The Good Doctor (2017–…): Season 4, Episode 19 - Venga - full transcript

During part one of the two-part season finale, the St. Bonaventure team travels to Guatemala on a surgical mission to help patients at a rural hospital. Once there, the team faces a small community that is in desperate need of their help but are assigned the daunting task of identifying who they can help most. And while Shaun seems to be thriving in Guatemala, Lea is still struggling with the loss of her baby.

Could you pop the trunk?

We made good time.

Thank goodness. Or else we
wouldn't have the full three hours

- to wait before our flight.
- Great.

All right. Thanks.

All right.

Starbucks is on me.

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

Hey, Dr. Reznick.

I thought this was
a surgical mission.

We're gonna bring
in some support.

Morgan's gonna help with
patient selection and aftercare.

Oh. That's great.

Ten days, huh?

- Can't have you forgetting me.
- I'll be back before you know it.

Tickets, passports,

travel wallet containing
quetzales and American currency.

- You've got them.
- I know because I checked.

- You all right?
- Oh, it's not that heavy. I got it.

That's not what I meant.

I'm okay. I think
this trip will be good.

Change things up, focus
on helping other people.

For whatever it's worth, if you ever
need to talk, you can always call me.

- I'm not gonna do that.
- I know.

We will not have
any time to shop,

but would you or Debbie
like anything from Duty Free?

Guatemala is known for its rum.

We're okay. Thanks.


- You're on this trip too?
- Yeah. I got inspired last night,

decided to take some
personal days, go help out.

And you're bringing
a toilet seat?

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

The airline will find your bag.

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

Would you like some vitamin
B12 to help with exhaustion

or a motion-sickness wristband?

I have an extra.

No, thanks.

I'm glad we're here.


After all the loss this year,

it's just such an amazing way

to be reminded what
we have to be grateful for.


Excuse me, sir. Could you
move your flock of sheep.

My sheep don't like to
be hurried. Be patient.

These people are our guests.

Well, I didn't invite them.

Yes, we are doctors.

It has been a long journey
and we need to get to our hotel.

A doctor?

You are a doctor?


It's a fungus.

It's a fungus.

It's a fungus.

- Thank you.
- My pleasure.

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

Hola, I'm Dr. Mateo Rendon.

Dr. Saravia and her team

have spent several
months gathering cases.

From those, we selected 40,
you're going to want to save them all.

You will not.

We will perform 12 operations.

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

- If we can add more cases...
- Before I heard you joined,

we were doing ten surgeries.

My organization has
spent years building trust.

We save 12 people here,

that trust grows, more
patients come to us,

more doctors volunteer.
But if we lose a patient...

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

Surgeries that don't
need a lot of aftercare.

Twelve patients, one alternate.

Everyone else gets sent home,

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

Oh, sorry. May you
tell me what this says?

Your closest relative.

Well, none. Just Ignacio,
he's my only family.

He Says his dog. Iggy.

Ugly dog.

Roberto Kantun Diaz.

Andrea Torres Tzul.

Aimé Navarro Gomez.

Aimé Navarro Gomez?

Here! Here!

We need to do an abdominal
exam and ultrasound

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

Please remove your
bandage and lie back.

Since when do you have that?

He's had it for a
year. Maybe longer.

He was told to go to the hospital,
but he couldn't afford the trip

or to miss work. He's the
sole provider for his siblings.

Their parents
died two years ago.

She has a large patent
ductus arteriosus.

I have only seen this
condition in infants.

The blood is reversed.

It's flowing the wrong way.

We could try going
through the femoral vein,

do a percutaneous
device closure.

She has irreversible
pulmonary hypertension.

It would have been
simple to treat as an infant,

but now closing the hole will...

kill her.

Her condition has
progressed for quite some time.

There's nothing we can do.

I'm sorry.

No. No.

I'm sorry.

No. No.

No. No.

- Tissue?
- Ah.

I stock up before
the Americans come.

And the French, they are
surprisingly sensitive people.

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

Never apologize for being human.

I have a strict
policy against it.

