The Good Doctor Season 4 Episode 19
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00:00You pop the trunk.
00:07Alright.
00:09We made a good time.
00:14Thank goodness, or else we wouldn't have the full three hours to wait before our flight.
00:18Great.
00:21Alright, thanks.
00:24Alright.
00:29Starbucks is on me.
00:30No kidding.
00:31And I'm getting a cake pop.
00:43Hey, Dr. Resnick.
00:48I thought this was a surgical mission.
00:50Bring in some support.
00:52Morgan's gonna help with patient selection and aftercare.
00:55Oh, that's great.
00:57Ten days, huh?
00:58Hmm.
01:07Can't have you forgetting me.
01:08I'll be back before you know it.
01:10Tickets, passports, travel wallet containing catalis and American currency.
01:24You've got them.
01:25I know, because I checked.
01:27You alright?
01:28Oh, it's not that heavy.
01:29I got it.
01:30That's not what I meant.
01:33I'm okay.
01:35I think this trip will be good.
01:38Change things up.
01:39Focus on helping other people.
01:41For whatever it's worth, if you have a need to talk, you can always call me.
01:48I'm not gonna do that.
01:49I know.
01:50We will not have any time to shop, but would you or Debbie like anything from Duty Free?
01:58Guatemala is known for its rum.
02:01We're okay, thanks.
02:02We're okay.
02:03Thanks.
02:04Okay.
02:12You're on this trip too?
02:14Yeah.
02:15Got inspired last night.
02:16Decided to take some personal days.
02:17Go help out.
02:18And you're bringing a toilet seat?
02:22Spoken like someone who's never been on one of these surgical missions.
02:52The airline will find your bag.
03:12We'll get you some clothes when we get situated.
03:17Would you like some vitamin B12 to help with exhaustion or emotion, sickness, wristband?
03:33I have an extra.
03:34No thanks.
03:38I'm glad we're here.
03:40Yes.
03:42After all the loss this year?
03:45It's just, it's such an amazing way to be reminded what we have to be grateful for.
03:51Aguas!
04:02Excuse me, sir.
04:03Or I can take care of your bathroom.
04:04The cows, don't like them to stop them.
04:06Have patience.
04:07These guys are our guests.
04:08Well, I didn't invite them.
04:10Yes.
04:11We're doctors.
04:12I really need to find out our hotel.
04:13The homenia?
04:14It's ahnummer.
04:15Yes.
04:16It's enough to take care of you.
04:17Is our haben?
04:18Oh yeah.
04:19Well, I believe so.
04:21Then that's what we're going to be saying, not a huge job on us.
04:22Usted es doctor.
04:23Claro que sÃ.
04:24Es un hongo.
04:25Es un hongo.
04:26It's a fungus.
04:52Gracias.
04:53Justo.
04:54Oh.
04:55Oh.
04:56Need help with that?
04:57No.
04:58That's a friend thing.
05:22No.
05:42Hola.
05:43I'm Dr. Mateo Rendon.
05:44Dr. Sarabi and her team have spent several months gathering cases.
05:48From those we selected 40, you're going to want to save them all?
05:51You will not.
05:52We will perform 12 operations.
05:54I'm Dr. Marcus Andrews, last-minute addition.
05:56If we could add more cases, I...
05:57Before I heard you join the trip, we were doing 10 surgeries.
06:00My organization has spent years building trust.
06:03We saved 12 people here.
06:05That trust grows.
06:06More patients come to us.
06:08More doctors volunteer.
06:10But if we lose a patient...
06:15We want surgeries we can do, but the locals couldn't.
06:18Surgeries that don't need a lot of aftercare.
06:2012 patients, one alternate.
06:23Everyone else gets sent home.
06:25No matter how sick they are, or how sad their story is.
06:29I don't know how bad their story is.
06:30I don't know how bad their story is.
06:32I don't know how bad their story is.
07:35He says he's a dog, Iggy, ugly dog.
