Season 4 Rewatch: 4×06 Lim

The Good Doctor Argentina on Twitter (@TheGoodDoctorAr) is currently running a ’20 Days Countdown to The Good Doctor Season 5’, and on Day 6 we’ll be recapping episode 4×06 Lim.

Patient Stories

Patient #1 is Ben Harris, a young man who was hit by a car. He comes into the ER together with Audrey Lim, who was first responder at the scene of the accident. His GCS is 5 upon arrival (which is not good, 3 basically means braindead — GCS is the Glasgow Coma Scale to determine responsiveness of a patient). He also had internal bleeding and a pneumothorax (a collapsed lung).

They operate on him and try to find the source of the internal bleeding, which seems to have been a liver laceration (the liver has a lot of blood vessels feeding it, injuries here can cause massive bleeds). They also find shrapnel in his bowels, which seems to be unrelated to the accident.

As Ben recovers, he suddenly has a violent PTSD flashback to his time in Afghanistan. He panics and runs from his room, thinking he’s back in the war during combat. His wife manages to talk him down, and we can see that they’re both struggling. This is clearly not the first time that’s happened, and he doesn’t seem to be able to talk about the incident that triggered it.

The wife talks about how terribly the PTSD has affected her husband, and that no treatment they’ve tried has helped in any way. They’ve cycled through a lot of them. Ben gets physically abusive when he has his episodes, and he ends up inadvertently hitting his wife in the face. They’re at a breaking point, even though she loves him.

Claire suggests amygdala ablation (focused removal of brain tissue in the amygdala region), which is an experimental procedure and Lim is not in favour, seeing how it’s dangerous and success is not at all guaranteed. They still do the ablation, and amazingly, Ben comes out of it without major complications, and he can finally talk about his combat experience in Kandahar.

Ben was featured to introduce us to PTSD and see the terrible effects it can cause not only on the patient but also their loved ones and people around them, and the helplessness that one feels when nothing they can do can make it better.

Patient #2 is Rose Bapcock, in the hospital for the repair of a distal radius fracture (broken wrist) after a fall. She seems to have a tendency to wander around the patient rooms to gauge people’s states of mind. She claims she’s an empath and can read and feel people’s emotions as her own.

It’s an intriguing concept, and I’m pretty sure that there are people who do and experience this to a degree. (Pretty foreign to me, since, even as a neurotypical person, I’m not always the best at reading people’s feelings.) I have friends who fall in the HSP spectrum, and I find it an extremely fascinating topic, and just talking about it has made me learn a great deal about being more open to the idea that not everyone’s brain works the same way as your own, and that other people’s perceptions and ideas are just as valid as your own, even if you may be experiencing a completely different thing yourself.

Rose’s symptoms baffle the doctors for a while, because she keeps claiming they are caused by her feeling other people’s emotions. They eventually figure out she has Prinzmetal’s angina, a heart condition that is exacerbated by stress. It’s what sent her into a heart attack. Seeking out other people’s pain is literally killing Rose.

Rose, in this episode, serves as a mirror for Dr. Lim — making her see and face her own PTSD issues. Rose had spikes in heart rate whenever Lim was in the room, taking on her stress and fear and overwhelming anxiety.

Shaun & Lea

Shaun and Lea take a backseat in this episode, as the big focus is really on Dr. Lim for this one. In fact, Lea is only very briefly featured from afar and doesn’t have a speaking part in this episode. The overarching theme here seems to be “meaningful gifts”, a.k.a. how do I appropriately express my appreciation for the person I love through a physical item?

The first time we see Shaun, he’s holding two singing frogs that play back pre-recorded love songs (yes, those super annoying and cheesy toys, one step up from Billy Bass, the singing fish), and he consults Claire and Morgan about which one to get Lea for her birthday tomorrow. He wants to give her something meaningful for her first birthday of them being a couple, and can’t decide what’s appropriate. Well, Shaun, neither of these are. Not by a long shot. (And how on earth can you not see that?)

