This is it. Dr. Shaun Murphy’s first interaction with an autistic patient. I knew it was coming — It’s an obvious and necessary direction for Shaun’s story to take. Even in the bizarre, distorted world of a prime time medical drama, Shaun can’t reasonably be the only autistic person on Earth.
There was exciting news: Liam, Shaun’s autistic patient, would be played by an actually autistic actor: Coby Bird. Bird is 15, talented, and has previously appeared on the ABC comedy Speechless. I hope to see him in future episodes of The Good Doctor. It would be wonderful if Shaun could act as a mentor or role model of sorts, rather than Liam merely being a patient-of-the-week.
That said, I was terrified that this episode would advocate for what Julia Bascom has called, “the IQ test for human rights.” Some toxic corners of our community believe autistic people perceived as “low functioning” are less deserving of respect and freedom. Dr. Shaun Murphy mostly speaks in ways that are easily understood by the people around him. He does not have an intellectual disability. He lives independently. He has a medical degree. He has a job in a competitive and high achievement field. Liam, his young patient, does not. I was concerned that a terrible line would be drawn: That Shaun deserves human rights because he is “high functioning” but that Liam does not.
Thankfully, the writers did not go down that path. Instead, they provided surprisingly incisive criticism of the biomedical autism supplement industry. The episode also highlighted the importance of the dignity of risk. Without risk and potential failure, it isn’t possible for anyone, autistic or not, to learn.
Shockingly, the worst part of 22 Steps was the B plot. This week, Dr. Kalu has an older patient with heart problems and chronic pain. The man does not want further surgical treatment for his heart problems and would prefer to die. The writers’ intention was clearly to be “heartwarming,” but in reality, Dr. Kalu basically straight up murdered his patient. Heart-wrenching, swelling orchestral music does not make Dr. Kalu’s actions acceptable. I am tired of medical dramas insisting that a doctor murdering a patient is an uplifting act of mercy. It’s not.
‘He’s not psychotic. He’s autistic.’
The episode opens with Dr. Murphy admiring an expensive, high definition television in the window of a store. He mentioned that he’d like a nice television in the pilot episode of The Good Doctor. The continuity and consistency is pleasing.
At the hospital, Dr. Browne is trying and failing to access the hospital records system. Dr. Glassman passes by and asks how she is doing. She expresses frustration with the computer working, but Dr. Glassman presses further. He wants to know how she is coping with the aftermath of accidentally causing a patient’s death. “I’m fine,” she tells him. “I think it is safe to say the one thing you are not is ‘fine’,” Dr. Glassman retorts. He orders her to see a grief councilor who specializes in helping hospital staff who have experienced trauma. “If she says you are fine, then, and only then, can you go back to surgery.”
In the emergency room, Dr. Melendez and his team are introduced to our B-plot patient-of-the-week. He is an older man experiencing heart problems. Dr. Browne looks at his medical notes before Dr. Murphy roughly pulls them away to take a look for himself. He should have asked Dr. Browne is she was done with the notes. Once again, that’s not autism. That’s Dr. Murphy being a bit on an ass. “He’s dying,” Dr. Murphy declares after examining the notes. “Well, he’s not dead yet,” Dr. Melendez responds. I recognize the writers probably thought they were just making a funny Monty Python reference, but given how this man’s story ends, it actually comes off as a darkly ironic. Not Dead Yet is the name of a major, disability-oriented anti-assisted suicide organization.
Dr. Murphy is sent to run to a lab. on his way, he passes the intake to the emergency room. A young man (Coby Bird), is panicking. “Hold him down, I don’t want to get stuck with a needle!” one man shouts, while another prepares restraints. As an autistic person who has been hospitalized for psychiatric reasons, this scene is hard to watch. “You’re scaring him,” Dr. Murphy tells the staff, as he tries to intervene. “You’re scaring him! He’s not psychotic. He’s autistic.” As soon as the staff stop touching the young man, he begins to calms down. A brief digression: You shouldn’t treat anyone that way, psychotic or autistic. Deescalation is a necessary skill for medical staff.
‘You’re good with people who have autism.’
Dr. Murphy helps stitch up a wound on Liam’s head. “You’re being an excellent patient,” he tells Liam. Two hospital staff members are holding Liam’s hands down. “You’re same as me,” Liam tells Dr. Murphy. Liam’s parents arrive. “Wrong stop! Wrong stop… Got lost. Got lost,” Liam tells them. “You’re our son’s doctor?” Liam’s parents remark, incredulously. Dr. Murphy informs them that they can’t take their son home yet. Liam is jaundiced, has a fever, and appears to be in significant pain.
Elsewhere, Dr. Browne is filling out a questionnaire for her upcoming therapy session. Dr. Murphy interrupts and asks her to assist with a procedure. “I need your help,” he tells her. “Why?” she asks incredulously. He’s done the procedure before, and it isn’t complicated. “You’re good with people who have autism,” Dr. Murphy tells her.
