Wow… this episode is like a bus crash. Oh snap. Couldn’t help myself. This episode had so much going on, it is quite hard to focus. But, let’s go into the episode – it shows our 3 favorite residents, Claire, Jared and Shaun all working their first night shift. It seems like a slow night, and then, out of nowhere, there is a phone call. A bus crash. A wedding night ruined. Over 20 patients about to be brought in. And all hands were on deck, pulling doctors from other areas, even their home. Each doctor has their own case, and mostly handle it themselves, with Glassman, Melendez and Andrews checking them constantly.
Source: American Broadcasting Company for The Good Doctor.
Claire’s patient is a young woman who has an injured artery. The injury should have bled out, but an item was blocking blood flow. Claire freezes, but is snapped back after a few seconds by Melendez, reminding her about her ABCs. Later, he talks with her about freezing, but she tries to say she was just thinking. It seems Melendez is warming up to Shaun, mentioning how he was thinking, she was just freezing. He encourages her to think outside the box. Later, while talking with Shaun, she comes up with an idea on how to help his patient. Checking back on her own, she realizes there might be one more victim out at the crash sight, and rushes to find her. She does, and notices bleeding in the brain. Taking a chance, she drills a hole in the skull, to relieve pressure. They rush back to the hospital, only to find her brain dead. The receiving doctor pulls Glassman to the side, and tells him how the last victim had been ventilated improperly. She was brain dead from lack of oxygen. Claire lost her first patient due to an error on her own part, but sadly, it happens.
Jared deals with a burn victim, a young woman who has burns covering most of her body. She is mortified by her injuries, and Jared isn’t the best at bedside manner. Luckily, Claire points out he can escape, she can’t, and makes her friend go back inside. It was really good to see him grow, and figure out how to help a patient regain confidence by trying a new medical procedure using fish skin to help heal the skin. It gave the woman hope for tomorrow, and taught Jared how to connect to his patients more.
Shaun had a tough case. Honestly, I was shocked he wasn’t overwhelmed with all the action in the ER. Because he kept his head, he was able create an artificial artery to help stabilize the patient with a shattered femur. We then have Claire’s brilliant idea of 3D printing the man a new femur. But, there was 10% chance of death. Enter the decision- walk again with chance of death, or amputate. The man’s family wanted to amputate. Why risk a life when he can get a prosthetic leg? His soon to be wife wanted the surgery. Soon, both sides are dragging up hidden truths, how he was an addict and moving kept him clean, and how he cheated on the fiance, just a month before the wedding. A 3rd party came in, and said the fiance had the best intentions for the man. Put in the Not Fake bone. The episode ends with the man waking up, thankful for the surgery, gushing about how he can’t wait to marry his fiance. We see between the lines, through looks and the message, “There will be plenty of time for a wedding later on”, that the bride isn’t so sure about their future. Makes sense, with so much dug up.
Source: American Broadcasting Company for The Good Doctor.
Melendez and Jessica showed more of their relationship this episode, even opening kissing. It was a nice break from the story line, as it showed how the different victims made them think about their own choices, and small talk during the slow periods, but I wish we had seen the proposal, or it had been shown they were engaged before. But their chemistry seems real, not forced for the sake of a story line. I just wish Shaun wanted love.
There isn’t an episode next week, So I will be back in 2 weeks, but for now, stay shiny!
Lets talk blood and guts! Let’s start with the ABCs! Airway, Breathing, Circulation. It is generally the first step in every medical situation. Open the airway, make sure it isn’t obstructed, make sure the person is breathing, and blood is circulation. In every victim, the doctors checked all 3, which is something all 3 doctors had to practice in this episode.
Jared had Airway – his patient had trouble breathing, so he believed, because of the burns, her airway was obstructed by smoke inhalation, makes sense, burns means fire. Dr. Andrews asks if he sees any soot around mouth or nose, and Jared says no. What happened is the burned layer of tissue has now scabbed, making it a solid layer. The tissue below the burns and being rehydrated, expanding, but cannot move outwards because of the burned tissue, so it began to put pressure on her esophagus, and possibly her veins and arteries. A simple cut to the scabs let the tissue below expand.
Claire had Breathing – with the patient she found on the side of the road, she began running her ABCs, noticing her eyes were dilated, which implies blood might be draining into her brain. Pressure on the brain causes damage, and the best thing to do is relieve the pressure. So, Claire opens up her airway, and inserts a ventilation port, before using a drill to relieve the pressure, and restore some normal circulation. The problem is afterwards, she didn’t check her ABCs again, and the port had been pushed too deep. Air wasn’t making it into her lungs, and tissues began to die. She was brain dead even before she made it to the hospital because of lack of oxygen.
Source: American Broadcasting Company for The Good Doctor.
Shaun had Circulation. Remember those two main arteries? They branch off a bit, but one of the biggest is the femoral artery. The problem with arteries is they push out a lot of blood, and are hard to stop flowing. The man’s leg was shattered, bone sticking out, and artery cut. The damage was so excessive to the artery, one clamp couldn’t stop the bleeding fully. So, Shaun makes an artificial artery to support the blood flow to the rest of the leg, using a man-made Resuscitative Endovascular Balloon Occlusion of the Aorta, or REBOA. Never heard of it before, but quite fascinating.
BONUS – when Claire froze, as a woman came in with an object protruding from an artery, does anyone know why they didn’t instantly remove it? It’s because if removed, the carotid artery would start spewing blood. Ironically, with most cuts to arteries, if the object is left in, the flow of blood will be less than if it was removed. The best practice is to secure the object in place, then wrap an ace bandage over the object and injury. The item will keep a seal of sorts, and makes bleeding out less likely. I remember that one from high school. Well, that’s all I got for this week! Stay shiny!