Shaun tries a few more things, which includes something he got from the hospital’s gift shop (we don’t see what exactly), and sex toys he might have ordered online (same day delivery?).

We never see the actual birthday party or anything beyond a wide angle shot of Audrey watching Lea and Shaun with a large birthday cake from a distance, with a bunch of doctors and nurses around them, singing Happy Birthday in the hospital hallway. Hm.

And you know what? If I’m being very honest, I found this whole gift thing super awkward to the point where I would even use the word “cringey”. (And I hate when Shaun makes me cringe, because that’s just not right.) Sure, we know Shaun can be clueless about what is socially or emotionally appropriate, but would he really consider buying tacky af singing stuffed toys for Lea? Or random items from the hospital’s gift shop?

And then the actual birthday surprise for Lea, which involves doctors and nurses that we’ve never seen before, that we can only assume aren’t particularly close to either Shaun or Lea? And where are Lea’s colleagues in this? Everyone but maybe two people in that scene is either wearing a lab coat or scrubs. It just seems completely weird and off to me.

We’ve seen Shaun come up with the most thoughtful ideas before, things that made you go ‘Aw, Shaunie!’, things that were creative and considerate and had Shaun’s name written all over them. (The movie date night in the park from 4×05 being one of them.) And seeing how this was for an event that a) he knew would have been coming for a while and he could plan, and b) meant something to both him and Lea, it just seems very out of character for him to still be looking for a birthday present the day before the actual event.

Wouldn’t he have made long lists with different ideas and weighing pros and cons weeks in advance? Wouldn’t he have incessantly consulted colleagues and Dr. Glassman on this? Wouldn’t he have ruminated over it back and forth for weeks on end, ensuring he had the perfect present for the one person who means the whole world to him?

I dunno, to me this whole thing felt very forced, and I wish I could pick the writers’ brains as to why they felt this was appropriate and in-character for Shaun. Melissa Reiner (the show’s autism consultant) doesn’t have any insights video up for this episode (the one she numbered 4.06 is actually for 4.07), and I really want to know what she had to say about this whole gift storyline and how it was handled.

The only rational explanation I have is that this was a short-notice script change and maybe kind of a stop gap because Richard Schiff contracted COVID during this time, and wasn’t available for scenes they may have had planned between Shaun and Dr. Glassman.

That said, dear writers, I forgive you. You gave us a lot more awesome and thoughtful and very much in-character stuff for the rest of the season, and that made up for all of this.

Dr. Murphy’s Teachings

Shaun’s mission this time around is teaching one of the first year residents to do a suction D&C (an abortion) on a young mother. When Lim asks him to find a resident who’s up for it, he tells her, “Oh, no, I’ll do it myself. I’m not going to teach anymore. I’m a good surgeon, I’ll do surgery.” Lim won’t have it, though. “Dr. Murphy, part of your job as a surgeon is to teach. You can’t opt out because it’s difficult.” And maybe she’s been expecting a bit too much. “I may have given you too much responsibility too soon, so I will supervise your supervision until you get the hang of it.” Shaun seems happy with that arrangement.

When Dr. Lim approaches him about the D&C the next time, Shaun tells her that he’s still going to do it himself, because the only First Year who hasn’t done one doesn’t want to do it (Jordan). “Wanting to is irrelevant,” Lim says, “it’s their job.”

It makes me chuckle that this scene cuts directly to Shaun standing in front of Olivia and Jordan, saying, “Wanting to is irrelevant, it’s your job.” Jordan doesn’t want to do the abortion for religious reasons. It goes against her Christian faith to prematurely terminate an unborn child’s life.

