1
00:00:10,241 --> 00:00:12,341
Morning, Doc!
2
00:00:12,366 --> 00:00:14,549
Good morning, Kenny.
3
00:00:17,671 --> 00:00:19,237
Hey, hey, hey.
4
00:00:22,493 --> 00:00:25,226
Brosef, your cable's out.
5
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I don't have cable.
6
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I have a digital antenna.
7
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- Why?
- Digital antennae
8
00:00:31,769 --> 00:00:35,938
receive superior picture
and sound quality,
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00:00:35,940 --> 00:00:37,473
and the channels are free.
10
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Yeah, but you get, like,
10 channels that way.
11
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I only watch three.
12
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You mind if I run a line to your tube?
13
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Cable guy can't fit me in
till next week.
14
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Mm.
15
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Come on, 10 channels
are better than none.
16
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Yes, they are.
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All right.
18
00:00:52,790 --> 00:00:54,457
Gracias, amigo.
19
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No hay na que agradecer.
20
00:00:55,960 --> 00:00:57,299
What?
21
00:01:00,698 --> 00:01:02,331
Dr. Reznick was orphaned
22
00:01:02,333 --> 00:01:03,866
once Dr. Coyle was transferred,
23
00:01:03,868 --> 00:01:05,501
so she'll be joining our team.
24
00:01:05,503 --> 00:01:06,502
Hi. I'm Claire.
25
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Nice to meet you.
26
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Are you the autistic one?
27
00:01:11,375 --> 00:01:13,008
No.
28
00:01:13,010 --> 00:01:14,210
That's me.
29
00:01:14,212 --> 00:01:15,778
Dr. Shaun Murphy.
30
00:01:15,780 --> 00:01:17,546
Hi.
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00:01:17,548 --> 00:01:19,915
We've got two
pretty straightforward cases,
32
00:01:19,917 --> 00:01:23,185
nice level playing field
for an eager group.
33
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Not interested.
34
00:01:24,322 --> 00:01:26,188
Competition can foster teamwork,
35
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which can lead to
a greater understanding
36
00:01:27,992 --> 00:01:29,458
and appreciation
37
00:01:29,460 --> 00:01:31,060
of residents' strengths and weaknesses
38
00:01:31,062 --> 00:01:32,495
and improve patient care.
39
00:01:32,497 --> 00:01:34,130
You're playing the same game
Glassman had us do
40
00:01:34,132 --> 00:01:35,131
when we were interns.
41
00:01:35,133 --> 00:01:36,132
Not interested.
42
00:01:36,134 --> 00:01:38,412
Winning team gets first dibs
43
00:01:38,413 --> 00:01:40,379
on assisting on all surgeries next week.
44
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- In.
- In.
45
00:01:41,302 --> 00:01:42,400
Out.
46
00:01:43,573 --> 00:01:45,141
Mm.
47
00:01:48,212 --> 00:01:49,879
I pick the boy genius.
48
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That's you.
49
00:02:04,896 --> 00:02:06,095
Dr. Browne.
50
00:02:07,765 --> 00:02:10,099
- Kalu.
- Dr. Reznick.
51
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Thank you. I'm looking forward to it.
52
00:02:15,300 --> 00:02:16,534
Thank you.
53
00:02:18,910 --> 00:02:20,943
Same stakes as last time?
54
00:02:20,945 --> 00:02:22,411
Absolutely.
55
00:02:26,751 --> 00:02:27,817
Hi, Quinn.
56
00:02:27,819 --> 00:02:29,084
We hear you've had some stomach pain.
57
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Do you mind if we take a look?
58
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It doesn't hurt that bad.
59
00:02:31,622 --> 00:02:33,589
Poor thing says everything is okay,
60
00:02:33,591 --> 00:02:36,192
but when Quinnie didn't
want to go swimming today,
61
00:02:36,194 --> 00:02:38,294
I knew that something must be wrong.
62
00:02:39,930 --> 00:02:42,097
We'll be as gentle with her as possible.
63
00:02:43,968 --> 00:02:45,401
Quinn's parents are out of town,
64
00:02:45,403 --> 00:02:48,103
so I'm... I flew in to babysit.
65
00:02:48,105 --> 00:02:49,205
Mm-hmm.
66
00:02:52,710 --> 00:02:54,410
Okay.
67
00:02:54,412 --> 00:02:56,011
Let's see.
68
00:02:59,550 --> 00:03:00,783
- That's a...
- Penis.
69
00:03:02,352 --> 00:03:03,919
She's not a girl.
70
00:03:03,921 --> 00:03:05,120
He's a boy.
71
00:03:06,117 --> 00:03:11,397
Synced & corrected by kinglouisxx
www.addic7ed.com
72
00:03:16,070 --> 00:03:17,036
It's just a phase.
73
00:03:17,038 --> 00:03:18,504
Stop saying that.
74
00:03:18,506 --> 00:03:20,006
I'm not a boy. I'm a girl.
75
00:03:20,008 --> 00:03:21,674
- You're transgender?
- Yes.
76
00:03:21,676 --> 00:03:22,875
No.
77
00:03:22,877 --> 00:03:25,978
Quinn has XY chromosomes
like Jared and me,
78
00:03:25,980 --> 00:03:27,446
not XX like you.
79
00:03:27,448 --> 00:03:29,415
Science says he's male.
80
00:03:29,417 --> 00:03:31,651
No, Quinn has gender dysphoria.
81
00:03:31,653 --> 00:03:33,986
Her assigned gender is not
the one she identifies with.
82
00:03:33,988 --> 00:03:35,922
She's mismatched, Dr. Murphy.
83
00:03:35,924 --> 00:03:37,189
But biologically...
84
00:03:37,191 --> 00:03:38,524
Other than biologically,
85
00:03:38,526 --> 00:03:40,359
how do you know
you're supposed to be a boy?
86
00:03:42,829 --> 00:03:44,830
Your question doesn't make sense.
87
00:03:44,832 --> 00:03:46,766
I'm not supposed to be anything.
88
00:03:46,768 --> 00:03:47,900
I am a boy.
89
00:03:47,902 --> 00:03:49,402
Biologically, that's it.
90
00:03:53,374 --> 00:03:55,174
Okay, deep tenderness
at McBurney's point.
91
00:03:55,176 --> 00:03:56,509
Could be acute appendicitis.
92
00:03:56,511 --> 00:03:59,345
Murphy, get imaging to confirm.
93
00:03:59,347 --> 00:04:00,546
Mm.
94
00:04:06,454 --> 00:04:08,321
Mr. Shaw, your chart says
95
00:04:08,323 --> 00:04:10,389
that you passed out in class.
96
00:04:10,391 --> 00:04:12,521
- What do you teach?
- History.
97
00:04:12,546 --> 00:04:14,660
I got a little dizzy
because I skipped breakfast.
98
00:04:14,662 --> 00:04:15,962
I-It's nothing.
99
00:04:15,964 --> 00:04:18,397
The school insisted on
calling an ambulance.
100
00:04:18,399 --> 00:04:20,333
Taken any medications
in the last few months?
101
00:04:21,401 --> 00:04:23,069
Uh, I took some Vicodin
102
00:04:23,071 --> 00:04:25,805
after I threw out my back six weeks ago,
103
00:04:25,807 --> 00:04:27,773
and then I had a stomach flu,
104
00:04:27,775 --> 00:04:29,342
so I took Ofloxacin.
105
00:04:29,344 --> 00:04:32,111
But the flu part didn't totally go away,
106
00:04:32,113 --> 00:04:34,714
so I took Azithromycin and Prednisone
107
00:04:34,716 --> 00:04:36,782
because my glands were swollen.
108
00:04:36,784 --> 00:04:39,685
But I still had a sore throat,
so I took some Cipro.
109
00:04:41,788 --> 00:04:43,422
What doctor prescribed you all that?
110
00:04:43,424 --> 00:04:45,391
Uh, they were leftovers
111
00:04:45,393 --> 00:04:47,960
I had in my medicine cabinet.
112
00:04:47,962 --> 00:04:50,563
- Uh...
- All right, lay back for me.
113
00:04:52,500 --> 00:04:54,667
Look, I'm a single dad with twins
114
00:04:54,669 --> 00:04:57,003
who bring home every disgusting germ
115
00:04:57,005 --> 00:04:59,271
they touch at preschool.
116
00:04:59,273 --> 00:05:01,173
I can't afford to miss work.
117
00:05:02,377 --> 00:05:04,310
You've got a fever
118
00:05:04,312 --> 00:05:05,611
and you've gone through two IVs
119
00:05:05,613 --> 00:05:07,446
which tells me that
you're severely dehydrated.
120
00:05:07,448 --> 00:05:09,315
You can't stand me touching your stomach
121
00:05:09,317 --> 00:05:10,483
without wincing in pain.
122
00:05:10,485 --> 00:05:13,185
Dr. Reznick, let's get
Mr. Shaw here an ultrasound.
123
00:05:15,397 --> 00:05:17,577
- We've been trying for a while.
- Five months.
124
00:05:17,602 --> 00:05:19,736
I realize my prime egg days
were two decades ago,
125
00:05:19,761 --> 00:05:21,093
but I've been vigilant.
