Season 4 Rewatch: 4×05 Fault

The Good Doctor Argentina on Twitter (@TheGoodDoctorAr) is currently running a ’20 Days Countdown to The Good Doctor Season 5’, and on Day 5 we’ll be recapping episode 4×05 Fault.

This one’s gonna be a long one, because a) I loved the episode so much, and b) there’s a whole lot to unpack, and the episode was chock-full with interesting tidbits and lessons to learn.

Patient Stories

Patient #1 is Ellie Lewis, a woman being seen for migraines with an aura. She has her boyfriend Zane by her side, and they seem very close, but it turns out they’ve only been seeing each other for eight days. Jordan and Enrique are assigned to this case, together with Claire. What they find is a dermoid cyst in the patient’s brain that is causing her symptoms, and a resulting seizure sends her into a coma.

When they’re trying to find next of kin to discuss the course of action, the boyfriend suggests calling the husband, who was oblivious to the fact that apparently their marriage wasn’t going well.

The team performs surgery and removes the dermoid cyst, but Ellie suffers temporary short-term memory loss afterwards, not able to remember why she was admitted to the hospital. The memory loss is likely from fluid leaking from the cyst, which they suggest to fix surgically, but there is a high risk of developing more permanent memory loss and Ellie losing all memory of the time prior to the surgery. Ellie finds that hard to deal with. What if she forgets meeting Zane and goes back to thinking she was in a perfect marriage?

Ellie finally decides that she wants to go through with the sugery, even if it means she might not remember who Zane is and what he means to her. And tragically, that’s exactly what happens after the sugery. She remembers her husband Brandon, but not Zane. Ellie watches a video she recorded before the surgery to remind her new self about Zane, but in the end she chooses her husband because he’s the one that she still has memories of and real feelings for.

What this shows us, perhaps, is that love is only as real as it feels to us, and memories can’t make up for tangible things in our lives. Love, in the end, conquers all, doesn’t it?

Patient #2 is Carlo Porter, a ballet master. He’s being examined by Asher Wolke — his first actual patient. He’s at the hospital for back pain. Asher orders a barrage of tests to find out where the back pain is coming from, thinking it’s an L2 compression fracture (a broken lumbar vertebra that is compressing on the spinal nerves). Shaun suggests to discharge him with a prescription of pain meds, a brace and physiotherapy.

Things take a surprising turn when Carlo suddenly collapses with abdominal pain, and they realise that his pain was caused by a ruptured surprarenal aortic aneurism, which Asher missed during his initial exam. He goes into surgery and they repair the damage. Over the course of his recovery, Carlo develops a secondary aneurism that causes his liver to fail. Shaun, Asher and Lim discuss their options, and it’s becoming increasingly clear that Carlo’s problems are critical now. “He’ll die without an intervention,” Lim says. “He’ll probably die either way,” Shaun concedes.

They suggest another surgery for a vein graft, but the chances that Carlo will survive it are slim. “Whatever happens, you’re gonna be an incredible doctor, and I am honored to have been your first patient,” Carlo tells Asher. Asher takes that as a prompt to tell Carlo that he screwed up when he missed the initial aneurism. Geez, boy. Don’t you realise this is prime opportunity for a lawsuit? How is this hospital not already bankrupt? Carlo then asks Asher to speak a prayer for him in Yiddish, which he reluctantly does.

During surgery, Carlo’s complications send him into DIC (a blood clotting disorder) and he has to be resuscitated. His heart fails and he goes into asystole. Asher keeps frantically performing CPR until Shaun tells him that Carlo is dead. “Take as much time as you need,” Lim says as everyone but Asher and Shaun clear out of the OR. Asher can’t believe that Carlo died, and it’s absolutely tragic.

Shaun & Lea

First, let me start this off with saying that I’m eating chocolate chip pancakes as I’m writing this. Thanks, Shaun. Not sure I appreciate the extra calories, but I get where you’re coming from. My go-to is usually apple pancakes. Why is Shaun not all over that? Someone introduce him, please. Or is that not a thing in the US?

