Season 4 Rewatch: 4×11 We’re All Crazy Sometimes

The Good Doctor Argentina on Twitter (@TheGoodDoctorAr) is currently running a ’20 Days Countdown to The Good Doctor Season 5’, and on Day 11 it’s time to take a closer look at episode 4×11 We’re All Crazy Sometimes.

Patient Stories

Patient #1 is Jeffrey Williams. This is actually one of Dr. Glassman’s cases, and it’s piqued the interest of all three remaining First Years, plus Alex and Claire. Jeff is one of Glassman’s long-standing patients, he’s treated him for years. (This wouldn’t actually be a neurosurgery but more an immunology case prior to surgical intervention, but okay…)

Jeff has ankylosing spondylitis, a chronic inflammatory disease that causes the bones in the spine to fuse together. I always get excited when TV shows feature lesser-known diseases and raise some awareness for them, because AS is often overlooked and misdiagnosed, and patients can go years with chronic back pain without knowing what’s wrong with them. And then, by the time they do get a diagnosis, the inflammation may already have caused permanent damage.

Jeff’s case seems rather drastic, although the full spinal fusion seen here can be the tragic end result for these patients. Sadly, there’s (currently) no cure, although the advent of more modern anti-TNF treatments has made quite a big difference in these patients’ treatment outlooks. But I digress.

The surgery they’re planning to un-fuse Jeff’s spine is incredibly complicated and dangerous, and there are many reasons not to do it. Jeff himself wavers quite a bit, and it turns out that the reason Jeff is hesitant about going through with the surgery is that he’s never had a normal life. He’s been in and out of hospitals since he was a kid, and he never made friends outside of hospital staff. He’s afraid that this surgery will throw him into a life he’s never known and doesn’t know how to fit into.

Patient #2 is Dannie Miller. (Can I just say I love Elizabeth Mitchell, and I was very happy to see her on the show.) This is Morgan and Shaun’s case, and an emotionally heavy one. Dannie has been in a coma for 10 years (the result of a ruptured brain aneurism), and Morgan has finally convinced her husband that it’s time to let go. Shaun and Morgan are ready to switch off the life support when Dannie’s thumb twitches.

Shaun makes the mistake of mentioning that this could mean there’s remaining brain activity. Immediately, Dannie’s husband Elias orders them to put life support back on and figure out what this means. They find out that Dannie has elevated levels of dopamine (a neurotransmitter that’s instrumental in sending signals to nerve cells), and Shaun wants to determine the cause, while Morgan wants Elias to move on.

An imaging scan reveals that Dannie has a tumour that irritated her nerves and caused the thumb twitch. Elias very much isn’t ready to give up on his wife, so now he wants them to remove the malignant tumour. And then the unimaginable happens, Dannie wakes up during the surgery.

What happened here was that, during the operation, large amounts of dopamine were released into Dannie’s system, which caused her brain to regain function. But the kicker is that the dopamine release is temporary, and they can’t give her dopamine externally because the dose needed to keep her awake permanently would be toxic. Which means that Dannie will lapse back into a coma within a day.

It’s as tragic as it gets, but Elias gets a chance to speak to his wife again with her being conscious and responsive, and finally to say goodbye to her and get closure.

As excited as I was for the AS case, the more annoyed I am with the medical inaccuracy of Dannie’s case. There is no way that a patient who has been in a coma for such an extended period of time comes out of it and is immediately fully aware of their surroundings, can talk coherently, and doesn’t have serious muscle atrophy.

Not to mention that Dannie had a tracheostomy tube (a breathing tube directly inserted into her trachea in her neck). Patients with a trach tube can’t talk, unless they learn techniques for this with the help of a speech therapist. They didn’t remove the tube from Dannie’s neck and there wouldn’t have been time for speech therapy, so she should not be able to speak through any of this.

I’m sorry, but this is bullshit, and it’s unfortunately one of those episodes where I’m having trouble suspending my disbelief. Guys, please do better next time for us who actually know a bit about medicine, okay?

Shaun & Lea

We start out with Shaun and Lea leaving the house to drive to work together. Shaun suggests that Lea should ask for a raise since she just saved the hospital from a major financial crisis. Their conversation is cut short when they see that Lea’s car is in the process of being towed, seeing how she parked in a spot that wasn’t assigned to her.

The guy running the towing company is a thoroughly unpleasant individual named Tricky, who starts abusing his power and extorts Lea for more and more money. Slightly amusing but also a bit unfortunate here is Shaun’s deadpan inability to back Lea up and lie, which gets Lea into even deeper trouble. (Not that I think Shaun resorting to white lies in this situation would have made any difference to the end result of Striped Tomato being towed away.)