126
00:05:21,095 --> 00:05:23,429
Ovulation kits, LH and FSH testing,
127
00:05:23,431 --> 00:05:24,530
basal body temp.
128
00:05:24,532 --> 00:05:27,199
I've checked my estradiol
and AMH levels.
129
00:05:27,201 --> 00:05:29,168
The old-fashioned way wasn't working.
130
00:05:29,170 --> 00:05:32,338
Okay, well, there are a lot of
possibilities to consider.
131
00:05:32,340 --> 00:05:34,874
Many benign, many easily corrected.
132
00:05:34,876 --> 00:05:37,176
So I will take some samples
from you both,
133
00:05:37,178 --> 00:05:38,644
run some tests, we go from there.
134
00:05:38,646 --> 00:05:39,845
There's a clock.
135
00:05:39,847 --> 00:05:42,214
We need to know
if we start with IUI or IVF...
136
00:05:42,216 --> 00:05:44,884
Both of you...
You need to stop worrying.
137
00:05:44,886 --> 00:05:47,586
Isabel, you are not
the first 40-something woman
138
00:05:47,588 --> 00:05:49,822
to come here and ask these questions.
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Myself included.
140
00:05:52,493 --> 00:05:54,326
You came to me
because you trust me, yes?
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00:05:54,328 --> 00:05:56,062
Right.
142
00:05:56,064 --> 00:05:57,630
So let me do what I do,
143
00:05:57,632 --> 00:05:59,131
and you two focus on each other.
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00:06:00,935 --> 00:06:02,601
Hey.
145
00:06:02,603 --> 00:06:04,203
We're a team, babe.
146
00:06:04,205 --> 00:06:06,539
In this together, all right?
147
00:06:06,541 --> 00:06:07,973
Okay.
148
00:06:17,518 --> 00:06:18,684
I'm afraid, Howard,
149
00:06:18,686 --> 00:06:20,753
your appendix has already ruptured.
150
00:06:20,755 --> 00:06:23,106
Book an OR stat and page Melendez.
151
00:06:23,131 --> 00:06:24,489
Wait. I need to figure out
152
00:06:24,514 --> 00:06:25,707
who's gonna take care of my kids,
153
00:06:25,732 --> 00:06:28,036
call the school so they can
get subs for my classes.
154
00:06:28,061 --> 00:06:30,129
Mr. Shaw, if we don't
get you into surgery now,
155
00:06:30,131 --> 00:06:32,465
your infection could spread
and you could become septic.
156
00:06:32,467 --> 00:06:34,467
Dr. Browne will make all
the necessary phone calls
157
00:06:34,469 --> 00:06:36,035
I prep you for surgery.
158
00:06:36,037 --> 00:06:37,703
Isn't that so, Dr. Browne?
159
00:06:40,073 --> 00:06:41,440
You're in good hands, Mr. Shaw.
160
00:06:41,442 --> 00:06:42,541
We've got you covered.
161
00:06:42,543 --> 00:06:43,709
Let's go.
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00:06:51,686 --> 00:06:53,552
Hello.
163
00:06:53,554 --> 00:06:54,520
Do you wear dresses?
164
00:06:54,522 --> 00:06:56,789
Murphy, don't.
165
00:06:56,791 --> 00:06:59,492
Quinn is a boy who thinks he's a girl.
166
00:06:59,494 --> 00:07:01,994
I want to know why he thinks that.
167
00:07:01,996 --> 00:07:04,130
Sometimes I wear dresses,
but sometimes I wear leggings.
168
00:07:04,132 --> 00:07:07,433
Do you like the color pink?
169
00:07:08,469 --> 00:07:10,035
I'm more of a purple girl.
170
00:07:10,037 --> 00:07:12,238
- Do you play with dolls?
- Since I was 5,
171
00:07:12,240 --> 00:07:13,939
but I'm super into mermaids.
172
00:07:13,941 --> 00:07:14,974
Do you take dance...
173
00:07:14,976 --> 00:07:16,642
Murphy, 20 questions are up.
174
00:07:16,644 --> 00:07:18,177
I only asked four.
175
00:07:18,179 --> 00:07:19,678
- Do you wear perfume?
- It doesn't matter.
176
00:07:19,680 --> 00:07:20,728
The CT's ready. Let's go.
177
00:07:20,753 --> 00:07:22,448
- Do you always paint your nails?
- Let's go.
178
00:07:32,360 --> 00:07:34,493
Perforated appendix is out.
179
00:07:34,495 --> 00:07:36,362
Lavage or no lavage.
180
00:07:36,364 --> 00:07:37,630
Dr. Browne.
181
00:07:37,632 --> 00:07:39,365
Lavage before closing the wound
182
00:07:39,367 --> 00:07:41,367
decreases residual fluid accumulation
183
00:07:41,369 --> 00:07:44,570
- and minimizes residual contamination.
- Claire's right.
184
00:07:44,572 --> 00:07:45,704
Although, a recent study
185
00:07:45,706 --> 00:07:47,339
documented a higher abscess rate
186
00:07:47,341 --> 00:07:49,775
when irrigation was used
for perforated appendicitis.
187
00:07:49,777 --> 00:07:51,844
Well, someone did their homework.
188
00:07:51,846 --> 00:07:53,846
I'm partial to AMSURG
since they published me.
189
00:07:53,848 --> 00:07:55,915
As a medical student?
190
00:07:55,917 --> 00:07:58,284
It was about the cost
and stabilization of disease
191
00:07:58,286 --> 00:08:00,085
in patients undergoing transcatheter
192
00:08:00,087 --> 00:08:01,854
and surgical aortic valve replacement.
193
00:08:01,856 --> 00:08:03,989
Are you thinking of specializing
in cardio-thoracic?
194
00:08:03,991 --> 00:08:05,824
A girl can dream.
195
00:08:06,927 --> 00:08:08,260
Staple up and close up.
196
00:08:11,464 --> 00:08:12,531
It's, uh...
197
00:08:12,533 --> 00:08:14,466
it's good to have you on board, Morgan.
198
00:08:14,468 --> 00:08:18,170
It's great to have
another female surgeon.
199
00:08:18,172 --> 00:08:21,340
Oh, uh, I'm sorry,
200
00:08:21,342 --> 00:08:23,075
you and I are not gonna be friends,
201
00:08:23,077 --> 00:08:25,144
hanging out, having sleepovers,
202
00:08:25,146 --> 00:08:26,912
braiding each other's hair.
203
00:08:26,914 --> 00:08:30,182
That's not exactly
where I was going with it.
204
00:08:30,184 --> 00:08:31,417
When residency's over,
205
00:08:31,419 --> 00:08:32,685
the hospital's likely
only keeping two of us.
206
00:08:32,687 --> 00:08:35,387
Shaun is Glassman's pet project,
so he's in.
207
00:08:35,389 --> 00:08:37,990
Jared is persona non grata, so he's out.
208
00:08:37,992 --> 00:08:40,192
Which means every time you win, I lose.
209
00:08:40,194 --> 00:08:42,094
And vice versa.
210
00:08:45,466 --> 00:08:47,032
Thanks for the heads up.
211
00:08:57,545 --> 00:09:01,714
Do you think he's complicated
or confused?
212
00:09:03,084 --> 00:09:05,384
Dude, you've got to quit
calling her a "he."
213
00:09:05,386 --> 00:09:06,986
We're never going
to win this competition
214
00:09:06,988 --> 00:09:08,207
with you disrespecting our patient.
215
00:09:08,232 --> 00:09:09,745
Don't they have transgender
people in Wyoming?
216
00:09:09,770 --> 00:09:12,725
Okay. Transgender patient care
217
00:09:12,727 --> 00:09:16,061
was not part of my
medical school curriculum.
218
00:09:16,063 --> 00:09:18,397
Was it part of yours?
219
00:09:18,399 --> 00:09:19,732
No.
220
00:09:24,504 --> 00:09:27,973
Quinn doesn't have appendicitis.
221
00:09:27,975 --> 00:09:31,010
He has testicular cancer.
222
00:09:33,781 --> 00:09:34,813
She.
223
00:09:37,734 --> 00:09:40,951
We found a mass
on Quinn's left testicle.
224
00:09:40,976 --> 00:09:42,509
She has cancer, but...
225
00:09:42,511 --> 00:09:44,025
- Am I gonna die?
- No, no.
226
00:09:44,079 --> 00:09:45,412
Prognosis is very good.
227
00:09:45,414 --> 00:09:46,619
We've caught it before it spread,
228
00:09:46,651 --> 00:09:48,550
and we'll do surgery on the mass
to remove it.
229
00:09:48,552 --> 00:09:51,787
The CT also showed he has osteopenia.
230
00:09:51,789 --> 00:09:53,956
Murphy, stop with the "he."
231
00:09:55,393 --> 00:09:57,960
Um, Quinnie, it's your mom.
232
00:09:57,962 --> 00:10:00,062
- I... I have to...
- Of course.
233
00:10:03,133 --> 00:10:04,366
Osteopenia.
234
00:10:04,368 --> 00:10:06,201
- That's low bone density, right?
- Yeah.
235
00:10:06,203 --> 00:10:07,469
How'd you know that?
236
00:10:07,471 --> 00:10:10,039
Do you know how I got cancer?
237
00:10:10,041 --> 00:10:12,207
There are several
possible causes, but I...
