The Good Doctor Argentina on Twitter (@TheGoodDoctorAr) is currently running a ’20 Days Countdown to The Good Doctor Season 5’, and on Day 17 it’s time to take a closer look at episode 4×17 Letting Go.
Patient #1 is Senator Marian Clark. Senator Clark had episodes of repeated involuntary face twitching, which is really not conducive to running a full on election campaign that requires frequent public appearances. Frankly, I’m a bit puzzled why Claire is assigned to this case. That doesn’t sound like a surgical issue. Morgan is there as well (also somewhat puzzling, perhaps – I’d pegged this more as a neurology issue and not something for an internist, but I suppose they see all kinds of things at the clinic).
They start the diagnostic procedures to find out what’s going on. The first treatment option they try doesn’t work, and they find out that one of Clark’s arteries is pressing on her facial nerve. It’s not a serious condition, but the twitching is not something they can make completely go away, which Clark says will kill her career.
They find a pretty risky surgical fix, and of course the senator says yes, but things aren’t going well. They need to modify the surgery, and now it’s even riskier. The senator makes it through and shares with Claire a lesson about why sometimes lies can be justified if they help saves lives.
Patient #2 is Artie Hill who has mild heart failure. Or at least so he says. Artie has already had a heart bypass a month ago. The treating physician is Dr. Paul Nakano, who turns out to have been Dr. Andrews’ Chief of Surgery when he was a resident. He works at San Jose General and comes to see Artie who called him. They plan a minimally invasive surgery to fix up Artie’s heart, and they want to do it at St. Bonaventure with Dr. Nakano leading the surgery.
Shaun gets more or less coincidentally involved in Artie’s case when he walks past and gets called into Artie’s room. Artie keeps complaining about having cold feet.
Shaun, now having been involuntarily roped into Artie’s case, concludes that Artie’s cold feet mean that there’s diminished blood flow because one of Artie’s vessels is damaged. The surgery they are planning would thus kill Artie, and Shaun urges the team not to go through with it. And that’s not all. Shaun tells Dr. Nakano, “You made a mistake during the bypass, most likely a tear in the aorta.”
Dr. Nakano and Dr. Andrews don’t agree with the assessment. Andrews tells him, “Shaun, this man has more cardiac experience than everyone in this room times ten.” Shaun insists they should perform an angiogram, which will show the aortic dissection.
They do the angio, and there is no damage. Which means they can go ahead with the initially planned surgery to fix Artie’s malfunctioning heart. With Shaun off the case, the team prepares the surgery, but Shaun comes rushing in, just as they want to repair the valve. He’s figured out that Artie has a congenital narrowing of the abdominal aorta, which would have killed Artie after all, but for a different reason.
Nakano is actually impressed that, this time, Shaun is right, and invites Shaun to join the direct valve replacement surgery they have to do instead of the minimally invasive method.
The surgery goes well, but Dr. Nakano announces afterwards that he will quit surgery. He almost closed up without a final antibiotic lavage, which one of the nurses noticed and quietly corrected the mistake before Dr. Nakano could make it. “I always told myself, once I started making tiny errors, I’d stop before I made a big one.” That’s perhaps a bit of a drastic view, but ultimately a very brave and admirable one.
Shaun & Lea
In this episode, we delve into the aftermath of Shaun and Lea losing their baby, and it’s not easy. What is probably a few days after Lea gets home from the hospital (or maybe even the next day?), Shaun is getting ready to go to work. Lea encourages him to do so. “The best thing to do is to just get back to normal. I’m glad you’re going back in to work. Couple more days of rest and I’ll be doing that, too.”
Shaun makes an attempt at probing how Lea is coping, when he asks her, “Are you sure you’re all right?” But it falls a bit flat because she seems to be holding back a little. “We just need some time.” Perhaps also for Shaun’s sake, because she doesn’t want him to worry, or to feel bad for going back to work.
There’s also something about their garbage disposal being broken, so they should use the regular trash instead until the landlord gets it fixed. And can I just say, this is such a foreign concept to people in Europe. We don’t put food waste down the kitchen sink. Boggles the mind.
At the hospital, Park and Lim ask Shaun how he’s doing, and he insists he’s fine. They’re surprised to see him, but he says he prefers to work rather than stay home. It feels pretty consistent with Shaun’s usual coping strategies. Distraction helps, right?
Back home, Lea is trying to find her own distractions. Television isn’t cutting it. She declines an incoming call from her mom. She’s restless and doesn’t know what to do with herself.
In the meantime at the hospital, Shaun is having trouble with his communication skills. All he wants is the best for the patient, truly concerned that Dr. Nakano made a mistake and will kill Artie if they go through with the planned surgery, but the way he communicates this is blunt, rude and offensive to Dr. Nakano. We’ve known Shaun to be better than this, but can we really blame him? He’s not really thinking clearly, is he?
Andrews is clearly uncomfortable with this in front of his old mentor, so he tells Shaun to get the hell out. Before Shaun leaves, he turns around again and insists, “You will kill him.” And as if the affront isn’t enough, Shaun actually goes back to Artie to tell him that Dr. Nakano made a mistake and that he should refuse the surgery because he’d very likely die from it.
