Season 4 Rewatch: 4×16 Dr. Ted

The Good Doctor Argentina on Twitter (@TheGoodDoctorAr) is currently running a ’20 Days Countdown to The Good Doctor Season 5’, and on Day 16 it’s time to take a closer look at episode 4×16 Dr. Ted.

Patient Stories

Patient #1 is Lea Dilallo. Our dear Lea. Screw this, I don’t want it. But here we are.

I actually already wrote up a medical case review blog for what happened to Lea medically in this episode, so I’m not gonna dive into that too deeply. You can read it here if you’re so inclined.

From a patient point of view, Lea is seen by Claire and Jordan to find out where her sudden abdominal pain had come from. Shaun made a list of all the things he wants them to rule out, and they get on that. What do they do find is that Lea has a condition that puts the baby at high risk of not surviving the delivery, which they fix surgically.

During recovery, Lea develops a pulmonary embolism. They debate how to treat it, and in the end decide to surgically insert a filter to prevent the blood clot from traveling further. While this is going on, the baby also has to be treated with steroids to speed up lung development.

Further post-OP tests reveal that Lea has another clot in her umbilical artery, which impedes blood flow to the baby and makes the pregnancy no longer viable. It’s the worst news imaginable to expecting parents, and the only course of action is to abort the pregnancy.

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Patient #2 is Maxine Stanley, an 87-year-old lady who comes into the hospital after collapsing on the dancefloor at an Art Nouveau fundraiser. Maxine’s vital signs tank very quickly and Asher is ready to resuscitate her, but Park sees the DNR (do not resuscitate) bracelet and so they stand by as Maxine goes into asystole.

Just as Park is ready to announce time of death, Maxine’s vital signs come back up. Turns out Maxine had a supportive pump implanted in her heart previously, which prevented her from, well… dying. And Maxine is pissed off. She was ready to go out with a bang. She has end stage lung cancer and wants to end her life on her terms. And now there’s this thing in her chest that won’t let her.

Maxine wants the device removed, and Asher is actually fighting this. Maxine is still so vibrant and full of life. Why would she want to end her life now?

Maxine throws a Going-Away-Soiree at the hospital. She invited all the people she wanted to say goodbye to, but she refuses to take the antibiotics that will keep her alive. She still wants to dictate her own ending.

However, life isn’t done with Maxine yet. Her infection clears without antibiotics (well, not quite, Asher covertly slipped them into her IV without permission) and she wakes up in the morning that she didn’t think she would see. She’s scared to go home alone. Asher comes through, though, by offering her help with an “Aid in Dying” request application form, so that Maxine can get her final wish to end her life on her terms.

Lea and Maxine in this episode are a thoughtful juxtaposition of life and death, or rather the different characteristics and nuances of life coming to an end. In Lea and Shaun’s case, they are being faced with the death of their unborn child, dictated by happenstance, coincidence, fate, tragedy, divine will, whatever you may call it – but it’s not voluntary and out of their control. It’s something they would give everything to change, but that choice is no longer in their power to influence.

On the other hand, we have Maxine who is ready to say goodbye to this world, who wants to end her life, but is repeatedly being given signs that it’s not her time yet. Even if she thinks she has the right and the power to end her life, it’s not always quite that easy, and sometimes the world has other plans for you.

Shaun & Lea

Ugh, guys, what are you doing to me? I just did all the screencaps for this one, and trying to dodge the three million punches to the stomach was thoroughly unsuccessful. Recapping this episode is gonna be so hard, and I’ve been procrastinating to try to avoid it, but I guess it’ll have to be done.

So then. I should be sitting here with a bottle of red wine, trying to drown my fictional character sorrows, but since that’s not conducive to either histamine intolerance or coherent writing, I’m just gonna settle for a pint of grape juice spritzer. Or maybe I should go back to watching season 5 of Bates Motel and subject myself to a whole other form of emotional torture. But on to the subject matter at hand… Go ahead and fuck me up already, why don’tcha? <whimpers softly>

We start out with Lea being seen by Claire to figure out what her sudden abdominal pain was all about. It looks like this is a day or two after Lea collapsed in front of the hospital, and we never get to see the immediate follow-up of the ending of the previous episode. Her OB-GYN thought it was round ligament pain, which is not unusual during pregnancy. Shaun has made a long list of possible causes and complications. He asks Claire and Jordan to rule them all out.