This week, you are
not just doing surgery,

you are doing miracles.

You are giving people
hope who had none.

Except for the ones
that we send home to die.

Focus on the miracles,

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

And I will have to
get more tissues.

Thank you.

Bastion Alonso Ramos,
12-year-old baseball fan,

roots for the St.
Louis Cardinals.

Also, he has an ameloblastoma.

Not a lot of baseball
fans in Guatemala.

You've been here before? Or
do you enjoy reading Wikipedia?

I did a medical mission
here during my residency.

Oh, that explains
"Dr. Toilet Seat."

You already have a nickname.

Good afternoon, Bastion.

I'm Dr. Andrews.

Hi, Dr. Andrews.


What is that? Let me see.

That looks like Yadier Molina.

Yes. Yadier Molina.
St. Louis Cardinals.


So are you a better
hitter or catcher?

He has a hepatic adenoma
in the right lobe of his liver.

- Does not appear cancerous.
- No, for now.

The lesion is localized,

well-circumscribed and not
close to portal vein branches.

There's a tumor found
in Adelmo's kidney,

but it's not cancerous.

The doctor believes
he can extract it.

He's a good candidate.

Thank you.

- Cheers!
- Cheers!

I can continue like
this for a long time.

But you have a weird accent,
it's not from Guatemala or Mexico.

Did you spend some
time in Venezuela?

In the library where I grew up
in, there were some films called:

"Speak Spanish Like A Spaniard."

I used to listen to
them every night.

Until they broke.

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

Decided to take a
closer look at the images.

See where the mass is
thinning the orbital floor

and extending up
near the skull base?

- But that's exactly what you can't do.
- Reconsider? Weigh issues?

Let emotion and personal attachment
influence treatment decisions.


There's no beveling or erosions.

I can stay extracranial and create a
bony plane to resect the superior tumor.

Did that sound too emotional?

Even if you stay out of the brain,
two major arteries are involved.

He could bleed out.

Can I get one of those?

Thank you.

Take them twice a day

for 10 days.

Thank you, Dr. Shaun
Murphy. Thank you.

You're welcome.

My chest hurts,
as well as my arm,

and I sometimes feel my
hand cold or completely numb.

It could be angina or a blockage,
which requires bypass surgery.

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

You don't have a cath lab.

Strech your arm, please.

Turn your head to the side.

Feel his pulse.

There isn't one.

Turn your head forward.

His pulse is back.

It's not a cardiac problem.

He has thoracic outlet syndrome.

Dr. Saravia has
demonstrated that your nerves

and arteries in your neck and chest
are being compacted by your ribs.

It's an unusual condition
that can cause you

to have blood cots

or an embolism.

He doesn't seem happy.

Did I translate wrong?

No. Your Spanish is perfect.

But you left out that
his problem can be fixed.

It has a cure.

Oh, okay.


I am not good at
communication in two languages.

A nurse


will come in a minute.

The translator
should be here soon.

- If you want, I can translate.
- You can speak English.

We lived in the
U.S. for a few years.

My mother cleaned houses.
I watch Grey's Anatomy.

Well, being a surgeon
is not much like that.

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


And do you have
indigestion or cramping?

Or ever feel like
you might throw up?


Sometimes. But she's lying.

It's always.

She has fevers
too and throws up.

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


Ms. Garza, I think
you have gallstones.

We will have to run some tests,

but it is likely that
you will need surgery.

No, no, no surgery.

I came here for pills.

You told me they were.

Listen to the doctor.

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

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

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

She says she can't miss work.
She needs to take care of me.

I... I need you to
translate accurately.

My mother was very sick too.

And she tried to hide her pain,

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

You can't take care of your daughter
if you do not take care of yourself.

Did you review Bastion's file?

Doing a bifrontal trepanation
and reconstructing the skull base

could prevent brain herniation.

What about risk of CSF leak?

It reduces with a multilayer
duraplasty using a pericranial flap.

I say five sentences to a
patient, you say five words.

A nurse wanted me
to give this to you.

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

All they care about is,
can we help, yes or no?

Your son's heart
valves are damaged.

