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Season 6 Recap: 6×03 A Big Sign

This episode made me as conflicted as I think the viewers were supposed to feel about the whole situation with Shaun and Lim. Because when I watched it, I was still so mad about the mess of last week’s episode. I think I really would have enjoyed it more if last week hadn’t left me so aggravated. But overall, I’ll give this one a tentative thumbs up.

The Technicalities

Written by Liz Friedman and Jessica Grasl
Directed by Rebecca Moline
Original airdate Oct 17, 2022

Patient Cases

Patient #1 – Cady Stinson

Treating physicians:
Alex Park, Jordan Allen, Danica Powell

Diagnosis:
Cuts, abrasions and suspected right distal radial fracture as initial reason for hospitalisation, follow-up diagnosis hydrocephalus resulting in altered mental state

Case notes:

  • Cady has a history of bipolar and depressive disorder, she sustained the injuries when she jumped out of a moving car because she thought her parents were kidnapping her.
  • Cady’s parents were on the way to admitting Cady to an inpatient psychiatric facility, she hasn’t recognised her parents in over two months and thinks they are strangers.
  • When Cady becomes agitated and jerks around, she exacerbates her fractured arm and her artery becomes lacerated and starts bleeding profusely. They sedate her and stop the bleeding.
  • The wrist fracture can be fixated externally or internally. The internal fixation has a higher risk of complications, the external one will required a longer hospital stay. Cady’s mother decides on the external fixation.
  • Now hospitalised, Cady expresses that she wants to be free of the restraints they put on her, but Jordan states they are necessary. Danica later takes off the restraints without authorisation from Jordan or Park, Cady escapes from her hospital room.
  • They find her in the hospital chapel, singing a rendition of Cindy Lauper’s “True Colors”. They find that she shuffles her feet when she walks and suspect an issue with her brain.
  • Cady undergoes a brain scan that finds that she has an accumulation of fluid in her brain that they start draining. The pressure in the brain is very high, the fluid must have been building up for years and could have caused irreversible damage.
  • Cady takes a while to wake up from the surgery but when she does, her follow-up exams show no mental deficits or further depressive state.

Patient #2 – Julianne Wade

Treating physicians:
Morgan Reznick (initially), Shaun Murphy, Asher Wolke, Daniel Perez

Diagnosis:
Fractured ankle after a fall, parietal lobe brain tumour causing a distorted sense of time, follow-up diagnosis of a second brain tumour in the occipital lobe

Case notes:

  • Julianne presents at the clinic with a fractured ankle after falling off a curb as a result of getting dizzy from hypoglycaemia (low blood sugar due to missing an insulin injection).
  • Upon speaking with her, Shaun and Morgan recognise there are issues with Julianne’s sense of time, Shaun suggests a brain MRI.
  • Brain imaging confirms a grade 2 oligodendroglioma centred in the parietal lobe disturbing the praecuneus region.
  • Julianne is given a choice between surgery to excise the tumour or radiation and chemotherapy. She chooses the surgery.
  • During surgery, Julianne goes into v-tach (an irregular heart rhythm that stops the heart from pumping blood), her blood pressure bottoms out. Shaun starts to administer CPR, then they shock her back into a normal rhythm. The cause of the tachycardia is unclear as there are no signs of surgical complications. Shaun orders cardiac tests and they perform another brain scan.
  • The scan comes back inconclusive but based on oedema in that region, Shaun suspects another multifocal brain tumour in her occipital lobe that isn’t immediately visible on the scan. It could be the explanation for the heart issues.
  • Julianne initially rejects the idea of another more exploratory brain surgery, explaining that she had a near death experience and saw her deceased husband whom she can join if she dies since she longs to be back with him. Shaun dismisses the notion; he is convinced Julianne had a seizure hallucination during surgery caused by the tumour.
  • Daniel convinces Julianne to undergo another brain operation, but she has another seizure during the surgery that she does not recover from despite several medications. Shaun tries giving CPR for a while, but they finally call time of death after twelves minutes. Julianne is hopefully reunited with her husband in the afterlife that she believed in.

Shaun’s Journey

Shaun and Lea have now upgraded their lovely blue plates they picked out together when they moved in because Shaun found the pattern soothing to new white “married people plates”. Shaun likes them because they have a pleasant heft and no rough surfaces.

What Shaun doesn’t like, however, is how sloppily Lea rinses the plates before they go in the dishwasher. So he clandestinely takes them out to re-rinse them when Lea isn’t looking. She does notice, however. And gives him a bit of a stink-eye.

Arriving at work, one of his tasks of the day is to consult on one of Morgan’s clinic patients – a woman named Julianne who is a marital therapist. And quite a famous one, at that, as Morgan can’t help contributing. Shaun proudly proclaims he’s been married for three months, seven days and thirteen hours, Julianne calls it the ‘wet cement year’. Shaun’s attention is piqued when she talks about how important it is during the first year that couples cultivate good habits and weed out the bad ones.

This then becomes Shaun’s new mission for the next day or two: Figuring out what good and bad habits are that will sustain his marriage with Lea for the long haul. He calls a ‘Meeting of the Divorced’, and it includes Glassman, Andrews, Park and Lim. “Please describe all of the bad habits that developed during the first year of your respective failed marriages. Or good habits, if you had any.” Oh dear.

He doesn’t get much in the way of helpful advice. Park shares, “Don’t get involved with a pathologically ambitious narcissist and be as emotionally open as possible.” Yeah, I don’t think Shaun needs to worry about any of those. Andrews adds, “Nothing is too small to discuss,” although Glassman contributes, “Except for the infinite number of differences of opinion.” Lim adjourns the meeting by saying Shaun best talk to his wife directly if he has concerns about their habits.

