The Good Doctor Season 4 Episode 20
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00:00How are you feeling?
00:07I want you to feel better.
00:11So if going home might make you feel better, it's a good thing.
00:31So like, come on, how would you say that?
00:34Venga, vamos!
00:36Venga, vamos!
00:39Is that right?
00:41Okay.
00:56What?
00:58You're smiling.
01:07Oh, my God.
01:10Yes! I approve, highly.
01:16Bienvenidos to day one.
01:18We are getting our feet wet with the three easiest surgeries.
01:21In OR1, Dr. Rendon and I have...
01:26Antibiotic flush.
01:43Okay, Dr. Murphy, I'll guide you to the lesion.
01:56Wow.
01:58Cool.
02:13No, no, no, no.
02:15Que todo el mundo se ponga a trabajar en esto.
02:17Espera.
02:18I'm so sorry.
02:19We get blackouts in the mountains all the time.
02:21That's why we have a generator, which failed.
02:24You gotta guess when it comes back.
02:26Sorry, no.
02:27Minutes, hours.
02:29We wait, we risk losing the whole day, dropping three patients.
02:32If I move my patient by the window, I can debris the ulcer.
02:34Go. Pray it stays clear out.
02:36I'll see what I can do about a herniated bowel.
02:38Can you resect a tumor without ultrasound?
02:40I will speak to Dr. Andrews about a revised surgical plan.
02:43Okay, go.
02:45Muchisimas gracias. Good luck.
02:47Good luck.
02:53Suction's out. Same for the electrocautery.
02:56Wanna use your fingers?
02:58It would minimize the blood loss.
03:03We could remove the lower lobe without ultrasound.
03:06Maybe we should close her up and do this tomorrow.
03:08It would be fatal.
03:11Not to her, to a patient down the list that we'll have to drop.
03:17Maybe you're right. We take the whole lower lobe.
03:37No, I was not right.
03:39I can locate the tumor without ultrasound.
03:42No.
03:53Her oxygen is low.
03:56Oh, I'm so sorry.
03:59¿Dónde es Oscar?
04:02Se tuvo que ir a casa.
04:04Su mamá está grande y muy enferma.
04:09He went home.
04:11A tu casa.
04:13SÃ.
04:17Stay.
04:19Please.
04:29I can feel pulsations of an underlying vessel.
04:32Must be the artery.
04:34Feel your way under and make the dissection plane deeper.
04:40I can feel the bowel.
04:43The sac is free.
04:48You're probably getting close to a fissure.
04:50I am. The tissue is becoming less pliable.
04:53I am. The tissue is becoming less pliable.
04:56The laceration there would be devastating.
04:59We could wait a few more minutes to see if the lights come on.
05:02I don't think we should.
05:05I feel something gravel-like at the tip of my pickups.
05:10I think that's the surface of the tumor.
05:14I'm there.
05:16Nice work, Murphy. We have a clean path to the tumor.
05:19Let's get it out.
05:21I guess we could have waited.
05:52How do you speak English so well?
05:55I'm American.
05:58Born in Mexico.
06:00But my mom is an L.A. Chicana.
06:03I went to high school in Santa Monica.
06:05I just fake the accent for sexiness purposes.
06:08I'm American.
06:10Born in Mexico.
06:12But my mom is an L.A. Chicana.
06:14I went to high school in Santa Monica.
06:17I just fake the accent for sexiness purposes.
06:21So, when's the last time you were back?
06:25Are we getting to know each other?
06:28I thought this was just a fling.
06:31So, we can chat about what schools you went to
06:34and where you worked in Africa,
06:36but old vacations are a bridge too far.
06:40Ten years. Happy?
06:43Quite, in fact.
06:46I have to go for a run.
06:48Now?
06:49You're clearly not a runner.
06:51I promise to be more rápido like a poof
06:54when it's gone, a fleeting but joyous memory.
06:57Oh, I can feel that accent-generated sexiness
07:00just vanishing by the second.
07:02Rápido, but perfectly paced.
07:05I'm going to hold you to both of those.
07:08Well, the truth is, I will not be more rápido.
07:13¿Me va a doler mucho?