07:44Roberto Cantan-Diaz.
07:47Andrea Torres-Tazul.
07:51Amy Navarro-Gomez.
07:55Amy Navarro-Gomez.
07:56We need to do an abdominal exam and ultrasound to see if there are any signs of obstruction or strangulation.
08:07Please remove your bandage and lie back.
08:09He's had it for a year, maybe longer.
08:26He was told to go to the hospital, but he couldn't afford the trip or to miss work.
08:40He's the sole provider for his siblings.
08:41Their parents died two years ago.
08:52She has a large piton ductus arteriosus.
08:57I've only seen this condition in infants.
09:00The blood is reversed.
09:02It's flowing the wrong way.
09:07We could try going through the femoral vein.
09:10Do a percutaneous device closure.
09:13She has irreversible pulmonary hypertension.
09:16It would have been simple to treat as an infant, but now closing the hole will kill her.
09:28The condition of Amy has progressed too much.
09:33There's nothing we can do.
09:36I'm sorry.
09:38No.
09:39I'm sorry.
09:42No.
09:44No.
09:46No.
09:47No.
09:48No.
09:48No.
09:48No.
10:03No.
10:07They stuck up before the Americans come.
10:10And the French, they are surprisingly sensitive people.
10:14I'm sorry, I know this isn't helping anyone.
10:17Never apologize for being human.
10:19I have a strict policy against it.
10:23This week, you are not just doing surgery.
10:26You are doing miracles.
10:28You are giving people hope who had none.
10:32Except for the ones that we send home to die.
10:37Focus on the miracles, or else you won't be able to help any of them.
10:40And I will have to get more tissues.
10:57Bastion Alonso Ramos, 12-year-old baseball fan, roots for the San Luis Cardinals.
11:02Also, he has an amaloblastoma.
11:05Not a lot of baseball fans in Guatemala.
11:07You've been here before, or do you enjoy reading Wikipedia?
11:11I did a medical mission here during my residency.
11:14Oh, that explains Dr. Toilet Seed.
11:18You already have a nickname.
11:23Good afternoon, Bastion.
11:24I'm Dr. Andrews.
11:29Buenas tardes, Bastion.
11:30Él es el Dr. Andrews.
11:32Hola, Dr. Andrews.
11:35Hola.
11:37What is that?
11:38Let me see.
11:42Oh.
11:44That looks like Yari Molina.
11:46Yes, Yari Molina.
11:48St. Luis Cardinals.
11:50Mm-hmm.
11:50So are you a better hitter or catcher?
11:53So are you a better hitter or catcher?
12:20He has a hepatic adenoma in the right lobe of his liver.
12:41That's not a pair of cancerous.
12:43No.
12:44For now.
12:45The lesion is localized, well-circumscribed, and not close to portal vein branches.
12:49Hay un tumor en el hÃgado de diadelmo, pero no es cáncer.
12:54El doctor cree que pueden sacárselo.
12:56Es buen candidato.
13:08¿Qué es?
13:09¿Qué es?
13:09¿Qué es?
13:09¿Qué es?
13:09¿Qué es?
13:09¿Qué es?
13:12Yo puedo continuar asà mucho tiempo.
13:15Pero tienes un acento extraño, ¿no?
13:17De Guatemala, un mexicano.
13:20¿Pasaste algún tiempo en Venezuela?
13:22En la biblioteca de donde crecà habÃa unas tintas llamadas Speak Spanish Like a Spaniard.
13:28Yo las escuchaba cada noche hasta que se rompieron.
13:33I thought you put this kid in the no-pile.
13:35I decided to take a closer look at the images.
13:37See where the mass is thinning the orbital floor and extending up near the skull base.
13:40But that's exactly what you can do.
13:43Reconsider?
13:44Weigh issues?
13:46Let emotion and personal attachment influence treatment decisions.
13:50Chicharonis?
13:51There's no beveling or erosions.
