Season 7 Commentary: 7×02 Skin In The Game

I’m not quite sure why Freddie Highmore said that season 7 was going to be “big”, because the first 20% of it that we’ve already seen hasn’t felt very big to me. This one was more on the mediocre side, although I will say that upon closer inspection, it had interesting nuances that you only see when you peel back the layers. All in all, a solid episode with some things I liked and some things I didn’t like quite as much.

The Technicalities

Written by Garrett Lerner & Nathalie Touboul
Directed by Freddie Highmore
Original airdate 27 Feb 2024

Patient Cases

Patient #1 – Richard Shelford

Treating physicians: Dr. Shaun Murphy, Dr. Jared Kalu, Charlene Lukaitis

Diagnosis: Suspected recurring pneumonia, later diagnosed as silicosis (pulmonary fibrosis) requiring a bilateral lung transplant

Patient #2 – Sal Zacharia

Treating physicians: Dr. Alex Park, Dominick Hubank

Diagnosis: Admitted with a skull fracture and large cerebral haematoma after a motor vehicle accident, later diagnosed with a malignant late-stage brainstem tumour

The Episode Plots In A Nutshell

Shaun, Lea & Steve

Little Steve isn’t gaining as much weight as he should just from Lea’s breastmilk, so they are given a recommendation to supplement with formula. Shaun isn’t very concerned – he knows this can happen and is happy with the supplementation plan. In fact, it will make some things in Steve’s care schedule easier.

Lea isn’t quite as happy about it. She feels like she’s failing as a mum because she wanted to raise her child solely on breastmilk and feels inadequate when she’s not producing enough of it to sustain her baby.

She tries to discuss it with Shaun, but to Shaun the science is simple: Lea’s hormone levels are somewhat low, which is causing her to produce less milk than she should, there’s little to be done about it and the solution is straightforward and not unhealthy. He’s not seeing any actually scientifically or empirically proven behaviour from Lea that she’s not a good mother, so where is the issue?

It is actually Morgan who gives Lea the much-needed reality check. There are way more important things to consider when raising a child than whether or not you feed with breastmilk. And just like Shaun, Morgan has compelling arguments to help Lea come to terms with the breastfeeding situation as Morgan shares her own inadequacies with Lea. Parenting seldom goes perfectly or the way you envision it to. And that’s okay.

Shaun & Glassman

Shaun is still mad at Glassman that he chose not to be there for Steve’s birth and the two weeks after that. So mad that he refuses to go to Morgan’s baby party because there’s a certain likelihood that Glassman will attend as well.

Somehow Glassman gets wind of it (did Lea tell him?), so he comes to Shaun’s office to try and talk about it, but Shaun pretty much shuts the conversation down. What Shaun needs from Glassman to want to move forward is an explicit verbal apology, and any less than that won’t do. Not even an admission on Glassman’s part that it was an error in judgement not to show up, or that they both had a right to be upset at each other.

In parallel, Shaun accompanies the emotional journey of his lung disease patient and the relationship with his daughter that is put to the test, which gives Shaun some pause and food for thought. In the end, Shaun learns that family ties should hold strong despite the occasional bump in the road, and that you don’t always have to agree with each other but can still be a functioning and loving family unit.

Alex & Morgan

Not much we learn about Alex and Morgan this episode, except that Morgan sleeps deeply enough to not always hear her baby cry at night and it’s actually Alex who takes care of the nightly feeding and caring duties more often than not. Eden seems to be doing well, although the realist in me would question that she wouldn’t be this perky a week after major open-heart surgery. Ah, the joys of creative license and TV medicine.

The Newbies

The Good Doctor does something this season that they’ve never done before – they’re introducing medical students. So now we don’t just have newbies, we have actual n00bs. In this episode, we meet Dominick “Dom” Hubank and Charlene “Charlie” Lukaitis – two third year medical students who join the St. Bon’s surgical team to learn the ropes and get some first-hand experience under their belt.