Side note: There’s a deleted scene on the season 4 DVDs where we can see that Lea’s dialogue was initially longer. What she says originally is, “I just got a spot last week, so it’s kinda new to everyone. And then somebody parked in my spot, so I parked in Rudy’s spot, because I know Rudy’s car is in the shop, but Rudy’s mother is 86 and gets confused and she must have called you, so, yes, it is not my spot, but that doesn’t make it the wrong spot.”

Lea being Lea, she doesn’t want to just buckle down. Tricky is an opportunistic sleezebag and Lea wants justice – and of course her car back without having to pay $350 for it. She starts getting to work on creating hundreds of fake negative online reviews for Tricky’s towing business that she plans to use as leverage against Tricky to release her car.

In the process, she asks Shaun if she can borrow his phone since she’s maxed out on IP addresses to use for the fake reviews. Shaun is hesitant. His phone is important. Does he want Lea to do something illicit with it?

This delves a little bit into the topic of trust, but more so the topic of being a team, of unconditionally having someone’s back. Shaun is now Lea’s boyfriend, her partner, her support system. He’s supposed to back her up in difficult situations, he’s supposed to support her, no matter what. And now Lea feels betrayed that he didn’t.

At the same time, Shaun struggles to understand why Lea feels that way. His stance on fairness and justice is very rational and pretty black and white. Tricky towing Lea’s car was rightful, she parked in a wrong spot and broke the rules. It’s only fair to penalise her for that, and there are laws and regulations that control exactly this.

Shaun is also unsettled by Lea’s somewhat erratic behaviour. She’s not known to go on irrational retaliation sprees and resort to illicit measures along the way. It all comes to a head when Lea seeks out Tricky at his towing lot to lay out her plans of tanking his business unless he gives her the car back.

But Shaun has a plan of his own that is a little bit less outrageous. He leaves Lea the car keys while he goes inside with Tricky to distract him, so that Lea can seize the car and make a run for it. Their plan works (what a stroke of “luck” that Striped Tomato was standing right there to be driven off with), and Shaun jumps into the car while they flee the scene.

Once they get home, Shaun confronts Lea with the subject matter at hand and admits that he paid Tricky the $250 he was initially owed for towing the car so that he wouldn’t come after Lea and retaliate. And then he asks Lea why she’s been acting so crazy lately. There’s a reason for it. “Shaun,” Lea says, “I’m pregnant.” Whoopsie daisies. Shaun surely didn’t expect that.

So there’s our big bomb being dropped that dominates the rest of the season. Pregnancy is a huge game changer – especially an unplanned pregnancy. What will they do with that? Will they keep the baby? If they do, what will that mean for them? All big things that will be tackled over the course of the next episodes. I’m excited!

The First Year Residents

Since Jeff’s spinal fusion surgery is a big and unusual case, everyone wants in on it. Glassman has the three First Years and Alex and Claire perform mock surgery on a model of a spine to pick out who deserves to be on his team. It’s Asher and Claire who make the cut (pun intended). So this episode, it’s actually Glassman who is doing the teaching, and not so much Shaun or the other Fourth Years.

We learn that Asher, who was raised a hasidic jew, was taught that eating anything that wasn’t kosher would mean betraying their faith. He explained that he felt that, if he ate a cheeseburger, it would cut his last lifeline to his mother, even though he had left the hasidic community and rejected their faith a long time ago.

Claire was present during this conversation, and she takes Asher to a bar later where he’s ready to dig in and try his first cheeseburger. “Kick its butt,” Claire encourages him. Asher takes a big bite. “It’s…. really, really good.” Great. Now I want a cheeseburger. It’s 11:30 pm and I have neither burger buns nor patties. Thanks, Asher.

The Others

We get a little bit of Morgan and Alex teasing. Well, actually not teasing. Morgan is incredibly supportive and earnest when she helps Alex figure out why he didn’t get picked for Glassman’s surgery team. It’s refreshing. More of this, please.

At the end of the episode, Alex brings Morgan her favourite ice cream. There’s curiously surreptitious glances being exchanged, and there’s undeniable chemistry there. None of them act on it, though.

When Claire takes Asher out to try his first ever chesseburger, it’s a bar with (what I’m guessing is) open mic night. Claire conquers her hesitancy and goes on stage with her acoustic guitar. “This is a song my mother taught me. If you don’t like it, shame on you.” She sings a beautiful rendition of Crowded Table by The Highwomen.

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