As Shaun is packing things in the apartment for Lea’s hospital stay, Dr. Glassman drops by to a) bring a teddy bear dressed as a doctor (which apparently Debbie picked out, later named Dr. Ted) and b) to check in on Shaun. He tells Shaun to relax and enjoy the time of watching his baby grow in Lea’s belly. “Shaun, this should be the most amazing moment of your life. If you blink, you’re gonna miss it, and you’re blinking!”

Where Lea is concerned, Claire and Jordan diagnose vasa praevia, a condition that puts the baby at risk under stress. Claire breaks the news to Lea and Shaun, and both are quite shocked. No one had expected that. C-section is not an option since it’s too early — the baby wouldn’t be viable outside of the womb. Shaun devises a surgical plan to fix the venous defect, and he wants in on the surgery, but Lim very firmly says no. With good reason. She makes a touching statement. “Shaun, I care about you and Lea too much to put your baby’s life at risk just to make you feel useful.”

Cue Shaun running to Dr. Glassman to go overrule Dr. Lim’s decision. Come on, Shaun. You should be smart enough to know that he’s not gonna do that. “Everyone, including you, is always telling me I’m not emotional enough, and now you are saying I am too emotional?” Well. Yes. And you are.

This next scene is so beautiful and I cannot express enough how much I love the understated and unsettling silence here. Lea and Shaun are waiting in pre-OP (in a really drab and depressingly dark and sterile room), with Shaun sitting quietly by her side. There is nothing to say. Everything is scary and eaten up by worry and uncertainty.

Shaun reaches into his pocket and takes out his red toy scalpel, carefully unwrapping it from the blue cloth. He touches it and thinks about this briefly (my beautiful boy, I want to give you so many hugs) and then wordlessly puts it in Lea’s hand. She knows exactly how much this means. She gives him a small smile and he meets her eyes. “I love you, too.” Knot number 1,298 in my stomach. Ugh. I love it. And hate it. And yet love it so much.

Not being allowed in the OR, Shaun watches the surgery from the gallery. But, like why is Glassman not there? He knew the surgery was going ahead, Shaun told him. Did he think this would be a good opportunity for growth for Shaun to go through this on his own? Did he have work that he couldn’t interrupt for half an hour? Of course we can also choose to believe he may have dropped in off-screen at some point. Let’s hope.

Who does come to see him, though, is Morgan, and she’s uncharacteristically sympathetic. It’s nice to know that Shaun has so many people rooting for him. She tells him, “You know, I never expected to take you seriously as a surgeon. I never saw you as competition, until that aortic dissection our second year.” Or course Shaun remembers. “There was surprise clotting in the false lumen.” Morgan adds, “That’s when I realized I’d underestimated you.”

Shaun takes that as a metaphor that Dr. Lim is now underestimating him, but that’s not what Morgan is saying. “I finally realized I wasn’t the only person here capable of doing great work. Lea’s in good hands, even if they’re not your hands.” A rare, genuinely touching moment for Morgan, and I’m all for it.

After the surgery, Shaun apprehensively waits next to Lea’s bed. Everything went well. Lea tries to take her mind off things with work, but Shaun hovers somewhat overbearingly next to her. She finally gives him a long, hard look and tells him, “Go do your job.”

Shaun actually crashes Maxine’s surgery. Asher turns to him and tells him, “I’m sorry about Lea. If there’s anything I can do…” Shaun responds, “No, you can’t. As a first year resident, you’re one of the least qualified doctors here.” Ever so charming, Shaun. But also kinda right.

While Shaun distracts himself with helping out in surgery, Audrey, Claire and Jordan spend some time with Lea, trying to cheer her up. They detected some amniotic fluid leakage, but they reassure her that this is not unusual, and often resolves on its own. There’s some definite companionship and bonding going on here, and I like it. I think it would be awesome if they could build more of a Lea and Jordan friendship in season 5, they already laid the foundation to that in the next episode, and I’d be here for it.

That said, makes me wonder about Glassy again. Did he not have a moment to come see Lea and talk to her, maybe reassure her, offer some support? We can hope that this happened off-screen, and there’s only so much time in a 42-minute episodic format to cover all the angles, but I think a bonding scene between Lea and Glassman here could have been powerful and strengthened their relationship.