Which he does forthwith when he is examining his patient Julianne while at the same time use her for marital therapy advice. Shaun made a list of Lea’s habits that he finds aggravating, and it includes snoring, minor tardiness and a disconcerting tolerance for dust. When Julianne asks which of Shaun’s habits Lea finds annoying, she says his way of taking dishes out of the dishwasher to re-rinse them after she’s already done it. Shaun says, yes, he does that because she’s doing it wrong. Cue another stink-eye for Shaun that is totally lost on him.

Turns out that Lea hates doing the dishes but Shaun actually enjoys it. So why are they trying to find common ground on this? They should divide and conquer.

Divide and conquer they do that night, with Shaun expertly scrubbing the dishes and Lea folding laundry. Turns out that’s not ideal either, because Lea is folding the shirts wrong, which Shaun can’t help but point out. Lea’s patience is wearing thin, she asks why Shaun doesn’t fold the shirts himself, then. Which he thinks it an excellent idea and gets right to it. Flies right by him, of course, that Lea is not happy that he’s pointing out one more flaw.

After some of his colleagues mention to Shaun the next day that maybe their dishes and laundry session the night before may not have been as much of a success as Shaun thought, he texts Lea that there’s an important matter that needs to be discussed as soon as possible. Lea comes rushing to the MRI observation room because she thinks there’s some kind of emergency. Nope. Just Shaun wanting to reflect on last night. Lea is definitely not happy, they will need to define what makes a matter qualify as “important and to be discussed asap”.

I love Paige’s delivery of the first “Shaun…” here. It clearly says, my boy, you done messed up. I’d hope that even Shaun picked up on the fact she’s not overly delighted.

He inquires whether she was mad last night that he took over folding the shirts. She explains she was frustrated because it can be unnerving and deprecating when he’s insisting to have things done his way. We learn why the episode is called the way it is, because Lea explains, “Knowing you think I’m wrong about so many things, sometimes it feels like you’re watching me and holding a big sign that says, ‘You’re doing everything wrong.’”

I love the little allusion here to Shaun’s way of doing things being fully research supported. I can only imagine the phrase, “I’ll show you the research,” is a frequent statement in their home.

Lea explains she doesn’t really care about dishes or laundry and she’ll find something else to be in charge of. Like grocery shopping, but Shaun comments that her ability to properly check the apples for bruises is also lacking, and the store won’t take them back. Oh dear, Shaun. You’re really putting your foot in it.

What I loved about this scene is that we subtly touch on the issue again that Shaun’s ASD can get in the way of their relationship, but Lea quickly quells that fear with an almost off-hand comment of, “I love your brain, Shaun.” That line practically goes unnoticed in light of the rest of the conversation, but it carries a lot of weight when you think about it.

When Shaun is getting ready to operate on Julianne, she tells him he shouldn’t worry too much on the wet cement. Most important is that he keeps telling Lea that he loves and appreciates her. It clearly gets Shaun’s brain into gear on how he could put that into effect.

That night after Shaun and Lea have dinner, Shaun tells her he thinks she should do the dishes. Is he sure, though? Does he not want to teach her his technique? Nope, he says, he’s gonna get ready for his night call. As she starts to rinse the plates, Shaun retrieves a hand-drawn cardboard sign he made. A big sign that he holds up for her to see.

Lea turns her head and laughs. “I love you too, Shaun,” she tells him, and adds that he doesn’t have to watch since it clearly still annoys him that her rinsing technique is too sloppy. When Lea tells him it’s okay for him to leave, he turns around and holds up the sign with his back turned to her.

Aww, Shaunie. And yep, you gracefully saved your butt this time. 😀

Why, though, are the lights on in the bedroom, guest room and the bathroom when they’ve clearly not used any of these rooms in the past half hour or so? I mean, yes, of course the answer is dramatic TV lighting, but would the shot really look that different if those lights weren’t on? Everyone talks about energy saving these days. Shaun would want to be on board with being pro-environment, no?

Lim’s Journey

Back at work, the surgery performed on her is clearly still on her mind. She goes to Andrews to request the M&M report. Andrews is reluctant at first, but in the end acquiesces to give her access to it.

He asks her outright if she is confident that she can review the report impartially, prompts her if she’s not just looking for a reason to punish Shaun. That’s an interesting question in light of how the episode ends.

Remember the medical case report I talked about last week that outlined a possible scenario for why Lim may have ended up getting paralysed? Turns out that I was half right. The explanation given in this episode is that during the embolization procedure, Lim had a bleed in a collateral vessel (a small blood vessel that connects the main heart artery to the main pulmonary artery), which caused her blood pressure to drop dramatically. This, in turn, led to lack of blood and thus oxygen supply to her spinal cord, which resulted in nerve damage.

That actually explains why the outcome of the investigation was that the causality between Shaun’s procedure and Lim’s paralysis was inconclusive. I don’t know how they would be able to prove that what Shaun did caused the bleed in the collateral vessel. That might have happened anyway, no matter what procedure they’d chosen to stop the liver bleed. The liver bleed and the bleed in the collateral vessel aren’t necessarily connected. If Lim chooses to sue Shaun over this, I really wanna know how a lawyer thinks they can make a believable case out of it, but there may be more to the story we’re not yet seeing.