What this episode also nicely underlines is that, when Shaun is teaching, he is also learning at the same time — learning how to navigate around his autism and how to anticipate pepole’s needs and weaknesses, at the same time acknowledging his own. He tends to shy away from uncomfortable situations and likes to actively avoid them, which he very much does this episode, refusing to teach his junior residents. And while Dr. Lim has intentions to support him overcoming that particular struggle, she has too much to deal with on her own turf to really do it in a meaningful and helpful manner.

There’s a beautiful scene here where Lim advises Shaun to walk Asher through the laser ablation on Ben’s brain, and Shaun immediately tenses. He sucks at teaching. He’d rather do it himself. I think this goes back to Shaun’s ASD hampering his ability to trade places with people, to put himself in others’ shoes. How can he advise someone when he has no idea what they’re currently experiencing? How can he communicate what it’s in his head, when it’s all there but the words aren’t? He struggles figuring out how to help Asher through the procedure. “Tell Asher what you see,” Lim encourages him. And then he does, and it helps.

Audrey Lim

As the title suggests, this episode spotlights Dr. Audrey Lim, which I think is long overdue since she’s often just there in her role of Chief of Surgery, giving advice, approving surgeries, or doing them because they need a senior person to lead a complicated sugery.

We very clearly see that Audrey is struggling. She is up at 4:30 am, still up at 5:30, and finally decides to just blow off some steam by taking her Ducati (motorbike) to ride it at top speed through the deserted outskirts of San Jose at dawn. We see her engaging in a few pretty risky manoeuvres, until she comes by what looks like a freshly occurred traffic accident.

She gets off her bike to help — a young man was run over by a car. This is patient #1, Ben. They take him to St. Bonaventure, and while they operate on the patient, Claire enquires why Lim was up and at ’em so early. She gives Claire a bogus answer about having to prep some budget meeting with Glassman. (A bit of a consistency error here, maybe, because Claire remarks the accident happened on the other side of town. Why would the ambulance not take them to the closest hospital if the patient was clearly critical?)

The overarching theme this episode is post traumatic stress disorder, and we get a glimpse of what it means to Audrey Lim. The topic itself was already covered on the show earlier, with Claire having been diagnosed with it, and now we’re seeing a new angle with it being tied to someone who is considered a pretty stable and confident person in a secure job without any one drastically traumatic event being the trigger.

Most people associate PTSD with traumatic combat experiences in the military, since that’s where the diagnosis initially came from, but stress can manifest in many different ways, and wreak havoc on our psyche and health, even if the trauma is not as radical as being active participant or first-hand observer in a warzone.

PTSD is a relatively new diagnosis. If Wikipedia can be believed, it was first recognised in the 1950’s, and more widely accepted in the late 70’s and beyond. It has likely existed long before that, though. It just didn’t have a name or wide-spread acceptance. PTSD became an official psychiatric diagnosis in 1980.

One of Audrey’s manifesting PTSD symptoms is a sudden onset of tinnitus (a loud and distracting constant beeping sound), which she mostly just wants to ignore. When it gets bad, she puts on headphones and turns up rock music really loud. But that’s a temporary band aid, at best. She’ll have to eventually face it, and admit that she’s suffering from a real disease that is impeding on her ability to function.

Audrey is increasingly short-tempered and irritable. She flies into an uncharacteristic bout of reprehension with Shaun when he offers insights into Ben’s course of treatment, yelling at him that he needs to stop making everything her problem and needs to grow up and accept some responsibility. Claire is there as well, and sees right thought it. She and Audrey have an honest conversation about Claire’s PTSD, but Audrey is still in denial and doesn’t accept the helping hand that is offered.

After a bit of soul searching, Audrey finally accepts that she may have a problem. She seeks out Rose, the empath, to tell her about her heart condition. “Go ahead, use your magic, tell me what’s wrong with me. How do I stop being like this?” Audrey asks of Rose. “Doesn’t work that way. I don’t have a magical wand. I can only hold up a mirror, make you slow down, look at the parts of yourself that you’ve been trying to ignore. Because you’re afraid that if you look too closely, you’ll break. Maybe you will, I don’t know. Maybe breaking is the point. You can’t outrun your pain, Dr. Lim. If you try, it’s gonna kill you.”

