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. PARK: 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.
Sometimes people just get sick.
Mommy drawk ma poop.
Your mommy drew your poop? No!
Drawk. Mommy drawk.
Drank?
Yes.
Mommy drawnk my poop.
The good news is, we've ruled out glossopharyngeal neuralgia.
You don't need brain surgery.
Never any good news without bad news.
We've got a list of a few things you don't have,
but we don't know what you do have.
So you'll run more tests.
We can't.
There are 21 different things this might be,
but they don't want us to run 37 more tests.
Well, this is lame.
I can afford the tests. I make good money.
I can't keep talking like this!
I need a...
She's hypotensive.
Code stroke.
We need stat brain CT and MRI.
Call angio. She may need mechanical thrombectomy.
3 cc's of 2% lidocaine.
Wow.
I-I didn't drink it. I just...
I just used her stool to do a home fecal transfer.
And you didn't think to mention that?
You said my UTIs were unrelated.
They didn't get better with antibiotics,
so I did exactly what I was supposed to do.
The video swore that it was completely safe.
Make sure your friend is completely healthy.
I've had the best results with vegans,
though if it were between
an 18-year-old carnivore and a 60-year-old vegan...
Well, don't make me choose.
We're gonna add the saline solution.
Should be a one-to-one match, more or less.
Then, we're gonna puree...
puree, and then puree some more.
While it's mixing...
Let's talk enema bags.
Marla must have seen her using the blender,
assumed she drank it.
Yeah, that's the mystery here,
not how anyone this stupid is still alive.
It's not completely irrational.
The E. Coli strain in drug-resistant UTIs
can hide out in the gut.
Repopulating the colon microbiome using FMT
has shown some success.
In a hospital, under controlled and sterile conditions.
Prep her for surgery.
Between the dilation and rigidity,
there may be colon perforation.
And test Marla's stool for toxins and infectious bacteria.
She was suffering a mini-stroke, and I saved her.
I saved her. I need to celebrate. Outside?
I want to celebrate by kissing you.
A lot.
I-Inside would be inappropriate.
Eagle Syndrome is very rare.
A longer-than-normal styloid bone
coming off the base of the skull.
And... I only get a five-minute break.
It impinged on her nerves,
causing the confusing symptoms
that baffled eight expert doctors.
And then when she turned her head suddenly,
it pinched her carotid, causing her TIA.
Yeah, it's him!
It's Dr. Murphy!
How do I know you?
He is cute!
Is that his girlfriend?
Kayley's hotter.
He's so cute!
My personal... Chernobyl.
What?
Seriously, guys.
Ohh, come on.
A zone of exclusion should be imposed around my kitchen.
Millions of people have watched that?
As of 9:00 a.m.
You're an influencer.
And you posted how I saved you?
But I take it I'm not saved yet? You still have to operate?
A normal styloid process
is 2.5 centimeters in length. Yours measures...
Don't do that.
There are two surgical options.
Transoral, where we go in through your mouth.
It's non-invasive, but creates surgical challenges
for physical and visual access.
The alternative transcervical procedure
involves an incision in your neck
with none of those access issues,
but with some post-operative scarring.
So one way is safer, but the other way, I'll look better?
It's a pretty bad-ass scar.
Can I take a bit to decide which?
Of course.
You had no right to tell the world about me.
It was flattering.
Not everyone wants to be famous.
Uh... If it's any consolation,
you've had over 70 marriage proposals.
It's not.
Some of us are more comfortable in the spotlight than others.
I think you're great.
Thanks.
I don't have to poop.
Be patient.
I don't have to poop!
Is there something your mom does
to help you when you can't go?
Sometimes she hold my hand.
Would you like me to?
You're not my mom.
Well, just keep trying.
Pbbbbbbht.
Sweetie, we really need you to go.
If you can't, there is another way we can do this.
How?
Well, it's not fun.
For either of us.
Isolate and divide middle colic artery and vein.
It's an epidemic.
People taking online medical advice.
It's not the problem. It's the symptom.
Medical care is a financial stress for lots of people,
not to mention physician arrogance,
incompetence, impatience.
So it's our fault?
Resect and cut the colon proximal and distal
to the perforation with GIA stapler.
A friend of a friend self-diagnosed
her own Cushing's disease online
after a series of doctors barely listened to her,
told her to get more rest.
I'm guessing she didn't then perform
do-it-yourself brain surgery at home.
Claire's right.
I was... supporting your point.
She convinced me I was wrong.
