I always thought it was when Sera had gotten on his knees ("dogeza" specifically) and begged Tokai for his help, was when Tokai first thought that Sera was different from the other doctors.
he stopped when Sera yelled how much would it cost to save Minagawa, and Tokai's interest was piqued slightly I'm sure when Sera said he would pay any amount, but when he began talking about the patient and how much he cared about her and began begging to save her (unlike other doctors, Sera said to save the patient, not to help him "clean up the mess") I think Tokai was a bit surprised by that.
I'm not entirely sure if anyone can see the small difference in his eyes (I don't know how to gif things sorry) but in this scene his eyes twitch and widen for a split second. I wouldn't say its a "big shock" moment for him, but more like "this is different" This is a first for him, for someone to wholeheartedly put down his dignity for a patient and ask for Tokai's help so vulnerably and honestly.
Half his face is covered by the surgical mask but as he walks towards Sera who is continually begging "please", I don't know how to say it but its like he felt slightly stirred. Something about Sera's willingness to strip away his pride and "self respect" for Tokai's help to save Minagawa had touched the surface of the built up hatred for the doctors who just wanted him to save their face — Sera's devout selflessness was something new for him. There's no sense of amazement about it, but a feeling that Sera's behaviour is out of place, that what he's doing is not something that is usually seen here. It's almost something profound.
when he stops in front of Sera, he pauses and looks at him for just a moment and I think it's the last bit of himself being convinced about Sera's pleading for his help, for him. Everything about this is genuine and artless fear for someone else's life. There is a person who is unashamedly putting someone else above himself when Tokai is so used to everyone being selfish and only needing him to fix their mistakes so they wouldn't be humiliated.
But I believe the moment when Tokai really realises that Sera is completely different from everyone else was during episode 2. This scene has a lot behind it, deeply connected to Sera being humiliated in the first part of the episode and later Takashina comforting him when he sees him mentally struggling and telling Sera he wouldn't let him run away, and the scene's depth reaches into the moment when Tokai had told Sera to quit being a surgeon if he was so afraid of holding someone's life in his hands.
When Takashina chooses to follow Saeki's orders and puts that above the patient, there's this understanding in Tokai that he knows another person will most probably die because of another doctor's lack of independence and their self worth being more important. No matter which doctor coming where from, they're all the same.
But Sera confronts Takashina. He ignores Saeki's orders to an extent where he could be fired immediately to get Takashina to help because the patient needs him. Sera instinctively puts the patient's life above Saeki's demands and the risk of being told to leave the department because he wants the patient to live. Takashina in this scene says, "I will accept whatever happens here." but for Sera that is not his right, he cannot decide that. The patient came here because they wanted to live. It is them who is on the surgery table, for Sera he believes it is the doctor's obligation to help them. Sera tells Takashina, "The patient is fighting without running away, so we have to save him."
Sera then directly yells at Takashina that he's avoiding the responsibility, his duty as a doctor. Takashina is running away when he had told Sera not to. And I don't think many doctors, much less even new interns, confront their superiors like this. In Tojo Hospital there's supposed to be some mutual consensus, some agreement amongst everyone that Saeki's words are above all and that the patient is second and that pride and image is everything. Sera opposes that and he's telling it as it is to Takashina, and I believe this is when Tokai now understands that Sera is different.
For the first time in a long time, Tokai sees someone with a heart come to this god forsaken hospital that completely relies on the words of one man and puts reputation over actual lives and he outright challanges this cycle of extreme respect that reaches the point of complete obedience and self righteousness that reaches the point of selfishness.
It is seen in that moment that Sera genuinely wants to help people, not to build a name for himself or because it was an order given by someone or to fulfill some kind of dream for himself. It is a worry and a concern, raw human instinct to help someone he sees is in trouble. So many doctors in Tojo lose this because their abilities become their focus point either they only work so hard to reach the standard of Saeki's skills or it becomes a matter of pride because they can save lives so easily so they are "higher human beings".
For Sera, he's just another person who is reaching out wanting to help someone else who is suffering and Tokai realises this in that moment and comes to understand that there is something in him that isn't in this hospital.
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