The Good Doctor 4x19

1. Can you pop the trunk?

2. Ah!

3. We made good time.

4. Thank goodness, or else we wouldn't have

5. the full three hours to wait before our flight.

6. Great.

7. All right. Thanks.

8. All right.

9. Oh.

10. Starbucks is on me.

11. No kidding. And I'm getting a cake pop.

12. Hey, Dr. Reznick.

13. I thought this was a surgical mission.

14. Uh, we're bring… We're bringing some support.

15. Morgan's gonna help with patient selection and aftercare.

16. Oh. That's great.

17. Ten days, huh?

18. Can't have you forgetting me.

19. - I'll be back before you know it.

20. Tickets, passports,

21. travel wallet containing quetzales and American currency.

22. You've got 'em.

23. I know, because I checked.

24. You all right?

25. Oh, it's not that heavy. I got it.

26. That's not what I meant.

27. I'm okay.

28. I think this trip will be good.

29. Change things up.

30. Focus on helping other people.

31. For whatever it's worth, if you ever need to talk,

32. you can always call me.

33. I'm not gonna do that.

34. I know.

35. We will not have any time to shop,

36. but would you or Debbie like anything from duty-free?

37. Guatemala is known for its rum.

38. We're okay. Thanks.

39. Okay.

40. You're on this trip, too?

41. Yeah, got inspired last night,

42. decided to take some personal days, go help out.

43. And you're bringing a toilet seat?

44. Spoken like someone who's never been on one of these surgical missions.

45. The airline will find your bag.

46. We'll get you some clothes when we get situated.

47. Would you like some vitamin B12 to help with exhaustion,

48. or a motion sickness wristband?

49. I have an extra.

50. No, thanks.

51. I'm glad we're here.

52. Yes.

53. After all the loss this year.

54. It's just… Such an amazing way

55. to be reminded what we have to be grateful for.

56. Careful!

57. Let's see.

58. Pardon me, sir, could you please move your flock of sheep?

59. My sheep don't like to be rushed. Be patient.

60. These people are our guests.

61. Well, I did not invite them.

62. We're doctors.

63. It's been a long trip and we need to get to our hotel.

64. Doctor?

65. You're a doctor?

66. Of course I am.

67. It's a fungus.

68. It's… It's a fungus!

69. It's a fungus.

70. Thank you!

71. Whew!

72. Ah.

73. - Need help with that? - No, that's a friend thing.

74. Hola, I'm Dr. Mateo Rendon.

75. Dr. Saravia and her team have spent several months

76. gathering cases.

77. From those, we selected 40.

78. You're going to want to save them all. You will not.

79. We will perform 12 operations.

80. I'm Dr. Marcus Andrews, last-minute addition.

81. If we could add more cases…

82. Before I heard you joined the trip, we were doing ten surgeries.

83. My organization has spent years building trust.

84. We save 12 people here, that trust grows,

85. more patients come to us, more doctors volunteer.

86. But if we lose a patient…

87. We want surgeries we can do but the locals couldn't.

88. Surgeries that don't need a lot of aftercare.

89. Twelve patients, one alternate.

90. Everyone else gets sent home,

91. no matter how sick they are or how sad their story is.

92. Uh, can you please tell me what this means?

93. Family…

94. Your next of kin.

95. Oh, well, nobody. Only Ignacio.

96. Iggy is my only family.

97. He says his dog, Iggy.

98. Ugly dog.

99. Roberto Kantun Diaz?

100. Yes!

101. Andrea Torres Tzul?

102. Aime Navarro Gomez?

103. Aime Navarro Gomez?

104. Here! Here!

105. We need to do an abdominal exam and ultrasound

106. to see if there are any signs of obstruction or strangulation.

107. Please remove your bandage and lie back.

108. Lie down and remove your bandages.

109. How long have you had that?

110. A year… Maybe more.

111. He's had it for a year, maybe longer.

112. My neighbor told me to go to the hospital in Xela,

113. but I didn't have enough for the trip

114. and I can't go a long time without working.

115. I'm the only one who takes care of my sisters.

116. He was told to go to the hospital,

117. but he couldn't afford the trip or to miss work.

118. He's the sole provider for his siblings.

119. Our parents died two years ago.

120. Their parents died two years ago.

121. She has a large patent ductus arteriosus.

122. I've only seen this condition in infants.

123. The blood is reversed.

124. It's flowing the wrong way.

125. We could try going through the femoral vein,

126. do a percutaneous device closure.