Some time later, Shaun goes to see Lea to tell her that her amniotic levels are stable, and things appear to be looking good. But not for long. Lea starts gasping for air, and Shaun quickly realises she is having a pulmonary embolism from a blood clot that travelled up her leg. He slaps an oxygen mask on Lea and pages Claire.

Side note: So we see that Shaun checks Lea’s leg for signs of thrombosis, and her leg is red and swollen. Why did Lea not notice this before? She doesn’t strike me as the type to keep symptoms quiet. If your leg looks like that, you would have noticed that as a patient for sure. Deep vein thrombosis usually hurts, and the leg feels warm. I dunno. Smells of inconsistency to me. But anyway…

They run an MRI on Lea, and a pulmonary embolism is confirmed. As they discuss the options for treatment, it looks like inserting a filter into Lea’s pulmonary artery is the best and safest way to go. Poor Shaun is hanging back, listening to all of this. They ask him what he thinks. “I… trust your judgment,” he tells them. Morgan’s speech up on the gallery must have really struck a chord.

This means another surgery, and there’s more waiting, more uncertainty, more helplessness. Shaun sits by Lea’s bedside, trying to reassure her that she’s in good hands, and that there’s a low complication rate. Lea sees what’s going on. “Shaun. It’s okay to be scared.”

Shaun’s usual fixation with wanting to fix things is right there. “But it’s not helpful. I want to make things better. I don’t know how.” Lea reaches for his hand and points to a couple with a baby out in the hallway. “Look. That’s going to be us. You don’t need to fix things, Shaun. Just believe with me that we’re gonna get through this, and the three of us are going home.”

In light of the tragic events about to unfold, that one really hurts. Because sometimes believing is not enough.

Next thing we see is Shaun sitting in one of the chairs outside of the path lab. He’s holding a clipboard with lab results, which we can only assume means he’s seen that the baby’s results aren’t looking good. Asher comes in and asks for Maxine’s blood tests, but Shaun doesn’t know. Instead, he inquires why Asher is so obsessed with keeping Maxine alive when she will die from the terminal cancer soon anyway.

Asher tells Shaun about how much his grandmother meant to him. She died a few years ago, and she was the only person in his family who truly understood him. “More time would have meant… everything. Time is hope.” Asher verbalises something that Shaun may have subconsciously already known, which was why he was sitting there with the lab results.

Claire has more news and goes looking for Shaun; she finds him still sitting in the lab waiting area. The news aren’t good. In fact, they’re the worst you could imagine. They found a second clot in Lea’s umbilical artery which is dampening the blood flow to the baby, causing development to stunt and making the pregnancy unviable. “I really, really wanna be wrong about this, Shaun,” she tells him. But Shaun already knows. “You aren’t wrong.” He saw the test results from the amniotic fluid: the baby can’t survive.

Claire asks him if he’s already told Lea. He hasn’t, and he doesn’t want to. Not yet. “I couldn’t protect Lea. The only thing I can do for her now is to give her more time. To hope.” But Claire can also read Shaun pretty well. “I don’t think you’re doing this for Lea. I think you’re protecting yourself from the pain of watching her pain.”

Shaun lets that sink in for a long moment and releases a heavy breath. (Stomach knots number 4,893 to 5,286 incoming.) Claire is close to tears. “Would you like me to be there?” Shaun hands her the clipboard and in a soft voice says, “No, thank you.” (Everything hurts. I want this to stop. I’ll just quietly cry into my cup of coffee, I guess.)

Shaun goes straight to Lea’s room, and we know what’s to come. His expression is stern, his steps hesitant. He can’t protect Lea any longer, and Claire was right. She smiles upon seeing him, but as soon as she sees his face, her own falls. Shaun doesn’t have to say anything. She knows what this means. He reaches out and draws her close. It’s a special kind of agony to see Lea cry as Shaun just holds her.

God, this scene kills me, and I wish they hadn’t faded out of it so quickly, but at least we got a few episode stills to go with it. Instant gut punch when I look at these.

