The Good Doctor (2017–…): Season 4, Episode 20 - Vamos - full transcript

Dr. Shaun Murphy must perform a risky surgery on a patient without electricity when the power suddenly goes out at the hospital in Guatemala. Additionally, Dr. Lim and Dr. Mateo Rendón Osma's relationship deepens as they overcome difficulties during their surgery.

How are you feeling?

I want you to feel better.

So if going home might
make you feel better...

it's a good thing.

So like, "Come on."
How would you say that?

[speaks in Spanish]

[repeats in Spanish]

[in English] Is that right?


- What?
- You're smiling.

Oh, my God.



I approve, highly.

Bienvenidos to day one.

We are getting our feet wet
with the three easiest surgeries.

In OR 1, Dr. Rendon and
I have León Castillo, 23...

[monitor beeping]

[Andrews] Antibiotic flush.

[in Spanish] The incision is open.
Nurse Morales, I need a Kelly clamp.

[in Spanish] Here
you go, Dr. Murphy.

Okay, Dr. Murphy, I'll
guide you to the lesion.

[theme music playing]

[Karla in Spanish] No, no, no.
Everyone needs to work on that ASAP.

[in English] I'm so sorry. We get
blackouts in the mountains all the time.

- That's why we have a generator...
- Great.

- Which failed.
- You got a guess when it comes back?

Sorry, no.

Minutes? Hours?

We wait, we risk losing the
day, dropping three patients.

If I move my patient by the
window, I can debride the ulcer.

Go. Pray it stays clear out. I'll see
what I can do about a herniated bowel.

Can you resect a tumor
without ultrasound?

I will speak to Dr. Andrews
about a revised surgical plan.

[Lim] Okay. Go.

[in Spanish] Thank you very
much. [in English] Good luck.

Suction's out. Same
for the electrocautery.

- Wanna use your fingers?
- It would minimize blood loss.

We could remove the
lower lobe without ultrasound.

Maybe we should close
her up and do this tomorrow.

It would be fatal.

Not to her. To a patient down
the list that we'll have to drop.

[sighs] Maybe you're right.
We take the whole lower lobe.

[dramatic music playing]

No, I was not right.

I can locate the tumor
without ultrasound.

[in Spanish] Her
oxygen is very low.

Oxygen. Low.

Her oxygen is low.

I'm so sorry.

[in Spanish] Where is Oscar?

He had to go home.

His mother is old and very sick.

[in English] He went
home. [speaking in Spanish]


[in English] Stay. Please.

[Mateo] I can feel pulsations
of an underlying vessel.

[Lim] Must be the artery.

Feel your way under and make
the dissection plane deeper.

[Mateo] I can feel the bowel.

Sac is free.

- You're getting close to a fissure.
- I am.

The tissue is
becoming less pliable.

A laceration there
would be devastating.

We could wait a few more
minutes to see if the lights come on.

I don't think we should.

I feel something gravel-like
at the tip of my pickups.

I think that's the
surface of the tumor.

I'm there.

Nice work, Murphy.

We have a clean
path to the tumor.

Let's get it out.

[power restoring]

I guess we could have waited.

[monitor beeping]

How do you speak
English so well?

I'm American.

Born in Mexico, but my
mom is an L.A. Chicana.

I went to high school
in Santa Monica.

I just fake the accent
for sexiness purposes.

[alarm chiming]

So when's the last
time you were back?

Are we getting to know each
other? I thought this was just a fling.

Mm. So we can chat about
what schools you went to

and where you worked in Africa,
but old vacations are a bridge too far?

Ten years. Happy?

Quite, in fact.

I have to go for a run.

- Now?
- You're clearly not a runner.

I promise to be muy
rapido, like a poof,

and it's gone, a fleeting
but joyous memory.

Oh, I can feel that
accent-generated sexiness

just vanishing by the second.

Rapido, but perfectly paced.

I'm gonna hold
you to both of those.

Well, the truth is, I
will not be muy rapido.


[in Spanish] Will it hurt a lot?

He wants to know if it'll hurt.

Oh, no, no, no.

We'll be giving you some meds

and you'll have very little
pain after the operation.

[speaking in Spanish]

And before the operation,

we will give you something
that will help you sleep

and when you wake up,
your Mom will be here.

[in Spanish] Yes.