Lim can’t let the whole thing go, she asks Glassman about what happened during the surgery and why he didn’t more vehemently push for the liver resection, which Glassman confirms he thinks was the safer option. Glassman defends Shaun’s decision, saying it was a hard call to make but that Shaun was comfortable making it based on the limited data and the change of the medical terms in Glassman’s absence.

Lim presses Glassman for more answers, asking if he would have made that same call in the same situation. Glassman says he thought it was safe to continue with the embolization when he got back to the OR. But was it about safety or about the fact that there was little choice since they were already way too far into the embolization at that point? Glassman expertly evades the answer. When Lim suggests that Glassman was angry at Shaun not because he ignored Glassman’s orders but because he made a bad call, Glassman reiterates what we keep hearing Shaun repeat ad nauseum as well: Shaun saved Lim’s life.

The next evening, Lim seeks out Glassman again. She needs more answers, needs someone to talk to about how angry she is that everybody seems to be fine with the fact that she’s now confined to a wheelchair because of the surgical approach that Shaun chose. Holding the glass of whiskey he just poured himself, Glassman says he’s not. He’s not fine with it.

What Shaun did was risky and headstrong, and it’s not what Glassman would have done. In fact, it’s what Glassman explicitly told Shaun not to do. But that said, Shaun did what he thought was best, and he didn’t make any mistake as such. It shouldn’t leave a mark on his surgical career because it was a difficult decision that surgeons sometimes have to make.

Glassman isn’t just in disagreement with Shaun’s decision, he’s actually angry. So angry that it keeps him up at night, thinking what if he hadn’t left the OR, what if he could have come back sooner, what if Shaun had listened to him? But it’s irrelevant now. It happened. No one can turn back time.

Audrey tears up because she’s grateful that finally someone is on her side, that someone expresses that Shaun may have made the wrong decision instead of insisting he saved her life. Glassman says in the end it doesn’t matter, because it’s not either/or. But Audrey says she’s not so sure. Yeah, this is gonna get ugly. The lawsuit is coming, mark my words.

Things come to a head when Lim comes to Shaun’s office to inquire about his deceased patient. Shaun isn’t concerned, she died from a seizure that happened even before they cut her open. Lim takes that as it is and is about to leave, but Shaun drones on about her relationship advice having been helpful.

And that’s when Lim kind of explodes in Shaun’s face. She tells him she can’t do this, she can’t be friends with him or act as a confidant. She’s having complicated feelings about her surgery, about Shaun having a hand in the outcome.

Shaun broken-records that he saved her life, because that’s what most important, right? Well, it’s important, but it’s more complex than that, which sadly Shaun has trouble comprehending. She points at her wheelchair. “This… is a struggle. You put me here, and I’m really angry about that!” She’ll be professional as his boss, but that’s all she can do. “I don’t want you to ask me about my personal life, and I don’t wanna hear about yours. From now on our relationship is medicine-only.” She leaves a totally blindsided and dumbfounded Shaun sitting on the couch in his office.

I really wonder why Lim went to Shaun’s office. Did he ask her there? She opens the conversation with, “You lost a patient today, Dr. Murphy?” That opener could mean a lot of things. On the surface, it may read as if she’s concerned Shaun had a fatality on his watch as newly appointed attending. If you dig deeper, it could be more malicious than that – her insinuating that Shaun made another mistake that led to a patient’s death. Interesting!

Also, did you pick up on the subtle and unintended humour on Shaun’s part? When Lim says, “Shaun, I can’t hear this,” of course she means, “I don’t want to listen to this.” Shaun thought she physically had trouble hearing him, so he blindly repeats the exact same sentence over again in a louder voice. Oh Shaun.

Jordan’s Journey

Jordan’s crush on the farm boy blossoms. She keeps vehemently denying that it’s even a thing, but Asher knows where it’s at. Both of them stare wide-eyed, however, when they run into a shirtless Danny who is glamorously shaking droplets of shower water out of his hair. Boy is ripped af.

I’m not sure what they wanted to achieve with the totally over-the-top shirtless wet hair shake trope shot, and I’m also not sure if I found it amusing more than out of place for the general tone of the show and the episode. But I do like that apparently they’re not taking themselves too seriously.

Clearly, Danny isn’t just a looker, he’s also a charmer. His bedside manner seems exemplary, especially the old ladies love it when he insists on accompanying them back to their hospital rooms. He likes fist-bumping young cancer children in the hallway, too. Jordan is smitten, although she tries to talk herself into denying how much of a crush she has.

Asher is supportive, texts her that Danny is perfect for her because he also believes in God and the afterlife. And then Danny buys Jordan her second all-time favourite breakfast snack – an almond croissant. It is at that point that she can’t deny it any longer. She has a massive, all-consuming, “my stomach rolls over when I see him” crush. Asher sure is happy about it!

Let’s see if we can look forward to a new pairing hashtag in the future. What’ll it be? #Janny, #Jordy, #Jorny, #Joriel or, lol, #Dandan?

Asher & Jerome

I still totally dig these two, they’re a sweet couple, and they get their moment with Julianne, the marital therapist, too. She asks what they’ve been fighting about, and Asher hates it when Jerome is on the night shift. Not just because they get less time to hang out with each other, it’s also the lack of sex. So Julianne asks why they have to wait until Jerome is home to have sex. Hmmmm.

Honestly, I totally misinterpreted this the first time around. I thought Julianne was encouraging Asher to, you know, boost his own morale when Jerome is not there. But that’s not where this was going. At all.

Next we see them, Jerome is carefully opening the door of the janitor’s closet to check if the coast is clear. Asher is exiting after him, straightening out his hair.

