- Dr. Shaun Murphy: Good morning, everyone!
- Dr. Neil Melendez: Right on time. What, did you sleep here or use a teleporation device?
- Dr. Shaun Murphy: I used a teleportation device.
- [Claire snickers]
- Dr. Shaun Murphy: Nonsensical questions usually imply sarcasm, which I've found people often answer sarcastically.
- Dr. Jared Kalu: Good one.
- Dr. Aaron Glassman: Shaun, that boy, he looks like...
- Dr. Shaun Murphy: Steve. He does.
- Dr. Aaron Glassman: Is he related?
- Dr. Shaun Murphy: His name is Evan Gallico, so I don't think so.
- Dr. Aaron Glassman: Wow. That is uncanny.
- Dr. Shaun Murphy: Just coincidental.
- Dr. Aaron Glassman: He looks exactly like your brother.
- Dr. Shaun Murphy: No, he doesn't. His hair is shorter.
- Dr. Aaron Glassman: It freaks me out. It doesn't freak you out?
- Dr. Shaun Murphy: No.
- Dr. Aaron Glassman: It's okay if it does.
- Dr. Shaun Murphy: No, he's not Steve. Steve's dead.
- Evan Gallico: Thank you.
- Dr. Shaun Murphy: Mm, I was wrong.
- Evan Gallico: You tried.
- Dr. Shaun Murphy: I was wrong. Your parents hate me.
- Evan Gallico: I know.
- Dr. Shaun Murphy: I gave you false hope.
- Evan Gallico: Yeah. But for a minute there, it was pretty awesome.
- Dr. Shaun Murphy: I'm going to ask you for a favor.
- Evan Gallico: Well, I'm not giving away my Make-A-Wish.
- Dr. Shaun Murphy: Mm, would you mind if I read you something? It's not long.
- Evan Gallico: That I can do.
- Dr. Neil Melendez: You're giving a fractured arm a head CT?
- Dr. Shaun Murphy: Yes.
- Dr. Neil Melendez: Get back to the pancreas.
- Dr. Shaun Murphy: He's not clumsy. He has a brain tumor behind the inner ear.
- Dr. Neil Melendez: Forget the pancreas.
- Dr. Shaun Murphy: The phrase "no biggie" gave me away.
- Dr. Aaron Glassman: You really got to learn how to lie, Shaun.
- Dr. Shaun Murphy: Am I in trouble?
- Dr. Aaron Glassman: Yes. Unless you're right.
- Dr. Shaun Murphy: If I'm wrong, they shouldn't be upset. They know it's highly unlikely.
- Dr. Aaron Glassman: False hope, Shaun. It's just plain cruel.
- Dr. Neil Melendez: Trauma wants a consult on a 66 year old male who collapsed from anaphylaxis, complicated by respiratory arrest. Now, his son just got back from Thailand. Almost immediately, the father had his allergic reaction.
- [loud groans of pain from nearby]
- Dr. Neil Melendez: Patient has a few allergies; pollen, mold, shellfish, but no corresponding allergens were in evidence.
- Dr. Claire Browne: Well, why are we doing a surgical consult on an allergy?
- Dr. Neil Melendez: Well, we're not. We're doing a consult on the excruciating abnominal pain he now has.
- [more groans of pain]
- Dr. Neil Melendez: As you may have heard.
- Dr. Jared Kalu: The guy was in some serious pain. Ten milligrams of morphine worth.
- Dr. Claire Browne: Test results show elevated lipase, amylase, pancreatic enzymes.
- Dr. Jared Kalu: Pancreas is enlarged. Could be pancreatitis, maybe alcohol-induced.
- Dr. Claire Browne: The son said he smelled alcohol on his father at 6:00 in the morning.
- Dr. Jared Kalu: And anaphylaxis has been known to precipitate attacks of pancreatitis.
- Dr. Neil Melendez: Guess that's it, then.
- Dr. Claire Browne: Meaning you totally disagree.
- Dr. Neil Melendez: Not everyone who starts their day off with a mimosa fries their pancreas. Your eyesight must be a hell of a lot better than mine, because I can't see the entire pancreas due to the overlying bowel gas.
- Dr. Jared Kalu: We'll order an abdominal CT and take a better look.
- Dr. Neil Melendez: There you go. Where the hell is Murphy?