127. She has irreversible pulmonary hypertension.

128. It would have been simple to treat as an infant,

129. but now closing the hole will… Will… Kill her.

130. Aime's condition is much too advanced.

131. There's nothing we can do.

132. I'm sorry.

133. I'm sorry.

134. No.

135. No.

136. No, no.

137. - Tissue? - Uh…

138. I stock up before the Americans come.

139. And the French.

140. They are surprisingly sensitive people.

141. I'm sorry. I know this isn't helping anyone.

142. - Never apologize for being human.

143. I have a strict policy against it.

144. This week, you are not just doing surgery.

145. You are doing miracles.

146. You're giving people hope who had none.

147. Except for the ones that we send home to die.

148. Focus on the miracles,

149. or else you won't be able to help any of them.

150. And I will have to get more tissues.

151. Thank you.

152. Bastion Alonso Ramos.

153. Twelve-year-old baseball fan.

154. Roots for the St. Louis Cardinals.

155. Also, he has an ameloblastoma.

156. Not a lot of baseball fans in Guatemala.

157. You've been here before, or do you enjoy reading Wikipedia?

158. I did a medical mission here during my residency.

159. Oh, that explains "Dr. Toilet Seat."

160. You already have a nickname.

161. Good afternoon, Bastion.

162. I'm Dr. Andrews.

163. Good afternoon, Bastion. This is Dr. Andrews.

164. Hello, Dr. Andrews.

165. Hola!

166. What is that? Let me see.

167. Oh.

168. That looks like Yadi Molina.

169. Yes! It's Yadi Molina. St. Louis Cardinals.

170. Mm-hmm.

171. So, are you a better hitter or catcher?

172. He has a hepatic adenoma

173. in the right lobe of his liver.

174. Does not appear cancerous.

175. No. For now.

176. The lesion is localized, well-circumscribed,

177. and not close to portal vein branches.

178. There's a tumor in Adelmo's liver, but it's not cancer.

179. The doctor believes they can remove it.

180. He's a good candidate.

181. Thank you.

182. Cheers!

183. I can continue like this for a long time.

184. But you have a strange accent.

185. It's not from Guatemala, or Mexican.

186. Did you spend some time in Venezuela?

187. In the library where I grew up,

188. they had some tapes named,

189. "Speak Spanish like a Spaniard."

190. I listened to them every night until they broke.

191. Thank you. I thought you put this kid in the "no" pile.

192. I decided to take a closer look.

193. See where the mass is thinning the orbital floor

194. and extending up near the skull base?

195. But that's exactly what you can't do.

196. Reconsider? Weigh issues?

197. Let emotional and personal attachment

198. influence treatment decisions.

199. Chicharrones?

200. There's no beveling or erosions.

201. I can stay extracranial

202. and create a bony plane to resect the superior tumor.

203. Did that sound too emotional?

204. Even if you stay out of the brain,

205. two major arteries are involved. He could bleed out.

206. Can I get one of those, please?

207. Gracias.

208. Apply it twice a day, for ten days.

209. Thank you, Dr. Shaun Murphy. Thank you.

210. You're welcome.

211. My chest hurts, and so does my arm.

212. And sometimes, my hand feels cold,

213. or it's as if I wasn't able to feel it at all.

214. It could be angina or a blockage,

215. which requires bypass surgery.

216. We should do an EKG before he goes to the cath lab…

217. You don't have a cath lab.

218. Stretch out your arm, please.

219. Turn your head to the side.

220. Feel his pulse.

221. There isn't one.

222. Turn your head forward.

223. His pulse is back.

224. It's not a cardiac problem.

225. He has thoracic outlet syndrome.

226. Dr. Saravia has just showed me that the nerves and arteries

227. in your neck and chest are being compressed by your ribs.

228. It's a very rare condition,

229. that may cause blood clots or an embolism…

230. He doesn't seem happy.

231. Did I translate wrong?

232. No. Your Spanish is perfect.

233. But you left out that his problem can be fixed.

234. It can be remedied.

235. Oh, okay.

236. Okay.

237. I am not good at communication.

238. In two languages.

239. The nurse should come momentarily.

240. The translator should be here soon. Um…

241. If you want, I can translate.

242. - You can speak English? - We lived in the U.S. for a few years.

