Season 7 Commentary: 7×06 M.C.E.

I’m glad that I liked this episode considerably better than the last few, although I wouldn’t give it more than a solid 6/10. Okay, maybe a 6.5/10 if you twisted my arm to set aside my misgivings about season 7 as a whole. Despite some good emotional intensity, not an episode that will go into my all-time favourite top 10.

The Technicalities

Written by David Renaud & Tristan Thai
Directed by Mike Listo
Original airdate 09 Apr 2024

Patient Cases

They had a whole lot of trauma patients, most unnamed. To list a few cases, we had

• Severe head injury, hypoxia and seizures, treated by Lim
• Blunt abdominal trauma, 40 weeks pregnant, treated by Shaun
• Massive flail chest, treated by Lim
• Riley (the driver): Lacerated femoral artery, treated by Jordan
• Facial lacerations from glass splinters, treated by Dom
• Dislocated ankle and nose bleed, treated by Dom
• Traumatic eye socket injury, treated by Morgan
• Traumatic leg injury requiring amputation, treated by Jared
• Abdominal injury (lying in the hallway)
• Ethan: Cardiac arrest from a tension pneumo, ventricular aneurysm, treated by Shaun, Glassman and Charlie
• Massive internal bleeding, treated by Lim
• Arm laceration, treated by Lim
• Complex liver laceration, treated by Glassman
• Open hip fracture, treated by Dr. Lee
• Pelvic injury, treated by Lim
• Traumatic injury to the neck (lying in the hallway)
• Facial laceration, treated by Morgan
• Chest impalement, treated by Park

The Episode Plots In A Nutshell

Shaun, Lea (& Steve)

It’s three days after Asher’s death and Shaun and Lea are attending Asher’s memorial service, together with their friends and colleagues. Lea is a little concerned that Shaun hasn’t really talked about losing Asher at all, but she’s also done some research and knows that grief can hit autistic people with a certain delay, so she tells Shaun that if he gets overwhelmed, he can always come to her. There’s also still the complaint from Charlie hanging over Shaun’s head, which he is supposed to discuss with HR later today.

Before they can get into it, all the hospital staff is being called back to work because of a mass casualty event – young man on a suicide mission who drove his car into a group of people attending an outdoor event.

With the hospital being short-staffed because several surgeons are all away at a conference (hey, convenient TV drama excuse that they also used in the exact same way in the season 5 Potluck episode), Shaun is put in charge as the lead to coordinate the ER and the surgical staff during the crisis.

While Shaun handles this high stress situation very efficiently and with poise and expertise, there is a moment where he gets overwhelmed by the barrage of urgent questions from staff that hit him all at the same time in the middle of the noisy chaos of the ER. It’s Charlie who helps him through the difficult moment before it can escalate into an autistic shutdown.

At the end of the stressful day when the ER has been cleared and everyone has time to breathe and come down from the constant adrenaline high, it finally sinks in that they’ve permanently lost a valuable team member and friend. This hits home when Jerome comes by with some personal items he found that were meant for the team.

Jerome hands Shaun a conference brochure for an articulating dissector that Asher thought Shaun would be interested in. And this is when it truly sinks in for Shaun. He hasn’t had enough opportunity to think much about Asher all day, although clearly he was on his mind here and there – like when he compared Charlie to Asher, or when he thought of the last time they were in surgery together, or when he inadvertently assigned a case to Asher.

With the brochure in hand, Shaun lets out a shaky breath, realizing how much he’ll miss him and how much it hurts.

I wanna say, the reassuring hand of Glassman’s on Shaun’s shoulder as he walks past doesn’t go unnoticed.

Asher & Jerome

If we had any hope that maybe Asher was only seriously injured and not actually dead after the end of the previous episode, this one definitely gives us a definitive answer right away, seeing how we’re plunged right into Asher’s memorial service. Turns out his family demanded that his body be transferred to New York and there’s no coffin to say goodbye to and no grave to visit.

Jordan gives a beautiful eulogy which she can’t finish since all the hospital staff are alerted that there’s a mass casualty event and they need all hands on deck in the surgical department immediately.