Not that huge of a focus on Shaun and Lea this episode, but we get a lovely scene about Shaun’s supervising proficiency when he tells her he needs to stay up all night to consult all these books on how to be a good mentor and team manager. ‘Navigating Trust in your Team’, ‘Leading Without Authority’, the works. I can empathise. Lateral leadership without hierachical structure isn’t always easy. But I’ve found that usually good communication and expressing your needs and concerns is the key to success here. Which we know Shaun isn’t always good at.

“You can’t sleep?” Lea asks him, “You want some more milk? My mother has, like 18 prescriptions for this, some of them are actual prescriptions.” She has awesome advice for Shaun, though. “Tech bros are always watching TED Talks on leadership, that could be quicker than those books.” Shaun loves the idea and immediately opens his laptop. It’s really sweet how Lea fondles his elbow while she talks to Shaun here.

Side note: Did you notice Shaun seems to be using Linux as an operating system? Makes sense, though, right? Lea is probably managing all their computer tech at home. She might have encouraged to favour a free open source system rather than the commercial operating systems. Shaun probably doesn’t care much, as long as the thing works.

Lea suggests to Shaun that they schedule a date night for the next day. “Why would we need a date night if we’re in a relationship and living together?” Lea’s answer is simple. “Because it’ll be fun.” That seems to be enough for Shaun. And then she surreptitiously invites Shaun for some other extracurricular activity, which he very much decides he prefers to watching leadership advice TED Talks.

While Shaun ponders what to do for date night, he ends up asking Asher and Olivia for advice. Over the course of this conversation, we learn that Lea likes cars, coding, Zelda – Breath of the Wild, sauvignon blanc, Skittles, Rupaul’s Drag Race and camping. Asher’s got nothing. Olivia suggests camping in Big Sur (yep, can attest it’s very beautiful there). They finally settle on movies.

But, no, it’s not what you may think. He’s not taking Lea to the cinema. He’s actually put a lot of thought into it, and he’s set up a makeshift screen in the park with a projector (okay, so where is he getting the power from?), and the film of choice is From Here To Eternity, a black & white movie from the 50’s about US Army soldiers around the time of the attack of Pearl Harbor, starring Burt Lancaster, Montgomery Clift, and Frank Sinatra. “Well done, Shaunie, I really needed this,” Lea tells him. She asks him if the TED Talk videos helped, and he says yes. Lea asks that he elaborate, which Shaun doesn’t actually do. Instead he tells her he needs to find a surgical fix for Carlo by tomorrow, otherwise he will probably die.

Lea asks if he shouldn’t be at the hospital, and Shaun tells her he plans to go back after Lea goes to bed. (Does he ever sleep?) Lea is awesome and supportive. “Shaunie, go to the hospital!” He insists that date night is important, but Lea won’t have it. “Someone else needs you more than I need you.” I love Shaun’s retort here. “It’s a hospital. It’s filled with sick people.” Well, yeah. “But tomorrow, will someone need you to come up with a way to save their life?” she asks. “Maybe. Probably… not tomorrow,” Shaun says.

Lea puts away her drink. “I am cancelling date night.” Shaun looks at her. “That’s rude.” Lea just shrugs. “Oh well.” Shaun slowly realises this is his cue to go to the hospital. Lea, you’re a saint.

The episode finishes on a beautiful and very understated moment between Shaun and Lea. Shaun gets home after this long and incredibly difficult and sad day. He walks straight into the bedroom where Lea is already in bed with a book. He hesitates next to the bed, and Lea easily reads him.

“You go home, you be with the people you love, you take comfort in that,” Aaron had told him. And that’s exactly what he’s doing.

It’s less often that Shaun is the one to initiate physical contact with Lea, and rarer yet that he gets touchy-feely. It’s a testament to how vulnerable he is in that moment, and how much he trusts and needs her. “I’m glad you’re here with me,” he says as he intertwines his fingers with hers and then pulls her close.

“And then you wake up tomorrow and start all over again.” Having Lea by his side makes that a whole lot easier. Ugh. Goddammit. I’m crying again.