07:16He wants to know if it'll hurt.
07:18Oh, no, no, no, no.
07:20We'll be giving you some meds
07:22and you'll have very little pain after the operation.
07:25Vamos a dar medicamento para que tengas muy poquito dolor
07:28después de la operación.
07:30No, no, no, no.
07:32No, no, no, no.
07:34No, no, no, no.
07:36No, no, no, no.
07:38No, no, no, no.
07:40No dolor después de la operación.
07:47Y, antes de la operación,
07:49te vamos a dar algo que te va a ayudar a dormir
07:52y, cuando te despiertes, ahà va a estar tu mamá.
07:59He didn't realize he was going to be asleep during the surgery.
08:05Nurse Morales, how would one say
08:08You, in addition to being very efficient, turn out to be very perceptive, as well.
08:26I feel like you may have added a few adjectives.
08:29Well, the truth is, I'm not always so perceptive.
08:35For example, I was almost sure you were coqueteando, flirting with me.
08:44But if you were, I'm sure you would have taken off your wedding ring.
09:05You know, it's okay to be nervous. I'm not.
09:11You should be proud. You did a remarkable thing, convincing her to come here.
09:16You probably saved her life.
09:22I'm just going to sit here for a little while, in case there's something that you want to tell me.
09:27I'm just going to sit here for a little while, in case there's something that you want to tell me.
09:36Because of me, my mother will live with someone else.
09:46And I prayed that she would do the operation, but she only did because Miguel, the guy with the dog...
09:56Because he got sick.
10:02You know, you're a good person.
10:05And sometimes that's hard, because you feel things that you don't deserve to feel.
10:11But sometimes, being good is fun.
10:20Come on.
10:26We freed the tumor from the paranasal sinuses.
10:31Periosteal disector.
10:38It's invading the orbital floor.
10:40Curved osteotome.
10:46And the ethmoid and sphenoid, too.
10:48We're going to have to remove multiple bones.
10:51Does the hospital have titanium mini plates and mesh?
10:53Nothing that would work here.
10:55Could we just cover the heart pallet?
10:57No. And we give him a few years of constant pain, and he'd still wind up with a fistula that kills him.
11:01Is there a private hospital, specialist, something?
11:07I have a friend from nursing school.
11:09She works for a dental surgeon who fixes all the rich people in this area.
11:12I can be there and back in an hour.
11:15Keep stable.
11:16Okay.
11:19I was not fair before, when I was too soon.
11:22You were very fair. I was flirting.
11:26And how would your wife feel?
11:28Well, she'd be fine with it.
11:32I've heard a man say that to me before.
11:37She told me a few days ago that she's moving out.
11:40And, uh...
11:42Well...
11:45She's seeing someone.
11:49So I'm down here, clearing my head, deciding if I want to try to make the marriage work.
11:56By flirting?
11:58I guess I just wanted to feel... wanted to feel good.
12:04It was selfish.
12:06I'm sorry it made you feel uncomfortable.
12:10It didn't.
12:17And I think you do want to make your marriage work.
12:22That's why you still wore your ring.
12:25Yeah.
12:55I'm sorry.
13:12We agreed on 20.
13:13You said four.
13:14I said 20.
13:15No.
13:16It was four. We agreed on that.
13:18A child's life depends on this.
13:20I'm sorry.
13:21I think there was a misunderstanding.
13:26No.
13:30He's telling us it costs us 20,000 quetzales now.
13:33Do we have that?
13:34No.
13:35I can go to an ATM.
13:36No, there's no automatic cashier machine I can use.
13:40This is my fault.
13:44No.
13:45I shouldn't have come.
13:47He sees an American doctor, knows he can ask for more.
13:50There's a hospital in Quetzaltenango a few hours from here.
13:56No.
13:59No.
14:02I'm all for this, too.
14:04No, no, no, no, no. You don't have to do this.
14:06I know.
14:08Just a ring.
14:26We need a ventilator.
14:28Ventilator?
14:29She's to go on a ventilator?
14:39Hello.
14:40Hey, Sean.
14:42How you doing?
14:43I just finished my second surgery, and it went well, and I am not doing well at all.