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

Because of his heart, we
can't remove his liver tumor.

It makes the surgery too risky.

I'm very sorry.

Thank you, doctor.

No, I'm sorry.

We can't do the
operation on your son.

He... I'm not sure he...

Thank you for
trying. God bless you.

León Castillo. 22-year old male,
large non-reducible umbilical hernia.

- He's the sole provider for his siblings...
- No personal details. They're irrelevant.

Two children's survival depends
on his. Seems relevant to me.

Decisions need to be
based on medical data alone.

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

There would be too many winners.

Without surgery,

the hernia is at a very
high risk for strangulation.

It's a fast, simple procedure.

He'll almost certainly
have a full recovery...

From a surgery he could
survive another 15 years without.

Replacing the valve with
a bioprosthetic means

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

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

This guy is an
athlete, a fútbol star...

Is that relevant?

Yes, because his underlying
cardiac health is excellent.

He should make a full recovery.

Unfortunately, his dental
health isn't. He has cavities,

which puts him at high
risk for endocarditis,

which would contribute
to valve deterioration.

A total abdominal colectomy offers
her an 80 to 90% chance at full recovery.

Otherwise healthy.
No complicating factors.

The tumor could be removed
using ultrasound-guided surgery.

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

The mass is round, localized,

no signs of infiltration in
the adjacent structures.

- Minimal chance of reoccurrence.
- If you get all of it.

- She just got married last week...
- Dr. Reznick...

Which is medically relevant
because studies have shown

optimistic people have
better long-term prognosis.

And she is full of hope.

There's a boy,
he needs blankets.

Blankets, please.

Over there.

Thank you.

The gallstones are intermittently
blocking the bile duct,

which could lead to
ascending cholangitis,

sepsis and death.

Her condition might
respond to medication.

Unlikely, given how
advanced her symptoms are.

But she has a non-surgical
option. Bastion doesn't.

It's a miracle he made it to 12.
Without surgery, he will not see 15.

He's unable to eat solid foods,
he's showing signs of malnutrition.

Shaun's surgical
plan is very ambitious.

It runs the risk of
graft failure necrosis.

You could leave
this boy worse off.

Meanwhile, Edna's
surgery is straightforward,

and she is all her
daughter has in the world.

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

and I'm done
pretending it can be.

We've got a mom who
needs a simple procedure

she might live without...

or a son whose only shot at
life is a very complicated surgery

that may not work.

We have to focus
on the miracles.

Let's go eat.

Okay, so look at the nail bed.

Karla said if you see alternating
redness with the pulse,

that's a sign of
aortic insufficiency.

Well, your heart is fine.
And your cuticles are great.

I get manicures.

Ah. You like? It's
a national treasure.

No. I just wanted
the experience.

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

Oh, no. I'm good.

You are terrible at this.

I am terrible, but I look
fantastic. Watch this.

- I'll get us another round.
- Okay.

- Tequila.
- Mmm.

What's going on over there?

- I'm getting my ass kicked in darts.
- You're flirting.

Just being nice.

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

You have nothing to worry about.

I guarantee it.

All right. I'll grab a
cab back to the hotel.


Good night, guys.


- Hotel Provincia?
- Yeah.

Mind if I tag along?
Big day tomorrow.


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

You wanna talk about it?


I just wanted to
know if you're okay.

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

You drew a line.

So don't ask me how I am

and then pretend to be some nice
guy who cares when you obviously don't.

I just got a text from
Karla. Miguel is crashing.

Shaun and I are gonna
head back to the hospital.

- Eight?
- I'm only fluent in six.

I didn't set out to learn them. I just
picked them up as I moved around.

Oh, so you're an
accidental language genius?

So, what are some of these places?
I mean, that you moved around to.

I was born in Mexico, went to
medical school in New Haven,

did my residency in Chicago.

Stayed a while in
Syria, Haiti, the Congo.

You throw in your stop
at Yale to impress me?

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

This is not the road to Hotel
Provincia. Where you taking us?

We are going to make a stop.

Do you want money?

I don't need your money.