Andrews is livid. He orders Shaun to his office and tells him to go home. But as messy as the whole thing now is, at least Shaun gets his way and Artie will get the angio. After Shaun leaves the room, Nakano tells Andrews, “I would have fired him.” Good thing that Andrews knows what Shaun and Lea just went through and is willing to give Shaun some leeway.
Lea’s phone runs out of juice when she plays some rendition of Candy Crush, and she can’t find her phone charger at home. And so she decides to venture out and look in her office. Perhaps it’ll be the welcome distraction she needs.
At the hospital, Shaun hides out in the break room. Alex finds him and tells him he shouldn’t be there, he should be home. Shaun is waiting for them to do the angio so that they can see he was right and then he can be back on the case. But it turns out Shaun wasn’t right. They did the angio and there was no damage. “We all make mistakes,” Alex tells him, “But I think you should leave the building while you’re still forgivable.”
Shaun is clearly thrown by this. How could he have been so wrong about this? It’s the first time in a long time that we see him ruffling his hair – one of his comfort gestures when he’s upset.
Lea’s first time back at the hospital brings many painful memories. Pregnant patients walking by, colleagues who greet her and express their sympathies. Nurse Villanueva sees her come in and walks up to her. “It happened to me, too. Twice.” Jordan also comes to see her and give her condolences. She tells a beautiful story of her grandmother’s funeral. “We said goodbye to the past. You’re saying goodbye to the future. I’m sorry for your loss.” It makes both Lea and I tear up.
Shaun, instead of going home, texts Glassman to meet him outside on the walkway. Shaun is pacing, telling Aaron about his inability to understand why his diagnostic skills failed him. Glassman sees the underlying issue, though. “What are you still doing here, Shaun? Do you not wanna go home? You gotta go home, you suffered a loss, you gotta deal with it, you gotta face it.”
Shaun doesn’t really understand. “Why do I have to face it, what does that mean? It happened.” Yes, it happened, and there’s nothing that can fix that. “Go home and be with Lea,” Aaron tells him. Shaun is still hesitant.
He does go home eventually, though. Lea remarks that he’s home early, and Shaun tells her Andrews sent him home, and Glassman wants the two of them to talk. But what is there to talk about? Everything sucks, and everything hurts, and nothing any of them can do will make it feel better.
Lea isn’t receptive to having meaningful discussions and makes some tea, and then her phone rings. It’s her mother again, calling for at least the third time that day. Shaun answers the phone, but Lea doesn’t want to talk to her mom. It turns out that she hasn’t told her parents yet about the loss of their baby.
Pam keeps babbling on about things she’s bought for the baby, and Shaun doesn’t know what to say while Lea indicates he should stop the call right now. He gets uncharacteristically aggressive and ends up yelling at Pam, tells her to shut up, and then hangs up.
Shaun goes out to the patio, taking out his toy scalpel to calm himself down. Lea comes to talk to him. “I’m not behaving normally,” he struggles. “I don’t think grief has an actual solution,” Lea offers. “It has to,” he says. “I can’t stay this way.” Well, Shaun, if only it were that easy. He has a eureka moment about Artie as they talk, and Shaun rushes back off to the hospital.
Shaun’s inspiration manages to save Artie’s life, but it prompts Dr. Nakano to quit his job as a surgeon. Dr. Andrews is surprised by that decision but supports it, and he tells Shaun that he’s going to have a drink with his old mentor because no one’s meant to shoulder loss alone. When Shaun asks why Dr. Andrews is the right person to spend the evening with Dr. Nakano, he explains, “Because we love the same thing, and he knows no one would understand what he’s lost more than I would.” And that hits closer to home for Shaun than Andrews can imagine.
Shaun goes home, and Lea is a bit of a mess. She babbles on about mugs she should be washing, and fruit flies near the drain. Shaun silently walks up to her and puts his hands on her shoulders, prompting her to stop and look at him. She’s still on about it being her fault if they get bugs, but Shaun can tell that she’s teary and vulnerable, and he just takes her into his arms and holds her.
I love this scene so much, and I have a lump in my throat. It’s so tender and raw, and Shaun is such a champion here. As much as he can be oblivious to other people’s feelings, he is so in tune with Lea. He can read her cues and act on them, he comforts her that exact moment she needs it. That’s a pretty huge thing for him. And it all happens silently. Look at how far he’s come. I’m vicariously proud.
Marcus sits down with his old mentor in his office over coffee. He defends Shaun, saying he’s going through some personal stuff, which is why he didn’t fire him. Because Nakano didn’t fire Marcus either when he was in a similar position in his old residency days.
They share a story about why Nakano supported Marcus as a resident and not his clearly more adept competitor. Turns out the other guy is more of a paper pusher, while Marcus was the born surgeon. If you want to read between the lines, then that means Marcus is supporting Shaun because he values him as a surgeon worthy of his support. I choose to believe that’s the case.
Claire is one of the residents treating the senator, and it turns out that Senator Clark was the commencement speaker at Claire’s high school graduation. Claire clearly remembers the inspiring speech that Clark gave about a little girl who overcame a disability and made her way in life, which prompted Claire to pursue a challenging career. But turns out the story is actually bogus and made up by Clark’s campaign manager as a promotional stunt. Makes you realise just how much of a fraud some people are in order to get somewhere in life. And maybe also that politics can be cut-throat and ruthless.