Okay, so they meant actual mutual sex – that also makes sense. Wasn’t there an on-call room with a bed where this would be much easier? Claire and Jared were using it just for this purpose in the pilot. Although Asher later admits that he actually likes the closet because they’re… coming out of the closet. Pun very much intended.

The Newbies

We do learn this episode that Danica has a prosthetic leg and also learn how that happened. When she speaks to the mother of her patient and how complicated it gets when your family is hit with a personal crisis, she shares her own story.

Danni used to be a lieutenant on an aircraft carrier when she was in the Navy. She witnessed many planes land on it, explains that the process involves catching on giant inch-thick steel wires so that the planes don’t skid off the other end. These wires are incredibly strong and they almost never break – until they do.

Danica was hit in the leg by a torn steel wire that sent her flying, had her go into a coma for weeks, leaving her parents with the difficult decision whether to amputate her leg. Her parents couldn’t agree, fought over it, but her mother won and the leg was amputated. Danni recovered and went to med school on one leg. We see her prosthetic when she lifts the leg of her scrub pants to demonstrate.

The story had a happy ending, because her parents are still happily married after 45 years, and here Danni is, strong and capable as ever. What she tells the mother is, “When a family member is sick, everybody gets a pass,” encouraging her to forgive her daughter’s stepfather for wanting her to choose between her daughter and him.

Unbeknownst to Danni, Alex is watching from outside the patient’s room. When Danni later apologises to Alex for being out of line when she acted against his instructions, she admits that chain of command was never her strong suit. Yeah, we’ve clearly seen that in action twice now already, with two different attendings.

Alex isn’t very concerned with that right now. He’s been witness to some of Danni’s very personal backstory, of what makes her tick. “Thank you… for your service, lieutenant,” he conveys to her. She smiles, and as he walks away, she asks, “Was anyone ever gonna ask about my limp?” Alex grins. “Shaun wanted to, but we told him he wasn’t allowed.”

Wow, I’m surprised Shaun didn’t ask anyway. Lol

I did complain last week that this wasn’t addressed at all in Change of Perspective, right? I almost wanna apologise for my tirade, because I think they did introduce us to the idea of Danni being an amputee quite beautifully and not in an obnoxious in-your-face way. I really liked that part. But goddammit, they could have given us that little “Shaun wanted to ask but was told not to” tidbit last week.

Things to Further Dissect

Oh man, I’m sorry to some extent for all my ranting last week, because they actually addressed some of the issues in this week’s episode that I vocally took issue with, so I’m somewhat placated, but I guess it still doesn’t change the fact that I felt last week’s episode was severely lacking in some respects. But let’s not talk about old news, let’s see what this episode had to offer.

Lim vs. Shaun

So obviously the humongous elephant in the room right now is the change to Shaun and Lim’s relationship, their feelings over it and how Glassman fits into that structure. The really sad part is that Shaun was totally blindsided by it, that it’s hard for him to understand where Lim is coming from.

Let’s go on a little excursion back into season 5 to put this into perspective. If you remember the episode Cheat Day in season 5, Shaun comes to the realisation that it’s no longer the medicine that’s most important to him, it’s the people around him who support him, who are his friends. He very much counts Dr. Lim as part of his tribe. Autism consultant Melissa Reiner also spoke to how big of a deal that was for Shaun to realise in her episode insights.

And now, here is Lim, telling Shaun that she can no longer be a confidant, that he can no longer count on her personal support and that she has lost the ability to see and treat Shaun as a friend.  It must be a huge punch in the gut for Shaun, because he had no idea. In Shaun’s mind, he saved Lim’s life, so his decision was the right decision, and that has to be good enough – it has to be better to be alive and in a wheelchair than being dead.

We also know Shaun is not the type to dwell on what-ifs. He lives by his reality, knowing that reality can’t be changed, and that it’s not productive to question potential other outcomes that you won’t be able to produce, now that whatever happened has irrevocably happened.

Shaun probably also feels somewhat vindicated that the M&M results came back as inconclusive, so there was no hard evidence that he made a mistake. In Shaun’s mind, everything turned out okay, and so everyone should be ready to accept and adapt to the situation and move on. Well, far from it. Lim is miles away from acceptance at this stage.

Shaun’s Side Of Things

Some people have been asking how on earth Shaun doesn’t get why Lim is so angry. The short answer to that is: His ASD. It was already established in s1 and beyond that Shaun has trouble with empathy, that it is hard, if not impossible for him to put himself in other people’s shoes. Melissa Reiner talked about it in one of her older episode insights, I don’t recall which one.

It doesn’t mean Shaun totally lacks the capacity for empathy, we’ve seen him being empathetic many times, but he doesn’t always understand the nuances or picks up on the cues. For Shaun, the world is very black and white with very little grey zone. In his mind, he saved Lim’s life and the surgical complications were a bad stroke of luck that he had no control over.

He thinks he did everything right, saved a friend’s life and her liver. The paraplegia was not something Shaun or anyone anticipated. It doesn’t occur to him that Lim could resent his decision when the complication that happened was out of his control, especially since she of all people should know that this can happen and it wasn’t Shaun’s fault. This was also expertly pointed out by Julianna on Twitter.

It’s not that Shaun doesn’t care about how Lim feels. He simply doesn’t realise that she struggles with being confined to a wheelchair every day. Shaun is the “make lemonade out of lemons” guy, he doesn’t dwell on what-ifs. It happened and no one can change it, now we need to move on. He doesn’t really have the capacity to fully understand her struggle without being prompted to think about it in that way.

