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S04.E21: Castles Made of Sand


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When an elder care facility shuts down, New Amsterdam is forced to intake many new patients. Max struggles with his decision to head back to London. Reynolds takes his personal frustrations out on his department with near disastrous results.

Original air date: May 17 2022

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That episode was an incoherent mess.  Reynolds should not be a doctor.  It isn't "ageist" to deny surgery to an elderly patient when the risks of the surgery outweigh the benefit one might get.  There's a reason he nearly lost all his patients, but the show rewarded his reckless behavior anyways.

And congrats Iggy for turning yourself into the victim of Martin.  All I can say is I hope he is much better off without you.

On a lighter note, the Sheffield's really screwed over Niles in the end for him to end up at New Amsterdam, didn't they?   

 

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Another boring episode. The STD outbreak among old people wasn’t even funny. Just a dumb stunt that fell flat. 

I actually thought Iggy was getting it together until he had the audacity to tell Martin the problem was HIS fault. Yeah Iggy. Martin is definitely the one who emotionally cheated and hired someone he had a crush on. He’s been such a good husband to you. Hopefully next week we find out Martin filed for divorce.

Why can’t this show just let Max and Helen get married without drama? Oh no gotta have a hurricane first! But hey, a Luna mention! Remember her?

”More joy”. Such a flop. 

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(edited)

Yeah, the obstacles for Max and Helen…..it’s beyond bizarre and not enjoyable at all.   I now believe the London storyline was contrived just to strain the relationship and add more hardship.  Since their relationship started, Helen is so miserable.  Last night she seemed in deep depression after realizing she didn’t want the big wedding.  Was that her mom who was telling her the history of her ancestors?  

Edited by SunnyBeBe
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38 minutes ago, SunnyBeBe said:

Yeah, the obstacles for Max and Helen…..it’s beyond bizarre and not enjoyable at all.   I now believe the London storyline was contrived just to strain the relationship and add more hardship.  Since their relationship started, Helen is so miserable.  Last night she seemed in deep depression after realizing she didn’t want the big wedding.  Was that her mom who was telling her the history of her ancestors?  

I get that TV shows need drama, but happy couples can be nice to watch if written correctly. I’ve seen it in other shows. Max and Helen were madly in love at the end of S3, and as soon as S4 was out of the gate the writers were determined to ruin it. I wonder if Freema and Ryan secretly roll their eyes about it as much as we do on these boards. Just let them have a wedding and be happy together before the series ends. 

And yeah it was her mom. I think they were trying to go for mom lashing out against the big bad wedding industry but it was so dumb. 

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So the London story line is over, right? I can at least be happy about that. Although, if all it took was Max telling Helen to come home, it seems like we could have done that a few episodes ago. Otherwise, not the most exciting episode.

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Does Iggy ever have scheduled patients? In every episode it seems like he is spending hours counseling a random person who walks in the hospital. I’m glad Bloom talked to the seniors about sex but it still seemed like they were making a joke about it. Seniors are adults not children and can have sex if they want to. I thought Helen was going to break up with Max but instead we get egotistical Iggy breaking up with Martin ( or least trying to blame him for everything ).

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WTF is wrong with Helen’s mom? What a piece of work. I get the part about where the money for the castles came from in the first place, but was that really the time or place to say that? And referring to Max and Luna as “that man and his daughter”, like they don’t even have names, in a scathing tone of voice was vicious. So her sudden about-face later, telling Helen she deserves everything and should get married in the castle if she wants to (what any good or even halfway decent mother would have said in the first place) was not even remotely believable. We saw absolutely nothing to bring that about that change of heart.

And then Helen saying she doesn’t want to get married in the castle, she’s not sure she wants any of it… it sounded like she was saying she didn’t even want to get married, and all I could think was I’m tired of getting whiplash from Sharpwin being on-again/off-again ad nauseam. The show should fire the writers because we internet commenters have shown ourselves more capable of coming up with storylines that make some damn sense, and we’re not even scriptwriters.

