"The Good Lawyer" TGD S6E16 Review
Jul. 25th, 2025 02:43 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
penwallaDisclaimer: I have not actually seen "The Good Doctor". I hate medical TV.
But I saw this episode's recap on YouTube by Doctor Mike & LegalEagle and I was flabbergasted. So flabbergasted that I had to see the episode for myself, because what the fuck?
Okay. I am not autistic nor I have OCD, so I am going to refrain from commenting on those elements. We're going to focus on the medical case the episode revolves around.
So the premise of this episode is that it is a backdoor pilot for "The Good Lawyer", which was a TV show starring the lawyer in this episode that they wanted to make happen. (It didn't happen.) Basically, the titular good doctor is being sued, and the episode chronicles the trial as he tries to clear his name.
A List of Complaints, in no particular order:
This guy is a working general surgeon...bro, did you sleep through your entire ATLS course? Through your BLS?
Side note: you can buy emergency kits with decent tourniquets in them for situations like this. Put 'em in your trunk if you've had any first aid training, it's probably more likely to be useful than any airway equipment you're carrying.
Okay, we've now reached the moment in the episode that made me realize I had to watch the full thing, not just a recap. You see...Shaun says that it matters what route he unnecessarily dragged this guy through the woods, because he might have angled the board and caused neurological injury, and that means that maybe he didn't need to AMPUTATE HIS HAND.
AMPUTATE. HIS HAND.
Sir, what the actual fuck?
I just want to be clear with everyone reading this. Doing amputations in the field on a random car accident victim is insanity. It's buckwild. As we'll see, in this episode it was especially buckwild, but even in real life the only field amputations I have even heard of were cases where removing the limb was the only way to get the patient to safety. There's probably some indication if you're, like, a medic in an active combat zone.
I am stopping to look this up, actually.
Okay, all the guidelines I have read confirm what I thought: field amputation is a very rare procedure reserved for situations where amputation is required to extract the patient safely. Because cutting off someone's limb in the field is an insane thing to be doing.
Let's...let's keep going. Keep in mind that as I have just explained, the patient whose hand has been amputated is not trapped! He's being dragged around on a board!
Let's hear Shaun's explanation of why he had to amputate the hand:
1. The radial pulse was thready.
2. The capillary refill in the hand was delayed.
3. His breathing became labored.
4. His hand was irreversibly damaged from lack of blood flow.
5. His hand was leaking toxins that would stop his heart.
YOU PUT A TOURNIQUET ON HIS HAND.
Like, there's other things very wrong here, but first off: the hand is not getting blood flow because you put a tourniquet on it to STOP THE BLOOD FLOW. Because his radial artery was injured and he was bleeding to death.
Let's set aside the breathing, because this guy was thrown from a vehicle at 70 mph, he almost certainly has other injuries, there's plenty of reasons for him to have labored breathing. His radial pulse is thready? What radial pulse, the artery is torn and also, tourniquet. His capillary refill (i.e. whether his hand blanches and then turns pink again if you push on it?) Gone, because, again, tourniquet. His hand was irreversibly damaged?
It's been like, minutes. You have no idea if his hand is irreversibly damaged. That is not something you can determine on the side of the road in the dark in the rain. And even if it is, you don't need to cut off his hand now! It can be cut off in the hospital at a later date!
Which brings us to the fucking toxins.
Okay, this is the part where I was like, who wrote this and why did no one stop you. I don't know what the fuck they are talking about. If they're talking about reperfusion injury (when you restore blood flow to dead tissue, all the stuff that is released from the dying tissue floods back into the body, which is bad) then that makes no sense, because the hand isn't reperfusing. You literally just told us it was NOT perfusing, which it shouldn't be, because, again, AGAIN, tourniquet. Yes, having any part of your body die is bad, but this ischemia is ischemia you just induced a couple minutes ago by putting on the tourniquet.
Park reasonably points out an ambulance is almost there, but Shaun says that they don't carry amputation kits so he still needs to cut off the hand. Again, no, he does not need to do that. The hand can be cut off if needed in the OR later on. Doing this wildly unsterile procedure in the field is fully crazy.
Wait, it gets crazier!
Park interrupts Shaun's retelling to point out that he suggested it might be because of a vasospasm, so they should wait until the ambulance arrives to administer calcium channel blockers!
What?