238
00:10:12,209 --> 00:10:14,610
- Microlithiasis, mumps, hypospadias...
- Murphy.
239
00:10:14,612 --> 00:10:16,478
Intraepithelial germ cell neoplasia,
240
00:10:16,480 --> 00:10:17,646
inguinal hernia, HIV...
241
00:10:17,648 --> 00:10:20,149
Murphy. Enough.
242
00:10:20,151 --> 00:10:22,785
Your parents are on their way here.
243
00:10:22,787 --> 00:10:25,220
Um, they just told me...
244
00:10:25,222 --> 00:10:27,089
Quinn, are you on puberty blockers?
245
00:10:28,658 --> 00:10:31,794
That's the likely cause
of the osteopenia.
246
00:10:31,796 --> 00:10:33,996
Are you taking leuprorelin or histrelin?
247
00:10:33,998 --> 00:10:36,632
I've been leuprorelin for nine months.
248
00:10:36,634 --> 00:10:38,267
Why didn't you say anything earlier?
249
00:10:38,269 --> 00:10:41,503
Because my parents didn't
want my grandma to know.
250
00:10:46,010 --> 00:10:47,976
Looks like he has an abscess.
251
00:10:47,978 --> 00:10:49,278
You have an infection.
252
00:10:49,280 --> 00:10:51,613
We'll drain it, put you on antibiotics.
253
00:10:51,615 --> 00:10:52,648
It's nothing to worry about.
254
00:10:52,650 --> 00:10:53,749
It just means
you might be in the hospital
255
00:10:53,751 --> 00:10:54,750
a couple of extra nights.
256
00:10:54,752 --> 00:10:55,784
I... I can't spend
257
00:10:55,786 --> 00:10:56,885
a couple of extra nights.
258
00:10:56,887 --> 00:10:58,253
I need to get out of here.
259
00:10:58,255 --> 00:11:00,255
Are you worried about your kids?
260
00:11:00,257 --> 00:11:02,458
Well, they're with my sister,
they're safe,
261
00:11:02,460 --> 00:11:04,259
but they've never spent
a night without me
262
00:11:04,261 --> 00:11:05,327
since they were born.
263
00:11:05,329 --> 00:11:06,995
Well, then consider this a blessing.
264
00:11:06,997 --> 00:11:08,464
A free vacation from your kids.
265
00:11:08,466 --> 00:11:10,099
They're my life.
266
00:11:14,105 --> 00:11:17,439
My wife died of ovarian cancer
last year.
267
00:11:20,177 --> 00:11:22,211
I...
268
00:11:22,213 --> 00:11:23,679
I hate hospitals.
269
00:11:23,681 --> 00:11:25,781
I'm so sorry.
270
00:11:25,783 --> 00:11:28,383
Why don't I find a laptop
271
00:11:28,385 --> 00:11:29,718
so you can Skype with them?
272
00:11:30,954 --> 00:11:33,689
And I'll rustle up a couple
of toy bears from Peds
273
00:11:33,691 --> 00:11:35,424
for you to take home.
274
00:11:35,426 --> 00:11:36,692
Thank you.
275
00:11:39,296 --> 00:11:40,796
I want to reassure you
276
00:11:40,798 --> 00:11:42,231
that the puberty blockers
277
00:11:42,233 --> 00:11:44,733
are in no way responsible
for causing cancer.
278
00:11:44,735 --> 00:11:47,569
The leuprorelin
did cause your osteopenia.
279
00:11:47,571 --> 00:11:49,872
Does this mean I have to stop
taking puberty blockers?
280
00:11:49,874 --> 00:11:50,973
Yes.
281
00:11:50,975 --> 00:11:52,307
We'll get you on dietary supplements
282
00:11:52,309 --> 00:11:53,542
to help regain your bone strength,
283
00:11:53,544 --> 00:11:54,843
but the puberty blockers
are hurting you.
284
00:11:54,845 --> 00:11:55,878
You'll be fine without them.
285
00:11:57,080 --> 00:11:59,248
Fine?
286
00:11:59,250 --> 00:12:01,283
I... I don't want an Adam's apple
287
00:12:01,285 --> 00:12:03,852
or a deep voice
or hair all over my body.
288
00:12:03,854 --> 00:12:05,888
You can't reverse that, can you?
289
00:12:05,890 --> 00:12:08,857
No, I'm afraid not.
290
00:12:16,901 --> 00:12:19,768
Girls have body hair, too.
291
00:12:27,811 --> 00:12:30,379
Toy bears, Skype with kids...
292
00:12:30,381 --> 00:12:31,814
you've got game.
293
00:12:31,816 --> 00:12:34,283
"Game"?
294
00:12:34,285 --> 00:12:35,751
I believe the name for what I did
295
00:12:35,753 --> 00:12:38,687
is "basic human decency."
296
00:12:38,689 --> 00:12:40,389
Everyone has an agenda.
297
00:12:40,391 --> 00:12:42,658
Sometimes it's conscious,
sometimes it's not,
298
00:12:42,660 --> 00:12:43,725
but it's always there.
299
00:12:43,727 --> 00:12:44,960
And you've got this whole
300
00:12:44,962 --> 00:12:46,728
"queen of kindness" thing down pat.
301
00:12:46,730 --> 00:12:49,131
Awfully cynical for someone so young.
302
00:12:49,133 --> 00:12:50,299
Mm, not cynical.
303
00:12:50,301 --> 00:12:51,466
Just the reality of how the world works.
304
00:12:53,437 --> 00:12:54,469
It's Howard.
305
00:12:55,840 --> 00:12:57,973
He spiked a fever, temp's 105.
306
00:12:57,975 --> 00:12:59,408
BP's tanking, 80 over 40.
307
00:12:59,410 --> 00:13:01,176
- He's soiled his sheets.
- Site's clean.
308
00:13:01,178 --> 00:13:02,644
Infection should be clearing by now.
309
00:13:02,646 --> 00:13:04,046
- What's going on?
- I don't know.
310
00:13:04,048 --> 00:13:05,113
Page Melendez.
311
00:13:05,115 --> 00:13:06,715
Give me 500 milligrams acetaminophen,
312
00:13:06,717 --> 00:13:08,584
2 grams of meropenem
IV infusion empirically.
313
00:13:08,586 --> 00:13:11,420
Run a chem panel, CBC,
and get cultures ASAP.
314
00:13:12,155 --> 00:13:13,655
Hang in there, Howard.
315
00:13:13,657 --> 00:13:15,023
We're gonna figure this out.
316
00:13:22,230 --> 00:13:23,931
Any word on Quinn Darby's labs?
317
00:13:23,974 --> 00:13:25,848
Big backup today. Nothing much I can do.
318
00:13:25,880 --> 00:13:27,279
Text you when they're ready.
319
00:13:27,281 --> 00:13:28,347
Yeah.
320
00:13:29,816 --> 00:13:30,883
Hey, Gus.
321
00:13:30,885 --> 00:13:33,085
I saw raspberry and rose petal doughnuts
322
00:13:33,087 --> 00:13:34,487
in the cafeteria today.
323
00:13:34,489 --> 00:13:36,218
Got you the last one.
324
00:13:36,280 --> 00:13:37,790
You remembered.
325
00:13:37,792 --> 00:13:39,458
Thank you.
326
00:13:39,460 --> 00:13:41,594
Howard Shaw's labs.
327
00:13:41,596 --> 00:13:44,063
- I put a rush on them for you.
- You're the best.
328
00:13:45,133 --> 00:13:49,001
Why did you give Gus a doughnut?
329
00:13:49,003 --> 00:13:50,202
I was being nice.
330
00:13:50,204 --> 00:13:52,705
I needed my patient's labs expedited.
331
00:13:52,707 --> 00:13:55,141
- Gus likes doughnuts.
- It's called bribery.
332
00:13:55,143 --> 00:13:56,876
I call it "basic human decency."
333
00:13:58,678 --> 00:13:59,812
See you later.
334
00:14:04,985 --> 00:14:06,786
Howard has a superbug.
335
00:14:08,321 --> 00:14:09,555
A C. Diff infection?
336
00:14:09,557 --> 00:14:12,825
It's resistant to all medication.
337
00:14:15,163 --> 00:14:16,729
Quinn's pre-op labs are normal,
338
00:14:16,731 --> 00:14:18,731
so we can do the surgery
first thing in the morning.
339
00:14:18,733 --> 00:14:19,765
The procedure is called
340
00:14:19,767 --> 00:14:21,734
a radical inguinal orchiectomy.
341
00:14:21,736 --> 00:14:24,503
It's radical in that
342
00:14:24,505 --> 00:14:26,705
the entire cancerous testicle
is removed.
343
00:14:26,707 --> 00:14:28,874
All functionality will remain the same.
344
00:14:28,876 --> 00:14:30,843
Quinn should be able
to resume her normal activities
345
00:14:30,845 --> 00:14:31,844
in one or two weeks.
346
00:14:31,846 --> 00:14:33,846
See? Baby, that's good news.
347
00:14:33,848 --> 00:14:35,181
No, not really.
348
00:14:35,183 --> 00:14:36,549
Without the puberty blockers,
349
00:14:36,551 --> 00:14:38,651
I'll be the freak in ballet
with a mustache.