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9 hours ago, Cloud9Shopper said:

I get that TV shows need drama, but happy couples can be nice to watch if written correctly. I’ve seen it in other shows. Max and Helen were madly in love at the end of S3, and as soon as S4 was out of the gate the writers were determined to ruin it. I wonder if Freema and Ryan secretly roll their eyes about it as much as we do on these boards. Just let them have a wedding and be happy together before the series ends. 

And yeah it was her mom. I think they were trying to go for mom lashing out against the big bad wedding industry but it was so dumb. 

Her mom has to be the most miserable character I’ve seen in a while…..she’s constantly upset about something, complaining, nasty, ……omg.  After all that raining on the parade, she says, but go ahead!  Omg……knowing how she is, WHY would Helen want to live near her?

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(edited)
3 hours ago, LittleIggy said:

The elderly pianist was the only person who roused any sympathy in me. Helen knew her mother was a miserable, angry person before she moved back so why did Helen do it to start with?

Something something more joy. 🤣(Whoever came up with that tagline should single-handedly be blamed for the show’s cancelation.)

Edited by Cloud9Shopper
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Aren't there people who specialize in looking for drug interactions and other problems when a patient has many medications prescribed by many doctors? Is this a subspecialty of pharmacy?

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25 minutes ago, Driad said:

Aren't there people who specialize in looking for drug interactions and other problems when a patient has many medications prescribed by many doctors? Is this a subspecialty of pharmacy?

I hope so, but two different doctors put my dad on two different blood pressure meds, for different reasons, and he was taking both for about a week until we figured it out after his BP dropped through the floor one day when testing at home.  They could have killed him, and no one in the doctor/pharmacy/insurance chain noticed.  What's worse, is that when I called each doctor to ask why he was taking two blood pressure medications, and asked if it was dangerous and maybe he should stop one, they each told me to contact the other doctor instead of being alarmed that he might be taking too much and asking questions.  All I can say, is pay very close attention to your meds in case no one else is.

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1 hour ago, izabella said:

I hope so, but two different doctors put my dad on two different blood pressure meds, for different reasons, and he was taking both for about a week until we figured it out after his BP dropped through the floor one day when testing at home.  They could have killed him, and no one in the doctor/pharmacy/insurance chain noticed.  What's worse, is that when I called each doctor to ask why he was taking two blood pressure medications, and asked if it was dangerous and maybe he should stop one, they each told me to contact the other doctor instead of being alarmed that he might be taking too much and asking questions.  All I can say, is pay very close attention to your meds in case no one else is.

I’d be careful to get all prescriptions at the same pharmacy and consult with the pharmacist as well as checking online. There are websites where you can enter a list of drugs and find out what their likely interactions are.

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NOW IT IS TIME FOR...WORST DOCTOR OF THE WEEK

wait uh last time did Fuentes resign or did I just imagine that to make the plot go away?

shooting from the hip: Max will be the worst doctor

well let's see

oh right bloom's ex moved in with her for immigration fraud

bloom you are rich why don't you have two bathrooms in your palatial apartment

floyd you earn a decent amount of money, why not just hire a PI instead of walking around NYC?

oh yay iggy and husband managed to repair their relationship so Iggy is no longer The Worst (at least for now)

wait so if there is no medical director people can just be foisted upon a hospital? well that must be fun

Also, in our universe, pretty much all of the hospitals on Roosevelt Island shut down in the mid 1900s. It looks like a chronic care facility still exists, though - it is Coler Specialty Hospital.

also all of Sharpe's problems with her mom being fixed in an afternoon is something

WHY ARE THEY TRYING TO TREAT THESE ELDERLY PEOPLE WHO WERE RESIDENTS OF A CHRONIC CARE FACILITY

uh floyd sometimes patients cannot tolerate surgeries - you cannot just "make it happen"

WHY IS AWSOME DEAF DOCTOR THERE, SHE IS JUST AN ONC SURGEON

uh did they overbook the surgeries - HOW

wait why did they just cut open pancreatic tumor lady without doing DUE DILIGENCE first

um Bloom you need to give everyone gonorrhea shots, not just the person it originated from. STDs aren't vampires

also you shouldn't be ashamed of asking a patient about their sexual history

floyd you did this to yourself

um Sharpe's mom, from everything the show has shown so far, you guys came from Africa, so your ancestors probably weren't as exploited through slavery - colonialism, sure, but yeaaah

also Max's old guy... why are his hands still swelling when he is still on prednisone and some arthritis meds? DId they even try mtx on him?

is Iggy actually going to help Elder Nurse? I will be shocked if Iggy does it ethically and in a way that sounds sane

oh ok he told the guy to quit his job

wait did Bloom just say "Everyone's got VD"

is VD even really used anymore? It's STD/STI used nowadays?