I don't...he has a tourniquet on that arm. And even if the patient has ulnar vasospasm (because, again, the radial artery was bleeding out) and that's somehow a greater contribution to the ischemia in the hand than the tourniquet, who is administering calcium channel blockers? Which would lower the blood pressure? In the field? To an ejected trauma patient who has labored breathing and is unconscious?
You want to give the guy who has a high likelihood of internal injury and therefore really needs to maintain his blood pressure a medication...that will lower the blood pressure...
That's insane. That's fully insane. No one would do that.
Incidentally, shout out to this other doctor for saying "Are you sure?" from several feet away and doing nothing else to prevent this unnecessary field amputation of a man's hand. Awesome work. Really doing no harm there.
Okay, so finally this part of the episode is over but the madness does not stop. We cut to Shaun holding the SEVERED HAND of the guy he mutilated, which he is testing the lactate levels of to see if he was right or not.
Who wrote this episode? And why were they not stopped?
The thing is, I've thought about it, and they could have had this guy's arm trapped under the car and had Shaun cut it off before the ambulance arrived and the episode would still work, and it would be a much better debate to be having instead of making everyone involved look like an idiot for not knowing what a tourniquet does.
And yes, I refer to him as Shaun because I don't respect him enough to call him doctor.
But I saw this episode's recap on YouTube by Doctor Mike & LegalEagle and I was flabbergasted. So flabbergasted that I had to see the episode for myself, because what the fuck?
Okay. I am not autistic nor I have OCD, so I am going to refrain from commenting on those elements. We're going to focus on the medical case the episode revolves around.
So the premise of this episode is that it is a backdoor pilot for "The Good Lawyer", which was a TV show starring the lawyer in this episode that they wanted to make happen. (It didn't happen.) Basically, the titular good doctor is being sued, and the episode chronicles the trial as he tries to clear his name.
A List of Complaints, in no particular order:
- Janet, the older lawyer Shaun initially meets with implies that the California Medical Board won't be notified if he settles, but I do not think that is true, and also...like, doctors get sued. Especially surgeons. It obviously sucks, but it's not necessarily a career-ending thing, especially in the USA where we're so litigious. As we will see, Shaun's actions are so egregious that he might actually lose his license in real life!
- Also, I think most cases of this kind settle. TV always presents it as this huge deal but I think that's actually a normal thing that happens.
- The show treats Joni needing to tap the table as being equally disruptive to her work as her inability to be on time or her inability to handle a chair squeaking, which it is just...is not.
- It takes WAY too long for these guys to call an ambulance. Secure the scene, call for help, THEN do whatever you're going to try to do on the side of the road during a storm.
- Okay, so Shaun finds the ejected passenger, who is bleeding from his radial artery. He tells Park that they "need to move him" but Park can't leave the other passenger. Let's break this down.
- You don't need to move him! You absolutely should not be moving a patient who was ejected from a fucking vehicle anywhere unless his location is putting his life in eminent danger! Wait for EMS so he can be immobilized appropriately for transport!
- I can't stress enough how stupid this is. You can injure the patient by moving them and you can injure yourself because moving a fully grown man on your own is not a physically easy task. It is safer for everyone if you just wait until EMS is there.
- Also, I get that Park is reluctant to leave this woman, but she's awake and talking, and he's not doing anything critical to save her, so can he call for a fucking ambulance?
This guy is a working general surgeon...bro, did you sleep through your entire ATLS course? Through your BLS?
Side note: you can buy emergency kits with decent tourniquets in them for situations like this. Put 'em in your trunk if you've had any first aid training, it's probably more likely to be useful than any airway equipment you're carrying.
Okay, we've now reached the moment in the episode that made me realize I had to watch the full thing, not just a recap. You see...Shaun says that it matters what route he unnecessarily dragged this guy through the woods, because he might have angled the board and caused neurological injury, and that means that maybe he didn't need to AMPUTATE HIS HAND.
AMPUTATE. HIS HAND.
Sir, what the actual fuck?
I just want to be clear with everyone reading this. Doing amputations in the field on a random car accident victim is insanity. It's buckwild. As we'll see, in this episode it was especially buckwild, but even in real life the only field amputations I have even heard of were cases where removing the limb was the only way to get the patient to safety. There's probably some indication if you're, like, a medic in an active combat zone.
I am stopping to look this up, actually.