243. Uh, my mother cleaned houses.

244. I watched Grey's Anatomy.

245. Oh.

246. Well, being a surgeon is not much like that.

247. Ms. Garza, can you show me where you feel pain?

248. Show them where it hurts you, Mom.

249. Here.

250. And do you have indigestion or cramping

251. or ever feel like you might throw up?

252. She wants to know if you have indigestion or cramping.

253. Do you feel like you might throw up?

254. Sometimes.

255. "Sometimes."

256. But she's lying. It's always.

257. She has fevers, too, and throws up.

258. I need to feel your abdomen. Can you lie on the bed for me?

259. She has to feel your stomach, Mom. Lie down.

260. Okay.

261. Ms. Garza, I think you have gallstones.

262. We will have to run some tests,

263. but it is likely that you will need surgery.

264. Mom, the doctor believes you have gallstones.

265. They need to do a test to be sure,

266. but you need surgery.

267. No, no. Not surgery.

268. I came here for medicine.

269. You told me they were gonna give me medicine.

270. Don't be stubborn. Do what the doctor says.

271. If she doesn't want surgery, why is she here?

272. I told her you would have pills that would help her.

273. I told her I wouldn't eat until she came.

274. I have to work.

275. I need to take care of you.

276. She says she can't miss work.

277. She needs to take care of me.

278. I-I need you to translate accurately.

279. My mother was very sick, too.

280. Her mother also was very sick.

281. And she tried to hide her pain,

282. but children know when people are suffering, especially their mothers.

283. She tried to hide her pain,

284. but kids know when people are suffering.

285. Especially when it's their mother.

286. You can't take care of your daughter

287. if you do not take care of yourself.

288. You can't take care of your daughter

289. if you don't take care of yourself.

290. Did you review Bastion's file?

291. Doing a bifrontal trepanation

292. and reconstructing the skull base

293. could prevent brain herniation.

294. What about risk of CSF leak?

295. It reduces with a multilayer duraplasty using a pericranial flap.

296. I say five sentences to a patient.

297. You say five words. A nurse wanted me to give this to you.

298. Because medical jargon does nothing but scare them and waste our time.

299. All they care about is, can we help…

300. Yes or no?

301. Your son's heart valves are damaged.

302. Your son's heart valves are damaged.

303. It's probably the result of his rheumatic fever last year.

304. Probably as a result

305. of the rheumatic fever he had last year.

306. Because of his heart,

307. we can't remove his liver tumor.

308. I-It makes the surgery too risky.

309. I'm very sorry.

310. Due to his heart, we can't remove the tumor in his liver

311. because it makes the surgery very risky.

312. We are very sorry.

313. Thank you, Doctor.

314. Uh, no, I'm sorry.

315. W-We can't do the operation on your son.

316. He… I'm not sure he…

317. But you tried.

318. Thank you for trying.

319. God bless you.

320. Everything's gonna be okay.

321. Don't worry.

322. Leon Castillo.

323. Twenty-two-year-old male.

324. Large, non-reducible umbilical hernia.

325. He's the sole provider for his siblings…

326. No personal details. They're irrelevant.

327. Two children's survival depends on his.

328. Seems relevant to me.

329. Decisions need to be based on medical data alone.

330. This can't turn into a contest of whose life is more tragic.

331. There would be too many winners.

332. Without surgery,

333. the hernia's at a very high risk for strangulation.

334. It's a fast, simple procedure,

335. and he will almost certainly have a full recovery.

336. From a surgery he could survive another 15 years without.

337. Replacing the valve with a bioprosthetic

338. means he won't need to be on blood thinners forever.

339. But he'll need follow-up surgeries to replace the replacement.

340. Well, this guy's an athlete, a football star.

341. Is that relevant?

342. Yes, because his underlying cardiac health is excellent.

343. He should make a full recovery.

344. Unfortunately, his dental health isn't.

345. He has cavities, which puts him at high risk for endocarditis,

346. which would contribute to valve deterioration.

347. A total abdominal colectomy

348. offers her an 80% to 90% chance at full recovery.

349. Otherwise healthy, no complicating factors.

350. The tumor could be removed using ultrasound-guided surgery.

351. But she has no access to post-op chemo and radiation.

352. The mass is round, localized.

353. No signs of infiltration in the adjacent structures.

354. Minimal chance of recurrence.

355. If you get all of it.

356. She just got married last week…

357. Dr. Reznick.

358. …which is medically relevant, because studies have shown

359. optimistic people have better long-term prognosis.