Both of them have their own quirks that present certain challenges. Charlie is autistic, and Shaun is actually her hero. She knows all his publications and his viral video from the heroic airport save made her want to be a surgeon. She thinks he’s the GOAT (greatest of all time), and she embraces her own autism as “awesome”. Unlike Shaun, Charlie is bubbly and talks a lot (and fast).

Dom isn’t quite as enthusiastic about his rotation in surgery, and for good reason. Dom is haemophobic, meaning he has a fear of blood. As we know, surgery isn’t the right place to avoid seeing blood, so fainting is becoming a frequent occurrence for him. Not lastly thanks to some helpful tips from Charlie, he makes it through watching his first surgery in person, although he does make a rapid exit from the OR when the surgery is over.

As for the reception of the newbies from the existing team, Asher seems the keenest about actually getting to teach the new generation of surgeons. Jordan and Jared are less inclined to spend time and effort on the fledglings, and Shaun… Well. Shaun is surely flattered by the attention and hero worship and it makes him immediately want to add Charlie to his team. However, he soon learns that she’s not quite the easily teachable asset that he might have expected her to be.

The Hospital Presidency

Responsibility ping-pong reigns the co-presidency, and Lim and Glassman are engaged in friendly rivalry of who is better at shirking off tasks to the other person. Instead of working together, they seem to be working against each other, creating more work for the other person, annoying each other in the process, even going out of their way to fob the other person. Despite respecting each other, they aren’t able to work as a functional unit quite yet to smoothly run the hospital in unison. There’s some work still to do until they get there.

The Patient Cases

We have one patient with a lung condition that requires an immediate lung transplant (which is miraculously immediately available, too). Not expecting such a drastic diagnosis, this father is suddenly faced with a situation where his daughter will have to become his caretaker, which she is fully committed to accept.

However, things take an unexpected turn when the father finds out that her daughter is actually a sex worker rather than the tech consultant that she claimed to be. He feels betrayed and disappointed, and the two of them start their journey to sort out this personal dilemma that also serves as a parallel for Shaun’s own emotional conflict regarding his relationship to Dr. Glassman.

The second patient is a gambling addict who receives an unexpected brain tumour diagnosis. The tumour is deemed inoperable, but naive newbie Dominick mentions the possible option of an experimental surgery, and suddenly the patient insists he get that surgery, even though the chances of success were extremely low and Park actively advising against it.

After some deliberation and the patient insisting he’d turn his life around and stop gambling, Park agrees to do the surgery. Surprisingly, the surgery goes without a hitch and turns out a big success, except that the patient’s promise of quitting to gamble turns out to be an empty one, and Park ends up being the one disappointed.

Things to Further Dissect

Breastfeeding Woes

Okay, where did this storyline come from? Lea worrying about not being the perfect supermom fits her like a size 8 shoe fits a size 11 foot. I get that they wanna touch on some baby topics this season, but did they forget that Lea told Glassman in season 6 that she didn’t want to be “just another 30-something mom in a practical car with a baby seat in the back and spit-up on her shirt”? Or how she felt so icked out by being a mother?

Just the episode before, she was totally winging it and trying to be chill about how to raise Steve. We literally had zero indication that Lea was aspiring to be the perfect mum. And suddenly, out of the blue, she gets her panties all up in a bunch and feels inadequate over what doesn’t seem to be a big deal and that’s easily solved?

The only way I can maybe justify it a little is chalking it up to low self-esteem issues, which we’ve seen her struggle with before. It’s one of the reasons why she initially rejected being with Shaun, but I’m not sure that it really aligns with what we’re seeing here. In the past, Lea didn’t trust herself that she was strong enough to deal with responsibility or commit to a long-term relationship with a neurodivergent partner.

The breastfeeding issue wasn’t about commitment or lack of trust in her abilities. It was more like the opposite – wanting to aim high and then being frustrated that the outcome wasn’t good enough. This whole storyline screamed “out-of-character” for me and had me frown in confusion. Not a fan.

I will say, though, I loved the scene with Shaun, Lea and Morgan in Shaun’s office. Morgan ushering Shaun out to salvage the conversation was such a Morgan move, and when Morgan is boss, even Shaun knows not to say no.