13:54I can stay extracranial and create a bony plane to resect the superior tumor.
14:00Did that sound too emotional?
14:01Well, even if you stay out of the brain, two major arteries are involved.
14:06He could bleed out.
14:10I'll get one of those of those.
14:13Gracias.
14:31Gracias, Dr. Sean Murphy.
14:39Gracias.
14:41Por nada.
14:47Me duele el pecho y también el brazo.
14:51Y a veces siento la mano frÃa o como si no pudiera sentirla para nada.
14:55Could be angina or a blockage, which requires bypass surgery.
15:01We should do an EKG before he goes to the cath lab.
15:04You don't have a cath lab.
15:06There isn't one.
15:20His pulse is back.
15:31It's not a cardiac problem.
15:33He has thoracic outlet syndrome.
15:35La doctora Sarabia me acaba de mostrar que los nervios y arterias de tu cuello y pecho están siendo prensadas por tus costillas.
15:41Es una condición muy inusual que puede causarte coágulos en la sangre.
15:46Una embolia.
15:47He doesn't seem happy.
15:50Did I translate wrong?
15:52No.
15:52Your Spanish is perfect.
15:54But you left out that this problem can be fixed.
15:59Tiene remedio.
16:00Ah, okay.
16:03Okay.
16:05I am not good at communication in two languages.
16:09The translator should be here soon.
16:22Um, if you want, I can translate.
16:25Oh, you can speak English.
16:26We've lived in the U.S. for a few years.
16:28Um, my mother cleaned houses.
16:29I watch Grey's Anatomy.
16:31Oh, being a surgeon is not much like that.
16:35Miss Gartha, can you show me where you feel pain?
16:40Tell me where it hurts, mamá.
16:45AquÃ.
16:46And do you have indigestion or cramping or ever feel like you might throw up?
16:51Do you want to see if you have indigestion or cólicos?
16:55Do you want to vomit?
16:59Sometimes.
17:01Sometimes.
17:03But she's lying.
17:05It's always.
17:07She has fevers, too.
17:09And throws up.
17:10I need to feel your abdomen.
17:14Can you lie on the bed for me?
17:16Tiene que pauparte el estomago, mamá.
17:18Recuéstate.
17:22Okay.
17:29Miss Gartha, I think you have gallstones.
17:33We will have to run some tests, but it is likely that you will need surgery.
17:40Mamá, la doctora creà que tienes cálculos pediales.
17:44Tienen que hacerte un estudio para estar seguros, pero necesitas una cirugÃa.
17:51No.
17:52No.
17:53Nada cirugÃa.
17:54Yo vine aquà por medicinas.
17:56Tú me dijiste que me iban a dar medicinas.
17:58Estés, si acaso, la doctora.
18:02If she doesn't want surgery, why is she here?
18:06I told her you would have pills that would help her.
18:08I told her I wouldn't eat until she came.
18:18She says she can't miss work.
18:20She needs to take care of me.
18:26I need you to translate accurately.
18:31My mother was very sick, too.
18:34She tried to hide her pain, but children know when people are suffering, especially their mothers.
18:45You can't take care of your daughter if you do not take care of yourself.
19:03No puedes cuidarle a tu hija si no te cuidas a ti misma.
19:09Did you review Bastian's file?
19:23Doing a bifrontal trepanation and reconstructing the skull base could prevent brain herniation.
19:27What about risk of CSF leak?
19:29It reduces with a multilayer duraplasty using a pericranial flap.
19:32I say five sentences to a patient, you say five words.
19:37The nurse wants me to give this to you.
19:38Because medical jargon does nothing but scare them and waste their time.
19:42All they care about is, can we help, yes or no?
19:44Your son's heart valves are damaged.
20:08Las válvulas del corazón de su hijo están dañadas.
20:12It's probably the result of his rheumatic fever last year.
20:15Probablemente como el resultado de la fiebre reumática que tuvo el año pasado.
