JACK WAS NOT A DOCTOR

Jack was not a medical doctor. He was never a great spinal surgeon. He never saved Sarah. It was all a lie or illusion.

Jack's back story is that of an incredibly talented surgeon. In 2001, Sarah's spine was severely crushed, and Jack told her she would never walk again. This bluntness bothered Christian. Sarah's fiance responded superficially upon hearing her condition, and Jack overstepped his professional relationship with Sarah, promising "to fix" her. He initially believed he failed, but a stadium runner named Desmond  suggested he may not have. Jack tearfully informed Sarah of his failure. She then wiggled her toes, and Jack realized he'd fixed her. The problem is that medical science would not have allowed such a miracle to happen. One cannot reconnect severed nerves.

In July of 2004, a nurse observed Jack's  intoxicated father botch a surgery. She called in Jack, who failed to save the patient. Christian asked he sign a falsified death report absolving him of blame, and though Jack initially refused, he later agreed. He then saw his father console the deceased woman's husband, who was threatening legal action, and learned the woman was pregnant when she died. Jack revised his statement, blaming his father's drinking for the patients' death. This cost Christian his medical license. In reality, Jack's conduct also would have cost him his medical license due to unprofessional conduct and malpractice under strict California regulations.

So Jack's back story is highly suspect. However, he could have "believed" that this happened to him because of the inner, subconscious desire to be "better" than his father, so Christian would acknowledge him. But if Jack as a boy was driven to prove himself to his father, but failed because he lacked the talent or will, then one could assume that would lead Jack down a dark path, emotionally and psychologically.  It could have led him into depression, drugs and alcoholism.

On the island, "miracle doctor" Jack had a horrible track record. Jack could not save the Marshall, Boone, Shannon or Sayid.  He refused to help an injured Colleen, which violates his oath as a physician. Beyond basic first aid, Jack really did not perform any highly skilled medical miracles on the island.

But it was his conduct with Ben's medical problem that is a real issue. Jack's review of Ben's spinal x-ray was wrong. The tumor was diagnosed on the wrong lumbar number. He later incorrectly stated that Ben's symptoms would be in his fingers and toes. Such symptoms are generally characteristic of cervical tumors - in the neck, not lower back (which would be toes only). Then when Jack now agreed to operate on Ben,  he deliberately cut Ben's kidney sack during the surgery, which based on the state of the OR and lack of personnel and blood, would have killed Ben, especially after he woke up during the surgery!

So what about the two different "versions" of Jack? The pre-island miracle doctor vs. the ordinary man on the island.

It could be argued that the pre-island version of Jack was Jack's own ego. A dream, fantasy, a mental condition of greatness because Jack could not equal his father's accomplishments. This puts Jack as a candidate for the theories that the LOST premise was all made up in the mind of a mental patient, or at least someone trapped in their own deep fantasy world.

It would stand to reason then that the pre-island back stories could also not be true. They could be the fantasies of the characters - - - such as Kate murdering her abusive father. She never did it; but she thought about it. The same would be true for Sawyer. He never became a con man to track down his parents killer.

But that still opens the question of whether the island was "real" or part of an imaginary, collective community dream (or massive on-line game, the latter being characteristic for all the "loners" in the series). Assuming that Jack landed on the island under his own cover of being a doctor, it is odd that no one challenged him when he made medical mistakes. Was everyone else naive, scared or plain dumb? Or, again in a game setting, it really did not matter. You chose your own character.

The idea that Jack was not really a doctor is intriguing because it opens up other avenues of investigation into the unanswered mysteries. If one part of the LOST experience was not "real" in the sense of actual events (such as Jack's back story), that may help explain the massive continuity errors in island events. It could also give us a clue to the basic premise of the show.