As expected, Jerome is devastated and grieving, along with all of Asher’s friends and chosen family. He sits alone in the chapel for a while after declining an invite from Lea to spend some time with her and Steve until he is being told he needs to vacate the room. He then goes back to the hospital to clear out Asher’s locker – which he’s put off until now because it’s so damn hard to see all the reminders.

Jordan finds Jerome in the locker room and agrees to help, and when they’re done, at the end of the long day, they find all of Asher’s work friends in the surgeon’s lounge to hand out a few mementos of Asher that Jerome thinks his friends should have. It includes a mug for Park he had printed that has a photo of Asher and Park’s little high-on-drugs topless dancing escapade from two years ago.

Everyone shares the moment and it’s beautiful notion that they all get the chance to reminisce about their friend and grieve together on the day of his funeral.

Jordan

Jordan has all this anger inside her at the injustice of one of her close friends being killed by a group of hateful homophobic antisemites, and she voices it during her eulogy, going a little off-script when she talks about how much contempt she has for the people who committed this hate crime and took a precious life in the process.

She projects all this anger onto Riley, the young man who drove his car into a social gathering in an in the form of a terrorist attack that was supposed to be a suicide mission but which Riley survived. His mother, who is incredibly distraught at the actions of her son but who is still his mother, did everything she possibly could to help Riley deal with his mental illness so that it wouldn’t come to something like this, but ultimately she was powerless.

When Riley is literally writhing in pain from his leg injury, his mother asks Jordan to adjust Riley’s painkillers. Jordan point-blank refuses with some vague excuse that he’s already maxed out the dose and she can’t give him any more than he already received.

Jared sees this and calls Jordan on the inappropriateness of it, and it takes Jordan a while to realise that what she’s doing is inhumane (and by the way, also breaks the Hippocratic Oath), so she eventually approaches Riley and his mother to give him more painkillers and promise she will keep him comfortable.

When the surgeons gather at the end of the day, Jordan apologises to everyone for going off-script during her eulogy and for projecting her anger in a way that was uncalled for and unprofessional.

Dom

Dom is assigned to the “green tags” during the mass casual event, meaning patients with minor injuries who are piling up in the waiting room. Due to the nature of the event, there are a lot of injuries with a good amount of blood involved, which isn’t easy for him. One particularly nasty facial trauma case pushes him over the edge and into puke territory, so they have to call Morgan in to save the day.

Dom ends up taking care of one particular patient in the break room who starts having a severe nosebleed. The patient starts losing a large amount of blood, and unable to stop it with conventional means, Dom needs to think quickly on his feet when no actual physician is available to help him. He ends up staunching the bleeder with a urinary catheter he shoves up the patient’s nose to inflate it. It’s not elegant but effective, and Morgan actually calls it kickass MacGyver medicine.

Charlie

Charlie is assigned to the “black tags”, meaning patients who arrived as DOA or who died in the ER. Shaun asks her to complete all the “these people are confirmed as dead” checklists and thus expedite the process of getting the patients moved to the morgue rather than taking up valuable space in the ER.

When Shaun seeks her out because she’s not clearing out dead patients quickly enough, she has trouble confirming the pupil dilation of one of the patients. Shaun takes a closer look, and it turns out the patient isn’t actually dead, so they wheel him back out into the ER with Shaun giving CPR as they go.

Charlie asserts that she saved the man’s life, which Shaun disagrees with since it was actually him who suggested the patient had a tension pneumo that was deemed fixable. He and Glassman start working up the patient with Charlie’s help – and in true Shaun form, he has lots of things to criticise about Charlie’s work until Glassman interferes and stops the bickering, telling Shaun he needs to make more of an effort to teach Charlie.

Charlie is tasked with helping Glassman for the rest of day while Shaun goes back to his coordination work, and Glassman instructs Charlie to monitor their pneumothorax patient Ethan. When Glassman is being called away for an emergency surgery, Charlie runs the labs and the ECGs, and she thinks there is something subtly unusual about Ethan’s ECG.