But that’s exactly what Audrey does. She goes trying to outrun her pain. On her motorbike at 100+ miles an hour. Her recklessness sends her swerving into an intersection where she loses control of the vehicle, which sends the bike to flip over and Audrey skidding into the road. She lies motionless for a moment but then drags herself up. The tinnitus is back, and it’s the sound of a heart monitor indicating asystole. it’s accompanied by the endlessly repeating chorus of patients with COVID being prounced dead by her and her colleagues. The episode fades to black on her saying, “Time of death….”

The First Year Residents

Some of the episode spotlights Asher, after last week’s catastrophic events where he lost his first patient. “How does Asher seem to you?” Claire asks Audrey at one time. “He seems fine,” Audreys responds. “Too fine… for someone who’s just lost their first patient,” is Claire’s assessment.

And Claire is right. Asher isn’t fine. He hesitates during surgery, not able to insert a needle, and Claire has to take over. Audrey sees it, but she has so much to deal with that it’s getting overwhelming to have to cater to her students’ needs on top of her own emotional fragility.

When one of the nurses tips off Lim that one of her First Years has been sitting in the stairwell for a while, we wee Lim reaching out to Asher. They sit and talk about loss, about all the patients they could have saved but didn’t. She tells Asher, “You get past it because that’s the job. You will always remember it. And you will eventually stop reliving it. Because if you don’t, you can’t be a surgeon. And I’m pretty sure you’re a surgeon.”

Part of the episode highlights Jordan’s Christian faith, and her stance on abortion, which she thinks is wrong and has her refusing to perform one, even though the Chief of Surgery clearly told her it is part of her curriculum as a budding surgeon. When Dr. Lim suggests that she expects more initiative from her residents and Olivia offers to do it instead, Jordan’s sense of competition suddenly fires, and she offers to do the D&C after all. However, when it comes to the actual procedure and the patient is ready for her to start, she pulls out. She just can’t do it, it goes against everything she believes in.

It opens us up for the question of when is it okay to refuse to do your job on the grounds of your personal beliefs. Can a doctor really be allowed to say no? And what if Jordan had to do this to save a patient’s life? There probably is no right or wrong answer to this.

Lim gets very mad at Jordan over it, though. “You had an opportunity to opt out before you walked into that room, but you agreed to do the procedure, you took on an obligation to that patient, and you failed her! If you ever do anything like that again, I will have you removed from my program. Maybe you should be cleaning bedpans for a while, hopefully there’s no moral objection to that!”

The well goes deeper than we think, because Jordan later goes to Audrey to tell her that she very much knows what abortion feels like. She herself chose her career over motherhood and over her faith, but she doesn’t regret it. And because of the choice she made, she now gets to live her dream of being a doctor.

The Others

The other residents aren’t a huge part of the episode, and one of the times we see Morgan, she is carrying a cardboard box with holes that has something chirping inside it. They never pick up on that again, though it was remarked upon by Claire and Audrey in that scene. Was this a missed opportunity? Something that fell victim to the cutting room floor? Or just a quirky little riddle for the viewers to figure out?

What I do like about that scene, though, is Morgan standing up for the abortion patient (whom she saw initially at the Clinic and then brought to the surgical department). She tells Lim, “You’re being unfair to the patient. She’s facing an emotionally fraught procedure. She needs the support of her doctors. And who she’s getting is a rookie who thinks she’s committing murder. And Shaun.”

We get a little bit of continued Morgan and Alex teasing. Apparently they’re having a dare over refusal to extricate a rat from the garage. And it involves wearing some sort of tooth grill with their names on it. It looks ridiculous. I dunno, it’s weird. I didn’t find it particularly amusing, to be honest. Neither does Lim, she sends both of them home.

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