20:21Because of his heart, we can't remove his liver tumor.
20:27It makes the surgery too risky.
20:31I'm very sorry.
20:33Thank you, doctor.
20:57No, I'm sorry.
21:01We can't do the operation on your son.
21:04He, I'm not sure he, no.
21:06Pero lo intentaron.
21:10Thank you for trying.
21:12God bless you.
21:13God bless you.
21:43Leon Castillo, 22-year-old male, large, non-reducible umbilical hernia.
21:53He's the sole provider for his siblings.
21:55No personal details.
21:56They're irrelevant.
21:57Two children's survival depends on his.
21:59Seems relevant to me.
22:00Decisions need to be based on medical data alone.
22:03This can't turn into a contest of whose life is more tragic.
22:06There would be too many winners.
22:11Without surgery, the hernia is at a very high risk for strangulation.
22:16It's a fast, simple procedure, and he will almost certainly have a full recovery.
22:20From a surgery, he could survive another 15 years without.
22:25Replacing the valve with a bioprosthetic means he won't need to be on blood thinners forever.
22:29But he'll probably need follow-up surgeries to replace the replacement.
22:32This guy's an athlete, a football star.
22:35Is that relevant?
22:38Yes, because his underlying cardiac health is excellent, he should make a full recovery.
22:43Unfortunately, his dental health isn't.
22:45He has cavities, which puts him at high risk for endocarditis, which would contribute to valve deterioration.
22:50A total abdominal colectomy offers her an 80 to 90% chance at full recovery.
22:56Otherwise healthy, no complicating factors.
22:59The tumor could be removed using ultrasound-guided surgery.
23:02She has no access to post-op chemo and radiation.
23:04The mass is round, localized, no signs of infiltration in the adjacent structures.
23:08Minimal chance of recurrence.
23:10If you get all of it.
23:14She just got married last week.
23:16Dr. Resnick?
23:16Which is medically relevant, because studies have shown optimistic people have better long-term prognosis.
23:22And she is full of hope.
23:32There's a boy.
23:33He needs blankets.
23:35Cabijas, por favor?
23:36Aye.
23:37Gracias.
23:46The gallstones are intermittently blocking the bile duct, which could lead to ascending cholangitis, sepsis, and death.
24:13Her condition might respond to medication.
24:15No, it's extremely unlikely, given how advanced her symptoms are.
24:18But she has a non-surgical option.
24:20Bastion doesn't.
24:22It's a miracle he made it to 12.
24:23Without surgery, he will not see 15.
24:26He's unable to eat solid foods.
24:27He's already showing signs of malnutrition.
24:29Sean's surgical plan is very ambitious.
24:32It runs the risk of graft failure and necrosis.
24:34You could leave this boy worse off.
24:36Meanwhile, Edna's surgery is straightforward, and she is all her daughter has in the world.
24:40Who a person is cannot be completely separated from their medical care.
24:45And I'm done pretending it can be.
24:54We've got a mom who needs a simple procedure she might live without.
24:57Or a son who's only shot at life is a very complicated surgery that may not work.
25:04We've got a mom who needs a lot of work.
25:34We have to focus on the miracles.
25:41Let's go eat.
25:47Okay, so look at the nail bed.
25:49Carlos said if you see alternating redness with a pulse, that's a sign of aortic insufficiency.
25:56Well, your heart is fine, and your cuticles are great.
25:59You get manicures.
26:00Ah, you like?
26:06It's a natural treasure.
26:08No, I just wanted the experience.
26:12Shouldn't have any more first day of surgery tomorrow.
26:14Oh, no, I'm good.
26:15You're terrible at this.
26:26I am terrible, but I look fantastic.
26:29Watch this.
26:31I'll get us another friend.
26:32Okay.
26:34Tequila dos, por favor.
26:35What?
26:36What's going on over there?
26:41I'm getting my ass kicked in tarts.
26:44You're flirting.
26:46Just being nice.