350
00:14:38,653 --> 00:14:40,953
Aren't there any other options?
351
00:14:40,955 --> 00:14:41,954
I wish there were...
352
00:14:41,956 --> 00:14:43,789
If we do a bilateral orchiectomy,
353
00:14:43,791 --> 00:14:44,824
Quinn will have
354
00:14:44,826 --> 00:14:46,458
the testosterone level of a girl.
355
00:14:46,460 --> 00:14:48,961
We are not removing both testicles.
356
00:14:48,963 --> 00:14:50,972
You want to castrate my grandson?
357
00:14:50,997 --> 00:14:52,064
- No.
- No.
358
00:14:53,234 --> 00:14:55,434
I'm so sorry for Dr. Murphy's outburst.
359
00:14:55,436 --> 00:14:58,103
I'm gonna have
gender confirmation surgery
360
00:14:58,105 --> 00:14:59,805
when I'm 18 anyway.
361
00:14:59,807 --> 00:15:00,873
Why not just do it now.
362
00:15:04,312 --> 00:15:05,978
Quinn is a child
363
00:15:05,980 --> 00:15:09,982
who still plays dress-up
and make-believe.
364
00:15:09,984 --> 00:15:12,255
He may want to have children
of his own some day.
365
00:15:12,280 --> 00:15:13,219
Ew.
366
00:15:14,088 --> 00:15:15,588
We'll give you some privacy.
367
00:15:15,590 --> 00:15:16,755
Thank you.
368
00:15:21,529 --> 00:15:23,762
- I will not allow you...
- It's not up to you.
369
00:15:26,410 --> 00:15:28,886
You are making me doubt the
wisdom of drafting you, Murphy.
370
00:15:28,911 --> 00:15:31,003
If you go around saying
inflammatory things to people,
371
00:15:31,005 --> 00:15:32,705
it will only upset them.
372
00:15:32,707 --> 00:15:35,007
How will I know if I said
something inflammatory
373
00:15:35,009 --> 00:15:36,375
until I say it?
374
00:15:36,377 --> 00:15:38,878
Test it on Kalu first.
375
00:15:38,880 --> 00:15:40,746
Which you can do
376
00:15:40,748 --> 00:15:43,349
the two of you prep
an SDA for this case.
377
00:15:43,351 --> 00:15:45,251
An SDA?
378
00:15:45,253 --> 00:15:46,652
A Shared Decision Aid
379
00:15:46,654 --> 00:15:48,888
is a paper presenting the pros and cons
380
00:15:48,890 --> 00:15:50,689
- of making a difficult...
- I know what it is, Murphy.
381
00:15:50,691 --> 00:15:52,057
But why am I being punished?
382
00:15:52,059 --> 00:15:53,525
It's not a punishment, it's necessary.
383
00:15:53,527 --> 00:15:54,660
It'll help Quinn's family
384
00:15:54,662 --> 00:15:57,596
understand all the options
available to them for her care.
385
00:15:57,598 --> 00:16:00,232
- Understood?
- Understood.
386
00:16:03,971 --> 00:16:05,437
The stool culture and sensitivity test
387
00:16:05,439 --> 00:16:06,605
indicate that you're resistant
388
00:16:06,607 --> 00:16:07,706
to every antibiotic.
389
00:16:07,708 --> 00:16:09,575
Which only happens
when you've been exposed
390
00:16:09,577 --> 00:16:10,542
to every antibiotic.
391
00:16:10,544 --> 00:16:15,247
I... I did this to myself?
392
00:16:15,249 --> 00:16:16,749
But I've used those medications before
393
00:16:16,751 --> 00:16:17,750
without a problem.
394
00:16:17,752 --> 00:16:18,817
Why did this happen now?
395
00:16:20,921 --> 00:16:22,755
You weren't under a doctor's care,
396
00:16:22,757 --> 00:16:24,790
so you were likely
taking the wrong medication
397
00:16:24,792 --> 00:16:25,958
for the wrong symptoms.
398
00:16:25,960 --> 00:16:27,860
But you can fix this, right?
399
00:16:27,862 --> 00:16:29,929
We're gonna have to perform a colostomy
400
00:16:29,931 --> 00:16:31,597
where we attach
an ostomy pouching system
401
00:16:31,599 --> 00:16:32,798
to your abdomen
402
00:16:32,800 --> 00:16:34,300
to collect waste from your body.
403
00:16:34,302 --> 00:16:35,901
For how long?
404
00:16:35,903 --> 00:16:37,036
Well, with the level of damage
405
00:16:37,038 --> 00:16:38,304
we're seeing throughout the colon,
406
00:16:38,306 --> 00:16:39,371
indefinitely.
407
00:16:42,043 --> 00:16:44,043
I'm so sorry, Howard.
408
00:16:52,653 --> 00:16:53,786
I don't understand
409
00:16:53,788 --> 00:16:55,187
why you'd suggest
the bilateral orchiectomy
410
00:16:55,189 --> 00:16:56,956
when you don't even
believe Quinn's a girl.
411
00:16:56,958 --> 00:16:59,725
I was answering Dr. Lim's question.
412
00:16:59,727 --> 00:17:01,760
She said there were no other options,
413
00:17:01,762 --> 00:17:02,828
but I found one.
414
00:17:02,830 --> 00:17:05,064
And now we're here.
415
00:17:05,066 --> 00:17:07,499
Yes.
416
00:17:07,501 --> 00:17:09,201
You're actually enjoying
this scut work, aren't you?
417
00:17:09,203 --> 00:17:11,270
Yes. We are being helpful.
418
00:17:13,073 --> 00:17:15,474
We're not doing this
to be helpful, Murphy.
419
00:17:15,476 --> 00:17:17,443
We're doing this because
you pissed off Lim,
420
00:17:17,445 --> 00:17:20,579
and I'm collateral damage.
421
00:17:20,581 --> 00:17:22,848
We're still being helpful.
422
00:17:26,386 --> 00:17:28,053
Doesn't matter.
423
00:17:28,055 --> 00:17:30,756
Doesn't matter, competition's over.
424
00:17:30,758 --> 00:17:32,424
Is it?
425
00:17:32,426 --> 00:17:34,059
We're in here and not with the patient.
426
00:17:34,061 --> 00:17:35,728
No face time plus you calling her a "he"
427
00:17:35,730 --> 00:17:37,930
equals crappy survey scores.
428
00:17:37,932 --> 00:17:39,365
It's okay. It's a game.
429
00:17:39,367 --> 00:17:41,600
- It's not important.
- It is to me.
430
00:17:45,505 --> 00:17:47,740
I'm a pariah.
431
00:17:47,742 --> 00:17:50,242
These scores are part of
our resident evaluation.
432
00:17:50,244 --> 00:17:52,344
Our jobs depend on them.
433
00:17:52,346 --> 00:17:54,380
Mine does, at least.
434
00:17:59,120 --> 00:18:03,122
Then we should do
this scut work very well.
435
00:18:14,100 --> 00:18:15,634
Finola called.
436
00:18:15,636 --> 00:18:17,736
She found an irregularity
with one of the tests
437
00:18:17,738 --> 00:18:19,338
but wants to re-run it to be sure.
438
00:18:19,340 --> 00:18:24,076
Okay, so we wait until she re-runs it.
439
00:18:24,078 --> 00:18:27,246
Marcus, we're both doctors.
440
00:18:27,248 --> 00:18:28,781
The results aren't gonna change.
441
00:18:32,852 --> 00:18:36,088
I waited too long.
442
00:18:36,090 --> 00:18:37,456
It's all my fault.
443
00:18:41,327 --> 00:18:42,828
This is the part where you say,
444
00:18:42,830 --> 00:18:43,896
"No, babe, it isn't."
445
00:18:43,898 --> 00:18:48,033
You had goals, other priorities.
446
00:18:48,035 --> 00:18:50,736
You said you supported
my career choices,
447
00:18:50,738 --> 00:18:52,404
just like I supported yours.
448
00:18:52,406 --> 00:18:54,840
I do support you. Always.
449
00:18:54,842 --> 00:18:56,375
And I am so proud of you.
450
00:18:56,377 --> 00:18:58,277
But it came at a cost
451
00:18:58,279 --> 00:19:00,279
that we both knew was possible.
452
00:19:00,304 --> 00:19:03,015
- We should have started trying sooner.
- When?
453
00:19:03,017 --> 00:19:05,350
When you were 3,000 miles away
teaching at Dartmouth?
454
00:19:05,352 --> 00:19:07,419
Or, what, when you were
chasing down head of surgery?
455
00:19:07,421 --> 00:19:09,922
- We would have figured it out.
- "Figuring it out"
456
00:19:09,924 --> 00:19:11,590
would have meant me and
a nanny raising a baby.
457
00:19:11,592 --> 00:19:12,658
I didn't want that.
458
00:19:12,660 --> 00:19:13,859
I tried to bring it up four years ago,
459
00:19:13,861 --> 00:19:15,394
but you wanted to get
your practice up and running.
460
00:19:15,396 --> 00:19:16,695
A baby didn't fit
in that picture, either.
461
00:19:16,697 --> 00:19:18,597
It is not the same.
462
00:19:18,599 --> 00:19:20,365
How many pregnant women
get hired for anything?