360. And she is full of hope.

361. Uh, there's a boy.

362. He needs blankets. Uh…

363. - Blankets, please? - There.

364. Thank you.

365. The gallstones are intermittently blocking the bile duct,

366. which could lead to ascending cholangitis, sepsis, and death.

367. Her condition might respond to medication.

368. No, it's unlikely given how advanced her symptoms are.

369. But she has a non-surgical option.

370. Bastion doesn't.

371. It's a miracle he made it to 12.

372. Without surgery, he will not see 15.

373. He's unable to eat solid foods.

374. He's already showing signs of malnutrition.

375. Shaun's surgical plan is very ambitious.

376. It runs the risk of graft failure and necrosis.

377. You could leave this boy worse off.

378. Meanwhile, Edna's surgery is straightforward,

379. and she is all her daughter has in the world.

380. Who a person is cannot be completely separated from their medical care.

381. And I'm done pretending it can be.

382. We've got a mom who needs a simple procedure she might live without…

383. Or a son whose only shot at life is a very complicated surgery

384. that may not work.

385. We have to focus on the miracles.

386. Let's go eat.

387. Okay, so, look at the nail bed.

388. Karla said if you see alternating redness

389. with the pulse, that's a sign of aortic insufficiency.

390. So, your heart is fine, and your cuticles are great.

391. I get manicures.

392. Ah, you like?

393. It's a national treasure.

394. No. I just wanted the experience.

395. I shouldn't have any more. First day of surgery tomorrow.

396. - Oh, no, I'm good. - Mm.

397. - Ah.

398. You are terrible at this!

399. I am terrible, but I look fantastic.

400. Watch this.

401. - I'll get us another round.

402. Okay.

403. Tequila, two, please.

404. Mm.

405. What's going on over there?

406. Uh, I'm getting my ass kicked in darts.

407. You're flirting.

408. Just being nice.

409. Well, don't be so nice that you regret it when you get home.

410. You have nothing to worry about.

411. I guarantee it.

412. All right, I'm gonna grab a cab back to the hotel.

413. Okay.

414. Up, down, to the center and to the belly.

415. Good night, guys.

416. Uh, Hotel Provincia?

417. Yeah.

418. Mind if I tag along?

419. - Big day tomorrow. - Sure.

420. I saw you break the news to that boy's dad.

421. You want to talk about it?

422. Morgan.

423. I just wanted to know if you're okay.

424. You don't get to ask me that anymore. We're not friends.

425. You drew a line.

426. So don't ask me how I am and then pretend to be some nice guy who cares,

427. when you obviously don't.

428. I-I just got a text from Karla.

429. Miguel is crashing.

430. Shaun and I are gonna head back to the hospital.

431. Eight?

432. I'm only fluent in six.

433. I didn't set out to learn them.

434. I just picked them up as I moved around.

435. Oh, so you're an accidental language genius?

436. So, what are some of these places,

437. I mean, that you moved around to?

438. Uh, I was born in Mexico.

439. Went to medical school in New Haven.

440. Did my residency in Chicago.

441. Stayed a while in Syria, Haiti, the Congo.

442. You throw in your stop at Yale to impress me?

443. I threw in my stop at the Congo to impress you.

444. Hey, this is not the way to the Provincia Hotel.

445. Where are you taking us?

446. We're gonna make a stop.

447. Do you want money?

448. I don't need your money.

449. What's happening?

450. Don't be too alarmed, but we're being kidnapped.

451. Come in, please! Hurry!

452. This is my niece.

453. She's been in labor for 14 hours.

454. 14 hours like this.

455. Uh, hello. I'm a doctor.

456. Can you handle the additional talking?

457. We're here to help you and your baby.

458. - We're going to examine you. - It hurts so bad!

459. Yes, here we go.

460. Well, the baby's head is down, so position's not a problem.

461. I can't hear anything.

462. The cab driver, he had a-a-a cup of coffee in his cab.

463. Have him get it.

464. Um, a cup of coffee from the taxi… Go get it quickly!

465. Please tell her I have to check her cervix.

466. The doctor will check your cervix.

467. Okay, yes, that's fine.

468. She's fully dilated.

469. Okay, tear out the bottom, hand it to me.

470. I can hear a heartbeat.

471. The baby has decels.

472. Oh, no, no! Don't push!

473. Don't push!

474. He became short of breath and then lost consciousness.

475. I believe his thoracic outlet syndrome

476. caused a clot in his arm, which went into his lungs.