We can only hope he will now reflect on this, will try to make an effort to understand Lim’s point of view as well as re-examine where he himself may have gone wrong. He’s been overly cocky of late, this season may just end up being his fall from grace. Personally, I’m intrigued by the change in dynamics. I think we’ll see a lot of really interesting drama and friction this season.

What I also see with Shaun is that I think the writers want to make the viewer really conflicted this season. We’ve grown to love Shaun as this sweet and innocent and loving person over the past five years who’s sometimes a little stubborn and misguided, and suddenly we’re faced with the fact that he may have screwed up in a big way that had some major fallout.

We wanna love him because he’s Shaun, but we also wanna hate him a little because he put another dear character in a wheelchair because of his stubbornness and, to an extent, hubris. Which is actually kind of poetic since he accused Melendez of being arrogant and cocky in season 1. Are we coming full circle?

Fandom Sentiment

There’s a lot of strong opinions going around online about the whole dilemma. Some people are angry at the Shaun supporters and say it’s not fair to totally disregard Lim’s feelings and reaction. Some say Lim is wrong in blaming Shaun for her plight and should be thankful Shaun saved her life, she needs to blame Owen instead. Some say Glassman has no right condemning Shaun and his actions, some say this or that character is overreacting or blowing things out of proportion. Some go as far as saying Glassman is a selfish arsehole and that everyone’s out to make Shaun an unreasonable scapegoat and fall-guy.

There’s a lot of anger on social media directed at Lim right now, a lot of antipathy towards her resentment for Shaun, towards her blaming Shaun for her paralysis. What puzzles me a little is the inability of people to see both sides and the lack of empathy for what Lim is going through. Because here’s the thing. You can both be in Shaun’s corner and empathise with Lim’s situation. I would even go as far as saying: You should.

Salen said that to Shaun in season 5. It’s possible that they can both be right, that there are nuances and angles and personal perspectives that explain and justify opposing views and diverging feelings. One can feel sorry for Shaun and agree with his thinking that he made the right call, but at the same time acknowledge Lim’s feelings of resentment and anger to be stuck in a life-changing situation that could have potentially been prevented if Shaun had made a different decision, respectively recognised the chain of command.

Some people are trying to make the point that if they’d gone with Glassman’s suggested approach, Lim would now be fine and better off for it. Others are saying that going with Glassman’s approach, Lim would have bled out and died. The thing is, we don’t know any of that. Lim or Shaun or Glassman don’t know that either. It could have gone either way.

The Morbidity and Mortality Conference

There are a lot of references made to the M&M in this episode, and I think some people may think that the M&M is the same as an in-depth investigation into the case with determinations as to who made what decision and why and whether those decisions were right or wrong. Well, no, an M&M is not that.

An M&M is a non-punitive lessons learned exercise to educate colleagues what to do on similar cases in the future. It is not an internal investigation, a medical courtroom to question or justify decisions or a tribunal to assign blame.

If mistakes were made while treating a patient that resulted in complications or a fatality, an M&M serves the purpose of factually presenting said mistakes with an intent for other medical staff learning from them in a manner that is non-punitive for the treating physician(s).

The M&M would have solely focused on medical facts related to Lim’s medical status, would have factually and objectively described diagnoses, symptoms, surgical and treatment decisions made and finally the outcome. It would not have touched on blame or decision justification.

More likely there would have been an internal investigation prior to the M&M with witness testimony, determining there was no conclusive evidence that Shaun’s embolization procedure caused the paralysis. The M&M could have alluded to that with regards to a recommendation and lessons learned.

Liver resection is considered a technically difficult surgery and there is a risk of complications such as infection, bleeding, bile leakage, liver failure and others. No one knows the short or long term effects for Lim if they’d gone for partial resection.

The question as to whether Shaun or Glassman’s decisions were right or wrong is hypothetical. It is impossible to know what the outcome of a partial liver resection would have been or if it would have resulted in better quality of life for Lim. No one can say for certain.

What we do know is that Lim’s paralysis was caused by a drop in overall blood pressure following the embolization and a resulting lack of oxygen in her spinal cord that caused nerve damage. It was not caused by embolization particles blocking the blood supply to the spine, hence the inconclusive causality.

And not to brag, but I put some of this explanation above about the M&M on Twitter in a longer thread, and it got a Like from the The Good Doctors Writers Twitter account, which I can only count as endorsement that what I’ve written up about the M&M is in line with their thinking.

Through Glassman’s Lens

There’s also opinions going around that Glassman is out of line for siding with Lim over Shaun. Is he, though? I don’t know that I agree with that statement.

Glassman is caught between a rock and a hard place. He loves Shaun like a son, he wants to protect him, wants him to do right and do well. But Shaun didn’t. He made a decision that Glassman didn’t agree with and that ultimately cost a friend the use of her legs. And he should be allowed to resent Shaun for that despite the fact that Shaun may have saved Lim’s life, despite the fact that Shaun is a brilliant surgeon and a surrogate son whom he loves.

Glassman is convinced the liver resection would have been the better option for Lim. He was angry when Shaun did the embolization instead because Glassman saw the risks and was afraid it would go sideways. And it did.

His main concern was Lim’s outcome. Hindsight is 20/20, now Glassman wishes Shaun had listened to him even more so. Not because he’s angry that Shaun disregarded his authority but because he’s convinced Lim’s blood pressure wouldn’t have dropped the way it did and the paralysis would have been avoided with his approach.

