Episode 4: No Man's Land

Oh, dear God. Let’s start with the name of this episode. I once saw a pornographic videocassette with this exact name. I vaguely remember horrible, long, fake fingernails and a lack of hair where hair is meant to be. In other words, this episode and I started out on the wrong, uh, foot.

Plot points:

Izzie struggles to help a patient who is getting a prostatectomy. He doesn’t want her in the room for the surgery because of her recent stint as a “Bethany Whisper” underwear model. Despite this, Izzie eventually saves the day after the urologist, “Limp Harry,” initially refuses to do a nerve sparing procedure because it would take “almost an hour longer” and he might miss his tee time. To right this injustice, Izzie storms the OR, demands that the nerves be spared, and chides the urologist for not planning to do so in the first place. This would be both heroic and compelling if only there were some medical truth to it (see “Lessons Learned” below).

(HAS ANYBODY ELSE NOTICED THAT THIS IS THE SECOND PENIS-THEMED EPISODE DEPSITE THE FACT THAT THIS IS ONLY EPISODE 4? Disturbing.)

Grey is subjected to more sexual harassment from Dr. McDreamy yet the episode ends with a date between Grey and McDreamy.

Spare me.


Sandra Oh! (Dr. Cristina Yang) spends the episode kowtowing to a former nurse with pancreatic cancer in hopes of being asked to scrub in the Whipple she may need. However, the joke’s on Oh!: there are no plans to take the nurse to surgery because she has come to the hospital to die. Unfortunately, no one tells Sandra Oh! this fact, and she insists on attempting to resuscitate the soon-dead former nurse even though the woman is DNR.

Meredith’s mother doesn’t know Meredith or her father in pictures but does remember her former, now dead, scrub nurse fondly.

George suffers all episode as his roommates walk around in their underwear and send him out to buy tampons. This all seems unlikely to me, probably because most roommates I’ve had don’t even share their milk.

Lessons Learned

OK, this is going to be nerdy, but I can’t resist: I don’t doubt that somewhere, some surgeons take the easy way out to get out an hour earlier (even when it does the patient a disservice), but the writers picked on the wrong procedure to illustrate this point. The obsession with doing a “nerve-sparing” prostatectomy to keep the patient potent misses the main problem with prostatectomies: most of the people who get them, regardless of whether the nerves are spared, end up both impotent and incontinent, and this is very unfortunate given that many men with prostate cancer will never die of prostate cancer because the disease isn’t always that serious. Therefore, many men who get prostatectomies probably don't need them. A very smart colleague of mine wrote an editorial in JAMA last month, on the question: How do we improve outcomes among men with prostate cancer? And his conclusion was, basically: Do fewer prostatectomies and outcomes will be better. I don’t know the fictional patient’s Gleason score, but it’s possible that “Limp Harry’s” greatest crime was not initially refusing to spare the nerves but rather the fact that he did the surgery at all.

Don’t resuscitate someone who is DNR. You’d think, what with all the movies and shows overusing this point to illustrate doctors’ insensitivity to patients wishes and/or these same doctors' general inability to admit defeat, that this would be something that never happens in real life. In fact, I have witnessed people doing just this on several occasions. One time, when I was code leader as a resident, I threw an attending out of the room for refusing to stop CPR on his patient after I repeatedly told him that the patient was DNR/DNI. I hate to see it on screen, because I think it makes doctors look bad, but I also get why it actually happens: it’s hard to watch someone’s heart stop right in front of you (maybe somebody you care about and have known for years) and do nothing.

Um. Sexual harass a girl you like and she will go out with you? Horrendous, but it seems like that’s what happened with Grey and McDreamy. How could she resist the handsome, relentless attending? The power dynamic is disturbing. Again, it’s not that this doesn’t happen. I’ve seen it happen a lot. (Although it’s generally messier than this case-the attending is usually married with between 1 and 4 children. He is nearly always a man and the resident is usually a blond woman who is a minimum of 15 years younger than he is. Often, the affair is protracted and painfully public-the two end up getting caught making out in a car in the hospital parking garage in the middle of the day, for example) Maybe because of all this ridiculousness, I’m not a huge fan of watching this sort of relationship develop on TV. This plot line was one of the reasons I didn't want to watch this show to begin with.

Best Lines

Dr. Isobel "Izzie" Stevens: We're women! We have vaginas! Get used to it!” and also, as she rips off her shirt, “Breasts! How does anyone practice medicine with these things around?”

(I can’t help thinking to myself, “What is this, a Take Back the Night March?”)

Liz: What you got waiting for you at home? Boyfriend?
Cristina: Nope.
Liz: A girlfriend?
Cristina: Nope.
Liz: A pet? Family?
Cristina: A bed.

(Yeah, unfortunately, I totally get this.)