463
00:19:20,367 --> 00:19:22,434
Or when they find out a
woman's got a child at home,
464
00:19:22,436 --> 00:19:23,435
suddenly it's all
465
00:19:23,437 --> 00:19:24,870
"Who's gonna take care of the baby?"
466
00:19:24,872 --> 00:19:26,538
No one asks men that question.
467
00:19:26,540 --> 00:19:29,108
Yeah, well, none of it matters now.
468
00:19:29,110 --> 00:19:30,909
Right? Because it's probably too late.
469
00:19:30,911 --> 00:19:31,977
And I knew it.
470
00:19:31,979 --> 00:19:33,378
I knew this was gonna happen.
471
00:19:35,582 --> 00:19:37,983
You've been stewing over this.
472
00:19:37,985 --> 00:19:40,018
Resenting me. For how long?
473
00:19:40,020 --> 00:19:42,454
I don't resent you, Is.
474
00:19:42,456 --> 00:19:45,390
But, you know,
if you want me to sit here
475
00:19:45,392 --> 00:19:47,926
and tell you that it's not your fault,
476
00:19:47,928 --> 00:19:51,196
I... I can't do that, I'm sorry.
477
00:20:08,882 --> 00:20:11,049
Hey. You like?
478
00:20:11,051 --> 00:20:13,519
That door was locked.
479
00:20:13,521 --> 00:20:15,220
Oh, I know.
480
00:20:15,222 --> 00:20:16,755
The cable guy had a cancellation,
481
00:20:16,757 --> 00:20:19,358
so he hooked me up,
got us a two-for-one.
482
00:20:19,360 --> 00:20:20,959
Little thanks for being
so chill earlier.
483
00:20:20,961 --> 00:20:23,395
Gracias, amigo.
484
00:20:30,404 --> 00:20:31,870
So, what kind of doctor are you?
485
00:20:34,707 --> 00:20:35,908
I'm a surgeon.
486
00:20:35,910 --> 00:20:37,543
A surgeon?
487
00:20:37,545 --> 00:20:40,546
Your stuff doesn't say surgeon, does it?
488
00:20:40,548 --> 00:20:42,714
It's like, uh, Selena and Justin.
489
00:20:44,450 --> 00:20:47,052
It doesn't really go together.
490
00:20:47,054 --> 00:20:48,554
Furniture's from, like,
a dozen different places.
491
00:20:48,556 --> 00:20:50,422
14.
492
00:20:50,424 --> 00:20:51,857
14.
493
00:20:51,859 --> 00:20:54,960
The people in Casper
knew I didn't have any money,
494
00:20:54,962 --> 00:20:57,062
so they gave me things to make a home.
495
00:20:57,064 --> 00:20:59,965
The bookshelf is from Jennifer,
496
00:20:59,967 --> 00:21:01,900
the town librarian.
497
00:21:01,902 --> 00:21:05,370
My table and chairs
are from Mr. Grady's diner.
498
00:21:05,372 --> 00:21:06,972
The lamp is from Sheryl
499
00:21:06,974 --> 00:21:09,308
who teaches Sunday school
at Highland Church.
500
00:21:09,310 --> 00:21:11,710
Dr. Glassman, he got me my bed.
501
00:21:11,712 --> 00:21:14,379
Well, you don't have to tell me
the whole list, but...
502
00:21:15,915 --> 00:21:17,950
Okay. Yes.
503
00:21:17,952 --> 00:21:19,418
Everything I have works.
504
00:21:19,420 --> 00:21:21,353
There is no need to change it.
505
00:21:21,355 --> 00:21:22,921
Respect.
506
00:21:42,075 --> 00:21:43,875
Hi.
507
00:21:43,877 --> 00:21:45,577
- I'm Dr. Glassman.
- Hi.
508
00:21:45,579 --> 00:21:46,945
I'm the president of the hospital.
509
00:21:46,947 --> 00:21:47,946
Is everything okay?
510
00:21:47,948 --> 00:21:48,981
Sit down.
511
00:21:51,351 --> 00:21:53,986
There has been no change
in Quinn's condition.
512
00:21:53,988 --> 00:21:56,455
However, her grandmother
513
00:21:56,457 --> 00:21:58,824
has made a claim of child abuse
514
00:21:58,826 --> 00:22:01,827
against you and your husband.
515
00:22:01,829 --> 00:22:02,894
She's claiming that
516
00:22:02,896 --> 00:22:06,531
putting Quinn on puberty blockers...
517
00:22:06,533 --> 00:22:08,533
and these are her words,
518
00:22:08,535 --> 00:22:12,271
"making her think
that being trans is okay"...
519
00:22:12,273 --> 00:22:16,208
is a form of emotional
and physical abuse.
520
00:22:17,678 --> 00:22:20,045
Now, just to be clear,
521
00:22:20,047 --> 00:22:21,913
we don't believe
any of these allegations
522
00:22:21,915 --> 00:22:23,448
have any merit whatsoever.
523
00:22:23,450 --> 00:22:24,683
I know my mom, okay?
524
00:22:24,685 --> 00:22:26,184
She's not gonna drop this.
525
00:22:26,186 --> 00:22:27,753
She'll go to court.
526
00:22:27,755 --> 00:22:29,087
Could she get custody?
527
00:22:29,089 --> 00:22:33,592
Well, she could try,
but, uh, Dr. Lim would testify.
528
00:22:33,594 --> 00:22:36,662
- They could put her in a foster home.
- Hey.
529
00:22:36,664 --> 00:22:38,363
Ty, she won't make it.
530
00:22:38,365 --> 00:22:40,899
If we let Quinn do the surgery
she wants now,
531
00:22:40,901 --> 00:22:42,034
it'll all be over.
532
00:22:42,036 --> 00:22:44,970
There will be no reason
for Ruth to fight us.
533
00:22:51,111 --> 00:22:52,827
Do what Quinn wants.
534
00:22:52,913 --> 00:22:54,561
Do the bilateral surgery.
535
00:23:03,043 --> 00:23:04,510
There is an issue.
536
00:23:05,121 --> 00:23:06,894
Your tests confirmed
537
00:23:06,933 --> 00:23:09,816
abnormalities in the semen parameters.
538
00:23:13,324 --> 00:23:14,524
I beg your pardon?
539
00:23:14,526 --> 00:23:16,581
The semen analysis.
It showed that you have
540
00:23:16,606 --> 00:23:18,562
a low sperm count and low motility.
541
00:23:19,561 --> 00:23:21,325
- It's my fault?
- No.
542
00:23:21,327 --> 00:23:23,661
We... we do not speak in terms of fault.
543
00:23:26,199 --> 00:23:28,866
15% of all couples
struggle with infertility,
544
00:23:28,868 --> 00:23:31,769
and of those, 50% have
a male factor component.
545
00:23:33,372 --> 00:23:35,778
It's not great news,
but it's not a dead end.
546
00:23:35,808 --> 00:23:37,341
So what's the next step?
547
00:23:37,343 --> 00:23:39,744
I'm gonna refer you
to Dr. Arjun Dhillon.
548
00:23:39,746 --> 00:23:41,479
He's an excellent urologist,
549
00:23:41,481 --> 00:23:43,748
and he'll give Marcus
a... a full physical,
550
00:23:43,750 --> 00:23:46,159
do some blood work, and an ultrasound.
551
00:23:46,184 --> 00:23:47,583
That can't be right.
552
00:23:47,585 --> 00:23:49,085
- Marcus.
- It can't be right.
553
00:23:49,087 --> 00:23:50,486
Marcus. We got this.
554
00:23:50,488 --> 00:23:51,687
Okay?
555
00:23:51,689 --> 00:23:52,955
We're gonna get through this together.
556
00:24:00,598 --> 00:24:02,264
Hey. Hey!
557
00:24:02,266 --> 00:24:03,899
Why didn't you tell me
Howard's labs came back?
558
00:24:03,901 --> 00:24:06,268
I should have been there
when you broke the bad news to him.
559
00:24:06,270 --> 00:24:09,271
So Melendez could see
your touching bedside manner.
560
00:24:09,273 --> 00:24:10,706
It doesn't matter anyway.
561
00:24:10,708 --> 00:24:12,575
Oh, it doesn't? How the hell not?
562
00:24:13,610 --> 00:24:15,277
The poor guy's getting a colostomy.
563
00:24:15,279 --> 00:24:17,380
There's no way we're winning
this competition.
564
00:24:19,116 --> 00:24:20,750
You really have no sympathy
565
00:24:20,752 --> 00:24:22,051
for what Howard's going through?
566
00:24:22,053 --> 00:24:23,919
It's a major bummer, no doubt.
567
00:24:23,921 --> 00:24:25,788
But we don't have time
to get emotionally invested
568
00:24:25,790 --> 00:24:27,056
in every patient that we treat.
569
00:24:27,058 --> 00:24:29,625
Our job is to go in, do the surgery,
570
00:24:29,627 --> 00:24:30,893
and get out.
571
00:24:30,895 --> 00:24:34,130
Afterwards... his poop,
someone else's poop...
572
00:24:34,132 --> 00:24:35,398
it's not our problem.
573
00:24:36,466 --> 00:24:37,700
Hey, well, wait.
