The Good Doctor

What?

It's time to wake up.

Mnh-mnh. It's still dark outside.

I'd like to have sex.

As romantically as that was put,

it's too early, Shaun.

It's exactly early enough to have sex

for the average duration it takes us

and still allow precisely enough time

to get ready for work.

How long have you been up figuring that out?

Since 4:53.

But it only took two minutes.

You've been waiting since then to propose this?

I let you sleep as long as possible.

That's... very considerate.

Ohh.

Sorry, I'm late.

I'm Dr. Shaun Murphy.

Kayley has a sore throat.

More like this constant feeling

like there's something stuck in my throat.

And I've fainted a couple times,

which I first thought was just random.

And I'm obviously losing my voice.

Since I've only just met you,

I have no idea what your voice normally sounds like.

Well, not this.

Sometimes when swallowing, I get a super intense pain,

like, worse than an ice cream headache.

My internist sent me to an ear, nose, and throat guy,

an orthopedic surgeon, um, three gastroenterologists,

a voice issues specialist dude.

An otolaryngologist.

A-a neurosurgeon who thinks it might be a messed up nerve

connecting the throat to the brain.

The ninth cranial nerve, glossopharyngeal neuralgia.

He recommended, like, brain surgery.

Microvascular decompression.

Which a second neurosurgeon said I don't need.

You're not happy with the answers you're getting

from a whole bunch of recommended specialists,

so you came to the ER?

I ran out of recommended specialists.

Hmm.

It is an intriguing combination of symptoms.

We'll admit you and run some tests.

Uh, Dr. Murphy?

You're...

Interesting.

I have autism.

That's so cool.

Uh, I mean, no...

Sor... Not... Not cool that you are.

Be more insensitive, Kayley. Um...

It's cool that you're this...

Totally chill, super knowledgeable medico.

Compliments... are very awkward.

Cute doctor who's gonna cure me.

Severe abdominal discomfort.

Fever, tachy, hypotensive.

It's okay, sweetie.

What's your name?

That's Marla.

No one to leave her with.

We're gonna take care of your mommy.

Abdomen tender and distended.

Dehydrated.

Delayed capillary refill.

Rapid respiratory rate.

Skin cool and bluish, looks cyanotic.

She's going into shock.

We need aggressive fluid resuscitation.

Start broad spectrum antibiotics,

place an NG to decompress distended abdomen.

Trend her lactates, initiate complete sepsis bundle.

Her CBC, BMP autoimmune panel,

nasal swab, and blood cultures.

All normal.

Ohh. That's exciting.

Negative tests are exciting?

No one's been able to find out what she has.

I'm going to get brain FIESTA and time-of-flight MRI

to assess the cranial nerves and vessels,

and Doppler ultrasound to...

I have to get back to work.

Our pre-dawn romantic interlude made me late.

Yes. There was a flaw in my methodology.

My calculation was based on

the mean duration of our sex overall, but generally,

we take statistically significantly longer

in the morning than at other times of day.

Well, maybe we can discuss

this whole timing-our-sex thing at lunchtime.

Mm. No, thank you.

I can't have lunch today.

Too much to do.

Sorry I'm late.

I was going to cancel our lunch.

Let me guess.

A patient more interesting than me.

Exactly.

Yeah.

She has a mysterious condition.

But I realized I could use our lunch to help understand it.

I ordered you a salad. Thank you.

How do I get an ice cream headache?

I've never had one.

You don't want one. Brain freeze is horrible.

The scientific term

is sphenopalatine ganglioneuralgia.

The trigeminal nerve reacts to

rapid temperature change in the mouth,

sending a signal to the brain,

which responds with changes in blood flow and dura irritation,

which combats what it perceives as a dangerous, noxious stimuli,

but is just ice cream.

I need to experience that.

Okay.

The technique I usually use is,

eat way too much, way too fast.

I'm quitting my job.

The job you came back from Hershey for?

Don't tell Glassy. He already thinks I'm a flake.

You kicking me out is just what I needed.

Mm-hmm.

I was in a complete rut.

In my personal life, at work, super stale.

I mean, we weren't developing anything,

just market testing designs...

Ow.

Ow! Ow, ow!

That's awful!

What's the cure? Time.

How much time? Depends.

Do you think I should include my job in Hershey on my resume?

It hurts so much!

Or does it make me look like

I'm unable to commit to anything?

Ow!

Okay.

The ultrasound showed your colon is distended.

We placed a rectal tube and an NG

to try to get that decompressed.

Mommy, can we go home?

Not yet, sweetie.

It would be helpful to try to find out

what could've triggered this.

Any history of Crohn's or ulcerative colitis?

No.

I, um...

I have had some UTIs lately.

That's likely not connected.

- Okay. - Diverticulitis?

Any recent international travel?

I have a three-year-old and no husband.

Okay.

We're gonna need to keep you on IV antibiotics

and monitor the distention.

In the meantime, is there anyone who can look after Marla?

No one.

My whole family's back east. It's... It's just us.

I'll get a social worker to look after her.

Thank you.

Go ahead, honey.

Why is my mom upset?

If her anterior inferior cerebellar artery

is encroaching on her glossopharyngeal nerve,

it's very minor.

Certainly not enough to justify

microvascular decompression surgery.

I agree.

It could also be acid reflux temporal arteritis,

laryngopharyngeal dysesthesia. We need to...

We need to do $50,000 of tests,

and it might be acid reflux?

Or temporal arteritis or...

It's a constellation

of relatively insignificant symptoms.

Have you ever had an ice cream headache, Dr. Andrews?

Yes.

I believe it didn't require brain surgery, Dr. Murphy.

As a compromise, we could do an MRI

and CT her neck and a swallow...

Shaun.

You don't compromise with your boss.

Start her on dilantin for her pain and send her home.

Can I just leave her with you?

I'm a receptionist, not a social worker.

And I'm a surgeon.

I didn't mean I'm more important.

I just meant we both have more important things to do.

When will the social worker be here?

She said half an hour.

Can you page her again?

I want my mama.

Why don't you just go play with the toys, okay?

Do you have her number? I'll call her myself.

I made Mommy sick.

No, sweetie. It's not your fault.