Episode 18: Thanks for the Memories

When watching is a show is a person’s part-time job, there are no more dreaded words than “special extended episode.” To make matters worse, this is episode 9 of season 2, and there are 27 episodes in this season alone. Yes, I’m only 1/3 of the way through season 2! But it’s one foot in front of the other with no thought about the destination, so let us trudge on:

In this special extended Thanksgiving episode, Izzie is making dinner, despite the fact that she’s “a baker, not a cook,” because:

Izzie: “We have this one day where we don’t have to cut anyone open. One day we get to be like everybody else. One day we get to be normal. One day where nobody lives and nobody dies on our watch. ”

The truth, however, is that in the hospital, Thanksgiving is a holiday, but only just barely-most residents work part of the day and a select few get to be on call for anywhere between 18 and 30 hours. As a medical student and resident, I was somehow on call five Thanksgivings in a row, and that was in a pre-work hours world where I came in Thanksgiving morning and stayed in the hospital until 5 PM on Black Friday. That was five Thanksgivings of cafeteria turkey and dressing drowning in a grey, jelly-ish goo the cafeteria employees swore was “gravy.” Five Thanksgivings trying not to be angry at the patients who ate too much salt at dinner and developed sudden congestive heart failure.  Five Thanksgivings trying not to be depressed that I couldn’t have a normal holiday like practically every other person in America. Five Thanksgivings away from friends and family. The problem, of course, wasn’t just that I was there. It was that, on those days, I resented my job. It’s no wonder my wife left me. And of all the unrealistic things presented on this show, this is that one that hurts a little bit, even now.

Still, we are left to believe that the surgeons miraculously all have the day off, out of the hospital, which disrupts the usual flow of the show.

Burke comes to Izzie’s Thanksgiving dinner as Cristina’s date. As usual, he has all the charisma of (and the appropriate outfit for) a Roman Catholic priest. 

In that outfit, I'd recommend staying more then 1000 feet from schools and playgrounds.

As they enter the dinner, Burke and Cristina have this exchange:

Cristina: Don’t mention Shepard. Or Addison Montgomery Shepard. And don’t mention anything having to do with syphilis.

Burke: You act like I’ve never been in a social situation before.

Cristina: Yeah, well, you haven’t been. Not with me.

Eventually, it's all too much for Cristina and she sneaks out of the dinner to go and see patients in the ER. Unlikely, but if I were dating Burke, I'd want to be at the hospital, too.

We meet George’s family for the first time, only to find that he doesn’t fit in with their manly culture. They take him hunting to shoot a turkey, and, through a series of mishaps, he first tries to get Cristina to pick him up from the hunting trip (“It’s like Deliverance out here,” He says. “Please come get me.”) and later watches in horror as his rowdy brothers accidentally shoot his father in the backside. Poor George stumbles into dinner, announcing, "Today I committed bird murder and I was forced to touch my dad's ass. I get bonus points for showing up at all." 

Poor George. Again, excellent choice of outfits.

Surprise, surprise, Meredith is on a whine fest, opening the episode with, “Gratitude. Appreciation. Giving thanks. No matter what words you use, it all means the same thing: happy. We’re supposed to be happy. Grateful. For friends. Family. Happy to just be alive. Whether we like it or not.”

She has volunteered to work on Thanksgiving because she thinks she “doesn’t have a whole hell of a lot to be thankful for.” (Jesus, Meredith, you’re a blond, beautiful, financially-stable, soon-to-be surgeon. It takes serious gall not to be thankful for any of that.) Because she’s at work, she gets wrapped up in an implausible, completely irritating plotline about a man in a persistent vegetative state who suddenly regains consciousness. In addition to dragging the audience through this ridiculousness, Meredith reels McDreamy into the drama. He decides to “administer amphetamine to wake the guy up.” (This is not evidence-based or sanctioned by anyone in the medical establishment so far as I can tell). Sure enough, they give the drug and the guy wakes up and starts talking! Moving! He’s been “in a coma” for 16 years! Not believable. Not possible. People can’t move after they’ve been in bed for a week.

This plotline was clearly based on the Terri Schiavo case, but unlike Terri Schiavo (who died in March 2005, six months before this episode aired), it inspires false hope among 1. families with neurologically devastated relatives and 2. right-to-life Republicans who would like to eternally keep all neurologically devastated people alive artificially (using public dollars, of course, while simultaneously cutting half of all Medicare spending). Even though the fictional patient dies by the end of the show, his miraculous wake-up is infuriating. In fact, these people almost NEVER “wake up.” I’ve been asked so many times during my career whether I’ve ever seen “someone in this state recover.” I always answer, “That would be a miracle, and although I’m not saying it’s not possible, I have never seen it during the course of my career.” Still, it happens on TV all the time, giving the public false hope.

Bailey is dealing with a “temp attending” who spends the entire day looking for a male resident nicknamed the “The Nazi.” It’s a nice little take on sexism in surgery, and Bailey, of course, gets the last laugh.

Attending: There’s only one resident I want in my OR. A guy they call the Nazi. You know him?

Bailey: The Nazi?

Attending: Great word of mouth. Stellar rep. Balls the size of Texas.

Bailey: Sounds like an impressive and talented man.