574
00:24:39,102 --> 00:24:40,236
What if we could get Howard
575
00:24:40,238 --> 00:24:41,470
a fecal microbiota transplant?
576
00:24:43,306 --> 00:24:45,041
FMT for a surgical case?
577
00:24:45,043 --> 00:24:47,543
Theoretically, we transfer
healthy feces to him,
578
00:24:47,545 --> 00:24:49,211
it restores good flora to the body,
579
00:24:49,213 --> 00:24:50,179
kills off the CDI,
580
00:24:50,181 --> 00:24:52,048
and he avoids surgery all together.
581
00:24:53,483 --> 00:24:55,117
We could actually win this thing.
582
00:24:56,687 --> 00:24:57,920
I'm gonna pull all the research
583
00:24:57,922 --> 00:25:00,089
before pitching it to Melendez.
584
00:25:02,627 --> 00:25:04,427
So, this meeting is called
585
00:25:04,429 --> 00:25:07,463
a Challenging Patient
Consultation Process.
586
00:25:07,465 --> 00:25:08,597
The name sucks,
587
00:25:08,599 --> 00:25:11,000
but there are things about it I do like.
588
00:25:11,002 --> 00:25:15,471
All you got to do is talk and listen
589
00:25:15,473 --> 00:25:17,273
and try to understand each other.
590
00:25:17,275 --> 00:25:18,407
What's to understand?
591
00:25:18,409 --> 00:25:20,543
Ruth accused us of being child abusers.
592
00:25:20,545 --> 00:25:21,877
And what's to discuss?
593
00:25:21,879 --> 00:25:23,145
We are Quinn's parents.
594
00:25:23,147 --> 00:25:24,880
We get to make her medical decisions.
595
00:25:24,882 --> 00:25:26,816
What if Quinnie's better off as a boy?
596
00:25:26,818 --> 00:25:29,985
You have no idea
what Quinn has been through.
597
00:25:29,987 --> 00:25:32,888
Every kid goes through rough patches.
598
00:25:32,890 --> 00:25:34,723
Every kid is confused.
599
00:25:34,725 --> 00:25:36,625
Quinn has always told us
exactly who she was,
600
00:25:36,627 --> 00:25:37,827
ever since she was 3.
601
00:25:37,829 --> 00:25:39,295
So you let Quinn play with dolls.
602
00:25:39,297 --> 00:25:40,596
Big deal.
603
00:25:40,598 --> 00:25:42,665
You don't make life-altering decisions
604
00:25:42,667 --> 00:25:45,167
because a child wants to be a princess.
605
00:25:49,773 --> 00:25:52,741
We used to let Quinn
do whatever she wanted at home.
606
00:25:52,743 --> 00:25:55,511
But when she went out in public,
607
00:25:55,513 --> 00:25:57,580
we made her present as a boy.
608
00:25:59,049 --> 00:26:01,083
It felt false to her.
609
00:26:01,085 --> 00:26:03,419
She hated it.
610
00:26:03,421 --> 00:26:04,553
She hated herself.
611
00:26:04,555 --> 00:26:07,957
She became reclusive, depressed.
612
00:26:07,959 --> 00:26:10,726
And then a year ago,
Quinn tried to kill herself.
613
00:26:17,101 --> 00:26:18,267
Sorry I'm late.
614
00:26:29,514 --> 00:26:31,380
Howard might not need the colostomy
615
00:26:31,382 --> 00:26:36,185
if we give him
a fecal microbiota transplant.
616
00:26:36,187 --> 00:26:37,953
Hasn't the FDA gone
back and forth on that?
617
00:26:37,955 --> 00:26:40,656
We could be introducing
new bacteria into his system
618
00:26:40,658 --> 00:26:41,824
that could kill him.
619
00:26:41,826 --> 00:26:42,925
The likelihood of that is low.
620
00:26:42,927 --> 00:26:43,959
But not zero.
621
00:26:43,961 --> 00:26:45,327
But if we do the colostomy,
622
00:26:45,329 --> 00:26:46,695
we may not really be helping him.
623
00:26:46,697 --> 00:26:48,364
15% to 30% of patients
624
00:26:48,366 --> 00:26:50,757
get recurrent CDI
after the initial bout.
625
00:26:50,782 --> 00:26:51,800
That's a good point.
626
00:26:51,802 --> 00:26:54,069
I believe 65% of that time,
627
00:26:54,071 --> 00:26:55,437
recurrent CDI becomes chronic,
628
00:26:55,439 --> 00:26:57,306
which can lead to repeated
hospitalizations and death.
629
00:27:00,244 --> 00:27:01,744
Are my numbers right, Claire?
630
00:27:01,746 --> 00:27:03,279
Yes.
631
00:27:03,281 --> 00:27:05,548
But recent studies
632
00:27:05,550 --> 00:27:09,685
show better than
a 95% success rate with FMTs.
633
00:27:09,687 --> 00:27:11,620
Howard is a good candidate.
634
00:27:11,622 --> 00:27:12,721
We should try it
635
00:27:12,723 --> 00:27:14,123
before he develops a toxic megacolon.
636
00:27:14,125 --> 00:27:16,258
Don't we owe it to him, to his twins,
637
00:27:16,260 --> 00:27:18,194
to at least try
an experimental treatment
638
00:27:18,196 --> 00:27:19,795
before doing an invasive surgery
639
00:27:19,797 --> 00:27:21,463
which will alter his life forever?
640
00:27:21,465 --> 00:27:22,965
You're right.
641
00:27:22,967 --> 00:27:24,667
Prep him for the procedure.
642
00:27:24,669 --> 00:27:26,869
I appreciate your passionate advocacy
643
00:27:26,871 --> 00:27:27,903
for your patient.
644
00:27:27,905 --> 00:27:29,505
Good work, both of you.
645
00:27:32,909 --> 00:27:34,677
Oh, now you're a team player.
646
00:27:34,679 --> 00:27:35,911
When it benefits me, yes.
647
00:27:35,913 --> 00:27:37,680
Speaking of which,
648
00:27:37,682 --> 00:27:38,981
you were doing your research,
649
00:27:38,983 --> 00:27:40,482
I found Howard a match
at the stool bank.
650
00:27:40,484 --> 00:27:41,817
Sample arrives in a couple of hours.
651
00:27:41,819 --> 00:27:42,918
Great.
652
00:27:42,920 --> 00:27:44,687
I let them know you'd be
the designated doctor
653
00:27:44,689 --> 00:27:46,121
to handle the medical chain of custody
654
00:27:46,123 --> 00:27:47,356
when the sample arrives.
655
00:27:47,358 --> 00:27:49,091
So...?
656
00:27:49,093 --> 00:27:51,760
So you're the only person
who can handle the sample.
657
00:27:51,762 --> 00:27:53,262
You'll have to dilute it,
blend it, strain it
658
00:27:53,264 --> 00:27:54,530
all on your own.
659
00:27:54,532 --> 00:27:56,498
To safeguard against
cross-contamination, of course.
660
00:27:56,500 --> 00:27:58,200
Of course.
661
00:28:06,776 --> 00:28:09,945
Your temperature and BP are normal.
662
00:28:09,947 --> 00:28:10,946
Normal.
663
00:28:10,948 --> 00:28:12,848
Whatever that means.
664
00:28:12,850 --> 00:28:15,618
Typical. Usual.
665
00:28:15,620 --> 00:28:17,419
Expected.
666
00:28:17,421 --> 00:28:20,389
Yeah, I don't feel like
any of those things.
667
00:28:20,391 --> 00:28:22,758
What does it feel like to be a girl?
668
00:28:27,497 --> 00:28:28,831
Are you angry?
669
00:28:28,833 --> 00:28:31,400
Was that an inflammatory question?
670
00:28:31,402 --> 00:28:32,434
I'd rather people ask questions
671
00:28:32,436 --> 00:28:33,502
instead of pointing and staring.
672
00:28:35,739 --> 00:28:37,773
When I used to look like a boy,
673
00:28:37,775 --> 00:28:40,075
I felt... different.
674
00:28:40,077 --> 00:28:43,479
The kids at school didn't understand me,
675
00:28:43,481 --> 00:28:44,947
so they picked on me.
676
00:28:44,949 --> 00:28:46,915
I spent a lot of time alone.
677
00:28:48,886 --> 00:28:52,121
When my parents let me be me,
678
00:28:52,123 --> 00:28:53,956
I felt...
679
00:28:53,958 --> 00:28:55,658
like I didn't have to pretend anymore.
680
00:28:57,594 --> 00:28:58,494
I felt free,
681
00:28:58,496 --> 00:29:00,296
like when you're in a pool
682
00:29:00,298 --> 00:29:02,197
and you just let go and float.
683
00:29:06,570 --> 00:29:09,038
I'm not a very good swimmer.
684
00:29:18,582 --> 00:29:20,949
I don't know what it feels like
685
00:29:20,951 --> 00:29:23,185
to be anyone but me.
686
00:29:26,023 --> 00:29:27,956
Me, too.
687
00:29:29,493 --> 00:29:32,294
Is the bilateral more risky
688
00:29:32,296 --> 00:29:34,496
than the unilateral surgery?
689
00:29:34,498 --> 00:29:36,131
The big issue with the bilateral
690
00:29:36,133 --> 00:29:38,467
is Quinn will never be able
to have biological children.