Site Note: Is it just me, or did that line about the champagne make no sense at all? Lea was supplementing Steve’s diet with formula, not replacing breastmilk with formula, right? So she was still breastfeeding Steve. Why would she suddenly be allowed to drink alcohol, just because she was now giving Steve formula in addition to breastmilk? What am I missing?

Familial Friction

When I said before that I would prefer the Shaun and Glassman friction not to be drawn out over half the season, I didn’t quite have this in mind. To call it anticlimactic might be an understatement.

Granted, they don’t have a lot of time this season to wrap up hold-over plots from season 6 and still move on to greener pastures, but can we quickly rewind to how Liz Friedman talked about being very interested in exploring the aspect of forgiveness and when and where it’s earned. Freddie Highmore talked about Shaun coming to terms with the fact that Glassman was MIA but eventually feelings of abandonment would be prevailing for Shaun.

It was pretty clear that, with the shortened season, they couldn’t delve as deeply into all of this as they might have wanted, but there was all this build-up. There was an extended period of radio silence and Shaun holding a massive grudge (remember when Glassman said to Lea in episode 3×10 that Shaun isn’t an angry person?), and then suddenly all of that is resolved and made right in two 1-minute conversations? I’m not even exaggerating, they were literally two 1-minute scenes.

Like, sure, I get that they need to move on and focus on other things, I get that they had to get the two of them back to good, but what this really needed was a longer, in-depth conversation between the two about the root-cause, about each other’s frustrations and feelings. I don’t expect for this show to give us a ten-minute scene that features all the dialogue on screen, but there could have been indications that a conversation was happening. You know, do a fast-forwarding montage or tease it or something…

Don’t get me wrong, I like that they managed to close the gap between them and have them be a happy family unit. I just wish it could have been done in a more profound way that showed us they were actually dealing with any of the underlying issues. What we saw dealt with nothing and glossed over all the important parts, casting them aside to rush to the finish line. Not a fan by a long shot.

Some fans are saying this may not be the end of it, and we might see this being put on the table again in future episodes because Shaun’s part in their fallout wasn’t addressed enough. Personally, I think they’re done with this storyline. It would surprise me if they weren’t.

Daniela had an interesting take on this, though:

The N00bs

First of all, let me say that, going into the episode, I knew nothing about the new characters. I actively try to stay away from spoilers or news. I had heard peripherally they were going to introduce two new characters this season and I was told the actors’ names (neither of whom I recognised), but didn’t look into anything beyond that.

So finding out that Charlie was autistic happened for me right there in the episode. And it was actually a fun thing to discover, because it wasn’t quite clear to me at the beginning whether she was or not. At first I thought she might just be a bubbly personality who tends to talk a lot when she gets nervous. Sure, the whole Shaun hero-worshipping was a big hint, and it was implicit in the handshake dialogue, but I’m not a native speaker and Charlie was talking a mile-a-minute, so I think her being autistic didn’t sink in for me until later.

I have said it before, but it bears repeating: I love going into the episodes blindly. Surprise reveal moments like this totally make it worth it.

By the way, I loved the callback to the pilot where Charlie refers to “the viral video of you saving that boy at the San Jose airport using a homemade one-way valve”.

As for Charlie’s autism, I’m super happy to see that they cast an autistic actress for the role. People who lived through the Dr. Han meme disaster on social media last summer might know that there was heavy and repeated criticism that the show chose to cast a neurotypical actor for the role of Shaun. Complaints were a dime a dozen that an allistic actor could never authentically portray an autistic character. It’s wonderful to see that the show took this to heart and cast Kayla Cromer for Charlie.

That said, there’s also the inevitable repeating criticism that we’ve already seen in the past, and it just seems like the show can’t win either way. This TV Fanatic episode review isn’t the only complaint out there that, in essence, they aren’t portraying autism the right way. Which is always a bit puzzling for me, because there is no one “right way” to portray autism, and you could never represent the full spectrum of autism in one single TV character. Or two or five or ten TV characters.