Divide mesentery with LigaSure.
We have a bleed.
It's major.
Tension during mobilization
must have caused a splenic capsule tear.
We need to do a splenectomy.
Cut the connecting attachments.
Kidney.
Diaphragm.
Take the vascular pedicle with a white load stapler.
Do not get the tail of the pancreas.
Dr. Melendez?
Can this wait?
I'm not sure.
The fecal sample that your team sent me...
It might be normal, but was it mislabeled?
It seems to be from a 70-year-old.
It's from a three-year-old.
SCFAs, elevated isobutyric and isovaleric acid.
She is at high risk for serious cardiac problems.
Oh, are you okay?
Her social media posts about Shaun have gone viral.
I've got reporters clamoring to speak
to the "twice-exceptional" Dr. Murphy.
Bad idea. Luckily, he won't do it.
He went off on Kayley about his privacy.
The publicity would be good for the hospital.
And I'm sure Dr. Glassman can make him see the wisdom of that.
I'm with Andrews.
It smacks of us patting ourselves on the back.
It could also come off as exploitative.
But the bigger issue is, it could blow up in our face.
Shaun is a complete communications wild card.
Who knows what he'll say about you, about me,
about being demoted, about screw-ups.
Well, we would have to coach him.
Do we have six years before they need to go to press?
I can go with him, manage the situation.
No, no, no.
If we consider Shaun an asset,
we shouldn't treat him like a liability.
I'll talk to him, see what he says.
You can see the proximity of her elongated styloid
to the nerves and carotid.
The trick is to break off the excess length
without injury to local neurovascular structures.
If done transcervically, entry point is key.
Minimizes risk of a marginal mandibular nerve injury.
Has she made a decision?
Not yet.
I'd like to lead.
Being that it's such a rare surgery,
I may not get another chance at it during residency.
When I have the benefit of supervision.
And it wouldn't have anything to do with hoping.
Kayley might then post glowingly about you?
Not at all.
Well, undoubtedly, a little.
Given the attention this case has drawn,
I think we should put our best, most experienced choice forward.
Well, this is a teaching hospital.
It's exactly the type of surgery we'd give to a third-year.
The fact that she has an online presence
shouldn't be a factor.
And yet here you are, the Chief of Surgery
working a case you say a third-year can handle.
It also might reflect well on this place
to have a young woman be the face of Kayley's surgery.
Assuming it goes well.
Live by the Internet, die by the Internet.
You still want to lead?
Yes.
It's yours.
Ann?
Ann.
Am I okay?
You're fine.
We had to wake you up a little earlier than we'd like
because we need to discuss something with you.
Do you understand?
Your gut biome showed markers for elevated cholesterol.
Which you don't have.
Your daughter does.
Marla has high cholesterol?
She has a genetic condition: Hyperlipidemia.
Coronary testing showed 90% narrowing
of the left main artery to her heart.
I'm afraid your daughter needs urgent heart surgery.
I don't want to.
Okay.
I'll tell the reporters that.
But can... can we talk about why?
Your computer just beeped.
I know.
I can think of a few reasons why you might be reticent.
You're shy. No, I'm not.
Well, you do have trouble with social interactions,
and you have trouble anticipating
what people might ask and how you might respond.
Yes, that is a problem when I'm meeting with a patient
or I'm at a job interview or I'm on a date.
Then my answers matter.
But if I'm talking to a reporter, they don't matter.
It beeped again.
Yes, I know. We're digitizing.
Every time a patient needs to take a drug,
we send them a reminder.
For some unknown reason, they keep sending me one, too.
I think stories do matter.
I think what you do and what you have done
might be inspirational for people to hear.
Okay.
Okay, you'll do it?
Okay, you've convinced me I should be nervous about it.
Now I have two reasons not to do it.
What's the other reason?
I'm very busy between doing my job and having sex.
I don't have a lot of free time.
You should hire Lea.
No. SHAUN: Yes.
She's very good at tech
and isn't happy in her job right now.
I'll tell you what, Shaun.
You think about this, you really think about this,
how your story can benefit people,
and I will...
Interview Lea.
Excellent.
I'll think about it.
I'll really think about it.
Okay.
Some people definitely thought I would look amazeballs
rocking a neck scar.
But the consensus was,
there's only so many turtleneck days in a year.
So I'm going with the no-scar approach.
Which one did you vote for?
Well, these are my people. I mean, they know me.
They know what's best for me and my brand.
"Wisdom of the crowd."