691
00:29:38,469 --> 00:29:40,602
If Quinn's parents think
that Quinn's mature enough
692
00:29:40,604 --> 00:29:42,137
and strong enough in her beliefs,
693
00:29:42,139 --> 00:29:43,238
then they should do it now.
694
00:29:43,240 --> 00:29:45,774
It's an elective surgery on a child.
695
00:29:45,776 --> 00:29:47,943
There is no medical necessity.
696
00:29:47,945 --> 00:29:49,978
Except with a previous suicide attempt,
697
00:29:49,980 --> 00:29:51,046
she's still at risk.
698
00:29:51,048 --> 00:29:52,614
Her situation is different now.
699
00:29:52,616 --> 00:29:55,484
She's socially transitioned
and living as a girl.
700
00:29:55,486 --> 00:29:57,786
But there just isn't enough good data
701
00:29:57,788 --> 00:29:59,488
on trans kids and their outcomes.
702
00:29:59,490 --> 00:30:01,623
On the other hand,
there's very good reason
703
00:30:01,625 --> 00:30:02,991
to preserve future fertility.
704
00:30:02,993 --> 00:30:05,194
Dr. Lim and Dr. Andrews
705
00:30:05,196 --> 00:30:06,495
are both very excellent surgeons,
706
00:30:06,497 --> 00:30:08,030
and they very clearly have
707
00:30:08,032 --> 00:30:09,331
some passionate points of view,
708
00:30:09,333 --> 00:30:10,833
but their views are their own.
709
00:30:10,835 --> 00:30:14,069
You all need to decide
what's best for Quinn.
710
00:30:15,572 --> 00:30:17,506
Whatever we decide,
711
00:30:17,508 --> 00:30:19,441
Quinn is still gonna be a girl.
712
00:30:22,612 --> 00:30:25,047
I don't know if I'll ever
be able to accept that.
713
00:30:26,649 --> 00:30:29,118
I know that makes me sound horrible.
714
00:30:29,120 --> 00:30:33,622
I know what it's like
to not put your family first,
715
00:30:33,624 --> 00:30:35,457
and it cost me.
716
00:30:35,459 --> 00:30:38,827
It cost me a great deal.
717
00:30:38,829 --> 00:30:41,730
And if I had to do it all over again,
718
00:30:41,732 --> 00:30:42,965
I'd ask myself...
719
00:30:42,967 --> 00:30:45,667
is it really worth sacrificing a life
720
00:30:45,669 --> 00:30:47,403
with someone I love
721
00:30:47,405 --> 00:30:51,607
over an idea that may never be?
722
00:30:57,214 --> 00:30:58,781
Why don't we give them the room?
723
00:31:07,291 --> 00:31:09,324
Hey. I got the page. What's going on.
724
00:31:09,326 --> 00:31:11,193
She started screaming in pain
and vomiting.
725
00:31:11,195 --> 00:31:12,161
Temp's 104.
726
00:31:12,163 --> 00:31:13,529
Increased groin pain
727
00:31:13,531 --> 00:31:15,230
could be attributed to epididymitis,
728
00:31:15,232 --> 00:31:16,832
kidney stones, inguinal hernia...
729
00:31:16,834 --> 00:31:17,997
The extra weight of the tumor
730
00:31:18,022 --> 00:31:19,635
could be causing the testicle
to twist on itself.
731
00:31:19,637 --> 00:31:22,204
There'd be no blood flow.
732
00:31:28,411 --> 00:31:31,313
She has a testicular torsion.
She needs surgery now.
733
00:31:38,694 --> 00:31:40,461
Excuse me. Have you made a decision?
734
00:31:40,463 --> 00:31:42,730
Not yet. I mean, there's a lot to...
735
00:31:42,732 --> 00:31:43,998
We need one now.
736
00:31:44,000 --> 00:31:45,500
Quinn has testicular torsion.
737
00:31:45,524 --> 00:31:47,139
The spermatic cord is twisted
738
00:31:47,164 --> 00:31:48,676
and cutting off blood supply.
739
00:31:48,701 --> 00:31:50,069
We need to operate.
740
00:31:52,275 --> 00:31:56,420
If you want Quinn
to live the way she wants,
741
00:31:56,579 --> 00:31:58,446
don't limit her future now.
742
00:32:00,990 --> 00:32:02,529
You heard her when my mom said
743
00:32:02,554 --> 00:32:04,252
she might want kids some day.
744
00:32:04,254 --> 00:32:05,820
She can't even fathom the thought
745
00:32:05,822 --> 00:32:07,855
because she's just a child.
746
00:32:13,738 --> 00:32:15,663
Just do what's medically necessary.
747
00:32:24,618 --> 00:32:27,986
Doesn't appear to be
any palpable lymphadenopathy.
748
00:32:28,044 --> 00:32:30,507
It's likely a stromal tumor,
749
00:32:30,532 --> 00:32:32,907
- but get that to pathology right away.
- Yes, sir.
750
00:32:37,787 --> 00:32:41,756
Quinn has tachycardia and hypotension.
751
00:32:41,758 --> 00:32:42,890
I'm not seeing any bleeding.
752
00:32:42,892 --> 00:32:44,425
EKG's normal. It's not coronary.
753
00:32:44,427 --> 00:32:46,894
CO2 and O2 are normal,
so it's not a P.E.
754
00:32:46,896 --> 00:32:48,629
It must be a reaction to the anesthesia.
755
00:32:48,631 --> 00:32:50,898
I'm already pushing fluids
and vasoconstrictors.
756
00:32:58,841 --> 00:33:02,110
Six syringes in, and no sign of leakage.
757
00:33:02,112 --> 00:33:03,544
Okay, we're wrapped up here.
758
00:33:03,546 --> 00:33:04,812
Let's get Howard into recovery.
759
00:33:04,814 --> 00:33:07,014
- Well done.
- Thanks.
760
00:33:07,016 --> 00:33:09,851
I was thinking of
writing up the procedure,
761
00:33:09,853 --> 00:33:11,552
possibly submit it for publication.
762
00:33:11,554 --> 00:33:13,254
I'd be happy to assist,
763
00:33:13,256 --> 00:33:15,423
seeing as I've done it before.
764
00:33:15,425 --> 00:33:17,425
Thanks, but I think I can...
765
00:33:17,427 --> 00:33:19,594
I read your paper in AMSURG,
Dr. Reznick.
766
00:33:19,596 --> 00:33:20,895
You continue to impress.
767
00:33:20,897 --> 00:33:21,863
Coming from you,
768
00:33:21,865 --> 00:33:23,431
I take that as a huge compliment.
769
00:33:25,134 --> 00:33:26,959
When you get a chance, Dr. Browne,
770
00:33:27,030 --> 00:33:28,102
you should read it.
771
00:33:28,104 --> 00:33:29,637
Will do.
772
00:33:37,714 --> 00:33:39,247
I've given vasopressors
773
00:33:39,249 --> 00:33:41,182
and reduced her meds as much as I can.
774
00:33:41,184 --> 00:33:42,817
She's losing volume somewhere.
775
00:33:42,819 --> 00:33:44,952
It was dry when we ligated
the spermatic cord.
776
00:33:44,954 --> 00:33:46,354
I'm still not seeing the bleed.
777
00:33:46,356 --> 00:33:49,123
Could be vagal stimulation
from the severed nerve.
778
00:33:49,125 --> 00:33:50,391
But she's not responding to epi.
779
00:33:50,393 --> 00:33:52,493
- Sepsis?
- It's too early for an infection.
780
00:33:54,263 --> 00:33:56,564
Her MAP is 20. She's barely profusing.
781
00:33:59,836 --> 00:34:01,169
Okay, excuse me, guys.
782
00:34:01,171 --> 00:34:02,804
- You're breaking scrub.
- I'm so sorry.
783
00:34:03,639 --> 00:34:05,072
Grey-Turner sign.
784
00:34:05,074 --> 00:34:07,041
Could be a retroperitoneal hemorrhage.
785
00:34:19,122 --> 00:34:21,222
Jared could be right.
786
00:34:21,224 --> 00:34:24,525
It is possible that
there's internal bleeding.
787
00:34:24,527 --> 00:34:26,360
The testicular artery
788
00:34:26,362 --> 00:34:28,596
can retract up into the pelvis.
789
00:34:28,598 --> 00:34:30,665
It's rare, but it can happen.
790
00:34:30,667 --> 00:34:32,600
Rare is an understatement. Dr. Andrews?
791
00:34:35,037 --> 00:34:36,804
I don't think we have any other choice.
792
00:34:36,806 --> 00:34:38,472
We need to do an ex-lap. 10 blade.
793
00:34:48,484 --> 00:34:49,784
Murphy, retract.
794
00:34:57,993 --> 00:34:59,627
Internal bleeding.
795
00:34:59,629 --> 00:35:00,928
Jared was right.
796
00:35:02,497 --> 00:35:04,298
Nice call, Dr. Kalu.
797
00:35:04,300 --> 00:35:05,466
Thank you, sir.
798
00:35:06,602 --> 00:35:08,769
Kalu, suction.
We need a clear view of the field.
799
00:35:13,547 --> 00:35:16,092
Fever's down, and the flora
in your system
800
00:35:16,117 --> 00:35:17,449
seems to be returning to normal.