The next day, they need to talk about what to do. Audrey tells them about their options. They can have a D&C, or they can induce labour and say goodbye to their child. Lea asks to have a minute to talk about their decision.

Shaun’s voice is small and full of pain when he asks Lea, “Do you want to discuss risks and benefits?” They both have tears in their eyes, and Lea says, “No. I’ve lost her. We lost her. This isn’t about medical questions anymore. But I can’t go into labor and not leave here with our baby.” Shaun takes her hand in both of his and they shed silent tears together.

This is the first and only time we see Shaun actually tear up during all of it, when usually he’s a fountain of raw emotion whenever things touch him on a personal level. I’m still trying to figure out if that’s because he was very badly trying to keep it together for Lea’s sake, or if there’s still the underlying issue of him being less connected to their baby than Lea. There’s no doubt that he’s deeply affected and distraught, but it’s still an interesting question how much of it is actually him feeling the loss of his unborn child, and how much is him feeling and seeing Lea’s pain.

Lea gets the D&C, and Shaun stays with her as long as he can. In a trance, he walks out of the procedure room. And there is Aaron, waiting outside, announcing his presence with a soft, “Hey,” that pulls Shaun out of his stupor. Shaun slowly turns his head, and unequivocally accepts the much needed comfort when he literally throws himself into Aaron’s arms. Their hug is everything. The fatherly pain is apparent when Aaron looks on as Shaun wordlessly walks away afterwards. I’m crying into my now empty cup of coffee.

Next we see Lea getting discharged from the hospital. A nurse pushes her chair out of the patient room and along the corridors with a quiet Shaun following with her bag in hand. The Dr. Ted teddy remains behind.

Shaun’s friends and colleagues watch them leaving, and I love this montage. The choice of song is perfect (Beth Orton’s acoustic cover of “Ooh Child”), and it pays tribute to how much Shaun and Lea are loved and respected at this hospital. Hey look, I’m crying again. The coffee cup is now in the running dishwasher and I can hear the soft sounds of swooshing water from the kitchen.

Shaun and Lea’s tragedy stays with Aaron, too. He’s packing up to go home for the day, but he picks up the phone and calls his wife. “Hey Deb. No, I’m not gonna be late. I just, uhm… I just…” his voice cracks, “wanted to hear your voice.”

Back home, Shaun and Lea are trying to process the events of the last few days. Shaun brings them a glass of orange juice, and both of them sit on the couch, forlorn, without a word spoken. There’s a distance between them, neither knowing how to make any of this better. Shaun switches on the Weather Channel and they sit in silence. The episode fades out on a caption of, ‘For support and resources for pregnancy and infant loss, visit RTZHOPE.org’.

Oh man. Everything in this episode is just epic hurt. It’s like a serrated knife endlessly being turned in your gut. The angst monster in me has a love/hate relationship with it, because I’m all about the emotional intensity, but goddammit, I also don’t want these two in so much pain.

What struck me throughout the episode is the beauty of silence that was woven through the episode like a golden thread. A lot of the gut-punchingly touching scenes had very little to no dialogue, and it made them so much more delicate and meaningful. A masterful display of ‘show, don’t tell’.

All the props to Paige Spara and Freddie Highmore (daily gushing ahoy), they really carried this episode, and they did it magnificently. If I could give them all the awards in the world, I would. This is the kind of television content I’m here for, even though it aches on the inside.

The First Year Residents

Asher, what the hell are you doing? Secretly slipping antibiotics into Maxine’s IV so she wouldn’t die, when she clearly said she didn’t want that? Just because you thought it was the right thing to do? Glassman is right that you should be fired for that. Thank God Glassman is smart and empathetic and gives Asher a chance to make it right. Our boy Asher has a lot to learn.

While Shaun is sitting in the lab, Asher comes join him and they talk about the value of prolonging life. Asher talks about his grandmother, and how much he loved her. She was the only person in his family who understood his fascination with the outside world, and every now and then she would secretly slip him something ‘verboten’ (German/Yiddish word for ‘forbidden’), something worldly that their faith would not allow. She passed away too soon, and Asher really misses her.

When they talk to Lea about motherhood, Jordan tells a story about “losing Junior” and a year later getting a cat. Everyone thinks she lost a baby, but Junior was actually a tortoise who inadvertently ran away. First pet she ever owned.

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