There’s a theory floating around that Glassman only reneged on his insistence on the liver resection because he knew there was no clear medical evidence that it would be the better option, and he didn’t want to appear stupid in front of Shaun and Jordan, same reason why he didn’t speak up against Shaun during the case investigation. I dunno, that sounds super implausible to me.

There was no medical evidence to suggest either approach was going to be the “right one” at the time. Why would a senior surgeon need to justify to his subordinates why he chooses a certain procedure over another? Sure, there can be discussion in the OR to challenge a certain approach if there are differences of opinion, but unless something is suggested that is super out of line, what the senior surgeon says goes. And then the responsibility will lie on his shoulders if it goes sideways.

So why did Glassman not push for liver resection when he got back to the OR? Well, this was clearly stated. Glassman let Shaun proceed because they were so far into the embolization procedure that it wouldn’t have made sense to abort and try something way more complex, time-consuming and aggressive. To me that was clearly outlined in the dialogue, and I didn’t think there were other ulterior motives at play.

Coming back to the matter of responsibility, Glassman’s anger is partly fuelled by Shaun taking the initiative while Glassman was not in the room without giving him the chance to intervene and right the course. The boat got rocked, and now that it has sunk, it’s all on Shaun. Glassman would rather be the person with the responsibility resting on his shoulders because Shaun is like a son to him and he wants to be able to protect him.

What I think is pretty clear is that Shaun has been a little too overconfident lately and that he’s been getting away with a lot of shit that maybe he shouldn’t have gotten away with. It wasn’t just the surgery. He strutted around like a peacock during mating season on his first day as attending, almost firing a junior resident, and he stated to Park that being an attending will be no more difficult than being a senior resident.

Well, I think a lesson in humility might not be the worst thing for Shaun right now. Not to punish him but to learn that actions have consequences. And I think we may see some of that play out over the course of the season.

In a recent The Lede interview, Freddie said something noteworthy, namely that “for a long time this season, Shaun will be in denial about the realities of what happened. That’s a very human journey, and a really interesting one to explore, especially through the lens of someone who has autism and who is experiencing that feeling of denial, and of shutting down emotions, in a different way.”

Daniela said that the comment led her to believe that the real problem here is not so much who was right and who was (medically) wrong between Shaun and Glassman. It may be more about Shaun learning how to take on objective responsibility when something he does goes wrong.

Shaun needs to learn how to handle these situations because it will happen again and again throughout his career as a surgeon. His reply to a distressed patient or a family member can’t be, “I was right,” or “I saved your life.”

Freddie commenting on Shaun shutting down his emotions gives new insights into the bigger picture, because while currently the whole focus seems to be centred around this big medical decision, the matter at hand and the lesson to be learned is actually much bigger than just the question of whether Lim’s paralysis was a medical-technical error on Shaun’s part.

The paralysis outcome is the perfect catalyst for a larger lesson that Shaun may need to learn, which is to process his own emotions and then to adjust his responses accordingly, sometimes to cast these emotions aside and act objectively. It will be all the harder for him because he doesn’t always recognize or have the ability to analyse what he’s feeling and parse it into his internal dictionary to make sense of it.

I think it’s really hard for neurotypicals (like me) to understand this. The way I see it, maybe it’s analogous to trying to explain to a blind-from-birth person what the colour red or blue or yellow is. The way I imagine what happens for Shaun is that he has all those bodily responses like tears welling up or his stomach clenching or the hitched breath but he doesn’t comprehend why this is happening until he finds a way to process it himself or until maybe someone tries to point out to him that he may be feeling sad or anxious or angry because of something that happened. Of course that’s merely guesswork on my part, because, well, it doesn’t quite work like that for me. But I digress…

Dare we postulate that perhaps Shaun’s residual guilt over Steve’s death is playing into this as well? Is part of it a defence mechanism of sorts for Shaun to not have to feel guilty over having ruined a friend’s life? I guess that’s a bit of a wild theory, so I’ll just leave this here as food for thought.

Is Lim Being Too Cold?

Some people online are saying that Lim has no right to be this resentful towards Shaun and needs to be more grateful because he saved her life. Thing is, he may have saved her life, but he also put her in a wheelchair, even if causality was deemed inconclusive.

Of course I know there are many fans who love Shaun and feel protective of him (I tend to sometimes as well), but saying Lim is an ungracious jerk completely invalidates Lim’s feelings. Yes, Shaun did save her life, but he also caused her whole world to be turned on its head and enormously change in an instant.

Please take a step back and imagine what it’s like as a single, strong, independent woman who had all options open to her to suddenly be disabled for the rest of her life. Perhaps some people are not aware of how much the world is not catering to people in wheelchairs. It’s a huge fucking deal. A large part of the world is no longer accessible to you, your independence has dwindled considerably. Can you really say you want to totally dismiss the right for Lim to mourn that loss?

Lim is going through a grieving process, as people who lose limbs often do. Anger is part of that, and she believes that, had Shaun listened to Glassman, she would not be in this position right now. That’s what she is angry about, and directing it at Shaun.

I want to believe that Lim is grateful that Shaun saved her life, but the resentment at everyone dismissing her anger is overshadowing that. Yes, Owen is ultimately to blame, but Owen is not the person she sees at work every day or who made a risky surgical call that paralysed her.

Shaun as her colleague and mentee is a constant reminder of the assault, of his (in her eyes) misguided decision that uprooted her life in a way that every single day is now a massive struggle. Saying she has no right to feel that way seems heartless, even if Shaun meant no harm.

