The Good Doctor – S04E20 – Vamos – 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.
The Good Doctor - S04E20 - Vamos

Air date: June 7, 2021

The doctors begin performing the scheduled surgeries hampered on the first day by a power loss that Shaun’s unique visualization ability allows him to work through; after revealing that his wife is leaving him for someone else, Andrews gives up his wedding ring to pay for the needed medical supplies to successfully complete the surgery on his young patient, Bastion. Claire’s patient Edna is discovered to have gallbladder cancer, not gallstones, requiring a more complex surgery; when Edna develops complications, Shaun encourages Claire to trust her own instincts on the matter and she is able to save Edna. One of their patients reinjures himself at work and Morgan decides to operate herself when no one else is available; despite experiencing intense pain, Morgan completes most of the surgery before Park takes over. Lim opens up to Mateo about her PTSD and in turn he reveals that he’s wanted in the United States for an assault; both decide to stop running from their pasts and move forward with Mateo promising to visit Lim once he gets his assault cleared up. Morgan opens up to Park about her fears and they admit their love for each other and begin a relationship. Claire decides to remain in Guatemala to continue helping people with her first patient being Miguel, the man who was kicked off of the surgery list after getting a blood clot; in a rare move for him, Shaun hugs Claire when they say goodbye. After helping to save a baby’s life, Lea decides not to return to Pennsylvania and instead proposes to Shaun who accepts.

* * *

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?

Venga! Vamos!

Venga! Vamos!

That right?



You’re smiling.

Oh, my God.



I approve. Highly.


Welcome to Day 1.

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

In O.R. 1, Dr. Rendon and I have Leon Castillo… [CONTINUES INDISTINCTLY]


SHAUN [IN SPANISH]: The incision is open.

Nurse Morales, I need a Kelly clamp.

Here you go, Dr. Murphy.

DR. ANDREWS [IN ENGLISH]: Okay, Dr. Murphy, I’ll guide you to the lesion.




KARLA [IN SPANISH]: No, no, no, no.

Everyone must get to work on this. Yes, hold on.

[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?

Mmm, sorry, no.

Minutes? Hours?

[SIGHS] We wait,

we risk losing the whole 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.

Okay. Go.

[IN SPANISH] Thank you so much.

[IN ENGLISH] Good luck.


Suction’s out. Same for the electrocautery.

Want to 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.



No, I was not right.

I can locate the tumor without ultrasound.


SOFIA [IN SPANISH]: Her oxygen is very low. Ox-Oxygen. Low.

[IN ENGLISH] Her oxygen is low.

Oh, I’m so sorry.

[IN SPANISH] Where is Oscar?

He had to go home.

His mom is old and very sick.

[IN ENGLISH] He went home.

[IN SPANISH] To your house?


[IN ENGLISH] Mmm… Stay? Please?


I can feel pulsations of an underlying vessel.

Must be the artery.

Feel your way under and make the dissection plane deeper.


I can feel the bowel.

Sac is free.


You’re probably 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.



I guess we could have waited.



How do you speak English so well?

I’m American.

Born in Mexico, but my mom is an L.A. Mexican-American.

I went to high school in Santa Monica.

I just fake the accent for sexiness purposes.



So when’s the last time you were back?

Are we getting to know each other?

I thought this was just a fling.

Mmm. So we can chat about what schools you went to and where you worked in Africa, but old vacations are a bridge too far?

10 years. Happy?

Quite, in fact.

I have to go for a run.


You’re clearly not a runner.

I promise to be very quick.

Like, poof, and it’s gone, a fleeting but joyous memory.

Oh, I can feel that accent-generated sexiness just vanishing by the second.

Quick but perfectly paced.

I’m gonna hold you to both of those.

Well, the truth is, I will not be very quick.


[IN SPANISH] Is it going to hurt a lot?

[IN ENGLISH] He wants to know if it’ll hurt.

Oh, no, no, no, no.

We’ll be giving you some meds, and you’ll have very little pain after the operation.

[IN SPANISH] We’re going to give you medication, so that you have very little pain after the operation.

And before the operation, we’re going to give you something to help you sleep.

And when you wake up, your mom will be right there.



[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”?


[IN ENGLISH] I feel like you may have added a few adjectives.

Well, the truth is, I’m not always so perceptive.

For example… I was almost sure you were flirting.

Flirting with me.

But if you were, I’m sure you would’ve 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 want to 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’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.

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 miniplates 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-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.

Uh, k-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’ve heard men say that to me before.

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

And, uh…


She’s seeing someone.

