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No Man Is An Island
By Nancy Kiu, Director of Medical Research
This is another story we've been excited to tell, and it ties up stories we've been setting up since the beginning of the season, from Sheldon's health scare first introduced in 601, to patient Nick in episode 602, and missing girl Sarah Nelson in episode 604.
First things first – Sheldon did turn out to be right about Nick. But at what cost did that come at? A therapist's job is a tricky one - they must enable their patients to feel like they are in a safe environment, one that's devoid of judgment so that the patient will feel free to open up about any issues, even if it's one that the therapist personally finds repugnant, such as in Sheldon's case with Nick. Because, as Sheldon pointed out to James in episode 604, just because his patient has this affliction, doesn't mean that the care Nick gets should be less than any other patient's.
But Sheldon played a very dangerous game, one where he had everything to lose. Therapists are bound by both law as well as moral and ethical professional standards to keep a patient's participation in therapy confidential. Laws vary state by state, but there are few exceptions to the confidentiality rule; a therapist can break confidentiality only if they believe that the patient is a danger to themselves or others. Sheldon had a hunch that Nick kidnapped Sarah. And while it was one that ultimately proved to be right, a hunch is still not proof, nor was it enough reason for Sheldon to have broken his doctor/patient confidentiality.
But faced with the helplessness in his own personal life, and frustration over being unable to help a little girl whose life hangs in the balance, Sheldon takes action. A 5150 allows qualified professionals, such as a therapist, to place an involuntary psychiatric hold on a person they think is a danger to themselves or to others. Sheldon concocts a plan to "break" Nick; gone is empathetic Sheldon, and present is a Sheldon up against borrowed time. He arranges to have Nick see Sarah's parents Ron and Dana as they arrive for their session with Violet; he badgers Nick during their session and accuses Nick of making up his girlfriend; and, knowing that Nick would walk out, Sheldon places the involuntary psych hold on Nick ahead of time and lies to the cops so that they would search Nick's house. Sheldon's plan was premeditated, and he walks across all legal and ethical lines to save Sarah. He ultimately does save her, but did the ends justify the means? What if Sheldon was wrong? Is it ever ok to use a patient's confidential information against them, in order to save an innocent life? Or do you always have to be a doctor on behalf of your patient, even if you believe your patient is guilty of a crime that they haven't admitted yet?
Sheldon feels like he's a man on borrowed time here, and that reason alone is why he has nothing to lose in doing everything he can to save Sarah Nelson. Now we finally know what the result of the biopsy test he did back in episode 603 was – Sheldon has prostate cancer. While prostate cancer is common – a man will have a 1 in 6 chance of being diagnosed with prostate cancer in his lifetime - most men die with prostate cancer and not from it. But, cancer is cancer, and it's pretty darn scary, even knowing the odds. And deciding on treatment options is even scarier – do you go for the more invasive surgery option and get a radical prostatectomy, with potential surgical issues as a result? Or do you opt for "active surveillance" – i.e., watching and waiting to see if the tumor grows, and then deciding a course of action? Or do you take the middle ground and go with radiation therapy, which would mean radiation treatments 5 days a week for 8 weeks straight?
Radiation treatment is a funny thing – it becomes part of your routine for two months, but nothing about it is routine. You check in to your radiation appointment, and you change into a gown that allows access to the area that is being targeted for treatment. You wait in a waiting room with other patients, also in gowns, and you become familiar with them, united in a common journey in the fight against cancer, but you are not friends with them. You get called up for your treatment, and you enter a giant room where the walls are made of lead and concrete because the x-ray levels are so high, and the door leading into the room is a foot thick lead shielding door. You lie flat on a table and allow a giant machine with multiple lasers to circle you and target the treatment area. A mold is made of that particular body area to help ensure you do not move when you are on the table, and as you are being treated, you are, as Charlotte aptly points out, "staying in one spot, contemplating everything bad that can happen in one continuous loop."
Nothing about this is routine, and it can be isolating going through this alone, as Sheldon has chosen to do. He's afraid; he's seen what this disease did to his father, and he doesn't want it happening to him. He's lost his ex-wife (again) thanks to the cancer; he can't talk to his shrink; he's afraid to open up to any of his colleagues about what he's going through because to do so would mean this is real. And he's afraid to accept Miranda's lunch offer because everything is overwhelming and frightening and out of his hands right now, and all he can do is lie on a table and be helpless. That is, until Miranda doesn't show up to treatment one day, and Sheldon realizes what his worst fear really is – that she could be dead, and he was so afraid to say yes to her, so afraid to live his life, and so afraid that he'd lose her, that now he has lost her. Faced with this wake up call, Sheldon's propelled into action; he's a man now with cancer and he has nothing to lose. So, he takes a chance, breaks the rules, and saves Sarah Nelson. And in the sober light of day, when he returns back to treatment, he finds Miranda very much alive, and he intends to no longer live his life in fear. Because while Miranda and Sheldon and everyone one of us will have to die someday, that day is not today.
For more information about cancer, treatment, or how you can join in the fight against cancer, please visit the American Cancer Society Website at: http://www.cancer.org/ or The National Cancer Institute at the National Institutes of Health at: http://www.cancer.gov/
Special thanks in this episode goes out to Hollywood, Health & Society at the USC Annenberg School for Communication and Journalism, whose mission is to help provide "entertainment industry professionals with accurate and timely information with health storylines." They have proved an invaluable resource to Private Practice over the years in connecting us with health professionals. For more information on HHS, please visit their website at: http://hollywoodhealthandsociety.org/