Anyone who says Lim is wrong for condemning Shaun, I really encourage you to seek out social media accounts and video blogs of people with disabilities who try to advocate and educate the public. Some of them are real eye-openers. I’m sure there are many others, but the ones I really like are these two interabled couples: Squirmy and Grubs and Roll with Cole & Charisma.

The Dishes and the Laundry

So, the domestic disputes in the Shea household… I think a lot of us felt that this was fabricated drama just for the sake of Shaun and Lea talking about habits that annoy the other person. Fine. I can get behind the idea, but it’s hard to imagine that the two of them have been living together (on and off) for three years, and they only now bring up the fact that it annoys the hell out of Lea that Shaun re-rinses the dishes or that we’re to believe Shaun hasn’t told Lea at least ten times that she folds the laundry wrong?

There’s perhaps a question here of how much does Lea swallow down her frustration with some of Shaun’s idiosyncrasies in favour of avoiding domestic friction? I’m pretty sure there have been many instances in the past where Shaun insisted on something that Lea didn’t agree with but still cared about, and she didn’t raise her discontent to Shaun. He wouldn’t necessarily be able to read her non-verbal cues of frustration and discontent, so it would likely result in Shaun thinking nothing’s wrong and Lea is silently stewing with subdued resentment.

That said, these things happen in any marriage or long term romantic partnership. Perhaps not exactly in the same way or as frequently as they do in a mixed-neurological relationship, but it’s very natural to get annoyed by certain habits or idiosyncrasies of your partner, and I think it’s important that these things are addressed between partners to at least create awareness.

So should we assume that the dishes and laundry storyline was mainly inserted to underline the fact that Shaun’s ego is being fed a little too frequently, that he’s been getting away with his overconfidence and sense of infallibility a little too much?

The sign at the end was cute, though, I’ll give them that. And it was the Shaun that we know and love, who is hit with a personal conundrum and then goes and figures out how to handle it, and we’ll get a sweet little aww moment eventually when he’s being thoughtful and clever and shows Lea just how much he loves and appreciates her.

What I found interesting is that Shaun had Lea’s snoring on his annoyance list. I mean, yeah, snoring is the worst, but it’s not like Lea can actively influence that. Shaun has every right to be annoyed by it, but what solution is there for that? Him sleeping with earplugs every night? I think we know he’ll hate that (he once voiced that he hates having things in his ears, although he also brought earplugs to their camping trip because sometimes Lea snores).

We also know he doesn’t want Lea to sleep in the guest room (as per the conversation around the wrist alarm in My Way). So likely he’ll be nudging Lea a lot at night so she turns around and snores less. Or a small miracle happens and he gets accustomed to it. (Does one ever get accustomed to their partner snoring? I honestly have no idea how my mum did it.)

Favourite Lines and Dialogue

Lea: We should have a dinner party. We have six smooth, beautiful married people plates. We can invite Park and Morgan.
Shaun: That sounds not fun, and like we might have fewer plates by the end.

I honestly love Shaun’s dry, deadpan sense of humour so much!


Shaun: As an attending I no longer have time to talk to you all individually, so I called a meeting… of the divorced.

Funny, I could have sworn that it would be the other way round, that residents are way busier than attendings. But what do I know? 🙂


Julianne: Shaun, instead of offering a critique, try stating a positive need. Something like, ‘I wish the situation was more like this.’
Shaun: I wish the situation was more like Lea knew how to wash the dishes.

Why did I know this was coming? Lol


Julianne: Why do you think night shifts are a problem?
Jerome: We have less time together to hang out and…
Asher: Sex. There’s no sex because he’s too tired when he gets home.

Oh wow, Asher, you’re pretty horny, aren’t you? I love it.


Lea: I got your text, is everything okay?
Shaun: Were you mad last night when I took over folding the shirts?
Lea: Shaun. At some point we need to define what qualifies as ‘an important matter that needs to be discussed as soon as possible’.
Shaun: Yes, okay. Were you mad?

So typical Shaun, made me smile.


Danica: And these wires, they can stop a 50,000 pound aircraft traveling a 150 miles per hour in two seconds. And they almost never break. Until… they do.

I thought this was really beautifully told, and in just a few sentences, we learn something really important about Danni, and learn it in a way that we can see it all play out in front of our mind’s eye. This was really poignantly written.


Glassman: And I’m angry, okay?! I’m angry. So what? It’s irrelevant. I’m so angry I could scream, it keeps me up every night! What if Andrews didn’t call me away, what if I had come back just five minutes sooner, what if, what if, what if?!

My God, this scene was so emotionally charged, and so expertly delivered by both Christina and Richard. You could really feel all their emotions and see them on their faces and read them in their spoken words. Kudos to both of them.


Shaun: I think you should do the dishes before I have to go.
Lea: Really? You gonna teach me your technique?
Shaun: No. I am going to get ready for my night call.

This is kinda cute because you can see by the glint in Shaun’s eyes that he very badly wants to add, “And surprise you with this super sweet thing I made because I love you to pieces.”

Sorely Missing

Not that much this episode that I felt was missing. I mean, I would have liked to see the scene where Alex and the residents tell Shaun he’s not allowed to ask Danni about her limp.

What I’m wondering is how much we’ll be seeing of the immediate aftermath of what Lim told Shaun at the end of the episode.

He said he had a night call, which I guess means a night shift or rather being on-call for the night (which as attending might mean he doesn’t have to necessarily see patients, just be there when he’s needed and otherwise sleep or rest or be in his office).

We can assume that when Lim dropped the bomb that she can’t be chummy with him anymore, it was the beginning of his shift, so he’ll have all night to stew on that. On his own. Is that’s what’s gonna happen?