FLOYD ARE YOU HAVING RESIDENTS OPERATE ON PEOPLE? that sounds like it'd be illegal

wait sharpe did you just find a veil there lying around and are trying it on?

WHY DID THEY TRY INJECTABLE STEROIDS BEFORE? OR SUBCUTANEOUS RA MEDS????

wait that exam room has a food pyramid chart? hasn't it been the plate method for years now?

who the hell in the writers room keeps putting venereal disease in the script

um.. iggy? there IS a nursing shortage

oh no, sharpe's mom is making sharpe have doubts

max's old guy is dead

BLOOM HOW DID YOU FIGURE OUT HE HAD A BRAIN ANEURYSM? ARE YOUR EYES AN MRI?

bloom doing sex ed for old people is quite the scene

um Bloom I am pretty sure making that joke about your ex girlfriend and subordinate is sexual harassment

Floyd, deaf doctor is not in your department - isn't she head of oncology?

um iggy if wearing a sweater makes you do that you need to talk to your therapist about that because you have even more issues

IGGY DO NOT BREAK UP YOUR MARRIAGE YOU MONSTER. HOW DO YOU SAY "It's not me, it's you" AFTER, what, LIKE 10 YEARS OF BEING TOGETHER? YOU WERE FINE BEFORE YOU HAD AN EMOTIONAL AFFAIR

time for bloom and ex to get back together because Bloom harassed her?

yup

sharpe are you breaking up with max

Max it has been much longer than the 3-5 hours you said at the start of the episode, you already missed that flight

wait max are you telling her to quit her job for you, well isn't THAT controlling? WHY DIDN'T THEY JUST USE THE SHARPE STROKE TO END LONDON INSTEAD OF THIS??

so this season is going to end with a wedding, The Good Doctor ended its season with a wedding, maybe The Resident will end its season with a surprise wedding (Haven't watched it yet, probably gonna watch it this weekend, so no spoilers)?

This episode was ridiculous, what the hell did I just watch

Okay, so who is the worst doctor? It's obvious - Reynolds. he almost killed every patient in his ORs.

However, who is the worst person in the episode? It's Iggy, because the writers are screwing our boy Martin - he is nothing but great to Iggy, but the writers don't want happiness there. Monsters.

I wonder how much worse the final season is gonna be...

Well, next week I have to figure out worst doctor of the season... and I might do worst human being and worst plotline of the season...... but we'll see. You'll probably see that post 7 days from now.

oh yeah, forgot to put it in there, but Floyd said it was a pain for him to get the care his mother needs when he knows the system - when we saw her, she was having no issues getting around and she was fine (That was this show, right?). 

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(edited)
8 hours ago, Driad said:

Aren't there people who specialize in looking for drug interactions and other problems when a patient has many medications prescribed by many doctors? Is this a subspecialty of pharmacy?

Some pharmacists do care enough to warn the patients and some doctors do care enough about the people they treat but there are so many cases of doctors just prescribing meds to move on to the next patient and avoid patients asking too many questions or "complaining" too much. There are also doctors who prescribe medications that require close monitoring of blood levels but they don't even ask for regular tests (personal experience). I do all my research all the time about al the meds and interactions. For elderly people it gets difficult because many don't have family or an advocate. That's the reality of our dysfunctional system of for-profit nursing homes

Lauren, you don't leave the water running when you brush your teeth, FFS!

Iggy continues to be the worst. 

 

Edited by circumvent
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Holy shit.  Iggy.  I don't think I'm going to be able to pick my jaw up off the floor.  He is always the absolute worst, but this is a whole new level.