Okay, all the guidelines I have read confirm what I thought: field amputation is a very rare procedure reserved for situations where amputation is required to extract the patient safely. Because cutting off someone's limb in the field is an insane thing to be doing.
Let's...let's keep going. Keep in mind that as I have just explained, the patient whose hand has been amputated is not trapped! He's being dragged around on a board!
Let's hear Shaun's explanation of why he had to amputate the hand:
1. The radial pulse was thready.
2. The capillary refill in the hand was delayed.
3. His breathing became labored.
4. His hand was irreversibly damaged from lack of blood flow.
5. His hand was leaking toxins that would stop his heart.
YOU PUT A TOURNIQUET ON HIS HAND.
Like, there's other things very wrong here, but first off: the hand is not getting blood flow because you put a tourniquet on it to STOP THE BLOOD FLOW. Because his radial artery was injured and he was bleeding to death.
Let's set aside the breathing, because this guy was thrown from a vehicle at 70 mph, he almost certainly has other injuries, there's plenty of reasons for him to have labored breathing. His radial pulse is thready? What radial pulse, the artery is torn and also, tourniquet. His capillary refill (i.e. whether his hand blanches and then turns pink again if you push on it?) Gone, because, again, tourniquet. His hand was irreversibly damaged?
It's been like, minutes. You have no idea if his hand is irreversibly damaged. That is not something you can determine on the side of the road in the dark in the rain. And even if it is, you don't need to cut off his hand now! It can be cut off in the hospital at a later date!
Which brings us to the fucking toxins.
Okay, this is the part where I was like, who wrote this and why did no one stop you. I don't know what the fuck they are talking about. If they're talking about reperfusion injury (when you restore blood flow to dead tissue, all the stuff that is released from the dying tissue floods back into the body, which is bad) then that makes no sense, because the hand isn't reperfusing. You literally just told us it was NOT perfusing, which it shouldn't be, because, again, AGAIN, tourniquet. Yes, having any part of your body die is bad, but this ischemia is ischemia you just induced a couple minutes ago by putting on the tourniquet.
Park reasonably points out an ambulance is almost there, but Shaun says that they don't carry amputation kits so he still needs to cut off the hand. Again, no, he does not need to do that. The hand can be cut off if needed in the OR later on. Doing this wildly unsterile procedure in the field is fully crazy.
Wait, it gets crazier!
Park interrupts Shaun's retelling to point out that he suggested it might be because of a vasospasm, so they should wait until the ambulance arrives to administer calcium channel blockers!
What?
I don't...he has a tourniquet on that arm. And even if the patient has ulnar vasospasm (because, again, the radial artery was bleeding out) and that's somehow a greater contribution to the ischemia in the hand than the tourniquet, who is administering calcium channel blockers? Which would lower the blood pressure? In the field? To an ejected trauma patient who has labored breathing and is unconscious?
You want to give the guy who has a high likelihood of internal injury and therefore really needs to maintain his blood pressure a medication...that will lower the blood pressure...
That's insane. That's fully insane. No one would do that.
Incidentally, shout out to this other doctor for saying "Are you sure?" from several feet away and doing nothing else to prevent this unnecessary field amputation of a man's hand. Awesome work. Really doing no harm there.
Okay, so finally this part of the episode is over but the madness does not stop. We cut to Shaun holding the SEVERED HAND of the guy he mutilated, which he is testing the lactate levels of to see if he was right or not.
- Where the fuck is he getting this severed hand? You can't just walk into a hospital path lab or whatever and grab a severed limb to play with?
- Who is going to run this lactate test? You can't just draw the blood, someone has to take it to the machine, process it, and result it.
- That hand is severed. Setting aside that it certainly would need to be preserved chemically and likely doesn't have viable blood for this test anymore...it's been detached from this guy's body for a period of time. The tissues have been oxygen deprived and will have died. The lactate level, if you could obtain it, WOULD NOT BE INDICATIVE of the state the hand was in at the time of amputation.
Who wrote this episode? And why were they not stopped?
The thing is, I've thought about it, and they could have had this guy's arm trapped under the car and had Shaun cut it off before the ambulance arrived and the episode would still work, and it would be a much better debate to be having instead of making everyone involved look like an idiot for not knowing what a tourniquet does.
And yes, I refer to him as Shaun because I don't respect him enough to call him doctor.
no subject
Date: 2025-07-29 03:28 pm (UTC)