Dr. Shaun Murphy, portrayed in the acclaimed medical drama The Good Doctor, is renowned for his exceptional diagnostic skills and unique approach to medicine. While we are accustomed to seeing Dr. Murphy in the role of a brilliant resident saving lives at St. Bonaventure Hospital, episode 2×18, titled “Trampoline,” flips the script, placing Shaun himself in the vulnerable position of a patient. This episode offers a compelling case study, not just in medical terms, but also in character development, revealing Shaun’s complex reactions under physical duress. Let’s delve into the medical intricacies of Shaun’s case in “Trampoline,” examining his injuries, symptoms, and the journey to his diagnosis and recovery.
Alt text: Shaun Murphy looking distressed in a hospital gown, highlighting his role as a patient in The Good Doctor episode “Trampoline”.
The episode begins with Shaun reeling from his recent firing by Dr. Han. Instead of pursuing job opportunities, Shaun finds himself at a bar, attempting to cope with his emotional distress through alcohol. It’s here that he encounters Zack Cordell. An altercation ensues, and Shaun becomes a victim of blunt force trauma when Zack punches and kicks him in the ribcage. Ironically, Zack himself collapses shortly after, leading to both men being transported to St. Bonaventure – Shaun’s former workplace – as patients.
Zack’s initial presentation in the ER is more overtly critical. He presents with loss of consciousness, a laceration indicating a closed head injury, and a concerningly low Glasgow Coma Scale score of 9. Medical professionals immediately suspect a brain contusion and possible epidural haematoma.
Shaun, in stark contrast, initially downplays his own condition. He denies pain and conceals the assault, claiming he found Zack in his collapsed state. However, subtle clues begin to emerge. While Zack undergoes initial assessments, Shaun’s behavior raises suspicion, particularly when he contradicts his initial story by mentioning Zack’s gait suggesting intoxication. This prompts Claire Browne to consider other underlying issues and order further neurological tests for Zack, including an EEG and a CT angiogram.
Alt text: Dr. Claire Browne questioning Shaun Murphy about the incident, hinting at the developing medical mystery around Shaun’s concealed injuries.
Despite outwardly stating he is fine, Shaun’s internal state is rapidly deteriorating. A pivotal moment occurs when Shaun examines his injuries in the bathroom. He discovers a significant haematoma on his right ribcage and, alarmingly, coughs up blood. Recognizing the severity of his symptoms, Shaun takes matters into his own hands, drawing his own blood and enlisting Carly Lever to analyze it under the guise of it being for Claire’s patient.
Carly, astute and observant, sees through Shaun’s deception but proceeds with the analysis. Shaun’s lab results reveal elevated white blood cell count (WBC) and prothrombin time (PT), coupled with slightly low haemoglobin. These values strongly indicate internal bleeding and impaired blood clotting. Carly’s differential diagnosis includes pneumonia and Disseminated Intravascular Coagulation (DIC), but Shaun, with his characteristic directness, identifies trauma as the root cause. Carly then suggests coagulopathy and urgently prescribes phytonadione to improve blood clotting, emphasizing the medication’s immediate importance.
Alt text: Carly Lever presenting Shaun Murphy with his blood test results, illustrating the moment his internal injuries start to become medically evident.
Ignoring Carly’s advice and prescription, Shaun prioritizes Zack’s deteriorating condition. He finds Zack being treated for rhabdomyolysis. Despite his own worsening state – now visibly sweating and unwell – Shaun engages Zack, even disclosing his personal and professional turmoil. While at Zack’s bedside, Shaun’s exceptional medical mind pieces together the puzzle and realizes Zack is misdiagnosed. He deduces Zack is suffering from a Treponema infection, requiring immediate and different treatment. However, before Shaun can effectively communicate this critical insight, he collapses, succumbing to his own injuries.
Shaun is swiftly admitted as a patient, diagnosed with a left haemothorax and a grade 2 splenic laceration resulting from a rib fracture. The blunt force trauma from Zack’s assault had indeed fractured a rib, which subsequently pierced his spleen, causing blood to accumulate in his pleural cavity. A chest tube is inserted to drain the pooled blood, and Shaun is intubated and placed on a ventilator to support his fragile respiratory status. Claire, realizing the truth of the assault, understands the cause of Shaun’s critical condition.
Alt text: Shaun Murphy being treated in a hospital bed, showcasing the medical interventions required due to his splenic laceration and haemothorax.
Fortunately, Shaun demonstrates a strong recovery. By the time Dr. Andrews visits, Shaun’s oxygen saturation is a healthy 97%, and urine output is robust, indicating good kidney function. The episode concludes with Shaun’s discharge and return home, physically recovered.
Meanwhile, Zack’s condition is correctly diagnosed as a ruptured aortic arch aneurysm caused by tertiary syphilis (Treponema pallidum infection). The aneurysm is surgically repaired, and Zack stabilizes, highlighting Shaun’s crucial, albeit belatedly delivered, diagnosis.
Medical Accuracy and the Portrayal of Pain:
The episode, while dramatic, takes some liberties with the realistic portrayal of pain. As noted in the original article, a broken rib, particularly one causing a splenic laceration and haemothorax, would induce significant pain. Shaun’s stoicism to the point of near-complete denial seems somewhat exaggerated for dramatic effect. However, this can also be interpreted as a manifestation of Shaun’s character, known for his focus on logic and sometimes diminished awareness of his own physical sensations in moments of stress or hyper-focus.
Alt text: Zack Cordell punching Shaun Murphy in the bar, illustrating the moment of blunt force trauma that led to Shaun’s injuries.
Despite the potential exaggeration of pain tolerance, the episode provides a medically engaging scenario. It accurately depicts the diagnostic process, the significance of lab results, and the critical interventions for conditions like haemothorax and splenic laceration. “Trampoline” effectively uses Shaun Murphy’s experience as a patient to showcase his resilience, diagnostic brilliance even when injured, and the complex interplay between his personal and professional life. It reinforces the audience’s understanding of Shaun Murphy not just as a doctor, but as a multifaceted individual capable of both extraordinary medical insight and human vulnerability.