Floyd is an idiot.  Why would he overschedule like that?  The patients had been waiting months, they didn't all have to have surgery at the same time.  He could have prioritized and spread it out over a couple of days.

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32 minutes ago, yourmomiseasy said:

Floyd is an idiot.  Why would he overschedule like that? 

The patients should sue the hospital because that's unacceptable. The whole story was ridiculous and I really thought he was having a bad dream at some point. Besides, he had plenty of time to go after his father so he could have be doing surgery on that time, if things were so clogged. No reason for that story at all, other than annoy viewers with pointless plots that are not even a plot.

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(edited)

I agree that the comment Bloom made about her girlfriend in the ED to the seniors was not right. It came out of no where and wasn’t really funny.  It was very inappropriate and I can’t imagine a professional saying that about a colleague in a setting like that.  These writers are crazy!  I guess they really dislike the character.  
 

Iggy thought that quitting his own job was the answer once before too.  Recall, he stopped treating patients, after he suffered a trauma.    They ruined his marriage for no real reason.  Then they keep screwing with Max and Helen.  They think destroying good relationships is amusing to the viewers?  Yet, they keep plugging away with Bloom and her girlfriend in their dysfunctional setup.  Bloom is a messed up person, imo. She can’t help herself.  When her girlfriend approached her to embrace….it was disturbing.  Very unhealthy dynamics.  

Edited by SunnyBeBe
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7 minutes ago, SunnyBeBe said:

Iggy thought that quitting his own job was the answer once before too.  Recall, he stop treating patients, after he suffered a trauma.    They ruined his marriage for no real reason.  Then they keep screwing with Max and Helen.  They think destroying good relationships is amusing to the viewers?  Yet, they keep plugging away with Bloom and her girlfriend in their dysfunctional setup.

Not to mention the interminable triangle with Floyd and his baby momma and her husband.

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Nothing about this episode made any sense.   

If they are trying to tell me a story about Martin being toxic they need to show me Martin being toxic.  If they are trying to show me a story of Iggy blowing up his life because it is Tuesday well... they've told me that story before.  I'm done with it.

The nursing home closed so they sent all the patients to NA?  Huh?  Is it so New Amsterdam social workers could find placements for these people rather than their families/the defunct nursing home?  I guess that would make sense but just dropping a whole nursing home on the hospital ed was a bit of a head scratcher.  

Okay so some doctors are going to find certain surgeries riskier than others.   There is absolutely nothing wrong with Floyd saying, "hey, lets take a look at these particular patients and see if the reasons they were denied surgeries is a problem for us but like, you run the tests before you decide, and then you do one surgery and then aother you don't do all the surgeries at the exact same moment.  

Pharmacists will sometimes catch drug interactions and flag the prescription but not always.  Some doctors will catch drug interactions but not always and sometimes the drug interactions are so insignificant a portion of the population they know it is a risk but it is a risk worth taking so... good luck.   My grandmother had very sudden onset dementia and they assumed she had a stroke or some other brain injury but they didn't find anything.   They shrugged it off and sent her home but my grandfather was like, I mean it happened so quickly it doesn't make sense so when he got her home he started experimenting and within a week he found the culprit.   At no point during the hospital stay where they were checking for stroke/aneurism/TBI did they switch her meds around.   

 

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21 hours ago, Madding crowd said:

I’m glad Bloom talked to the seniors about sex but it still seemed like they were making a joke about it.

I think Bloom did a good job. She had to loosen up the audience. Even the crack about Leyla invited another person (not of the group) into this slightly embarrassing situation, and clearly, she knew Leyla could take it, because she did. Seeing Leyla's reaction made the group more comfortable and everyone was chuckling. As a matter of fact, I Bloom was the only doctor who impressed me in this episode. 

There's enough happening in this hospital that I really don't need to go home with these people.

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It’s unfortunate to say but after this season, I think the cancelation is definitely well deserved.
 

The only consistent thing about this show, outside of the solid acting(what a waste of a talented cast)is how terrible every single character’s storyline is. Because nothing else makes sense. Not timelines, not characterization/development, not conversations and definitely not the medicine. But that’s actually the most forgivable. 
 

