Episode 7: The Self-Destruct Button

Number of times I fell asleep while watching this episode: 4. Now, this could be just that my life has been really crazy and I have been super-tired, but it might also be that this show is honestly terrible. After falling asleep the third time, I woke with a start (when the credits started to roll) and said to myself, “Why couldn’t I have chosen a GOOD show to blog about? I could have watched retro episodes of The West Wing or ER, the show that was on while I was in training (yes, I am old. I admit it.). In other words, I’m experiencing the kind of regret that Lawrence Dai must have felt after watching Julie and Julia for the 17^th time. Julie, like Meredith Grey, is really really whiny, the kind of person that, in time, one starts to hate.

This snoozer of an episode opens with an alarm going off, indicating that it’s 5:20. We find Meredith and McDreamy struggling to get out of bed after a very late night (of course, 5:20 is very late for a surgical intern. 4:20 or 3:20 would be more realistic; Ask Dr. McAwesome, who told me today that she rode her bike to work at 3:30 AM during a surgical rotation). Despite the unbelievably late hour, The Grey-McDreamys’ lack of interest in sleep may be somewhat realistic. As I have said before, residency affects a person in odd ways. Suddenly, an exhausted intern has thoughts like, “I haven’t slept in 30 hours, but I feel fine. I should drive two hours to the beach to hang out with my friends for 12 hours before I have to be at work again.” (It seemed like a good idea at the time.)

Key points of this episode:

1. Grey is taking care of a thin college girl who got a gastric bypass in Mexico to please her even thinner mother; Frat Boy tends to a young guy with a GSW who chooses to get shot repeatedly for the purpose of body art; and Cristina Yang can't stop puking from a "flu." None of these story lines are all that interesting: it's not news that rich, too-thin white people try to force their kids to be the same and their kids try to comply in any way possible; I don't believe anybody gets shot on purpose, and this is the second episode with this "flu," so it's starting to seem fishy, but we're given little information until the end. More interesting is that George, who is taking care of a young child who needs a hemispherectomy, intervenes when he believes the anesthesiologist has been drinking. He’s right, but he gets thrown out of the OR, anyway (by McDreamy). Only later, when the anesthesiologist falls asleep during surgery, does McDreamy realize he’s made a mistake in criticizing George rather than investigating the problem. In real life, if you’re a surgeon and anyone accuses your anesthesiologist of improper behavior, I’d recommend you believe the accuser until proven otherwise. Sorry, anesthesiologists-I don’t trust anybody with a pocket full of fentanyl. 

 

 2. In line with all the other quality problems at Seattle Grace, Bailey asks Izzie to do a bronchoscopy by herself despite the fact that she has never even attempted one under the supervision of the attending. Apparently, this is the way things are in the Seattle Grace “see one, do one, teach one” residency program. SODOTO is an old-fashioned ethic that no longer exists, except in the case of some minor procedures with very limited likelihood of complications. Where I work, our residents practice procedures on mannequins for months before attempting anything on a real person. They are always supervised, keep a record the numbers of procedures they do, and don’t do any procedures alone until they are “signed off” by an attending (i.e., they’ve done a sufficient number of procedures successfully). There were many reasons SODOTO ended (including diminishing tolerance by hospitals and the public for poor quality care), but one of the first reasons this started to change was because of lawsuits brought by former residents, like this one in 1998:

“A jury has ordered the University to pay $12.2 million to a former who contracted HIV from a needle prick ten years ago. The plaintiff, identified only as "Dr. Jane Doe," said that her superiors had failed to train her properly.

Dr. Doe had been a resident for seven weeks when her supervisor asked her to insert a catheter into an AIDS patient's artery in August 1988. When blood spewed from the catheter after she removed the needle, Doe put her thumb over the opening to stop the bleeding, sticking herself with the nearby needle in the process. Her attorneys argued that she had not been told how to minimize the risk of the procedure, which she had performed only once before. Hospital attorneys maintained that Doe had received excellent training and should have taken better precautions. They also said that the hospital, not the University, was responsible for her training.

"Hopefully this will send a message loud and clear that you have to train people," said Doe after the jury announced its award.

My personal worst case of SODOTO occurred while I was trying to put in an IV as a third year medical student during my second rotation. After I saw a nurse put in an IV once, I was expected to “do one” without supervision on the next patient who came in. Unfortunately, I didn’t take off the tourniquet at the right time and the patient bled all over the floor. I called for help, but no one came to help me, so I started swearing (loudly, every word in the book and right in front of the patient) while I attempted to stop the bleeding. The patient complained about my “unprofessional behavior” and I got a “talking to” from the resident. For the rest of the rotation, all of the residents and attendings thought I was some kind of a**hole. The main lesson I took from this, besides that SODOTO is a ridiculous way to teach anything, is that some days, being a medical student is WAY worse than being an actual doctor.

3. Burke's outcomes continue to be abysmal. Does he have any patients that live?

Best lines:

Grey to Bailey:

“She’s febrile” (pronounced to rhyme with tendril rather than feb-rile)

McDreamy to drunk anesthesiologist:

“Get out of here and get it together.”

(My thought: This is how we deal with impaired physicians? This hospital is in the dark ages)

Grey to gastric bypass girl:

“Life is not supposed to be this hard.”

(My thought: but it often is.)

“Why do I keep hitting myself with a hammer? Because it feels so good when I stop.”

(I’m keenly aware that this is sort of the way I live).

Closing thoughts? The picture below is supposed to be but is not pus. It looks like whipped cream. I have been sprayed with pus (testicular abscess opened by urologist with me assisting in the ED, total yikes) and it was not nearly this pleasant:

Oh! Big revelation: Cristina Yang's flu? She's pregnant. This might actually be getting interesting….