

You said he's training for a race.

Obviously, he turned his life around.

Still dissipating.

Bypass made it physically impossible

for him to eat as much as he wanted.

It's gone. The contrast is gone.

- That makes no sense. - Where did it go?

He probably has a fistula,

a tunnel connecting his bladder to his intestine.

Air and bacteria moving the other direction

caused bubbles in his urine.

Her liver and thyroid are normal,

but her electrolytes are off.

Her albumin is at 2.1.

She's severely malnourished.

She'll be totally vulnerable to post-op infections.

She needs this surgery to survive,

but she may be too sick to survive the surgery.

In order to operate safely,

we need to boost your caloric intake,

optimize protein.

Can't you do that through my IV?

It's more efficient to pump a nutritional supplement

directly into your stomach.

We use a tube running down from your nose.

I had an NG tube once.

It didn't work.

She couldn't tolerate it.