477. That would explain the drop in blood pressure and respiratory rate.

478. But not his elevated end tidal CO2 level.

479. That is inconsistent with a pulmonary embolism.

480. What is it consistent with, Shaun?

481. His brain. A clot that traveled from his arm

482. through a hole in his heart into his aorta and up to his brain.

483. His gag reflex is only active on one side.

484. I was right. He has a small clot in the brain stem

485. near the respiratory center.

486. Well, we can surgically remove a clot in his lung, but in his brain…

487. We can't do that here.

488. If we have TPA, we could break it up.

489. TPA? No.

490. But we have a snake venom derivative.

491. I-It does the same thing, more or less.

492. - Any movement at all? - None.

493. No cord presentation.

494. - Maybe her pelvis is too narrow? - The heart rate's getting slower.

495. - Wait, wait, wait.

496. I can feel a hand by the face.

497. The baby's sucking its thumb.

498. That's why it's not progressing.

499. I can do an episiotomy, try to pull the baby out,

500. but with the arm where it's at, I'm probably gonna

501. break the clavicle and damage the brachial plexus nerve.

502. Reach inside

503. find the baby's finger, and pinch it hard.

504. It worked.

505. Okay, dear, now we are going to push, okay?

506. - Push. - Push.

507. I'm sorry…

508. Um…

509. Do you speak English?

510. No. I don't speak English.

511. My name is Lea…

512. I'm with the Americans.

513. Mm.

514. I'm Sofia.

515. He is my husband, Oscar.

516. And she is Isabela.

517. Isabela.

518. She is perfecta.

519. Um…

520. I found these in my suitcase.

521. My mom got them for…

522. It gets cold in here.

523. A gift for Isabela.

524. Thank you.

525. Would you like to hold her?

526. Uh…

527. No, gracias.

528. Uh, I have to go.

529. Congratulations, Mom.

530. What a good-looking boy!

531. Shaun's keeping an eye on Miguel.

532. Okay.

533. You know, it's okay to not be okay.

534. I j…

535. Every time I feel like things are getting better…

536. it's there again.

537. Yeah, I know.

538. Like it comes in waves.

539. Eventually, it subsides.

540. It's a process.

541. It's a terrible process.

542. And it's one you don't have to go through alone.

543. Shaun has no idea, does he?

544. No.

545. He's doing great, important work.

546. I don't want to interfere with that.

547. And…

548. He can't fix it.

549. It's not about fixing it.

550. It's about the two of you just being in this together.

551. He's waking up.

552. What happened?

553. You had an embolism,

554. but we were able to give you treatment.

555. Can I still have the operation tomorrow?

556. No, I'm afraid not.

557. Tiziana?

558. Tiziana, wake up.

559. Hey, I need you to tell your mother something.

560. We're gonna do her surgery.

561. Mom, Mom, they're going to do your operation!

562. You told me that I could die without that surgery.

563. Thank you!

564. You're welcome.

565. That was…

566. It was.

567. Good night, Audrey Lim.

568. You know…

569. I'm not really tired.

570. Me either.

571. Tomorrow, I will be removing an adenocarcinoma

572. from a young woman's mediastinum.

573. That can be a very dangerous area

574. because of the vasculature.

575. It will be an excellent challenge.

576. Are you coming to bed?

577. I would like to turn off the light.

578. I don't want to ruin your trip.

579. You're having such a good time.

580. But…

581. I'm not.

582. W-What's wrong? Are you sick?

583. Did you open your mouth in the shower?

584. That is very common.

585. I'm just…

586. sad.

587. Every time something reminds me of the baby, I get even sadder.

588. I'm glad you're doing better than I am.

589. I'm glad you're happy, but…

590. Sometimes, you being happy makes me feel worse.

591. I hate that I feel that way, and I didn't even want to tell you,

592. but I think I need to tell you.

593. I'm sorry.

594. Do you want me to not talk about work?

595. No. I can't ask you to do that.

596. Yes, you can.

597. I want you to feel better.

598. It won't help, Shaun.

599. What will help?

600. Nothing.

601. I miss her so much.

602. I mean, even looking at your blue eyes breaks my heart,

603. because I dreamed she would have them.

604. My parents are really worried,

605. been calling all the time.

606. They want me to come back to Hershey for a while.

607. They think it'll help.

608. Do you…

609. want to?

610. I think it would be good for me to get some time away.

611. From everything.

612. I'm sorry you're sad.