14:49Okay.
14:50Leah is sad.
14:52And I don't know how to make her less sad.
14:56Do you?
14:58I don't know if I'm the right person to talk about this right now.
15:04Why not?
15:08I just don't think that right now...
15:13I've always loved that you've asked me for advice, and I always will.
15:17But I've noticed the last while, you've needed me less and less.
15:25I don't know if you've noticed, but it got me to thinking about what Steve told you,
15:30that you're the smart one.
15:33You can do anything.
15:40You're good at this.
15:42Better than me.
15:44You're good at this.
15:46Better than...
15:49Better than you think.
16:00Ready?
16:10Did it feel good?
16:14Beautiful.
16:41How did you end up in Guatemala?
16:43Totally.
16:44You're just not good at planes, are you?
16:46You should be asking me if I've read the Kanna Sutra, my favorite whipped cream.
16:54It's a good job.
16:56I get to coordinate these missions, help some people.
17:00So you're the workaholic, dedicate your life to the downtrodden hero type.
17:05Is that what drives you?
17:06I also get to sometimes have sex with American doctors.
17:10You're only here for a week.
17:12We don't need to bare our souls to each other.
17:15On the other hand, I'm only here for a week, so why not?
17:22You first.
17:23What are you hiding?
17:25I'm not hiding anything.
17:27Okay.
17:28I prefer a fresh local product, but if you have lactose issues...
17:31Why did you ask me that?
17:33Seriously, why are we having this conversation?
17:37You think I'm being dishonest.
17:39What do you think I'm hiding?
17:41I don't know.
17:43But between your excessive need to exercise,
17:46the alarms going off that you never answer when you're around me,
17:49and the nightmares that you have every night,
17:52you're hiding something.
17:58Let's get ready for the day.
18:07You ready to start?
18:09Almost.
18:13There's three kinds of foreign doctors who come down here.
18:17The first, they care too much.
18:20All the people they can't save.
18:22It overwhelms them.
18:24The second care too little,
18:26and that has problems of its own.
18:29And the third group,
18:31they find a way to these things,
18:33And the third group,
18:35they find a way to these things themselves,
18:37so they can do their job.
18:40I'd better be in that group.
18:42You are in your own group.
18:45You care so deeply.
18:48But that only gives you more strength.
18:58Well, let's go.
19:03Entering the peritoneal cavity.
19:06I need a long retractor.
19:08Retractor largo.
19:17That's not just gallstones.
19:19There is an immobile, irregularly shaped mass.
19:28She's got gallbladder cancer,
19:30and it spreads to the surface of the liver.
19:32How long will the duration of the surgery?
19:34Triple. You're looking at 12 hours at least.
19:36I'll need to swap with one of you.
19:37That's not possible.
19:39Neither of us are prepped.
19:40It would be endangering two patients instead of one.
19:42We can't just close her up.
19:44Unfortunately, we can.
19:47I'm sorry, but you've never led anything like this.
19:53I think we should let her keep going.
19:55What's the worst that can happen?
19:57Beyond death.
19:58If this patient was going to die anyway,
19:59it at least gives her a fighting chance.
20:07Okay.
20:13¿Qué pasó?
20:16Con el ventilador.
20:18Se lo llevaron.
20:19Lo necesitaban para la cirugÃa.
20:22Lo necesitaban los doctores.
20:26The doctors needed it?
20:28And where's the nurse?
20:30La infirmera.
20:32¿Ocupada?
20:34Mucho trabajo.
20:36Okay.
20:38I'll stay.
20:40Stay aquÃ, no matter how long it takes.
20:47¿Hay un problema?
20:48Ya, el paciente volvió.
20:59Leon, the guy with the ventral hernia,
21:01took himself out last night and went to work.
21:03In construction.
21:04He re-herniated?
21:05Not bad.
21:06About an inch of bowel is incarcerated.
21:08Probably ischemic.
21:09He'll be dead in days unless we operate on him.
21:11Can you fit him in after your skull reconstruction?
21:13Not without big risk to both of them.
21:15What about the other surgeons?
21:17You think I'd be here if anyone else was free?