Deciding to focus on personal relationships should have elevated the show and made things more expansive and interconnected but the way they’re going about it is genuinely making this season one of the worst I’ve seen in years. 
 

Everything is so dramatic yet it somehow feels like there are no stakes? I don’t get it. Life altering things happen just to happen and that’s it; the characters confusingly contradict themselves and are basically clean slates every week and it’s just getting hard to care since nothing actually sticks(Helen’s stoke was pure ridiculousness because what even was the point/Leyla’s entire storyline has been abysmal from the beginning and this manufactured codependent relationship with Lauren is bordering on offensive now/Helen’s mom is pretty much a stereotype which shouldn’t surprise me since cartoonishly villainous older female characters seems to be a theme/Martin’s not been given any depth outside of sainthood so the ‘it was him all along’ switcharoo isn’t even halfway believable)and no one actually grows from their conflicts.
 

TV obviously isn’t reality but it does have to have coherent structure as well as entertain and this show hilariously misses the mark every time. 

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18 hours ago, Driad said:

Aren't there people who specialize in looking for drug interactions and other problems when a patient has many medications prescribed by many doctors? Is this a subspecialty of pharmacy?

Usually multiple medications are given to seniors so ideally a gerontologist would be overseeing the prescriptions. Unfortunately gerontologists are not paid anywhere near sexier specialties like surgery get so not enough medical students go into the field.

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I take many of the medications Max’s old man patient takes and I get my meds from Walgreens which check for interaction. I’m 60 not 80 but I think most adults of all ages usually have a primary doctor and don’t go to separate doctors for things like blood pressure, hypothyroidism and high cholesterol. Primary doctors can prescribe for all of those things. 

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My parents are super fortunate with their pharmacy. It’s privately owned.  The owner/operator/pharmacist went to school with my mom!    He’s still working, vital and running a successful pharmacy. He has a great team of pharmacists and techs. Several of them were taught in elementary school by my mom!  They keep a careful eye on my parents meds and will call them, ask questions, confirm instructions, etc.  And offer to fill their prescriptions, if it comes after hours!  Even holidays!  They recently started the free home delivery.  
 

Im with Wallgreens, long story why, but I thought the system is programmed to alert if two meds that are contraindicated are put into a person’s pharmacy chart.  The same goes for a med you’re allergic to. It would kick it out and alert the pharmacist who’s trying to fill it, if you have it duly noted on your chart with the pharmacy.  

 

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So the largest public hospital in the country, with thousands of employees, has only four surgeons on staff at any time, and one of them is the head of oncology? Thankfully they perform non emergency surgeries without bothering with pesky pre-op testing or full patient histories because the department head misses the father he never knew because he’s gonna be a father soon even though two-thirds of his throuple skedaddled to Denver to get the hell away from him.

Oh look, they’re still letting a non-employee doctor treat patients and prescribe medication in hallways. That usually ends well.

There must be a law that requires all medical dramas have an episode about rampant STDs in nursing homes.  I never expected the view through the stirrups camera angles, so way to go director?  And everyone knows how cute it is when old people talk about S E X and is what every TV viewer craves.

Why exactly did Helen move to London again? Her mother isn’t getting any less nasty, we haven’t seen hide nor hair of the niece that was her rescue project and she doesn’t seem to have any friends.  It makes sense for her to take the next flight out of town to NY and get married the very next day because last minute airline tickets are always the cheapest, NY allows for same day weddings like it’s Reno, and Max’s impetuous decisions have literally always ended well.

Hey Iggy, Martin wouldn’t feel he needs to constantly be saving you if you weren’t so goddamn needy and always making stupid reckless decisions that put you in positions of having to be saved.  Don’t blame him when you fooled around with your hot assistant because you miss your days of single life when you’re the one who insisted on adopting all those kids in the first place.  We all know that you’re the world’s worst psychiatrist, but even a first year student would know where the fault lies.  You’re the worst.