It’s clear that Shaun does not feel comfortable around Liam, which is heartbreaking. What follows is even more heartbreaking. During the procedure, Dr. Browne asks if Dr. Murphy has spent much time around other autistic people. “I’ve never met another person with autism,” Dr. Murphy confesses. It’s a little shocking. 1 in 68 people is autistic. It is amazing to me that he’s never met anyone else like himself. It is amazing to me that he has never met anyone who he even suspected might be like him. It is indescribably sad. Dr. Murphy is fully capable of using the internet. He’s never been to Wrong Planet? He’s never sought out people like him, who have shared struggles and experiences? “It must be nice to spend some time around Liam, then,” Dr. Browne continues. Dr. Murphy scoffs. “Why? Why would that be nice?” My heart breaks even more for him.
The test results show that there are no gallstones. Unexpectedly, Liam seems to have extensive scarring.
‘There are 22 steps from the ambulance to the ER.’
Dr. Melendez, Dr. Browne, and Dr. Murphy consider their next steps. Scarring could be a sign of any number of dangerous diseases for Liam, including more than a few cancers. Dr. Melendez suggests an MRI. Dr. Murphy immediately dismisses the possibility, as Liam “stims” too much to sit still for an MRI. They are worried he will stop breathing if they give him something to sedate him. Suddenly, Dr. Murphy has an epiphany and rushes off. “Guess he has an idea,” Dr. Melendez remarks.
When we next see Dr. Murphy, he is pacing in a hospital room. “Shaun, what are you doing?” Dr. Glassman asks. “Counting,” Dr. Murphy replies, as if the answer is completely obvious. “I want $1643.” He wants to buy a television. “I am a surgeon. I get paychecks,” he insists. “You’re not a surgeon yet, you’re a surgical resident. And there’s a huge difference in the paychecks their, pal,” Dr. Glassman tells Dr. Murphy condescendingly. “I’m not a child, pal,” Shaun retorts.
Dr. Murphy goes to perform the MRI on Liam. To help calm Liam down during the MRI, Dr. Murphy talks to Liam about one of Liam’s major interests: counting distances and numbers of fixtures. “There are 24 steps from the ambulance to the ER.” “There are 22 steps from the ambulance to the ER,” Liam corrects him. “He has very long strides,” Dr. Murphy remarks. “There are 37 steps from the elevator to room 405.” “There are 37 steps from the elevator to room 405,” Liam echoes. “In room 405, there are 6 steps to the sink.” “6 steps to the sink.” Liam appears much calmer than he did a few minutes ago. It’s beautiful. Dr. Murphy works hard to meet Liam where he is and make him feel comfortable, even if his method doesn’t make obvious sense to other people.
Liam begins to tense. His mother grabs the microphone away from Dr. Murphy. Dr. Murphy is no longer able to comfort Liam, as a result. “You’re doing wonderfully, honey, just breathe,” she tells him. It is extremely obvious that she’s not being helpful. Dr. Murphy takes the microphone back. “No, it’s seven steps to the door…” Liam has a meltdown. He begins to scream, and accidentally hits his head against the MRI machine.
‘You’re like me.’
Later, Dr. Murphy is watching television. “I can see the pixelation,” he complains. “Great,” Dr. Browne says. “It’s not great. On a high-quality display, the human eye at 20/20 cannot detect the pixels.” Dr. Browne changes the topic to confront Dr. Murphy: “You disappeared, after the MRI.” “I failed,” Dr. Murphy admits. It goes deeper than that, though. Liam reminds Dr. Murphy of his own disability. Of his own weaknesses. “Doctors don’t have to like their patients, Claire.” “You don’t like him?” Dr. Browne responds incredulously. “I don’t know him,” Dr. Murphy replies. Dr. Browne points out that Dr. Murphy and Liam share a diagnosis. “Do you like all people with psoriasis?” Dr. Murphy retorts. “You [have psoriasis] and you can never get rid of it.” The implication is that Dr. Murphy wants to get rid of his autism. feel so sorry for him.
Dr. Murphy and Dr. Browne go to prepare Liam for his surgery. Liam does not want to have surgery. He begins to panic about having gotten off the bus. “Can’t do bus. Can’t do food,” he shouts. “I took the bus,” Dr. Murphy responds, quietly. “I got off at the wrong stop. I got scared, but then I found my way. I did an MRI and a man got hurt. I made a mistake. I make a lot of mistakes.” Liam becomes visibly calmer. “You tried to walk. You made a mistake. But mistakes are good. You should make more. You’re like me.” Dr. Murphy admits that he struggles with the same things Liam struggles with.
In the hall, Dr. Melendez discusses Liam’s surgical options with his parents. Of course, because Liam’s parents are The Worst, they take Dr. Murphy’s earlier confession as a declaration of incompetence. They refuse to allow Dr. Murphy to participate in the surgery.