21:21Give him some morphine.
21:23Until when?
21:24That sucks, but it's his own fault.
21:26That sucks, but it's his own fault.
21:27We told him he needed to rest.
21:28This isn't some tech bro and San Francisco waltzing out to party.
21:31He needed to keep his job and not watch his family starve.
21:34If we operate on him, we don't operate on someone else.
21:41I'll operate on Leon.
21:43I've been doing PT the last year.
21:45It's been going great.
21:46You really think you can handle the surgery?
21:49I know I can.
21:50I think I can do it without any pain.
21:57We need to do a cross-clamp resection.
21:59Have you ever done one?
22:01I've seen one when I was an intern.
22:10Freeing up the vein.
22:18Dividing the pedicles.
22:20Dividing the pedicles.
22:28Transsecting the segments.
22:46Step two.
22:51That doesn't look ideal.
22:53That doesn't look ideal.
22:55It's a midline ventral defect.
22:57Also, the tissue planes are friable.
22:59Also, the tissue planes are friable.
23:01Organic component separation.
23:03Organic component separation.
23:05And I cut the posterior rectus sheath,
23:07And I cut the posterior rectus sheath,
23:09mobilizing soft tissue off of the external oblique fascia,
23:11mobilizing soft tissue off of the external oblique fascia,
23:13and then incise it.
23:16Common femoral artery is almost completely occluded.
23:18Common femoral artery is almost completely occluded.
23:20I'll prep the inflow anastomosis site.
23:22I'll prep the inflow anastomosis site.
23:28I have PTSD.
23:32I have nightmares because of it.
23:34I exercise to help me manage my symptoms,
23:36and the alarm on my phone is to remind me
23:38to take my daily cocktail of fluoxetine,
23:40parazacin, and cataepine.
23:42Can you help me?
23:44Can you tunnel the bypass graft
23:46in the subcutaneous plane?
23:48I'll get it clamped through.
23:52I lost a good friend a year ago,
23:54I lost a good friend a year ago,
23:56and then lost more to COVID,
23:58and then lost more to COVID,
24:00and then spent a lot of time denying I had an issue,
24:02and then spent a lot of time denying I had an issue,
24:04running from pain.
24:06running from pain.
24:10In the future,
24:12I'm hoping to do more running toward things
24:14than away from them.
24:20I'm ready for the graft.
24:22I'm ready for the graft.
24:44You're exhausted.
24:46You should lie down.
24:48Ten minutes.
24:50Five minutes.
24:52I'm good.
24:54I'll rest next.
24:56Yo después.
25:00Ten minutes.
25:02Gracias.
25:04Ten minutos.
25:18If you need a break...
25:20I'm fine.
25:22I just cramped a little.
25:24I'm fine.
25:26I'm done.
25:28I can take over.
25:44This ventral wall defect is huge.
25:46This ventral wall defect is huge.
25:48Yeah.
25:58Two corporate flaps.
26:28Heart rate is spiking.
26:30Pee pee's dropping.
26:32She's crashing.
26:34Why? What happened?
26:36I don't know.
26:38I don't know.
26:42Edna's bleeding out.
26:44At this rate, she has minutes to live.
26:46There is post-op blood around the liver.
26:48Nothing crazy.
26:50The surgical drain also has blood.
26:52Nothing crazy.
26:54The surgical drain also has blood.
26:56The surgical drain also has blood.
26:58No evidence of bio-leak.
27:00Okay, so the patient could have
27:02GI bleed unrelated to surgery
27:04or a leak into the liver from the hepatectomy.
27:06Yes, which one?
27:08What's the surgical drain output
27:10over the last half hour?
27:12If it's over 200 cc...
27:14200 cc, exactly.
27:16I think it's the stomach.
27:18The clouded blood in the NG tube
27:20could be holding back a flood.
27:22An intra-hepatic bleed is statistically more likely.
27:26I still think it's the stomach.
27:28But I came to you for a reason.
27:30Okay, thanks.
27:32Claire,
27:34neither of us knows for sure,
27:36but...
27:38you are good at this.
27:42Better than you think.
27:50BP's almost bottomed out.