It also seems very premature after just one introductory episode to start complaining about Charlie being too stereotypical or too similar to Shaun or too colourless. We’ve seen all of ten minutes of her. Give it some time, ok? They’ll flesh her out more, I’m sure. And we’ll see that she’s not a carbon copy of Shaun. What we do need to remember, though, is that she’s a med student, so clearly they had to create a character whose autism wouldn’t preclude her from finishing med school.

Personally, I like her. I like the potential she brings to the show to create more interesting stories. More about that later. I’m excited to get to know her more.

Some random observations for Charlie regarding her autism so far: One of her stims seems to be touching her earring. She does it repeatedly if you watch closely, usually in situations when she’s stressed or insecure, including the scene where Shaun throws her out of the OR for contaminating her gloves by touching her ear.

Taylor Swift seems to be one of Charlie’s hyperfixations. I vaguely recall Freddie Highmore having mentioned in an interview that he liked her music, so was this his idea?

Like Shaun, Charlie seems to be a meticulous note taker. Also interesting that later she mentions she’s an auditory learner. And she tends to overshare, which Shaun also sometimes does.

She has a bracelet that spells the word “folklore” and one that spells “fearless” – presumably related to the Taylor Swift albums of the same name. She finds the sound of people eating to be unsettling and thus prefer to eat on her own. And she drives what I think is an old Ford Escort in metallic teal.

She has never worn a lace bra but would like to know what it’s like, which might make us presume she has some tactile sensory sensitivities. She has worked as a waitress for an extended period of time.

As for Dom, I’m not as enthusiastic about him as I am about Charlie, but we shall see where they take his character. Seeing that he and Charlie are already well acquainted and have a certain personal bond is sweet. Not a fan of the haemophobia storyline, I will admit. How did he make it this far in med school? Surely, this wouldn’t be the first time he’s seeing or handling blood. Seemed a bit contrived to me.

It probably wasn’t a coincidence that they teamed Dom up with Park in the first episode. Him switching careers from renowned college football player (nicknamed “The Dominator”) to medical doctor has certain parallels to Park switching careers from cop to surgeon.

Though I gotta say: How did Dom make it this far in med school when he apparently hasn’t seen an imaging scan of a brain before, or doesn’t know what the anterior and the posterior part of the skull is? Surely, they would have taught this in med school by the end of year three…?

The New Melendez

Last episode, I was wondering what the big season story arc would be this time around, and I think this episode gave us the answer – at least where Shaun is concerned. They already tried some of this last season with Danica Powell, but Charlie is the ultimate instrument in Shaun’s impending big learning curve.

We know that Shaun often has preconceived ideas, and we know he sometimes has a hard time with social interactions and reading people. We also know Shaun doesn’t have a good radar for questioning his effect on people and then self-reflecting on it. And that can get in the way of mentoring people in an effective and positive way.

Shaun has mentored people his junior before, and while that wasn’t always easy, they ultimately seemed to come to a mutual understanding and respect, and Shaun always seemed to be eager to please and perform well as a mentor. Now that he’s an attending, he seems a little too cocksure of his abilities and skills.

Having Charlie there to mentor presents a unique challenge for Shaun. He may think it’ll be a breeze to teach a fellow autistic doctor. Shared similarities such as Shaun agreeing with Charlie that “neurotypicals are weird” may make him assume that she thinks or reacts very similar to himself. And that’s gonna be his fallacy.

The wonderful thing about this is that Charlie is basically Shaun as a first-year resident – the young grasshopper who doesn’t know much about applied medicine, about how things work in a hospital, about how to handle the emotional and conversational complexities of seeing actual patients. The young grasshopper who relies on an understanding and supportive mentor who is willing acknowledge the mentee’s flaws and inadequacies, who will have the patience to deal with ignorance and treat mistakes as learning opportunities.

And Shaun currently has none of that. His way of mentoring Charlie was to assume that she knew already what she needed to know, and when she didn’t, he asked Jared to deal with it. Shaun was either absent when he should have been there as a teacher, or he ignored advice to intervene. And when Jared actively pointed out to him that Charlie’s social interactions might have had a detrimental effect on their patient’s willingness to agree to the much needed lung transplant, Shaun doesn’t want to hear any of it.