What's happening?

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

Come in, please. Hurry!

She is my niece.

She's been in
labor for 14 hours.

Fourteen hours like this.

Hi, I'm a doctor.

Can you handle the
additional talking?

We came to help you and your
baby, OK? We'll check you up.

- OK.
- It hurts a lot.

Here we go.

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

I can't hear anything.

The cab driver, he had a cup of
coffee in his cab. Have him get it.

A cup of coffee in
the cab, bring it, now.

Tell her I have to
check her cervix.

The doctor will touch you.


She's fully dilated.

All right, tear out the
bottom, hand it to me.

I can hear a heartbeat.

The baby has decels.

No, no, no. Don't push!

He became short of breath
and then lost consciousness.

I believe his thoracic outlet
syndrome caused a clot in his arm

which went into his lungs.

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

But not his elevated
end-tidal CO2 level.

That is inconsistent with
a pulmonary embolism.

What is it consistent
with, Shaun?

His brain. A clot that traveled from
his arm through a hole in his heart

into his aorta and
up to his brain.

His gag reflex is only
active on one side.

I was right.

He has a small clot in the brain
stem, near the respiratory center.

Well, we can surgically
remove a clot in his lung.

But in his brain, we
can't do that here.

If we have tPA, we
could break it up.

TPA, no.

But we have a snake
venom derivative.

It does the same
thing, more or less.

Any movement at all?

None. No cord presentation.

- Maybe her pelvis is too narrow.
- Heart rate's getting slower.

Wait. I can feel a
hand by the face.

The baby's sucking its thumb.
That's why it's not progressing.

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

but with the arm where it's
at, I'm gonna break the clavicle

and damage the
brachial plexus nerve.

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

It worked.

OK, honey.

Now you will push.

- Push.
- Push.

I'm sorry.

Do you speak English?

No, no, I don't speak English.

Me llamo Lea. I'm
with the Americans.

Hmm. I'm Sofia.

He is my husband, Oscar.

And she...

is Isabela.


She is perfecta.


I found these in my suitcase.

My mom got them for...

It gets cold in here.
A gift for Isabela.


Would you like to carry her?

No, gracias. I have to go.

Congratulations, Mom.

What a beautiful son.

Shaun's keeping
an eye on Miguel.


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


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

it's there again.

Yeah, I know.

Like it comes in waves.


Eventually, it subsides.

It's a process.

It's a terrible process.

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

Shaun has no idea, does he?


He's doing great, important work.
I don't wanna interfere with that.


he can't fix it.

It's not about fixing it.

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

He's waking up.


What happened?

You had an embolism, but
we were able to treat you.

Will I still be able to get
the surgery tomorrow?

No, you will not.

Tiziana. Tiziana, wake up.

Hey, I need you to tell
your mother something.

We're gonna do her surgery.

Mom, you will get the surgery.

♪ And when you wake up ♪

I could die without
that surgery.

♪ We've got the time
To take the world ♪

Thank you.

You're welcome.

♪ And make it better
than it ever was ♪

That was...

It was.

Buenas noches, Audrey Lim.

You know...

I'm not really tired.

Me either.

Tomorrow, I will be
removing an adenocarcinoma

from a young
woman's mediastinum.

That can be a very dangerous
area because of the vasculature.

It will be an
excellent challenge.

Are you coming to bed? I
would like to turn off the light.

I don't wanna ruin your trip.

You're having such a
good time, but... I'm not.

What's wrong? Are you sick?

Did you open your mouth in the
shower? That is very common.

I'm just sad.

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

I'm glad you're doing better
than I am, I'm glad you're happy.

But sometimes you being
happy makes me feel worse.

I hate that I feel that way and
I didn't even wanna tell you,

but I think I need to tell you.

I'm sorry.

Do you want me to
not talk about work?

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

Yes, you can. I want
you to feel better.

It won't help, Shaun.

What will help?


I miss her so much.

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

because I dreamed
she would have them.

My parents are really worried,
been calling all the time.

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

They think it'll help.

Do you...

want to?

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

I'm sorry you're sad.