Refreshingly, we break with The Good Doctor episode structure formula in the following two episodes that wrap up the fourth season. In episodes 4×19 and 4×20, we leave St. Bonaventure Hospital and actually leave the country as well.
The surgical team (plus Morgan & Lea, and minus the First Years) travel to Guatemala on a medical relief mission. It’s a welcome distraction and everyone is glad for the break from their usual routine.
Arriving in Guatemala, they are greeted at the local clinic by Dr. Mateo Rendon, who introduces them to their mission. The local doctors have pre-selected a total of 40 patients that will be evaluated by the San Jose surgical team, 12 of which can get an actual operation. They want surgeries that the locals can’t do and that don’t need a lot of aftercare. It also means they will have to send 28 patients home without treatment, no matter how sick they are or how sad their story is. And thus, the patient evaluation marathon begins.
Those San Jose doctors who can’t speak Spanish (which seems to be everyone but Shaun) get a local translator, and then they start talking to patients and checking their medical conditions and prospective outcomes to see who goes on the ‘No’, ‘Maybe’ or ‘Waiting’ pile.
Many cases are personal and heartbreaking, and it’s very hard to pick, but judgment day eventually comes, and they need to choose the final 12 surgical candidates. The last slot is a tough decision. They’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. They finally pick the boy, and Claire repeats to Shaun what the local nurse, Carla, had told her earlier. “We have to focus on the miracles.”
We actually have a whole slew of patients in this episode, and not just the usual two that we focus on. So let’s see…
Patient #1 is more of a passer-by – a random guy herding sheep that block the road as their bus drives the San Jose team to their hotel. He shows Shaun red spots on his back and Shaun diagnoses them right away. “Es un hongo,” it’s a fungal infection. (Shaun later seeks out the guy to bring him a cream to treat the symptoms.) Nice moment here for Shaun (and Freddie Highmore) to shine and show off their fluent knowledge of the Spanish language.
(For those who don’t know, Freddie Highmore actually studied languages at Cambridge University and speaks fluent Spanish, French and Arabic.)
Patient #2 is León, a young man with a large mass on his abdomen (a large, non-reducible umbilical hernia) which he’s had for a year. He’s the sole provider for his siblings and hasn’t had time or money to go to a hospital to get it checked out until now. León ends up on the final list of patients to get an operation.
Patient #3 is a girl with a large patent ductus arteriosus, a hole in major blood vessels. It would have been easy to fix as an infant, but now that she’s older, there’s nothing they can do for her. One of the patients where it breaks the doctors’ hearts to have to send them away without being able to do anything for them.
Patient #4 Bastion, a 12-year-old boy with a large blastoma on his face. He goes on the ‘No’ pile at first, but Andrews runs the case by the others to see if they should reconsider. He gets the needed operation with Andrews as the surgeon.
Patient #5 is Adelmo, a boy with a tumour in his liver that’s not cancerous. He may be a candidate for surgery, but they find out later that his heart valves are damaged and thus they cannot do the surgery. Adelmo goes on the ‘No’ pile.
Patient #6 is Miguel, a middle-aged man with thoracic outlet syndrome. He’s one of the people whose problem can be fixed. However, he develops a blood clot that travels to his brain that they need to dissolve. This unfortunately prohibits him from having the surgery to fix his thoracic outlet syndrome, which means that Edna (patient #7) moves up on the list instead.
Patient #7 is Edna, a woman and mother with abdominal pain. Claire thinks she has gallstones and needs surgery. Edna doesn’t want any surgery, though. She has to work to take care of her daughter. Claire manages to convince her to get the surgery. Edna was the case who was competing for the last surgery spot, and got rejected at first, but later could have her surgery when Miguel couldn’t be operated on because of his last minute complication.
Patient #8 is a pregnant woman who has been in labour for 14 hours, but it doesn’t seem to be progressing. She’s fully dilated, but the baby has late decelerations, which usually means low oxygen saturation. Dr. Lim finds out that this is because the baby is sucking its thumb, which prevents it from passing through the birth canal. This is the patient that Rendon and Lim get kidnapped to help, and Lim manages to reposition the arm so that they can deliver the baby safely. A kidnapping well worth it.
Shaun & Lea
Shaun is all prepped for the big trip. Tickets, passports, travel wallet, local and American currency. Aaron drops them off at the airport and asks Lea if she’s all right. “I think this trip will be good. Change things up, focus on helping other people.” It’s actually kinda sweet that Aaron offers for Lea to call him if she wants to talk. I think he’s a bit lonely. Lea doesn’t think she’ll do that, though. “I know,” Aaron says.