Or would he try to find Glassman and speak to him? And what if Glassman was actually still there at the time and that happened? Would Glassman keep him at arm’s length because he himself is conflicted about the whole thing? How would Shaun take that?

I would also hope Shaun tells Lea about it, but likely this wouldn’t happen until the morning when he gets home. Are they even going to see each other in the morning with their different work schedules?

And what if Shaun doesn’t immediately talk to anyone about it? Would it spin circles in Shaun’s head and grow and fester? Would it cause him to come close to a meltdown, or at the very least make him upset and anxious? Are we gonna see any of those possible scenarios in the next episode?

Best Shaun Muffin Face

No Spoilers, please!

Quick reminder that I love feedback but try very hard to actively avoid any kind of spoilers for upcoming episodes. Please don’t mention any spoilers in your comments, which includes information from episode promos, stills and other official promo material. Thanks, guys!


4 Comments

  1. Julianna

    Great commentary as usual. I appreciate the explanation about the M&M; I had no idea how that worked.

    The Big Sign sequence was wonderful. Shaun holds up the totally “awww”-inspiring (sorry) sign. Lea tells Shaun that he doesn’t need to watch her; he promptly turns, holds the sign backward so she can still see it, silently telling her that he indeed doesn’t have to watch her do the dishes; he just wants to tell her that he loves her. Sweet.

    The Lim/Shaun/Glassman story line is going to be interesting to watch. I totally agree that there’s no one right or wrong here, medically or personally. With Lim as Shaun’s boss, it’s gonna be tricky though, particularly if she ends up suing him. She said that she’ll be professional as his boss, and I’m sure she intends to. But can she? Possibly we got a preview when she came to his office and questioned him on the loss of the patient Julianne. Sure, as his boss she has a right to, but I sensed an undertone there.

    You wrote, “ Dare we postulate that perhaps Shaun’s residual guilt over Steve’s death is playing into this as well? Is part of it a defence mechanism of sorts for Shaun to not have to feel guilty over having ruined a friend’s life? I guess that’s a bit of a wild theory, so I’ll just leave this here as food for thought.”

    I don’t think it’s a wild theory at all. Shaun’s first thought, after acting as a first responder, was a vision of Steve’s fall. He was properly focused and got past it then (but not later). It seemed that he was equating the possible loss of Lim with the loss of his brother…Lim as family. He could well feel that guilt, and be in denial over it, not recognizing it. Which would make her anger at him and rejection of friendship doubly painful.

    A quick word about Danny…does the guy have ANY faults? I mean, good looking, thoughtful, great with patients, of course women love him. All TGW characters are 3 dimensional; I wanna see him kick over a potted plant in anger or impatience or something.

    I like Danni a bit better now though.

    • TeeJay

      Thank you, I’m always so happy to hear when my musings can be helpful.

      I haven’t seen 6×04 yet, so I don’t know how this plays out further, but I would agree that it might be hard for Lim to stay objective towards Shaun in a position as his boss. Especially if she’ll end up suing him. It’s an interesting concept and dynamic!

      You know, the more I think about it, and also based on what you said, I think Shaun’s guilt is a key factor in all of this. He may be trying to bury all these feelings to protect himself, to not be marred by more gnawing emotions that undoubtedly affects him deeply. I think we’re sometimes fooled into thinking he’s an “emotional duck” where things just roll off his back, but I don’t think that’s the case. He just processes and perceives all of this differently, but he’s far from being an emotional klutz. Freddie often refers to that as well, emphasising that Shaun of course has feelings, he just shows and acts on them differently.

      Danny is a bit of a Mary Sue right now, isn’t he? Although I’m sure we’ll see him fuck up at some point. They do try to make these characters three-dimensional. Btw, he’s totally not my type and does nothing for me personally, but I can see how he may hold appeal for a certain subsection of the viewership. 🙂

      Yes, I think they may have had Danni redeem herself a little. I’m curious to learn more about her over the course of the season.

  2. Edward Kihanya

    Another excellent episode analysis. I know Shaun doesn’t understand irony, but I thought (even as a person on the autism spectrum myself – I have Asperger’s) that it was ironic that Shaun called a “Meeting of the Divorced” with his colleagues when his new wife, Lea, was also divorced before marrying Shaun.

    The Big Sign sequence was great. I thought it was a very cool way for Shaun to redeem himself with Lea!

    I, too don’t think your theory about Shaun’s residual guilt over Steve’s death playing into that situation is a wild theory. I wholeheartedly agree with Julianna’s explanation of exactly how it does this. Her explanation makes sense to me because Shaun wanted to become a surgeon precisely because of Steve’s death. He thought that becoming a surgeon would help him make up for not being able to save him and would bring him peace, but this has not been the case. I think he needs to see a therapist to get help with working through this.

    • TeeJay

      Thank you! And, wow, you’re right about Lea also being among the divorced, I hadn’t even considered that. Then again, Shaun probably didn’t want her at the “Meeting of the Divorced” because the conversation was going to be about her to some degree. Could’ve been awkward. 🙂

      The more I think about it, I believe you and Julianne (and Daniela) are right about Shaun’s guilt factoring in more significantly. Shaun may sometimes fool us into thinking emotional matters totally roll off his back, but he actually feels very deeply about certain things. And it affects him deeply as well.

      There’s so much at play here, also all the crap that happened during his childhood, the rejection issues and abandonment issues. It all paints a picture that I think we’ll see unfold over the course of the season. I think it’ll be an interesting journey!

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