I don’t thing everyone’s going to survive the very original season-ending disaster cliffhanger next week. Let’s give a Helen a break though and have her flight be cancelled.

Where’s Luna?

 

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The only thing wrong with this show is they don’t start you off emphasizing that the premise of New Amsterdam Hospital, NewYork City or London, as portrayed in the show, takes place in an alternate universe, or a space station or some other fantasy universe where ANY hospital operates with NO Medical Director/Administrator in place.  Even as an interim, until a permanent replacement is found.

If they just had some alien species represented, maybe one of the medical staff or at the very least an extra just scurrying by decked out in scrubs in the background, then I could completely suspend my disbelief and enjoy the show!

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I don't get Helen. Who suggested the big castle wedding wasn't it her? Now she's saying she doesn't want it. She seems so unhappy near her mother that Max's dictate return home didn't even bother me. The reason she wanted to be in London for her job seems to be long gone. 

 

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I got all excited when Helen said "Mina" was coming with her to the castle...then realized I was not in fact watching The Resident, and it was not the awesome Mina Okafor she was referring to, womp-womp.  I completely forgot about Helen's niece.

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Where's Luna

I'm telling you, they keep that kid in a locker at the airport!

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(edited)

My current pharmacy, which is by far the best one around here, has labels for all their medication bottles, which say: if you have questions about your medications, ask you doctor.

When I tried asking my previous pharmacy a question about a medication, they told me they don't answer questions, look it up. At the time, I had gone temporarily blind and could not read the label at all and I told them they needed to tell me what the instructions were on the label, or provide them in an accessible format, because I was blind and they said "we don't do that". I said: "you don't provide a reasonable accommodation for a blind patient to find out what the instructions are on her medication bottle if she can't read print?" and finally after I continued to talk about how I guessed I'd have to look into the liability issues that implied for them... they told me what the label said.

The doctor who had prescribed the medication had just told me they would write the script and call it in to the pharmacy where I could pick it up, and I did not think to make sure they told me what dose and how often and whether to take it with food or without or if there were any other instructions, because I was in incredble pain at the time and not at my most rigorous thinking, plus I assumed the pharmacy would tell me when we picked it up.

So I have no trouble at all believing a patient was put on multiple meds with no one monitoring their interactions, or that a patient was not listened to when trying to assert his priorities wrt something like his hands swelling. Doctors are in a hurry. They aren't interested in complexity.

I tend to be more assertive, educated, and good at research and self-advocacy than most people, but even I have a lot of trouble getting the professionals to do their damn job. I think a lot of people are struggling with this issue IRL.

--

Three nursing homes local to where I live are simultaneously being closed. The local news has been reporting on how there is literally no where to re-home the residents, and that they have all been given only 3 weeks to find new placements. The families have been saying they are worried their parents will be shipped to other states against their will, and then the families won't be able to continue to visit them. I have no idea what happens to the residents who don't even have families who are involved, but I'm sure it's worse as they'll have no advocates at all. So this story about a nursing home's population being dumped at an emergency room didn't seem far fetched to me. A company decides a facility is not profitable enough, they close it down. Good-bye and good luck! We have unhoused people of all ages in this country.

--

The story of the burned out nurse was so hard to watch. People like me depend on help, and it's true that most people refuse to take these jobs. Iggy's callousness to the people who the nurse cares for was not helpful. I get that it's impossible for the few who care to do it all, so he wasn't wrong about that. But the fact is, the degrading lack of care and the brutality of caregivers who hate the job, is not going to be solved by all the caring people quitting, either. They will just hire worse and worse people or let people go without care. The answer would be to start a campaign to improve pay and working conditions for the good workers, and also to change the public attitude towards people who need care. That is a Max style solution, though, not an Iggy type of thinking.

--

I'm with Helen's mom on the castle issue, but I didn't understand why Helen was so happy to be commanded to quit her job and take the first flight back to the USA. The writing for her has been execrable this season.

--

It's true that some people will treat their spouse like damaged goods and get off on feeling superior and pretending to rescue them. But I haven't seen Marvin do that with Iggy. I have seen Iggy blame everybody else for his own issues ever since Kapoor left. Sickening.

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