Dr. Murphy’s Teachings

This episode, Shaun supervises Asher and Olivia. Both are assigned their own patient — Asher the ballet dancer with back pain, Olivia a woman who came in with a stroke. Shaun is supposed to oversee how they handle the patients, both medically and emotionally. And Shaun really doesn’t know how to do that well.

Lim sees him hovering nearby, watching the residents’ every move, and she tells him, “I told you you have to trust them.” Shaun doesn’t, though. Lim says, “Then act like you do.”

What happens next is Shaun somewhat overinterpreting the advice he’s been given, and he gives Asher and Olivia completely free rein. When Shaun suggests to discharge the patient with back pain that Asher diagnosed as compression fracture of a vertebra, Asher asks Shaun, “Do you wanna recheck anything?” Shaun still has Lim’s words in his head that he’s supposed to trust his First Years, and so he says no.

Let’s hop back for a moment to season 1 here, because I think this is an interesting callback to a lesson that they taught Shaun as a first year resident himself. In 1×02 Mount Rushmore, Shaun was being assigned Melendez’s scutwork, and he was ordering barrages of (unecessary) tests that Melendez told him off about. “This isn’t a medical issue, send ’em home. Every patient in this hospital could have malaria. That doesn’t mean we go around testing for every medical condition we think they could have. An exampe: That MRI you ordered for the guy with the ear infection? Nice call, genius.” Shaun takes it as a compliment. “Thank you.” Uhm, Shaun? Not a compliment. “I was being sarcastic. It’s normal. He’s healthy. Send him home, too.”

Skip ahead three years, and of course Shaun has learned and internalised that, when you hear hooves, you shouldn’t necessarily be testing for whether it’s a zebra, donkey, mule, horse, cow, reindeer, moose, or antelope. Trust your gut, and if in doubt, go with horse, right?

This case expands on the theme from the previous episode that Shaun, as a supervisor, is responsible for the performance of his first year residents. And not only that, he is responsible for their errors as well, and for making sure they are supported where needed, while giving them enough room to breathe and make mistakes they can learn from. That’s a hard balance to strike even for neurotypical teachers. Unfortunately, this time around, it has dire consequences when things veer off course.

As they operate on Carlo, Shaun remarks that he would have not have missed the aneurism during the abdominal exam, the way that Asher did. Lim tries to come to Asher’s defense, but Shaun insists, “The aneurism is 6.5 centimeters, Dr. Wolke should have felt it.” It’s not always prudent to dwell on what-ifs, but Shaun just can’t let it go. “He asked me if I wanted to double-check. If I had, I would have caught the aneurism before the rupture.” Lim puts an end to it. “Stop it.”

And here’s the hard lesson for Shaun to learn. When is supervision too much, and when is it too little? Lim tells Shaun that he, too, made a mistake. Shaun counters that Lim told him to back off. “I didn’t tell you to abdicate responsibility. When a First Year asks if you want to recheck their work, your answer should always be yes. The fact they’re asking is a warning sign.” Shaun is caught off guard. “I didn’t know that.”

This takes me back to something that happened at my own workplace, actually. We had an important audit, and there was one particular major finding that resulted in a colleague being put in her place that she should have paid more attention and shouldn’t have abdicated the responsibility to a vendor we were working with. These things happen, and the best you can do afterwards is learn not to repeat the mistake. Thankfully, in our case, no one suffered serious consequences.

Shaun’s teaching skills journey continues to progress. He tells Asher and Olivia, “You are not very good at your jobs, and I’m not very good at teaching you, so we are going to focus on one step at a time. You will master each skill separately, I’ve made a list of 400 skills. I didn’t have the time to finish it last night, because–” (Gee, we wonder why!)

Cute and funny moment when Shaun, Olivia and Asher brainstorm over how to approach the next course of treatment for Carlo. Asher and Olivia exchange ideas about the surgical approach, and Shaun does his thousand-yard-stare brain visualisation mind palace thing. Asher looks at Olivia and whispers, “Did we break him?”