So I’m down here, clearing my head, deciding if I want to 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 want to make your marriage work.

That’s why you still wear your ring.





[IN SPANISH] We settled on twenty.

You said four. I said twenty.

No. It was four. We agreed on it.

A boy’s life depends on this.

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


[IN ENGLISH] He’s telling us it costs us 20,000 Quetzales now.

And 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.


I shouldn’t have come.

He sees an American doctor, 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, no, no, no.

You don’t have to do this.

Ana, just a ring.



[IN SPANISH] Her oxygen level is much too low.

Oh, God. No.

The doctor is coming to give her steroids to try to stop the inflammation in her lungs.

We need a ventilator.

Ventilator? She has to go on a ventilator?





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?


[IN ENGLISH] Beautiful.

[IN SPANISH] Beautiful.




How did you end up in Guatemala?

Yikes, 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, “dedicate your life to the downtrodden” 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.


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

Wait, why 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, uh, 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.

[CHUCKLES] Thank you.

Well, let’s go.


Entering the peritoneal cavity.

I need a long retractor.

KARLA [IN SPANISH]: Long retractor.


[IN ENGLISH] That’s not just gallstones.

There is an immobile, irregularly shaped mass.



CLAIRE: She’s got gallbladder cancer, and it’s spread to the surface of the liver.

It will double the duration of the surgery.


You’re looking at 12 hours at least.

I’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 can happen?

Beyond death? This patient was gonna die anyway.

Claire at least gives her a fighting chance.




[IN SPANISH] What happened to the ventilator?

They took it away. 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.


I’ll stay.

Stay here no matter how long it takes.


[IN SPANISH] Is there a problem?

Yeah. The patient returned.




[IN ENGLISH] Leon, the guy with the 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 own 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 Leon.

I’ve been doing P.T. 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.



Freeing up the vein.

[IN SPANISH] Freeing up the vein.


[IN ENGLISH] Dividing the pedicles.

[IN SPANISH] Separating the pedicles.


[IN ENGLISH] Transecting the segments.

[IN SPANISH] Transection of the segments.




[IN ENGLISH] Okay. Step two.


[SIGHS] That doesn’t look ideal.

It’s a midline ventral defect.

Also, the tissue planes are friable.

We’re gonna need component separation.


I’m gonna 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. Oh, it’s my turn.

[IN ENGLISH] You’re exhausted. You should lie down.

No. No.

10 minutes.

[IN SPANISH] Ten minutes.

[IN ENGLISH] I’m good. I’ll rest next.

[IN SPANISH] Me next.

[IN ENGLISH] 10 minutes.

[IN SPANISH] Thank you.





If you need a break…

I’m fine. Just cramped a little.

PARK: I’m done.

I can take over.



This ventral wall defect is huge.



Two Kocher clamps.




Heart rate is spiking.

B.P.’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 is 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 G.I. bleed unrelated to surgery or a leak into the liver from the hepatectomy.

Yes. Which one?

Mmm, what’s the surgical drain output over the last half-hour?

If it’s over 200 cc, the answ…

It’s 200 cc. Exactly.



I think it’s the stomach.

The clotted blood in the N.G. 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.



KARLA: B.P.’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.

P.T. was going great.

Uh… almost no pain at all.

And… [SIGHS]

It’s all dumb because I like being an internist.

I just… [SIGHS]

Hate failing.


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.


[IN SPANISH] Her lungs sound good, without retractions.

But there’s only one way to be sure that the steroids have worked.

[IN ENGLISH] Stop bagging.

Hopefully she can breathe on her own now.



[IN SPANISH] Goodbye.

No, no.

[IN SPANISH] We need to go sleep a little. And you do as well.

[IN ENGLISH] We need to sleep.

[IN SPANISH] No, she doesn’t finish yet.

She needs to say goodbye.

She already said goodbye.

It’s one of the three phrases she knows in Castilian Spanish.

Oh, I want… her to hold my baby.

[IN ENGLISH] She wants you to hold her baby.






She is so beautiful.



DR. ANDREWS: Bastion.





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.


Last night.





You think you love me?

I do.


I think I love you, too.


I committed a crime.

My first year of my 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-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.

[VOICE BREAKING] 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.




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. [CHUCKLES]


I’ve never hugged you, Claire.










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’ve 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.


We are getting married.


[GASPS] We are getting married.

We are getting married!



Thank you.


I have to tell Claire.


[IN SPANISH] Ten, nine…

[IN ENGLISH] Scalpel.

Yes, Doctor.



Venga! Vamos!




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