[in English] He didn't realize he was
gonna be asleep during the surgery.

Nurse Morales. How would one say,
"You, in addition to being very efficient,

turn out to be very
perceptive as well."

[speaking in Spanish]

I feel like you may have
added a few adjectives.

[in English] Well, the truth is,
I'm not always so perceptive.

For example...

I was almost sure
you were coqueteando.

Flirting with me.

But if you were,

I'm sure you would have
taken off your wedding ring.

- You know, it's okay to be nervous.
- I'm not.

You should be proud.

You did a remarkable thing,
convincing her to come here.

You probably saved her life.

I'm just gonna sit
here for a little while

in case there's something
that you wanna tell me.

Because of me,
my mother will live.

But someone else...

I prayed that she
would get the operation.

But she only did
because Miguel...

the guy with the dog...

Because he got sick.

You know, you're a good person.

And sometimes that's hard
because you feel things that you...

You don't deserve to feel.

But sometimes...

being good is fun.

Come on.

I've freed the tumor from
the paranasal sinuses.

[monitor beeping]

Periosteal dissector.

It's invading the orbital floor.

Curved osteotome.

And the ethmoid
and sphenoid too.

We're gonna have to
remove multiple bones.

Does the hospital have
titanium mini-plates and mesh?

Nothing that would work here.

Could we just cover
the hard palate?

No. We'd give him a
few years of constant pain

and he'd still wind up
with a fistula that kills him.

Is there a private hospital,
specialist, something?

I have a friend
from nursing school.

She works for a dental surgeon who
fixes all the rich people in this area.

I can be there and
back in an hour.

Keep him stable. Okay?

Thank you!

I was not fair before
when I was teasing.

You were very
fair, I was flirting.

And how would your wife feel?

Well, she'd be fine with it.

I have heard men
say that to me before.

Well, she told me a few days
ago that she's moving out.

And, uh...

Well, she's seeing someone.

So I'm down here
clearing my head,

deciding if I wanna try to
make the marriage work.

By flirting?

I guess I just wanted to
feel wanted. To feel good.

It was selfish. I'm sorry it
made you feel uncomfortable.

It didn't.

And I think you do wanna
make your marriage work.

- That's why you still wear your ring.
- [engine starting]

- [in Spanish] The deal was 20,000.
- [in Spanish] You said 4,000.

- I said 20,000.
- No.

It was 4,000. We had that deal.

The life of a boy
hangs on the line.

I'm sorry. I think there
was a misunderstanding.

[in English] He's telling us it
costs us 20,000 quetzales now.

- Do we have that?
- No.

- I can go to an ATM.
- No, no.

There's no automatic
cashier machine I can use.

This is my fault.

No. I shouldn't have come.

He sees an American doctor
and knows he can ask for more.

There's a hospital in
Quetzaltenango a few hours from here.

- Offer him this too.
- No.

No, no, no. You
don't have to do this.

Ana, it's just a ring.

[alarm beeping]

[in Spanish] Her
oxygen level is very low.

[in Spanish] Oh, my God.

The doctor will give her steroids in
order to help prevent lung inflammation.

We need a ventilator.

Ventilator. She has
to go on a ventilator?

[video call ringing]

- Hello.
- Hey, Shaun. How you doing?

I just finished my second
surgery and it went well,

and I am not doing well at all.


Lea is sad.

And I don't know how
to make her less sad.

Do you?

Well, I don't know if I'm the right
person to talk about this right now.

Why not?

I just don't think
that right now...

I've always loved that
you've asked me for advice.

And I always will.

But I've noticed the last while,

you've needed me less and less.

I don't know if you've
noticed, but it got me to thinking

about what Steve told you,
that you're the smart one.

You... You can do anything.

You're good at this.

Better than...

Better than you think.


[in Spanish] Does it look good?


[speaking in Spanish]

How did you end up in Guatemala?

Órale, you're just not
good at flings, are you?

You should be asking me
if I've read the Kama Sutra.

My favorite whipped cream.

It's a good job.

I get to coordinate these
missions, help some people.

So you're the workaholic,

hero type? Is that what drives you?

I also get to sometimes have
sex with American doctors.

You're only here for a week.

We don't need to bare
our souls to each other.

On the other hand, I'm only
here for a week, so why not?

You first. What are you hiding?

I'm not hiding anything.