801
00:35:17,451 --> 00:35:20,166
- We expect a full recovery.
- Thank you.
802
00:35:20,191 --> 00:35:21,824
For everything.
803
00:35:21,849 --> 00:35:23,515
Do you know when I can have visitors?
804
00:35:23,544 --> 00:35:25,536
I thought you might ask that question.
805
00:35:25,561 --> 00:35:27,394
There are a couple of eager preschoolers
806
00:35:27,419 --> 00:35:28,852
who'd like to say hi.
807
00:35:28,933 --> 00:35:29,899
Oh.
808
00:35:29,901 --> 00:35:31,323
- Daddy!
- Keira!
809
00:35:31,348 --> 00:35:34,069
Sammy! Oh!
810
00:35:34,071 --> 00:35:36,372
Oh, I think you guys have grown!
811
00:35:36,374 --> 00:35:38,169
Hey.
812
00:35:38,194 --> 00:35:40,576
Hey, these are the doctors
that saved Daddy.
813
00:35:40,578 --> 00:35:43,544
Dr. Reznick and this is, uh...
814
00:35:43,677 --> 00:35:45,560
Uh, I'm sorry, I forgot your name.
815
00:35:46,069 --> 00:35:48,348
Dr. Browne.
816
00:35:48,350 --> 00:35:50,050
- Thank you.
- Thank you.
817
00:35:50,052 --> 00:35:51,585
You're welcome.
818
00:35:52,639 --> 00:35:53,854
Blah!
819
00:35:55,991 --> 00:35:57,291
Okay.
820
00:35:59,043 --> 00:36:00,227
Who's this guy?
821
00:36:00,229 --> 00:36:01,261
- Bear Bear.
- Bear Bear?
822
00:36:10,638 --> 00:36:11,772
Did you do it?
823
00:36:11,774 --> 00:36:12,906
Did you remove both?
824
00:36:14,309 --> 00:36:15,409
No.
825
00:36:15,411 --> 00:36:16,543
Just the cancerous one.
826
00:36:16,545 --> 00:36:18,412
What? Why not?
827
00:36:19,697 --> 00:36:21,099
That's on me.
828
00:36:21,124 --> 00:36:23,317
I couldn't, in good conscience,
remove a healthy organ.
829
00:36:28,404 --> 00:36:30,071
Quinnie.
830
00:36:30,096 --> 00:36:31,529
This was our decision.
831
00:36:31,569 --> 00:36:33,446
No! You said you were on my side!
832
00:36:33,471 --> 00:36:36,218
Hey, we are. Always.
833
00:36:36,243 --> 00:36:38,198
We haven't had enough time to talk,
834
00:36:38,200 --> 00:36:40,767
not with each other,
with your therapist,
835
00:36:40,769 --> 00:36:42,208
with your doctors.
836
00:36:42,233 --> 00:36:43,837
So I'm gonna turn into a boy.
837
00:36:43,839 --> 00:36:45,772
Well, not right away.
838
00:36:45,774 --> 00:36:47,474
Your endocrinologist will talk to you
839
00:36:47,476 --> 00:36:48,475
about the right timeline
840
00:36:48,477 --> 00:36:50,444
for starting feminizing hormones.
841
00:36:53,582 --> 00:36:54,961
You know...
842
00:36:55,918 --> 00:36:58,352
the thought of having
your own kids someday
843
00:36:58,354 --> 00:36:59,987
is a big decision,
844
00:36:59,989 --> 00:37:01,855
but you never know
what you will or will not want
845
00:37:01,857 --> 00:37:03,023
once you get older.
846
00:37:03,025 --> 00:37:05,092
Cis people are always so worked up
847
00:37:05,094 --> 00:37:06,527
about having bio kids.
848
00:37:06,529 --> 00:37:08,362
If I really want a kid that bad,
849
00:37:08,364 --> 00:37:09,830
I can just adopt.
850
00:37:13,234 --> 00:37:14,701
You know, I'll be back when I'm 18
851
00:37:14,703 --> 00:37:16,603
for my gender confirmation surgery.
852
00:37:16,605 --> 00:37:20,541
And when you do,
I'll be here to help you.
853
00:37:28,249 --> 00:37:30,450
Patient satisfaction
survey scores are in,
854
00:37:30,452 --> 00:37:31,952
and it was very close.
855
00:37:31,954 --> 00:37:33,654
Not really. She's being kind.
856
00:37:33,656 --> 00:37:37,691
Congratulations go
to Dr. Reznick and Dr. Browne.
857
00:37:37,693 --> 00:37:39,493
- Yes.
- Thank you.
858
00:37:41,062 --> 00:37:43,063
Congratulations.
859
00:37:43,065 --> 00:37:44,131
Thank you, Shaun.
860
00:37:44,133 --> 00:37:46,066
Claire and I make a nice team.
861
00:37:49,370 --> 00:37:50,871
You should be psyched.
862
00:37:50,873 --> 00:37:52,639
Yeah. I should be.
863
00:37:55,253 --> 00:37:57,711
To the victor belong the spoils.
864
00:37:57,713 --> 00:37:59,212
Pay up.
865
00:37:59,214 --> 00:38:01,815
Oh, humility was never your strong suit.
866
00:38:03,751 --> 00:38:05,819
- Thank you, Mortimer.
- Mm.
867
00:38:05,821 --> 00:38:07,988
Don't spend it all in one place.
868
00:38:07,990 --> 00:38:09,423
Spend it?
869
00:38:09,425 --> 00:38:11,024
I'm gonna frame it.
870
00:38:13,395 --> 00:38:15,896
What made you think of
a retroperitoneal hemorrhage?
871
00:38:15,898 --> 00:38:16,863
Homework.
872
00:38:16,865 --> 00:38:17,931
You were right.
873
00:38:17,933 --> 00:38:19,700
Prepping for an SDA was important.
874
00:38:19,702 --> 00:38:21,435
We make a good team.
875
00:38:24,706 --> 00:38:26,873
Quinn doesn't like pink.
876
00:38:26,875 --> 00:38:28,141
Oh.
877
00:38:28,143 --> 00:38:30,877
Uh, I think she will like these.
878
00:38:30,879 --> 00:38:33,146
I hope so.
879
00:38:35,350 --> 00:38:38,151
She's more of a purple girl.
880
00:38:45,594 --> 00:38:47,661
Did you read Morgan's
AMSURG article yet?
881
00:38:48,764 --> 00:38:51,331
It is on the top of my to-do list.
882
00:38:51,333 --> 00:38:53,600
I didn't tell you to read it
to rub it in.
883
00:38:56,238 --> 00:38:58,271
I told you to read it so you
knew what you'd be up against.
884
00:38:58,273 --> 00:39:00,340
You think I need to be more cutthroat?
885
00:39:00,342 --> 00:39:01,354
No.
886
00:39:01,379 --> 00:39:03,913
That's Morgan's M.O. You're different.
887
00:39:03,979 --> 00:39:05,812
You're smart, you're special.
888
00:39:05,814 --> 00:39:09,750
Rise up, play the game
on your own terms.
889
00:39:09,752 --> 00:39:11,184
Don't wait for it.
890
00:39:39,348 --> 00:39:42,049
I heard you saved Quinn's life.
891
00:39:42,051 --> 00:39:44,785
Jared and I did.
892
00:39:44,787 --> 00:39:46,453
I like her.
893
00:39:46,455 --> 00:39:47,554
"Her."
894
00:39:49,191 --> 00:39:53,727
So you get that she is a "she."
895
00:39:53,729 --> 00:39:55,729
I have lots of questions.
896
00:39:55,731 --> 00:39:58,699
Yeah, well, questions are good.
897
00:39:58,701 --> 00:40:01,802
Leads to awareness and understanding.
898
00:40:01,804 --> 00:40:04,004
And, who knows, maybe even acceptance.
899
00:40:05,860 --> 00:40:07,235
Being a kid is tough enough,
900
00:40:07,260 --> 00:40:09,810
But being a trans kid?
Oh, man, that's...
901
00:40:09,812 --> 00:40:11,111
that's off the chart.
902
00:40:13,549 --> 00:40:15,849
I can't imagine how it must feel
903
00:40:15,851 --> 00:40:19,119
to be so different on the outside
904
00:40:19,121 --> 00:40:20,320
than you are on the inside.
905
00:40:27,296 --> 00:40:29,229
Hey, Shaun.
906
00:40:29,231 --> 00:40:32,032
I can give you a lift.
907
00:40:32,034 --> 00:40:33,667
We could grab a bite.
908
00:40:36,138 --> 00:40:39,506
You said you can't be my friend.
909
00:40:39,508 --> 00:40:41,241
So, no, thank you.
910
00:40:46,248 --> 00:40:47,447
Okay.
911
00:40:55,858 --> 00:40:57,224
Hey, amigo. What's up?
912
00:40:57,226 --> 00:40:59,760
I need your help.
913
00:41:43,605 --> 00:41:47,474
You're not gonna do any laps or nothing?
914
00:41:47,476 --> 00:41:48,742
No.
915
00:41:51,413 --> 00:41:52,712
Then what are you doing?
916
00:41:55,183 --> 00:41:57,417
Understanding.
917
00:42:12,389 --> 00:42:17,189
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