She runs it by Shaun, who is stressed and being pestered by several different people and going into overstimulation shutdown, but she is instrumental in helping him through the difficult moment and gets him to take a look at their patient.

Charlie’s hunch with the ECG was right, and Ethan is in dire straits because he has a ventricular aneurysm that nearly kills him. With no ORs or surgeons other than Shaun available, they operate on Ethan right there in the OR, and Charlie expertly assists him during their impromptu open-heart surgery. They both save Ethan’s life.

When Ethan is later admitted to the regular ward, Shaun and Charlie share a moment, where Shaun admits to her that he may have been wrong about her – she may yet make an adequate surgeon one day. The tentative praise and encouragement is enough for Charlie to withdraw the HR complaint about Shaun.

Dr. Lim

Lim seems to be struggling quite a bit with where she stands in life right now. She pushed Clay out of her life and she has to contend with a somewhat overbearing mother who is judging her lifestyle and her choices, who is also awkwardly sleeping with her hospital co-president. Lim is exhausted and is finding lots of excuses as to why she can’t go to Asher’s funeral, reluctantly getting out of bed when the hospital calls her in, but not before brusquely brushing her mother off who has something important to tell her that she never gets the chance to.

During the mass casualty crisis, Lim just can’t win. Her patients are all severely injured or take a turn for the worse, and even though she knows that comes with the territory of being a trauma surgeon, it’s still hard to have to tell families that their relatives didn’t make it.

At the end of the long and hard day, she finally finds out what it is that her mother wanted to share with her. Lim’s father lived with clinical depression for most of his life, and he and Eileen hid it from Audrey until now. Her father was always ambitious and didn’t want to disappoint his daughter, he wanted to be seen as strong and someone to be looked up to.

And this is why Eileen is worried about Audrey, is worried that she might be consumed by the pitfalls of mental illness and not seek the help she may need. When Eileen says that she’s proud of her daughter and that she doesn’t want her to end up like her father, we can only wonder what that means. What did his depression lead to? Could it imply he committed suicide? The way they talk about him, he is clearly not alive anymore.

It’s surely an impactful revelation, and perhaps it can help her come to terms with where she is right now. Audrey finishes off the day by tending to a man with minor injuries – one of the last green tag patients still left in the waiting room. She ends up chatting with him about being a caretaker for his wife he loves very much who has multiple sclerosis.

Dr. Glassman

With Glassman having been pretty much professionally sidelined since his stroke diagnosis to solely tend to clinic duties, this mass casualty situation catapults him back into the thick of things. Interestingly, Shaun actually wants him to help out in a surgical capacity, but Glassman reminds Shaun that he’s been involuntarily retired from surgery so he’ll be helping out with the yellow tagged patients.

When push comes to shove and there’s a patient with a liver laceration that Shaun doesn’t have any surgeons for, he insists Glassman should be doing the surgery. Both are well aware it’s a complex procedure, but Shaun asserts that it’s Glassman or a patient’s death, so they both reluctantly agree.

Glassman makes it through the surgery without issue and the patient makes it. Nurse Rochelle even tells him afterwards that he still has game, but Glassman knows when to call it quits. It seems he’s made peace with the fact that his surgical career is indeed over.

His lady friend days are gonna be over, too. Eileen tells him that she’s leaving town the next day, but they both seem to have enjoyed their little tryst. Glassman definitely still has game.

The Patient Cases

There are a large numbers of patients in this episode, most unnamed, most with trauma injuries of all shapes and sizes. The more notable ones are Riley, the driver, who is being treated by Jordan for a lacerated femoral artery and Ethan, the black tag patient who turns out isn’t actually dead and is treated for a tension pneumothorax and ventricular aneurysm by tag-team Shaun and Charlie.

Things to Further Dissect

The Good

Shaun

What I really liked about the episode is that it brought a semblance of the mojo back that I felt had been missing for the past few episodes. We were back in the thick of things, the episode packed a good amount of emotional punch and it’s always great to see Shaun being boss (in a good way), and also interesting to see Shaun being pushed to his limits.