Okay. I prefer a fresh local product,
but if you have lactose issues...

Wait. What did you ask me that?

Seriously. Why are we
having this conversation?

You think I'm being dishonest.
What do you think I'm hiding?

I don't know.

But between your
excessive need to exercise,

the alarms going off that you never
answer when you're around me,

and the nightmares that
you have every night...

You're hiding something.

Let's get ready for the day.

You ready to start?


There's three kinds of foreign
doctors who come down here.

The first, they care too much.

All the people they can't
save, it overwhelms them.

The second care too little,
and that has problems of its own.

And the third group, they find
a way to distance themselves

so they can do their job.

I better be in that group.

You're in your own group.

You care so deeply.

But that only gives
you more strength.

Thank you.

Well, let's go.

[Claire] Entering
the peritoneal cavity.

I need a long retractor.

[speaks in Spanish]

[in English] That's
not just gallstones.

There is an immobile,
irregularly shaped mass.

[Claire] She's got gallbladder cancer.
It's spread to the surface of the liver.

It will double the
duration of the surgery.

Triple. You're looking
at 12 hours at least.

- We'll need to swap with one of you.
- That's not possible.

Neither of us are prepped.

It would be endangering
two patients instead of one.

We can't just close her up.

Unfortunately, we can.

I'm sorry, but you've
never led anything like this.

I think we should
let her keep going.

- What's the worst that could happen?
- Beyond death?

This patient was gonna die anyway.
Claire gives her a fighting chance.


[in Spanish] What happened...

with the ventilator?

[in Spanish] They took it.
They needed it for the surgery.

The doctors needed it.

[in English] The
doctors needed it?

And where's the nurse?

[in Spanish] The nurse?

Busy, lots of work.

[in English] Okay.

I'll stay.

Stay aquí. No matter
how long it takes.

- [in Spanish] Is there a problem?
- [in Spanish] Yes, the patient came back.

[dramatic music playing]

León, the guy
with ventral hernia,

checked himself out last night
and went to work. In construction.

He reherniated? How bad?

About an inch of bowel is
incarcerated, probably ischemic.

He'll be dead in days
unless we operate on him.

Can you fit him in after
your skull reconstruction?

Not without big risks to both of
them. What about the other surgeons?

You think I'd be here if
anyone else was free?

Give him some morphine.

Until when?

It sucks, but it's his fault.
We told him he needed to rest.

This isn't some tech bro in San
Francisco waltzing out to party.

He needed to keep his job
and not watch his family starve.

If we operate on him, we
don't operate on someone else.

I'll operate on León.

I've been doing PT the last
year. It's been going great.

You really think you
can handle the surgery?

I know I can.

I think I can do it
without any pain.

We need to do a
cross-clamp resection.

Have you ever done one?

I've seen one when
I was an intern.

[monitor beeping]

Freeing up the vein.

[in Spanish]

Dividing the pedicles.

[speaking in Spanish]


Transecting the segments.

[speaking in Spanish]

Step two.

That doesn't look ideal.

It's a midline ventral defect.

Also, the tissue
planes are friable.

We're gonna need
component separation.

We cut the posterior
rectus sheath,

mobilizing soft tissue off of
the external oblique fascia...

and then incise it.

Common femoral artery's
almost completely occluded.

I'll prep the inflow
anastomosis site.

I have PTSD.

I have nightmares because of it.

I exercise to help me
manage my symptoms.

And the alarm on my
phone is to remind me

to take my daily cocktail of
fluoxetine, prazosin and quetiapine.

Can you tunnel the bypass
graft in the subcutaneous plane?

I'll get a clamp through.

I lost a good friend a year ago

and then lost more to COVID...

and then spent a lot of
time denying I had an issue.

Running from pain.

In the future, I'm hoping to
do more running toward things

than away from them.

I'm ready for the graft.

[in Spanish] Oh, it's my turn.

You're exhausted.
You should lie down.

[in English] No. No.

Ten minutes.

[speaking in Spanish]

I'm good.

I'll rest next.

[in Spanish]

Ten minutes.

[in Spanish] Thank you.

[Morgan gasps]

- If you need a break...
- I'm fine.

Just cramped a little.

[Alex] I'm done.

I can take over.

This ventral wall
defect is huge.


[Alex] Two Kocher clamps.

