Episode 11: Enough is Enough

I get the feeling this episode was written by a free-lance writer, the sort of person who doesn't really know the characters but can write "filler" episodes when needed. The opening scene is the best scene in the television-hour (the televion hour is 42 minutes; 8 minutes shorter than a therapy session and hundreds of dollars cheaper) and features Meredith and Cristina wallowing in pity. Meredith is drunk and lying on the bathroom floor. Cristina is sitting in an empty bathtub, fully clothed. As Meredith slowly sinks into oblivion, her head in the toilet, the narrator announces the theme of this episode: that even when given the option to “say when,” to declare that enough is enough, most of us don’t because we mistakenly think that more is always better. 

It's not that the theme is untrue (why, Ex frequently said to me as I was piling our dinner plates with food or overpacking a suitcase for a weekend trip, "Remember that more is just more."). My issue is that the theme doesn't make total sense with the majority of story lines in this episode. Not that I care.

                              "Judy" dolls.

The one "patient" in the episode who embodies the theme is a man who ate a stomach full of Barbie heads (well, they were called “Judy doll heads” because Barbie is trademarked, but we all know what they meant).

Grey: "Why 10 doll heads?"

Man: "Because 11 would have been too many."

I’ve seen several patients like this during my career, people who suffer from a disorder called pica. (Not to be confused with Pica’s restaurant outside of Philadelphia. It looks to be as good as its name.) Pica can be caused by iron deficiency, but can also be due to psychiatric problems. People with the psychiatric type of pica will eat just about anything: entire 12 packs of AA batteries, fistfuls of ibuprofen, small glass figurines, lumps of coal, car keys, and yes, even doll heads; the result of these ingestions is abdominal pain and bowel obstructions that lead to emergency room visits, hospital admissions, frequent radiographic imaging, and medical procedures like endoscopies and surgeries to remove these items. The bottom line is that people with this sort of pica can be infuriating, in the worst cases requiring long-term psychiatric hospitalization because they pose such a danger to themselves. I remember momentarily leaving the bedside of a woman with pica only to find she had swallowed the latex gloves I’d accidentally left on her table. I looked down, realized my mistake, and calmly turned to the intern and said, “Will you please call GI to let them know that we need to revise our earlier consult request to now read ‘patient has ingested 4 batteries, a fistful of ibuprofen, a Hummel figurine, and two latex gloves?’”

(The scary, and funny, thing is that there is a unique brand of pica, described in the New England Journal as “Tomatophagia,” that I actually suffer from. Don’t believe me? Check out this excerpt from an entry I wrote on a previous blog:

“It started in late July. I was walking through Whole Foods, minding my own business, looking to purchase a bottle of $30 truffle oil, $10 marinara sauce, or maybe fifty dollars of prepared food. That's when I saw them. They were beautiful, round, luscious, soft, colorful heirloom tomatoes. I picked one up touched it to my cheek, smelled it, and then put it back (hoping no one would see that I had just exposed it to so much bacterial flora). I knew I shouldn't buy one. They were $5.99 a pound.

"But," I thought, "What's a few dollars in the grand scheme of things?" So I gently set one in my basket, and then bought it (at the checkout, the cashier held it up and said, "You know that this is a seven dollar tomato, right?" After I nodded, she mumbled, under her breath, "Mm-mm. crazy.").

Unfortunately, it took only one taste of that magical fruit to create an addiction I could not keep a handle on. It ruled me. In no time, I was eating 14 dollars worth of tomatoes a day. And that's when I knew that I must admit it: I am a tomatoholic. I admit that I powerless over heirloom tomatoes.”

Geez. In addition to my other chronic conditions, I now have tomatophagia. Well, to be clear, I’m not iron deficient, so maybe I don’t actually meet criteria.)

But back to Greys. After the doll heads are removed (surgically, of course) Grey confronts the pica patient:

Grey: “How do you feel?”
Pica: “Empty.”

Grey: “Yeah, I’ve been feeling a little bit of that myself lately."

Of course, Grey’s emptiness is not caused by a lack of doll heads in her GI tract: she’s empty because she spent the previous night puking her guts out and also because she and McDreamy broke up when she discovered he was married. I hope we get back to that plot line because this episode was WAY less interesting without it.

The rest of the plot centers on an alcoholic wife beater on the liver transplant list who caused an accident because of his road rage. Somehow, the alcoholic’s only hope for survival is that his son agrees to donate a piece of his liver to his abusive father.

Alex (Frat Boy), after his first season as a one-dimensional character (and that dimension would be “douchebag:” e.g., he was “patient zero” in the hospital-wide syphilis outbreak, he plastered the hospital with posters of Izzie’s underwear model stint, and he said those mean things to the now-dead lady with the 60-pound tumor), is getting a second season makeover. Unfortunately, these writers have inadvertently turned him into the sensitive naked man, the sort of person who, in the last episode, spent hours at the bedside of the bartender with the “standstill operation,” and this episode is the only physician to identify a Barbie head on an Xray. Later, he convinces a battered women into being honest about her situation and connects with the son of the alcoholic wifebeater. This turnaround is not believable (people don’t change this much this quickly) and because my brain can’t make sense of it, I repeatedly looked at him on the screen and said, out loud: “You’re a great guy and all that but I’m still feeling really creeped out by the fact that you’re naked.”

George revives the “Weekend at Bernies” theme when he decides that a woman who is supposed to be an organ donor is actually alive because she is exhibiting a behavior known as “decerebrate posturing.” True, she’s not technically brain dead but she’s damn close, and McDreamy’s claim that “she’s still got a good shot at recovery” is both misleading and disturbing. Recovery in a patient this far gone has only very, very rarely been described in the medical literature.

Last points:

The code at the beginning of this episode may rank as the worst CPR ever seen on television. And that includes the fifteen or so “precordial thumps” in the first season of Lost. Good job, George. Again, I wonder what happened to the show's medical consultant (p.s. you also described asystole as “pulseless Vtach” and then shocked an asystolic patient.)

 

                              worst CPR in the history of television.

The poor CPR effort would seemingly go against the very lesson Bailey was trying to teach you, George: 

Q: “Why do we hump on every dead person that comes through the door?”

A: “So we can tell their families that we did everything we could possibly do.” 

Cristina’s best line: “The worst part is not that he broke up with me. It’s how he broke up with me. And what’s worse than that is that I care.”

On my end, I'm one day from leaving for "fitness camp" my spa-exercise vacation. Wish me luck, as I will definitely need it. I'm excited to blog about my time there, although I fear my arms will be so sore I won't be able to hold them up to type.