And it turns out that Aaron hasn’t told Shaun about his troubles with Debbie yet. Hm. Afraid to breach the subject? Afraid that Shaun will think he’s a failure? Afraid to dump even more on Shaun after the loss of their child? All of the above?
When they’re having drinks at the bar after their first day, Shaun explains to one of the locals why he speaks perfect Spanish with a Spain accent. Apparently, he learned it as a kid from tapes in the library, a course titled ‘Speak Spanish like a Spaniard’. He listened to them every night until they broke. Not sure that explains why he knows all the medical terms, but I suppose he could have looked into it more as he grew up.
Kinda cute when Shaun speaks to a patient and gets wrapped up in all the medical details but neglects to mention the more emotional aspects. Nurse Carla makes him aware of this slight mishap, and Shaun says, “I am not good at communication… in two languages.”
Lea helps out with some of the administrative burden and documents their trip, taking photos. Trying to make herself useful, she goes looking for blankets that one of the patients needs, and walks past the small neonatal treatment room. There’s a young couple there with a sick baby. Lea watches them from afar and her eyes tear up. One more reminder of what they lost, and it still hurts.
Later that night, Lea seeks out the young mother whose name is Sofía to give her a pair of baby socks that she found in her suitcase so that baby Isabela can have them. Sofía asks Lea if she wants to hold Isabela, but Lea clams up and declines. Not sure if Sofía can read between the lines here.
Claire finds Lea afterwards in one of the hallways, sitting alone on a bench, crying. She’s having a hard time with all the baby reminders and seeing Shaun so happy when Lea is still struggling so much. Claire has a suspicion. “Shaun has no idea, does he?” No. He doesn’t. Lea doesn’t want to distract him from the important work he’s doing. And she knows he’ll want to fix it, which he can’t. But maybe it’s not about fixing it. Maybe it’s about the two of them being in it together.
After their long day, Shaun is getting ready to go to bed. He brushes his teeth and excitedly tells Lea about the surgery he’s going to perform the next day. Lea makes the decision to talk to him about how she’s feeling, because maybe, after all, he needs to know what she’s going through.
“I don’t wanna ruin your trip,” she starts. She tells Shaun how sad she is, how many reminders there still are of the loss they faced, how sometimes seeing Shaun happy makes her feel worse. You can see that this comes as an unexpected blow for Shaun. And Shaun being Shaun, he immediately goes into fixing-mode. “Do you not want me to talk about work?”
Lea tells him that wouldn’t help, and he wants to know what will help. But that’s the problem. Nothing will. Except maybe time. Or some distance. Lea tells him her parents have been asking her to stay with them for a while, just so that she can get some time away.
The truly gut-punching thing here, for me, is when Lea tells Shaun that even looking at his blue eyes breaks her heart, because she dreamed their daughter would have them. That’s like saying every time she looks at Shaun, she is reminded of the tragic loss they faced, that him just being physically there causes her pain. That’s a pretty huge impasse, because damned if you do, damned if you don’t. I feel so much for the both of them.
Shaun asks Lea if she wants to stay in Hershey for a while, and Lea thinks that it would do her some good. He’s near tears, but he takes her hand and tells her, “I’m sorry you’re sad.” There’s good solution here. Just more sorrow and grief and hopelessness.
Huh. Alex is now actually together with Heather. She drops him off at the airport and they kiss goodbye. Morgan watches it with disdain.
During their trip to Guatemala, Alex makes an effort to reach out to Morgan after he saw her struggling with giving bad news to a patient. She’s not receptive to the idea, and (IMHO rightly so) snaps at him that he needs to make up his mind. Either they are friends, or they aren’t.
Marcus, meanwhile, flirts with Ana Morales over a game of darts. Audrey reminds him he has a wife at home. There’s definitely sparks there between Marcus and Ana.
Audrey and Mateo hit it off as well, and there’s some serious chemistry in the air here. I mean, can you blame her? Mateo is definitely easy on the eyes. The two of them head back to the hotel together in one of the transit buses, but the bus driver takes them on an unplanned detour (i.e. he kidnaps them) to help a woman in labour.
Also, Mateo is fluent in six languages. He was born in Mexico, went to medical school in New Haven, did his residency in Chicago, stayed a while in Syria, Haiti and the Congo. He’s a much travelled guy.
After Mateo and Audrey save the baby during their “kidnapping”, they get back to the hotel. They’re about to go to their separate rooms, when Audrey calls to him, “You know, I’m not really tired…” Mateo tells her, “Me either,” and they kiss and vanish in Audrey’s room. Audrey’s getting some nookie!