I need to know what’s real and what’s not real.
Don’t we all.

“Book him, lads!”
“Death is an increasing problem,” reflects the voice over at the start of Extremis.
The first five episodes of the season had largely been about establishing the new cast dynamic. The Pilot, Smile and Thin Ice were an old school present-future-past triptych to start the year in introduce Bill. Knock Knock focused on Bill’s life outside the TARDIS. Oxygen marked the first episode to properly incorporate Nardole into the adventure. This was largely work setting up a dynamic that would carry across the season. However, the table has now been set.

It ain’t Oval ’til it’s Oval.
It makes sense that the season should turn its attention to the prospect of death at this point in the year. This will be the final season of Doctor Who to star Peter Capaldi. It will also be the last season produced by Steven Moffat. Extremis is the sixth episode of the twelve-episode season. It marks a point of transition for this final year, particularly positioned as the first episode in a mid-season pseudo-three-parter.
Death permeates Extremis, in a manner both literal and metaphorical. It is an episode in which the Doctor effectively commits suicide, along with many of the planet’s best and brightest, accepting his own uselessness in the context of the world around him. This primary plot is juxtaposed with a framing sequence in which the Doctor bears witness to the execution of Missy, a sequence that goes into great detail about just how difficult it must be to kill a Time Lord.

The light at the end.
Extremis is a very grim episode, in a manner that recalls Heaven Sent. Both are episodes built around the big twist that the audience is watching an iteration of the Doctor, rather than the definitive version of the Doctor himself. It is possible to contextualise this within the broader framework of the Moffat era, populated as it is by doppelgangers and counterpart Doctors; the ganger!Doctor from The Rebel Flesh and The Almost People, the Teselecta from The Wedding of River Song, even Clara at the end of Hell Bent.
However, the iterations of the Doctor in Heaven Sent and Extremis exist to ask their own particular question. These are episodes built around the challenge of what the Doctor does when he is confronted with a problem that he cannot solve, a trap that he cannot escape. In Heaven Sent, no single iteration of the Doctor can escape the clockwork prison. In Extremis, this iteration of the Doctor is actively helping the enemy. Neither is the “definitive” Doctor. What does the Doctor do when confronted with the idea that he is not “real”? He fights anyway.

He hasn’t a prayer.
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