My warrior goddess lead surgeon.
We'll get you prepped for surgery.
New blouse? It's nice.
Dr. Murphy, do you have a minute?
I really am sorry I upset you.
And I really am grateful.
Being sick was...
You don't need to explain
why you're grateful we diagnosed your illness.
Well, I do.
You saved me and my career.
At first, my followers were super into
what I was going through, but after a while,
you just start being "the sick girl."
You give up your privacy. Doesn't that bother you?
I have nothing to hide.
No one should.
We should all just be who we are.
We are...
The decisions we make.
And you let other people make them for you.
So you're not being anyone.
You know how you and I like to do so many things together?
We make clay mugs.
That's right.
Mommy was sick, and she needed to be fixed.
And you're sick, too.
I don't feel sick.
That's good.
And the doctors just want to make sure
everything is all better before you do.
How?
They're gonna go inside you and...
How?
They're gonna make a little cut...
No!
You're gonna be asleep.
No! Just like Mommy.
I... No, no, no, no, no!
I'll be with you, Marla. I'll take good care of you.
No, no, no, no, no! It's okay. Just breathe, sweetie.
Count to three. No!
Hey, sweetie, you have to be brave. No!
No!
Code blue!
What's happening?
Please help my baby.
She's had a heart attack!
Marla.
Marla?
Marla!
Uh, would you like my CV?
No.
I know who you are. I don't need to see a list.
Where do I work?
It's a tech company.
You were there.
Cars. Something about cars.
You have no interest in hiring me, do you?
No. It's not personal.
It's a little personal.
I'm doing a favor for Shaun. I don't really need anyone.
Did he ask you to waste my time?
Yeah... It's okay.
I didn't really want to work for you anyway.
You're a bit of a grouch.
But make sure whoever does do the job shores up your firewall.
A kindergartner can hack it.
Thank you. I'm sure we'll be fine.
And you're right, you know.
We are not a good fit.
And our mutual affection for Shaun
isn't enough to stop us from killing each other.
I...
Your Chronicle subscription is about to expire
because they don't have your updated credit card.
The coffee maker you ordered,
third new one in the last six months,
will be delivered Tuesday.
And you're deducting way too much money
out of Debbie's paycheck for FICA.
Would you like to hear about your Google searches?
Thank you.
Lea!
Severe proximal LAD disease with mid total occlusion.
Angioplasty won't resolve that stenosis.
High risk of rupture in someone this young.
A stent?
Won't be enough effective revascularization.
She needs a left IMA to LAD anastomosis.
I've never done a coronary bypass on a three-year-old.
Neither have I.
I guess it was the right call
to put her daughter's poop up her tush.
Cost her a large chunk of her colon.
Saved her daughter's life. Yeah, lucky coincidence.
I'm sure the mother doesn't regret a thing.
At least she shouldn't.
I'm with Claire.
Do you have time for lunch?
And by "lunch," you mean...?
Lunch.
I need advice.
I need to really think about something.
Oh.
Then yes, of course.
It could be patronizing,
being put up as some kind of feel-good, human interest story.
Or objectified and glorified
as some kind of a symbol for people who are different.
But I also know that when I told my sister your story,
she cried.
She was sad?
No, she was inspired.
I... don't know what your advice is telling me.
I don't know what you think I'm supposed to do.
Shaun, you aren't supposed to do anything,
except what you believe is right.
Thank you.
Now I'm going to go see what Lea thinks.
I thought you had a surgery.
I'm just going upstairs.
Lea's meeting with Dr. Glassman about a job.
A job here? Yes.
Lea told me at lunch yesterday
that she was looking for different work, so...
Wait, you... you had lunch with Lea? Yesterday?
And... And you kept it from me?
I didn't keep it from you.
There was no reason to mention it
until just now, when I did.
Shaun...
You know how I feel
about how Lea hovers over our relationship.
And...
You're just sneaking around with her?
Arranging for her to work here,
where she'll just loom all the more.
She won't be looming or hovering.
She'll be on a whole other floor.
Yeah, where you can go and get her two cents
whenever the advice given by your actual girlfriend
is deemed insufficient.
Yes.
Hey.
What are you doing?
Eh, fresh air.
You?
Shaun lied to me about having lunch with Lea.
No, he didn't.
Shaun is incapable of deceit.
He must have genuinely thought that you wouldn't mind.
Well, then, he is completely tone deaf and insensitive,
which are not better qualities in a boyfriend.
True.
