The Good Doctor

Previously on "The Good Doctor"...

Glassman found movement in my psoas and glutes.

He and Murphy found an endoscopic solution.

- How about I make you dinner? - Sounds good.

It's a date then.

A date.

Audrey... Will you marry me?

Shaun. I'm pregnant.

My OB told us it isn't safe for me... or the baby.

Danny!

No, no, no. Danny.

Danny.

- Good morning. - Morning.

I'll get the coffee.

This is my third stay in a week.

I no longer require guest-level service.

I want the practice.

Two cups, no cane,

no guarantee how long it'll take.

Well, when it comes to you, my patience is boundless.

One of the many things I adore about you.

It's been three months.

The man's a saint.

I have been recovering from a major surgery

and re-learning to walk.

Your recovery's remarkable.

So is your procrastination.

I am taking the time to consider

the biggest decision of my life.

Clay's fine.

No man... no person...

is fine waiting this long for an answer to that question.

Ever done one of whatever this is before?

No. You?

Mm-mm.

I've been clean for 92 days.

I went to rehab for two months,

and I go to meetings every single day.

I don't know if you two can ever trust me again,

but I am willing to do whatever it takes

to earn back my place here.

And we'll do everything we can to support you in your recovery.

But our number-one obligation is to our patients.

For their safety and yours,

we need to put some guardrails in place.

You'll be on probation for six months.

You cannot prescribe or administer

any controlled substances.

You will be given random drug tests,

and every step of your patient care

will be supervised by the Senior Resident on your case.

Today that is Dr. Allen.

You okay with those terms, Dr. Perez?

Absolutely.

I'm just happy to be here.

How are you?

Better.

A lot better.

I hadn't heard from you.

Which is totally understandable.

I just wasn't sure...

I didn't know what to say.

You're not the reason that... that happened.

As your supervisor on the case,

I will oversee your charting, your patient interactions,

double-check your med orders.

And this.

Fetal movement is good.

Heart rate is normal at 150.

I've been monitoring the heart rate daily.

It ranges from 146 to 163 BPM.

Her last emesis was three weeks ago.

So the nausea's getting better.

- Great. - And the fatigue.

Less improvement on the constant state of terror.

You made it through the first trimester.

- You're doing great. - Mm.

You two want to know the sex of the baby?

- Yes. - No. Don't look.

It'll be a fun surprise.

Oh.

It is fun to be prepared.

Oh.

What's going on?

There is a small, thinning area

on your uterine wall.

It is slightly hypoechoic,

likely a result of the scar tissue from your prior surgery

and Asherman's syndrome.

Is that bad? It sounds bad.

Mm.

If it progresses, your uterus could rupture

and we would lose the baby.

But it's very possible the lining will remain stable

and your pregnancy will progress normally.

What happens now?

We'll put you on bed rest and monitor you closely.

You're wrong.

There may be a surgery that can fix this.

I need to talk to Dr. Lim and Dr. Glassman.

Hello. I have admitted Lea for close monitoring

and a follow-up MRI,

which detected a small amount of free fluid in the abdomen.

This, plus a slight decline in the hematocrit,

increases the likelihood of rupture by 3% to 5%.

Shaun, I'm so sorry.

How are you and Lea holding up?

Oh. Fine.

I found a surgery to fix it.

I have spent the last three months

researching every complication of Asherman's syndrome.

I discovered an experimental procedure

to reinforce the uterine lining with collagen fleece

that will expand as the uterus grows.

I have studied the technique,

and I will teach you how to do it.

How many times has this procedure been done?

Five. Three had good outcomes

and the babies were carried to full term,

and the odds are better for Lea

because you are above-average surgeons.

Shaun, I don't need to remind you,

but this procedure can induce labor

and can cause major bleeding.

You could lose the baby.

If we wait and the uterus ruptures,

we will definitely lose the baby

and Lea could suffer a catastrophic hemorrhage.

Due to the size of the uterine window,

there's a good chance it won't.

No, with Lea's prior surgery and the significant scar tissue,

I put the likelihood of rupture at close to 65%.

Those chances...

not good.

Lea's body, her call.

Drew Dewitt.

Has recurrent desmoid tumors caused by Gardner's syndrome.

The one on his liver is benign,

but it hasn't responded to chemo.

It's encroaching on the stomach and spleen. It has to come out.

Thus, the surgical consult.

He has almost no small intestine.

He needed a major resection a year ago.

He's been living off IV nutrition ever since.

I've treated him for post-op infections

and pain management over the last year.

I've never seen this much scar tissue in a patient.

How many surgeries has he had?

20. Plus 16 rounds chemo and 34 hospital stays.

Unfortunately, we have to add one more surgery to that list.

Will this surgery affect his place on the transplant list?

We've been waiting over a year for a small bowel.

Apparently, I'm "too healthy" to move to the top.

It shouldn't, barring long-term infection or other organ damage.

When you're ready, we can take you to pre-op.

- You got this, D. - You know it.

I have no idea.

Would you like us to go over

the risks and benefits again?

No, I know everything that could go wrong.

All I can see is what can go wrong.

You don't have to decide right now.

We can continue to monitor.

If we wait, the uterine window could expand

and make the surgery more risky.

Now is the safest time.

Don't pressure her, Shaun.

Okay. Okay, I know I trust you.

So if you think surgery is the right decision, then we should do it.

On one condition.

I want you in the OR.

Not for me, but if something were to go wrong

and we lose our baby,

I need you to be with her.

Or him.

With my guidance, I think there is a very good chance

our baby will be fine.

Mm.

Forceps and Metz.

How's it feel to be in the OR again?

Very good, sir.

We're all very glad to have you back.

We've exposed the surface of the liver.

Tumor's invaded the liver capsule and parenchyma.

That's twice the size it appeared on imaging.

If we take out all of the tumor,

he'll only have half a liver left.

We don't have a choice.

Ultrasonic dissector for resection.

Make sure to approximate the edges

so it overlaps with the uterine window.

I internalized that the first three times you told me, Shaun.

I'm sorry you and Lea are going through this.

Mm. Dr. Lim was able

to place the fleece patch seven seconds faster.

But your laparoscopic suturing technique is superior.

You will be in charge of that.

Practice it now. Please.

Shaun, I've done it a million times.

You have never done them on my wife.