27:52What do we do?
27:56The stomach.
28:06You did good work.
28:08I just had to close and clean up.
28:10The patient's in recovery,
28:12doing well.
28:20I need a friend.
28:26Yeah.
28:30I hadn't really given up
28:32on being a surgeon.
28:34PT was going great.
28:38Almost no pain at all.
28:42It's all dumb because
28:44I like being an internist.
28:46I just...
28:50hate...
28:52failing.
29:00Seriously?
29:02This is funny?
29:04A little.
29:06I've never seen you vulnerable.
29:10Your face gets kind of...
29:12ugly.
29:14Shut up.
29:18You didn't fail.
29:22You never fail.
29:24For three years,
29:26I've watched you
29:28kick ass
29:30at everything.
29:32You inspire me
29:34and annoy me.
29:40Small price to pay.
29:52Your mom's gonna be
29:54all better.
30:14Stop begging.
30:18Hopefully, she can breathe
30:20in her own hell.
30:46No.
30:48No.
30:54We need to sleep.
30:56She has to say goodbye.
31:00She already said goodbye.
31:02It's one of the three phrases
31:04she knows in Spanish.
31:08I want her to carry my baby.
31:16She wants you to hold her baby.
31:26Come on.
31:52She is so beautiful.
31:56I love you.
32:08That's it.
32:26She's good.
32:56I love you.
33:16I'm sorry I've been weird
33:18for a year.
33:22I really do care about you.
33:24And I wish you and Heather the best.
33:28Well, it's a bit late for that.
33:30I broke up with Heather.
33:32When?
33:34Last night.
33:36No.
33:38Yeah.
33:42Because...
33:44you think you love me?
33:48I do.
33:54I think I love you, too.
34:08I committed a crime.
34:12My first year
34:14of residency,
34:16I was arrested for pot position.
34:18The cops were jerks.
34:20I argued with them
34:22and...
34:24it got physical.
34:28When my court date came around,
34:30I skipped.
34:32And now there's an active warrant
34:34out for me in the States.
34:36That's why I haven't been back.
34:40But what if I got a lawyer?
34:42Got this cleared up.
34:46What if I was to start running
34:48toward things?
34:52Would you be interested in a visitor
34:54in San Jose?
35:02There's something
35:04I want to ask you.
35:22I think you should take the job.
35:24Of course she wasn't going to poach you
35:26without asking me.
35:32I can't speak the language.
35:34I don't know anyone here.
35:36I just started a relationship
35:38with my father.
35:42I'm not ready.
35:44All legit concerns.
35:46But what I didn't hear
35:48was one single reason
35:50you don't want to do this.
35:52You've spent so many years
35:54thinking your heart was a liability.
35:56It made you care too much.
35:58It hurt too much.
36:04But maybe here...
36:06Maybe here,
36:08caring too much
36:10is exactly what's needed.
36:12Maybe here, caring too much
36:14is exactly what's needed.
36:43Wow.
36:54This is about time.
37:02You were far too good
37:04for us anyway.
37:06I know.
37:12Or how do you factor that?
37:28I'm never quite sure
37:30what you're thinking.
37:32Many things.
37:36That I'm sad.
37:38That this airport
37:40is the only one I've been to
37:42without a Cinnabon.
37:44That people need to move forward.
37:50That...
37:52I hope you're moving forward.
37:58I think I am, Sean.
38:02What do we do now?
38:04We get a little...
38:08I've never hugged you, Claire.
38:38No.
39:00We're not going to Hershey.
39:04Are you done being sad?
39:09But...
39:11Right now I know
39:13I won't be sad forever.
39:15And I don't think I would've gotten there
39:17without you.
39:24I want to spend
39:26the rest of my life with you.
39:30I want to spend
39:32my life with you too, Leah.
39:38Will you marry me?
39:42Of course.
39:44I love you.
39:46I love you too.
39:58We are getting married.
40:02We are getting married!
40:08We are getting married!
40:20I have to tell Claire.
40:38I have to tell Claire.
40:46Scalpel.
40:48Yes, Doctor.
40:52You're welcome.
40:56Venga. Vamos.