Dr. Melendez goes to Dr. Glassman. “Who cares, what difference does it make?” Dr. Glassman snaps. “If you agree with them then the only problem is that they’re stepping on your poor little toes. If you don’t agree… Then tell them that. Tell them to go screw themselves.” Dr. Glassman forces Dr. Melendez to acknowledge Dr. Murphy’s competence.
‘You love Liam. I didn’t have that from my parents.’
Dr. Melendez informs Liam’s parents that Dr. Murphy is competent and has his complete competence. They still won’t budge. “I want. He said I could do it. I want Dr. Shaun,” Liam tells them. Shockingly, Liam’s parents listen to him.
During surgery, Dr. Melendez trusts Dr. Murphy to hold the scalpel for the first time. It is a meaningful moment for Shaun — It reminds him of the toy scalpel his brother got for him as a child. The surgery is successful.
After the surgery, Dr. Murphy and Dr. Melendez go to speak with Liam’s parents. Despite knowing better, Liam’s mother hugs Dr. Murphy. Dr. Murphy is, predictably, incredibly uncomfortable. To be honest, I feel like most neurotypical people would also feel uncomfortable about being hugged by a stranger.
Dr. Murphy informs Liam’s parents that although they were doing what they thought was right, the two feet of bowel he and the other surgeons had to remove was the direct result of a supplement they were giving Liam to “treat” his autism. It’s a brief scene.
Elsewhere, Dr. Kalu and Dr. Browne discuss the patients whose lives they ended. Dr. Browne’s was an accident. Dr. Kalu’s was not. Based on the swelling, sensitive sound editing, I assume viewers are supposed to find these actions morally equivalent. They’re not.
Dr. Murphy informs Liam that he will be able to go home in two weeks. Liam’s father is suddenly concerned by the lights. Except this time, he stops to ask Liam if Liam actually needs them dimmed. This is the first time in the entire episode either parent has asked Liam what he might want. “They’re OK,” Liam responds. The episode ends.
- As always, all the Dr. Murphy sass forever.
- “I’m not a child, pal.” YES. Assert your autonomy, Shaun!
- “Is that a thumb?” Dude, it’s an emoji.
- “There are 47 residents here. All of them show up late. All of them make mistakes. And hopefully. All of them learn… You fought to hire him because you know he can learn. The question is, are you willing to let him?” I have never loved Jessica more than I do right now.
- Is Dr. Glassman controlling Shaun’s finances? That’s bizarre. Dr. Glassman is not Shaun’s parent or legal guardian.
- Liam’s parents’ response to Shaun is pretty unrealistic. Usually, when faced with an autistic person successfully doing something unexpected, autism parents will deny that the autistic person is truly autistic at all. “Not like my child.”
- California has legal assisted suicide. Also, palliative care exists. There are zero legitimate reasons for Dr. Kalu to give a patient a massive dose of morphine instead of referring that patient to palliative care. He not only murdered his patient, but he circumvented available legal pathways for no apparent reason. This isn’t heartwarming. It is horrifying. The entire B-plot was horrifying.
- “Oh my god. You’re an ass. Your point is you didn’t suffer because you were good looking and smart. You suffered because you were rich.” A patient-of-the-week says about Dr. Kalu what we’ve all been thinking. The quote itself is great. Dr. Kalu is what’s not working. He needs more flaws.
- Why didn’t the doctors get a list of all of the supplements Liam is on when his parents came to the hospital? There’s clearly a lot of them — References are made throughout the episode.
Neurotypical Bullshit (NTBS)-O-Meter
- “You won’t be taking that bus again.” I think Liam’s mother is trying to be comforting, but at this point I just want to scream at her through the television. Covering Liam in bubble wrap so he never make mistakes or has bad experiences is setting him up to fail.
- While heartbreaking, I find Shaun’s confession to have never met another autistic person entirely believable. Being autistic and successful is incredibly isolating, because most people do not believe it is actually possible to be both. For his entire life, Shaun has been taught to look at himself as exceptional, as transcending his disability. To some extent, he seems to hate being autistic. He hates that part of himself. He has fully internalized the toxicity of the neurotypical world around him. I hope the writers help him grow and meet other autistic people. San Jose is a big city. According to Google, there’s at least four meetup groups for autistic adults.
- “It’s amazing how accomplished you are for someone with ASD.” Also literally everything else Liam’s parents say and do during the episode.
- Liam’s mom hugs Shaun. Even though she knows Shaun doesn’t like it. Even though she knows her son doesn’t like hugs either. She does it anyway. And she makes it Shaun’s problem for being autistic, not her own problem for failing to respect clear boundaries.
- The writers went way to easy on Liam’s parents. OK. Great. They love Liam. It literally caused two feet of his bowel to die. The fact that they never let him do anything even slightly risky, that they never allow him to pick himself up to try again when he fails, is even worse for him than whatever supplements they were giving him. But the overall message is, “love is enough.” Sometimes, it’s not. Love does not make everything parents do to their autistic children acceptable.
So what did you think? Good, bad, or just indifferent? Weigh in on the comments below.