Jared couldn’t be any less on the nose about the fact that Charlie is acting exactly like Shaun did when he was a first-year resident. And what does Shaun do? He refuses to listen or reflect on it and orders Charlie to do scut work. Shaun effectively became Melendez.

The look that Jordan has on her face when Jared flat-out tells Shaun that Charlie is basically a mini-Shaun is priceless, tho.

Let’s go down memory lane for a moment, because this is a callback to season 1, specifically episode 1×02 Mount Rushmore. Shaun was repeatedly a little too blunt in front of patients, blurting out things about their medical conditions that were inappropriate in that situation and caused discomfort to both the patients and the medical colleagues. Melendez’ response to it was to punish Shaun by assigning him to do scut work while fellow first-year residents Claire and Jared were given the chance to actively participate in upcoming surgeries.

And this is so very ironic, because back then, when Shaun realised he was being punished and actively kept from participating in surgeries, it must have stung, and it must have felt humiliating and demeaning. And here is Charlie, a young, inexperienced greenhorn in need of a capable mentor – a mirror being held up to Shaun that couldn’t be any more apt – and things are coming full circle. Now Shaun is Charlie’s Melendez, and it’s poetic that he’s making the very same mistake.

In terms of episode 1×02, Melendez kept insisting that he had authority over decisions regarding how to handle his surgical team, and despite Shaun’s excellent diagnostic skills saving a girl’s life that day, he was about to send Shaun out of the OR and home. Shaun only got to stay because Andrews pulled rank, and so Shaun was reluctantly given approval to stay on suction. It took Melendez the better part of the season to come to accept Shaun as a valuable member of his team with the same privileges as the other first-year residents.

As I alluded to before, we had similar situation with Danica last season, where she displayed certain inconvenient, sometimes even recalcitrant traits, and Shaun himself being blind or unwilling to recognise that he himself was prone to displaying the same behaviour that often had potential to make others uncomfortable.

We might argue that Shaun isn’t necessarily doing this on purpose. It’s not uncommon in autistic people to have a deficit in cognitive empathy and in perspective taking. In some ways, Shaun will have difficulty in recognising that a mirror is being held up to him when he sees Charlie or Danica displaying some of his own disagreeable behaviours or shortcomings.

When they scrub in for the surgery, Shaun tells Charlie: “I have become very good at displaying empathy.” Have you now, Shaun? Or is that just your own interpretation? Objectively, yes, he has become better at it. Would I call it “very good”? Probably not. It’s also an ironic line of dialogue here, because clearly Shaun is not displaying a lot of empathy for Charlie as total newbie in need of supportive professional mentoring.

The argument of Shaun not being aware of his own behaviour being mirrored breaks down when we consider that Jared actually pointed this out to Shaun. And instead of taking a moment to self-reflect on it, Shaun chose to ignore it and then deflected and went on the offense in a way that was neither helpful nor desirable. He failed as a mentor.

And that will be a great lesson for him to learn this season, and I’d like to think that they will write more situations where Shaun will come up against the challenge to teaching Charlie and failing at it. Perhaps we’ll see Glassman trying to support him on this journey. I think it’s an interesting prospect. I hope they do this well.

Another thing that Daniela pointed out was some inconsistent writing in this episode – for instance when Charlie shares with Shaun that it’s okay to make mistakes because that’s how you learn. Shaun point-blank tells her that her professor is wrong. That’s pretty hypocritical of Shaun, because he’s built most of his career on learning from mistakes. He even told the parents of the autistic patient in 1×07 22 Steps, “Mistakes are good. You should make more.” So how come he suddenly thinks that mistakes are unforgiveable?

The President’s Seat

Not quite sure where they’re going with this storyline. Right now it just seems to be there as a means for comic relief, although admitted the 80^th birthday thing was pretty amusing. If they keep this up for no reason other than to give Lim and Glassman something to do, I think it’s gonna get old pretty quickly, but I’ll try to keep an open mind to see what the end game is here.