[monitor alarm beeping]

- Heart rate is spiking.
- BP's dropping. She's crashing.

Why? What happened?

I don't know.

Edna's bleeding out. At this
rate, she has minutes to live.

There was post-op blood
around the liver, nothing crazy.

The surgical drain also has
blood, no evidence of bile leak.

Okay, so the patient could have
GI bleed unrelated to surgery,

or a leak into the liver
from the hepatectomy.

Yes. Which one?

Mm. What's the surgical drain
output over the last half hour?

- If it's over 200 cc, the ans...
- It's 200 cc exactly.

- Oh.
- Yeah. I think it's the stomach.

The clotted blood in the NG
tube could be holding back a flood.

An intrahepatic bleed
is statistically more likely.

I still think it's the stomach.

But I came to you for
a reason, okay, thanks.


Neither of us
knows for sure, but...

you are good at this.

Better than you think.

[monitor alarm beeping]

BP's almost bottomed
out. What do we do?


You did good work.

I just had to close
and clean up.

The patient's in
recovery, doing well.

I need a friend.

I hadn't really given
up on being a surgeon.

PT was going great.

Almost no pain at all until...

It's all dumb, because...

I like being an
internist. I just...



Seriously? This is funny?

A little.

Never seen you vulnerable.

Your face gets kind of ugly.

Shut up.

You didn't fail.

You never fail.

For three years, I've
watched you kick ass.

At everything.

You inspire me.

And annoy me.

Small price to pay.

Your mom's gonna be all better.

[hopeful music playing]

[in Spanish] The lungs sound
fine without any retractions.

There's only one way to tell
if the steroids worked well.

[in English] Stop bagging.

Hopefully, she can
breathe on her own now.

[baby cooing]

[in Spanish] Bye.

[in English] No, no.

[speaking in Spanish]

[in English] We need to sleep.

[in Spanish] She
is still not finished.

She has to say goodbye.

[in Spanish] She said goodbye.

It's one of three phrases
she knows in Spanish.

I want her to hold my baby.

[in English] She wants
you to hold her baby.

[Lea] Oh.


She's so beautiful.

["El Invento" playing]


- [in Spanish] For me?
- Yes.

[in Spanish] Thank you.

I'm sorry I've been weird.

For a year.

I really do care about you.

I wish you and Heather the best.

Well, it's a bit late for that.

I broke up with Heather.

- When?
- Last night.

- No.
- Yeah.

Because you think you love me?

I do.

I think I love you too.

I committed a crime.

My first year of residency, I...

I was arrested
for pot possession.

The cops were jerks, I
argued with them, and...

it got physical.

When my court date
came around, I skipped.

And now there's an active
warrant out for me in the States.

That's why I haven't been back.

But what if I got a lawyer,
got this cleared up?

What if I was to start
running toward things?

Would you be interested
in a visitor in San Jose?

There's something
I want to ask you.

I think you should take the job.

Of course she wasn't gonna
poach you without asking me.

I can't speak the language.

I don't know anyone here.

I just started a
relationship with my father.

I'm not ready.

All legit concerns.

But what I didn't hear
was one single reason

you don't want to do this.

You've spent so many years
thinking your heart was a liability.

It made you care too much.

It hurt too much.

But maybe here...

maybe here, caring too
much is exactly what's needed.



This is about time.

You were far too
good for us, anyway.


Proud of you, Dr. Browne.

- Oh.
- Love you.

I'm never quite sure
what you're thinking.

Many things.

That I'm sad.

That this airport is the only one
I've been to without a Cinnabon.

That people need
to move forward.


I hope you're moving forward.

I think I am, Shaun.

What do we do now?

I don't know.

I've never hugged you, Claire.

[dramatic music playing]

I'm not going to Hershey.

Are you done being sad?


But... right now, I know
I won't be sad forever.

And I don't think I would
have gotten there without you.

I want to spend the
rest of my life with you.

I want to spend my
life with you too, Lea.

Will you marry me?

Of course. I love you.

I love you too.

["Hasta la Raíz" playing]

- We are getting married.
- Yeah.

We are getting married!

We are getting married!

Oh, yeah!

- Congratulations!
- Thank you.


Oh, yeah.

Okay. I have to tell Claire.


Yes. I'm ready.


Yes, doctor.


[in Spanish] Come on.

[closing theme playing]