26:47Well, don't be so nice that you regret it when you get home.
26:53You have nothing to worry about.
26:55I guarantee it.
26:56All right, I'm going to grab a cab back to the hotel.
27:01Okay.
27:05Good night, guys.
27:10Uh, Hotel Florencia.
27:25Mind if I tag along?
27:26Big day tomorrow.
27:27Sure.
27:27Good night.
27:28Good night.
27:40I saw you break the news of that boy's dad.
27:47You want to talk about it?
27:58Morgan.
28:02I just wanted to know if you're okay.
28:05You don't get to ask me that anymore.
28:06We're not friends.
28:09You drew a line.
28:10So don't ask me how I am, and then pretend to be some nice guy who cares when you obviously don't.
28:22I just got a text from Carla.
28:25Miguel is crashing.
28:25Sean and I are going to head back to the hospital.
28:27I'm only fluent in six.
28:45I didn't set out to learn them.
28:47I just picked them up as I moved around.
28:49So you're an accidental language genius?
28:52Yes.
28:58So what are some of these places, I mean, that you moved around to?
29:01I was born in Mexico, went to medical school in New Haven, did my residency in Chicago, stayed a while in Syria, Haiti, the Congo.
29:10So you're throwing your stop at Yale to impress me?
29:13I threw in my stop at the Congo to impress you.
29:15Don't be too alarmed, but we're being kidnapped.
29:17Don't be too alarmed, but we're being kidnapped.
29:45Don't be alarmed, but we're still limpi.
29:54Pase, por favor. Apúrense.
30:16She's my sister. She's been born for 14 hours.
30:2514 hours like this.
30:28Hello, I'm the doctor. Can you handle the additional talking?
30:32We're going to help you and your baby, okay? We're going to review you.
30:36Yes, we're going.
30:39The baby's head is down, so the physician's not a problem.
30:43I can't hear anything.
30:49The cab driver, he had a cup of coffee in his cab. Have him get it.
30:54Please tell her I have to check her cervix.
31:00She's fully dilated.
31:10If you tear out the bottom, hand it to me.
31:17I can hear a heartbeat.
31:22Maybe he has D-cells.
31:25No, no, no. Don't push!
31:27He became short of breath and then lost consciousness.
31:32I believe his thoracic outlet syndrome caused a clot in his arm,
31:36which went into his lungs.
31:38That would explain the drop in blood pressure and respiratory rate.
31:40But not his elevated end tidal CO2 level that is inconsistent with a pulmonary embolism.
31:46What is it consistent with Sean?
32:05His brain. A clot that traveled from his arm through a hole in his heart into his aorta and up to his brain.
32:12His gag reflex is only active on one side. I was right. He has a small clot in the brain stem near the respiratory center.
32:26Well, we can surgically remove a clot in his lung, but in his brain. We can't do that here.
32:32If we have TPA, we could break it up.
32:36TPA? No. But we have a snake venom derivative. It does the same thing, more or less.
32:45Any movement at all? None. No cord presentation. Maybe her pelvis is too narrow?
32:54Heart rate's getting slower. Wait, wait. I can feel a hand by the face.
32:58The baby's sucking its thumb. That's why it's not progressing.
33:02I can do an episiotomy, try to pull the baby out, but with the arm where it's at,
33:06I'm probably going to break the clavicle and damage the brachial plexus nerve.
33:09Reach inside. Find the baby's finger and pinch it hard.
33:14It works.
33:29Okay, mamita. Ahora sÃ, vamos a empujar, okay? Push.
33:34I'm sorry. Do you speak English? No, no. I speak English.
33:49I'm sorry. Do you speak English? No, no. I speak English.
34:00My name is Leah. I'm with the Americans.
34:04SofÃa. Él es mi marido, Oscar. Y ella es Isabela.
34:19Isabela. She is perfecta.
34:25I found these in my suitcase. My mom got them from...
34:40It gets cold in here. A gift for Isabela.