Because look how far Shaun has come. From bumbling first-year resident who kept stepping on toe after toe, to being coordinating lead in a mass casualty event crisis, and (mostly) acing it. Not sure I agree that he’s a good leader, but he is definitely an adequate leader. 🙂

What I also loved is how they gave us insight into Shaun’s grieving process. When Lea said to Shaun at the beginning that she’s read that deeply emotional incidents can hit autistic people with a certain delay, that’s very much rooted in experiences you hear from actually autistic people very often. Their emotional processing can be delayed, and emotions can hit unpredictably with heighted intensity. Surely this is different from person to person, but I really liked that they showcased it this way for Shaun.

It wasn’t just the scene at the end where it finally hits home when Jerome gives him the product brochure. Shaun had little flashes of it during the day – the reminder in the procedure room where he remembers that it was where he worked with Asher last, him comparing Charlie to Asher as a mentee, or him inadvertently assigning a case to Asher without it having fully sunk in that Asher isn’t with them anymore.

Surely the pressure of the day is playing its part, not just the sheer case load but also performance pressure for Shaun to coordinate the whole ER and optimise the personnel assignment. It made perfect sense for the grief to fully hit when he finally has the chance to breathe and digest everything. I daresay that, as usual, Freddie portrayed it subtly but beautifully.

It was also heartwarming to see that Shaun had all the people he loves and who love him around him, catching him in their safety net in this tough and emotional moment. I loved that whole grief arc for Shaun.

Shaun & Charlie

What I also liked is that they drove the Charlie storyline with Shaun forward to a point where we finally saw some movement in the right direction. I didn’t love it unconditionally (more on this below), but I’m glad to see that Shaun has the capacity to move past the Melendez/Han inspired arrogance and hubris he was displaying for a hot second.

Charlie is imo undeservedly getting a lot of flak and hate on social media. You see statements like I hate Charlie, I can’t stand Charlie, Charlie is annoying, Charlie gets on my fucking nerves, I wish they had killed Charlie instead of Asher…

Admittedly, most of these comments come from people who don’t seem to understand the dynamics of dramatic TV writing or the idea that a character needs to have a development arc or redeeming qualities in order to be interesting. It’s still sad that so many people don’t want to make an effort to try and understand the underlying forces of why and how Charlie behaves the way she does, or what kind of upbringing and outlook on life she has, which are very much juxtaposed against Shaun who comes from a totally different background and foundation.

It’s super interesting to see when you scratch a little at the façade to see behind the surface. They are presenting us with two autistic characters this season who are in some ways very similar but in some ways also polar opposites.

I’ve seen some well written posts about all this on Reddit that outlined their differences, speaking to how Shaun and Charlie grew up in very different environments with very different support systems (or lack thereof in Shaun’s case). No doubt this has shaped and moulded these two people’s personalities and their approaches to life, and it’s disheartening that so few people seem to be able to see that and immediately judge a book merely by its cover.

The Mediocre

Lim

I think the Eileen Lim storyline falls into the more mediocre parts of this episode, because ultimately we now understand its purpose. It seemed puzzling at first why she was even introduced, and for a while it looked like it was to give Glassman a meaningless romance, when actually her purpose was to give Lim some final closure on her personal journey.

Lim’s had a lot of struggles and ups and downs over the years, some of which were related to her PTSD, and now we learn that there’s a significant history of mental illness in her family, which I believe served as bringing the PTSD storyline full circle for Lim. She also managed to reconcile some (previously unbeknownst to us) familial friction and misconceptions to close that chapter for her.

The one thing I didn’t quite like about this was that I fail to see the true significance of the “big” revelation that Lim’s father lived with clinical depression. Yes, individuals with a family history may have a predisposition to mental illness, but it’s not like having a father with depression is a sure-fire indicator that you’re also going to have depression or another mental disorder. For me, there wasn’t quite that “oh, it all makes sense now!” revelation that perhaps the show might have been going for.

Asher

I liked the way they set up the memorial and gave us insights into how different people were dealing with the loss, particularly after there were so many complaints after Melendez’ death that we never saw a funeral or the immediate aftereffects of the tragedy. What I didn’t like about this particular episode was that they skipped over seeing how the news of his death was delivered and how that was received by his friends and colleagues.