But not exactly unanticipated
when you get into a relationship with Shaun.
And it's never really about the lie.
It's what's underneath.
You're jealous of Lea.
I am not jealous.
I am concerned...
You don't need to justify. I'm on team jealousy.
It's flattering, stimulating, it...
It means you're committed and you care.
It's ugly and reflects underlying trust issues
that I don't want to...
Yeah, yeah, yeah, like all things,
a little is good, and a lot will kill you.
My advice...
Admit you're jealous, give in to it,
and then get over it.
Finding the styloid
via digital palpitation of the tonsillar fossa.
There.
Making incision vertically along the mucosa of mandible.
Next?
I will free the styloid process from its muscle
and ligament attachments.
Done.
Dissecting away from the internal carotid medially,
and external, laterally.
Now fracture and excise the styloid.
Bradycardia. Hypotensive.
Loss of EEG waveform. Cerebral ischemia.
You may have injured the carotid.
Or compressed it by fracturing the styloid.
See if the fragment is impinging on the vessel.
Dr. Murphy, extend her head.
Yes. Found it. Easing it away.
Carotid decompressed.
EEG back to baseline normal.
Resuming styloid extraction.
Kayley's in ICU, stable.
CT shows no signs of any permanent damage.
No reason to anticipate any future problems.
So, the question is, what do we tell her?
That the surgery was a success.
She had a cerebral ischemia. On the table.
That did no damage and that there's no evidence of.
Hospital policy is transparency...
We don't tell them what music we played,
what we talked about.
This isn't relevant to the outcome or to her prognosis.
Would you be taking the same position
if Kayley wasn't someone whose criticism could go viral?
I don't know.
But it would be delusional to think it's not relevant.
Dr. Reznick.
Any thoughts?
I don't think I can fairly offer an opinion,
because my career could hang in the balance.
Yeah, well, none of us are disinterested parties,
given the hospital's reputation is also at stake.
Did you screw up?
Could that crisis have been avoided?
If it could have been, then we are all responsible.
We were watching everything she was doing,
and none of us told her to stop.
This is an easy call.
There's only one reason to tell her everything,
and that's you might feel guilty if you don't.
On the other hand, there's the future of this hospital.
Okay.
Shaun, if the patient asks for details about the surgery,
can you limit your answers?
I... don't know.
Okay, we need to know if...
No.
Dr. Murphy, I hope you will limit your answers.
But I won't order you to defy your conscience.
We don't normally have patients share rooms, but...
She's...? Gonna be completely fine.
And once she's recuperated, we'll begin her on statins and Ezetimibe,
and she'll undergo lipid apheresis.
It's kind of like dialysis,
but it'll allow us to extract LDL out of her blood.
Should get her cholesterol to within normal range.
She'll need those drugs and that other stuff
for the rest of her life?
Yes. But hopefully a very long one.
Thank you so much.
Thank God I did what I did.
Everything went great?
The repair was successful. You should have no...
Everything went great. Say it. Say it to your fans.
Everything went great.
You rocked it.
You'll be with us another few days, and then you...
She rocked it, right?
She was lead surgeon in a successful...
And how gorgeous is that hair?
Dr. Morgan Reznick, take a bow!
She was wrist-deep all up in my mouth, y'all.
She is a damn hero!
You've got work to do.
We're proud of you.
Any reason you screwed up?
I didn't. It could've happened to anyone.
Not anyone suffers from arthritic pain.
That didn't affect anything.
You sure about that?
'Cause I'm not.
Did you speak to Lea?
Yes.
I know she's a good friend.
And it would be unfair
for me to expect you to cut her out of your life.
But...
You going to ask her opinion right after I had given mine,
it just called up Wyoming all over again.
That you preferred Lea to me.
I was jealous.
And it's something that I have to work out.
For the two of us to work out.
Together.
What was Lea's advice?
That it'd be selfish not to share my story with the world.
I liked your advice better.
Hey.
Uh-oh.
Actually, yeah.
There's something awkward we need to talk about.
You and Claire.
You can reopen the door.
There's nothing remotely improper going on.
I received an anonymous favoritism complaint.
We need to deal with it.
I don't want to talk to reporters.
I know.
So if I talked to reporters,
it wouldn't be honest to who I really am.
Well, sometimes, Shaun,
people present a different version of themselves
depending upon the circumstances.
Like, I'm not always the same here as I am at home.
I don't.
No, you don't.
I considered all the arguments.
I want to be known as a good doctor.
Not a good autistic doctor.