34:54Would you like to charge her?
34:57No, gracias. I have to go.
35:27Felicidades, mamá.
35:31Que niño más guapo.
35:34¿Qué?
35:42Chuan's keeping an eye on Miguel.
35:58Okay.
36:11You know, it's okay to not be okay.
36:17It's...
36:19Every time I feel like things are getting better,
36:22it's there again.
36:24Yeah, I know.
36:29Like it comes in waves.
36:33Eventually it subsides.
36:36It's a process.
36:39It's a terrible process.
36:43It's one you don't have to go through alone.
36:50Sean has no idea, does he?
36:52No.
36:59He's doing great, important work.
37:01I don't want to interfere with that.
37:04And...
37:08He can't fix it.
37:11It's not about fixing it.
37:12It's about the two of you just being in this together.
37:17It's about the two of you just being in this together.
37:26You're waking up.
37:30What...
37:31What happened?
37:33You had an embolia, but we could give you a treatment.
37:36It's about the treatment.
37:39Is it still...
37:41Can I have the operation tomorrow?
37:45No.
37:46I don't think so.
37:50Tiziana?
37:52Tiziana, wake up.
37:54Hey, I need you to tell your mother something.
37:56We're going to do her surgery.
37:57We're going to do her surgery.
37:59Mom.
38:00Mom, you're going to do the operation.
38:03What?
38:07He said...
38:09...that I could die without that surgery.
38:11I need you to give up.
38:13We've got the time to take a walk.
38:15Oh, my God.
38:17No, no, no.
38:18I'm not sure if you're going to do it.
38:20Don't you give up.
38:22We've got the time to take a walk.
38:24No, no, no, no, no.
38:25No, no, no...
38:27No, no, no, no.
38:29No, no, no, no.
38:32No, no, no, no.
38:34No, no, no, no.
38:36No, no, no.
38:37That was...
38:42It was.
38:52Buenas noches, William.
39:00You know...
39:02I'm not really tired.
39:11Me either.
39:22Tomorrow, I will be removing an adenocarcinoma from my young-owned mediastinum.
39:28That can be a very dangerous area because of the vasculature.
39:36It will be an excellent challenge.
39:39Are you coming to bed? I would like to turn off the light.
39:43I don't want to ruin your trip.
39:52You're having such a good time, but...
39:57I'm not.
39:59What's wrong? Are you sick?
40:01Did you open your mouth in the shower? That is very common.
40:04I'm just... sad.
40:09Every time something reminds me of the baby, I get even sadder.
40:14I'm glad you're doing better than I am.
40:17I'm glad you're happy, but...
40:19Sometimes you being happy makes me feel worse.
40:23I hate that I feel that way, and I didn't even want to tell you, but I think I need to tell you.
40:28I'm sorry.
40:33Do you want me to not talk about work?
40:38No. I can't ask you to do that.
40:41Yes, you can. I want you to feel better.
40:44I won't help, Sean.
40:46What will help?
40:53Nothing.
40:58I miss her so much.
41:02I mean, even looking at your blue eyes breaks my heart because I dreamed she would have them.
41:14My parents are really worried.
41:18I'm calling all the time.
41:21They want me to come back to Hershey for a while.
41:25They think it'll help.
41:29Do you...
41:33want to?
41:38I think it would be good for me to get some time away...
41:43from everything.
41:44I'm sorry you're sad.
41:56I'm sorry you're sad.
42:14you're been here...
42:16I would go...
42:17I'm sorry I don't want you to be bad.
42:18I don't want you to...
42:22If anyone would have a problem, that's enough room.
42:23I think it's normal.
42:27I don't want you to get...
42:28I don't want you to be good.
42:30I think I might be good before anybody else.
42:32I don't want you to be good at it.
42:34I think I'm afraid I'm afraid I'm not going here, but I want you to be good at it.
42:37I'm...
42:39I'm not going I'm sorry.
42:40I'm not going to be good at it.