I get why they did it, especially since we don’t have that much more time left to delve into all the details, but I still would have loved to see that being explored.

I’m still not quite sure why they had to throw a major character death into the equation five episodes before the show’s big finale, when all it did was shock viewers for a hot second and then give us a somewhat tangential grief storyline alongside a high-intensity mass casualty crisis.

Charlie

While I really liked the Shaun and Charlie dynamic in this episode, what I don’t like is something that is based on a mere assumption of mine at the moment, so I might be entirely wrong about this. I have a feeling that, with Charlie withdrawing her HR complaint and Shaun having admitted he may have been wrong about her, the whole Shaun vs. Charlie friction storyline has been wrapped up and is over and done with.

For the fact that this was the one consistent tether throughout the season so far, it was awfully conveniently and quickly wrapped up. Again, I may not be giving the writers and showrunners enough credit here, but it seemed way too sudden for Shaun to accept Charlie as a capable surgeon after just one comment from Glassman and one emergency surgery incident for him to come 180° on believing in Charlie.

Glassman

Not quite sure I understood the “going out on a win” thing that they squeezed into the episode. Yes, it was great to see Glassman back in the thick of medicine, but it was confusing that Shaun repeatedly pushed Glassman into performing solo surgery, when he had been the one to very adamantly insist that Glassman should never operate on another patient ever again, and in a way that it humiliated Glassman in the process and caused a very big rift between the two.

It came out of the blue and without good reason for Shaun to suddenly renege on that, just because he was short-staffed. Shaun is a rules guy. There is little flexibility when it comes to colouring outside the lines, and this was very outside-the-line colouring. Possibly another victim of having to cut the season shorter than they initially planned, perhaps there was supposed to be more substance around this that they had to scrap. If that’s the case, you could definitely tell there was something missing.

The Not So Good

Jordan

The story around Jordan’s anger made sense, and we know that a well-established formula of the show is to write the medical cases so that they reflect something going on in the private lives of the characters, but in some episodes it feels more construed than in others.

It was awfully convenient that the source of the MCE was an individual with a hate crime motive who caused the senseless death of others, and then for Jordan to happen to be the one in charge of the guy’s medication regimen. Also, like… shit like that would get you fired if it was taken to the superiors. You know, Hippocratic Oath and all that.

Then again, Shaun has gotten away with so many things that should have gotten him fired, so…

Overall Impressions

While this episode was a definite improvement over the two previous ones, I didn’t think it was quite up to par with what we know the show can deliver. Knowing we’d be dealing with some kind of mass casualty event hitting the hospital while everyone also dealing with the aftermath of Asher’s death, somehow I expected more emotional gut punching. While we definitely had some of it, and I definitely got a little teary once or twice, the depth of it didn’t quite deliver what I had hoped.

Maybe it’s the angst monster in me, but I think the best episodes of the show were those where Shaun took us on a deeply emotional journey, where we’d feel every sucker punch and relished in the resolution of having a safety net to fall into and the helping hands to guide him through. And while Shaun definitely has matured and doesn’t need that safety net as much anymore as he may have in recent years, I feel like they could have done more with this.

Personally, I think this is still a detrimental effect of the show being overcrowded with characters, which hampers the writers’ ability to offer us enough contact surface that will let us connect and get immersed and emotionally invested. The scene in the ER where Shaun was nearing a shutdown could have been great if they’d had more than two minutes to devote to it. As it was, it felt rushed and just like one little thing among at least ten others that they had to hurry along.

Perhaps it’s a selfish notion, but I miss the times when the show had two or maybe three main character stories each episode that they’d explore in more depth, rather than six at the same time that we get whiplash switching back and forth between.

I have mixed feelings about the last four episodes that we’ll still get to see before the show is no more. I really want to be open enough to embrace the ending of the show in a way that it doesn’t feel like a disappointment, that it’s something that I can wholeheartedly say felt like they were doing the ending justice. Where we currently stand, it’s hard for me to see how they will still pull that off. I really hope they do.

Best Shaun Muffin Face

---