Carlo goes into surgery but doesn’t make it out alive, and everything slows to a screeching halt. It’s heartbreaking when Shaun seeks out Dr. Glassman afterwards. That whole scene is so tender and emotive, it gets me in the gut every time. Shaun steps into Aaron’s office, not saying a single word as he slowly sits down in one of the chairs. “He died,” he finally says in a small voice. Aaron listens quietly while trying to gauge Shaun’s frame of mind.

“I don’t know what people are thinking or feeling. I can’t communicate what I need, and more patients will die,” he tells Aaron in an unusually soft-spoken tone. Aaron sits down next to him. “You don’t think your ASD had anything to do with your patient’s death, do you? Because it didn’t.” Shaun feels like his failure killed Carlo, but Aaron knows how to reassure him. “Shaun, you’re gonna do most things better than anyone else, and there are days where you’re gonna fail, like everyone else. Today might be one of those days.” Shaun’s eyes tear up. “So what do you do then?” Aaron sighs heavily. “You go home, you be with the people you love, you take comfort in that, and then you wake up tomorrow and start all over again.”

What I think is a pretty monumental moment follows, because Shaun sees Asher sitting alone in the hallway, and Shaun recognises that there’s something profound going on here, that Asher needs emotional support — and that’s a huge thing for Shaun. He’s come such a long way.

“You can go home,” he tells Asher. “I just… don’t want to be alone right now,” Asher admits. Shaun silently sits down next to Asher and just stays with him while Asher cries. It’s beautiful. Another gut-puncher, and I’m so proud of Shaun. I don’t think Shaun was quite right when he told Aaron he never knows what people are feeling. It may not be as obvious to him as it is for neurotypicals, but he’s not as oblivious as he thinks.

The First Year Residents

Quite a few things to learn about the First Years this episode. Not surprisingly, Asher has little knowledge of American pop culture. When his ballet dancer patient mentions Betty White, Asher asks, “Is she a dancer?” No, Asher, not quite.

He confides in his patient Carlo that he grew up in Williamsburg, Brooklyn (Williamsburg represents one of the largest Orthodox Jewish communities in the US) and only spoke Yiddish as a child. He worked really hard to lose his accent and didn’t think people noticed anymore. And Carlo understands, because he’s been there, except 30 years ago, things were quite different for people like them.

Over casual conversation in the OR, Enrique makes an offhand comment that he’s been polyamorous for years. Everyone stares at him. He doesn’t think it’s a big deal, and monogamy is overrated.

The Others

We get a look at the domestic life of Alex and Morgan, and it’s going exactly as we thought. Alex just wants to get along, but Morgan is nosy and meddles with everything. She confronts Alex about the wooden parrot figurine she found in his closet (rummaging through Alex’s closet now — srsly, Morgan?), and he says he’s a Parrothead — a Jimmy Buffett fan. “It’s fun getting to know you better,” she tells him. “Worth every damn bit of sacrifice.” (Fun fact: This last line are actually Jimmy Buffett lyrics from the song “Cheeseburger in Paradise”, which Morgan explains when she uses it again a second time after she changes Alex’s phone ringtone to a Jimmy Buffett song.)

Side note: Jimmy Buffett is an American singer-songwriter and musician. He has a devoted base of fans known as “Parrotheads”, apparently this term comes from a reference to a concert in Cincinnati, OH where fans had inflatable parrots on their heads.

Morgan keeps teasing Alex relentlessly, and she actually finds out that the Parrothead confession was a bit of a white lie, and the parrot figurine was actually a memento of Mia’s that she made herself and gave to Alex as a gift.

Alex finds opportunity to retaliate, when he wakes Morgan up from her morning slumber and presents all the different exhibits he found around the apartment that seem to explain why she’s still hung up on previous relationships. She explains them all away.

Morgan and Alex end up ritually burning their mementos from times past as a symbol to move on to new and better times. Morgan starts singing Buffett’s “Margaritaville”, and Alex reluctantly joins in. They finish on, “It’s my own damn fault.” Which interestingly seems to be what they were first planning to name the episode title (according to trivia on the TGD Fandom Wiki, anyway).

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