- Dr. Shaun Murphy: I know why Evan tripped. He has a tumor in the temporal bone behind his left ear, which is affecting his balance. I've arranged for a consult with Dr. Najid in oncology and she's going to...
- Mr. Gallico: No, that won't be necessary. We...
- Mrs. Gallico: We already have an oncologist.
- Mr. Gallico: Evan's been diagnosed with stage four osteosarcoma.
- Mrs. Gallico: He was complaining of a sore shin. The last thing that we expected was bone cancer.
- Mr. Gallico: The doctors at SFM, they gave him a year to live. That was seven months ago.
- Dr. Shaun Murphy: Osteosarcoma explains the severity of his fracture. He will need pins in his arm after all.
- Mrs. Gallico: Uh, can we see him?
- Dr. Shaun Murphy: Yes. He's in room 414.
- Mrs. Gallico: Uh, Dr. Murphy? He doesn't know about his diagnosis.
- Mr. Gallico: We would really like to keep it that way.
- Dr. Neil Melendez: Instead of a death sentence, he could have something that could easily be treated with prednisone?
- Dr. Shaun Murphy: Next, we need to do a bone marrow aspiration to confirm.
- Dr. Neil Melendez: I assume you've looked at his file.
- Dr. Shaun Murphy: For a very long time.
- Dr. Neil Melendez: Well, there must have been a biopsy. What did the pathology report say?
- Dr. Shaun Murphy: Yes. There were two biopsies. Both were positive for osteosarcoma.
- Dr. Neil Melendez: Murphy...
- Dr. Shaun Murphy: They could false positives.
- Dr. Neil Melendez: Do you have any idea how unlikely it is to have two false positives?
- Dr. Shaun Murphy: .03%.
- Dr. Shaun Murphy: Which we can comfortably round off to "not likely".
- Dr. Shaun Murphy: It is possible...
- Dr. Neil Melendez: Yes, but it means telling the parents of a dying child that there's hope, when really there isn't. Grab a shower and get ready for rounds.
- Dr. Shaun Murphy: Where are your parents?
- Evan Gallico: They're coming. They both work in the city, so it's a long drive for them. I was on a school field trip, and I tripped over my own feet. Of course, it was right in front of Shelby Lomar. At least it was pretty gross, so I got some sympathy points for that.
- Dr. Shaun Murphy: I would expect this to have been caused by a more serious accident.
- Evan Gallico: Nope. Just a trip. I do that a lot. What can I say? I'm clumsy.
- Dr. Jared Kalu: Dr. Glassman?
- Dr. Aaron Glassman: Yeah?
- Dr. Jared Kalu: You used to be a neurosurgeon, right?
- Dr. Aaron Glassman: So they say.
- Dr. Aaron Glassman: As you've seen, allergic reactions get worse each time they happen. So a third one, that would be bad. That would be...
- [sardonic chuckle]
- Dr. Aaron Glassman: That would be very bad. So we're gonna have to surgically remove all the cysts intact.
- Dr. Jared Kalu: Dr. Glassman's one of the most highly-acclaimed neurosurgeons in the state. You are very lucky to have him.
- Dr. Aaron Glassman: And Dr. Kalu is fast becoming a very accomplished flatterer. The cranial cyst, that is a big deal. We're gonna have to take off the top of your skull.
- Mr. Wilks: You'd be digging into my brain?
- Dr. Aaron Glassman: Well, yeah. Pretty much. With saline. We use it to gently displace the cyst, and then poof, it magically pops out. Kind of like delivering a baby. You know, if childbirth were painless.
- Dr. Shaun Murphy: It might not be cancer.
- Dr. Neil Melendez: Fractured arm?
- Dr. Shaun Murphy: Yes.
- Dr. Neil Melendez: You said he'd been diagnosed with stage four osteosarcoma.
- Dr. Shaun Murphy: Evan was diagnosed with the flu eight months ago, but his symptoms are actually a better fit with Epstein-Barr virus, which is linked to Langerhans cell histiocytosis, which causes osteolytic lesions in the long bones of the upper limbs.
- Dr. Neil Melendez: And those lesions could be misdiagnosed as signs of osteosarcoma.
- Dr. Shaun Murphy: Yes.
- Dr. Neil Melendez: What about his brain tumor?
- Dr. Shaun Murphy: Langerhans can also manifest in the skull.
- Dr. Jared Kalu: It's not about how small or how big the venture is. It's about doing something that's yours.