Medical Bullshittery

Oh, excuse me, yes. It’s called creative license. And I know they need to sometimes apply it to tell interesting stories that make sense within the constraints of the show, but this was an instance where they took it a little too far to still be within of the realm of the believable.

What I mean is Sal’s brain surgery case. There is no way in hell that a second-year attending would be performing a highly risky, highly experimental, highly specialised brain surgery on his own without involvement and supervision of a specialist. This surgery would be performed by or at the very least be observed by an experienced neurosurgeon. Having Park do it all on his own was such BS, to the point that it messed with my suspension of disbelief. I hate it when this happens.

Have you noticed, though, that this was the second time that Lim told Park no, you’re an attending now, figure it out on your own when he came to ask her for help? I get that she wants to promote independence and inspire trust in her attendings, but is that really something a good Chief of Surgery should do – send their attendings away without even looking at the case when they think they could use some guidance on a complex case from a senior doctor with more experience? Especially when the Chief of Surgery’s involvement would actually be advantageous for the patient?

What I also found puzzling was this whole case with the gambling addict and how it was handled. I can get behind the idea of showcasing that some gambling addicts will never stop gambling, no matter what kind of curveballs life throws at them, but especially that scene with Park going to the guy to convince him why Park should do the high-risk surgery fell flat for me.

First of all, it seemed out of place for Park to go to the guy and bully him about personal motivations, not to mention that this is ethically and morally questionable. That aside, they amped this up for some kind of storytelling climax and important moral lesson, with Park going like, “Give me one good reason why I should do this crazy Hail Mary surgery,” and the guy goes, “Because without it, I’ll die.” Okay. Duh. And then Park is like, okay, cool, you convinced me. Let’s do it!

And I sat there, thinking… huh? How is that a convincing argument that clears all your misgivings and reservations out of the way after all this build-up? It made no sense to me.

More medical bullshittery was when Shaun was checking his lung transplant patient’s IV post-op. That’s nurse work. Attending surgeons have more important things to do. And I also love when patients who are just coming out of major surgery with, like, half their chest having been cracked open and sewn back together a few hours ago, lying there with their hands all over their chest or their family members touching them all over. IV pain meds notwithstanding, yeah, no, it doesn’t quite work like that.

Random Observations

Knowing that Freddie Highmore directed this episode, one might guess it’s not a coincidence that the shot towards the end of Charlie sitting on the bench outside the hospital on the gangway is very reminiscent of a scene they used in the pilot of Shaun sitting in that exact spot. The footage we see on screen in the pilot doesn’t feature this exact same shot, but there’s an episode still from set photographer Jeff Weddell that has Shaun sitting on a bench in a similar spot.

Interestingly, the season 2 episode that Freddie Highmore wrote (2×01 Hello) had a scene between Jared and Claire at the end where Jared is sitting alone on that bench with a view towards the door after his last day at St. Bonaventure, and Claire coming out to talk to him.

In this season 7 episode, Charlie sits on the bench after her first case, having been somewhat unfairly rejected by her hero and boss Shaun, with her trying to digest where this rejection is coming from. In the pilot episode, Shaun was sitting there, rejected by his own (future) boss Dr. Melendez and trying to figure out what to do with the situation – a clear parallel to Charlie, but also another parallel to Shaun effectively now having become his own version of Dr. Melendez.

Speaking of Freddie directing, it’s always lovely to know he got to be in the driver’s seat for another episode. This video on Instagram is well worth a watch where Freddie talks about why he likes directing on the show.

It was cute to see that Shaun and Lea are still using the Peanut beanie for baby Steve. He was wearing it in the last scene at Eden’s Sip & See party.

I wonder if the scene where Charlie and Dom arrive at the hospital that’s showing Charlie walking in through the revolving door is a small nod to Extraordinary Attorney Woo (a Korean drama revolving around an autistic lawyer), which prominently features the autistic attorney Woo having trouble with revolving doors.

Best Shaun Muffin Face

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