Attending: You know him or not?

Bailey: Never heard of him. (aside, to Grey) Like I said, the stupidity of the human race. Grey. Be thankful for that.

Alex finally admits he failed the boards, albeit only to Meredith. She then takes her turn to complain about her life: 

Meredith: "I feel like one of those people who are so freaking miserable that they can't be around normal people. Like I'll infect the happy people. Like I'm some miserable, diseased, dirty ex-mistress."

Alex: [whistles at Meredith] "A miserable, diseased, dirty ex-mistress? That's hot. I feel better already."

Much of the episode centers around whether McDreamy will continue flirting with Meredith or go back to his hot wife Addison, who at one point in this episode is seen on a ferry wearing a newsboy cap. I have decided not to care about this plotline (save Addison’s hotness) until the angst is over and the situation is decided. Do what you want, McDreamy. I no longer care.

Ferry boats and newsboy caps.

 Meredith returns from the hospital and her day with the vegetative patient and McDreamy to find her friends gathered at her house and the dinner finally prepared. Because she is anorexic, possibly alcoholic, and a whiner, she stands outside the house and looks in the window rather than entering and joining the dinner. It’s an awkward scene, leaving the viewer wondering, “Is she going to stand out there in the rain forever?” (For God’s sake, Meredith, it’s your house.) But no, she’s not, she’s going to a bar where she is going to get picked up by a hot guy who doesn’t work at the hospital. OK, call me stupid, but isn’t this how you ended up in this situation with McDreamy to begin with? Why are you out at a bar on Thanksgiving picking up what is probably ANOTHER married man when you could be at home with your friends eating more calories in one meal than you usually eat in a week?

It’s all too much for me to process. I leave you with her last voice over:

“At the end of the day, the fact that we have the courage to still be standing is reason enough to celebrate."

Yeah, OK, I’ll give you that.

Episode 17: Let It Be

Recently, I’ve had the problem understanding the concept of a “blog.” A blog indicates frequent posts, generally at least daily, yet I’m only posting once a week, I’m still pretty early in season 2, and it’s almost been three months. That’s one-fourth of a year. I know. This is rapidly spiraling into trouble.

In my defense, I was sick and I was busy. Even more than busy, I’ve been exhausted somewhere deep down. It’s been a long few months and it’s all catching up with me. But still, it’s no excuse. I said I would do this and I will. And I will shut up about it because, for the most part, whiners are no fun.

Speaking of whiners that are no fun, this episode opens with a very long Meredith whine. She is still kicking herself for falling for and subsequently being dumped by McDreamy (and even though this probably for the best given his all around douchiness, Meredith’s going to have complain about it for a least another twenty episodes, I’m sure) Her voice-over intro:

“When fate comes into play, choice sometimes goes out the window. At the ripe old age of 13 I was very clear that love, like life, is about making choices, and fate has nothing to do with it. Everyone thinks it's so romantic. Romeo and Juliet, true love, how sad. If Juliet was stupid enough to fall for the enemy, drink the bottle of the poison and go to sleep in a mausoleum, she deserved whatever she got!”

In other news, a woman with a “genetic mutation” (most likely BRCA 1 or 2) presents to Addison for a prophylactic mastectomy, hysterectomy, and oophorectomy. Although there’s a lot of painful back and forth (The discussion somehow involves the entire hospital. Inappropriate.), and the woman’s husband is very upset, there is evidence that prophylactic mastectomy may be an appropriate choice for certain very high-risk patients (reducing risk of breast cancer by 90%), so I don’t know why they’re giving this woman such a hard time about this decision. At one point Izzie advises her, “Take your chances, get cancer, and fight like hell to survive.” I’m not sure that’s sound medical advice if this woman is really this high risk, particularly when ovarian cancer is so likely to be deadly. Also, it’s the patient’s body, and this is what she wants, and it’s supported by evidence. Therefore, I don’t think the surgeons’ level of angst is realistic.

Cristina and Burke are going a date.

Cristina in shiny lavender dress: “I can do hot in my sleep. I look hot in scrubs. I’m a hot person.”

Their date is quite hilarious, in part because it reminds me of some of the more awkward Internet dates I’ve been on:

Cristina: "I’m having steak."

Burke (looking horrified): "You eat red meat?"

Cristina: "You don’t?"

First Dates: Really, can you think of anything more fun?

Of course, the irony is that these two have been sleeping together for some time, but have somehow never seen each other “outside of the hospital” and thus never had a conversation like normal people. They don’t have a relationship. They’ve been hooking up in a call room for months. This little revelation is creepy and awful for whoever uses the call room on the other days. I’ve seen my share of call rooms my day, and the only thing I can recommend is to try not to think about it.

After a few more awkward glances, the two socially-challenged surgeons are graced by fate: a Marfan’s patient happens to develop an aortic dissection in the middle of the restaurant where Burke and Cristina’s date is bombing so fabulously. They leap from their table, diagnose the patient (by determining that the joints are hyperextensible, observing the patient’s long arms, and noting that the palate that “meets the definition of high arched”) and rush the patient straight to the OR. Suddenly, all the awkwardness falls away and they are back in the hospital, doing surgery together with Nouvelle Vague’s remake of Modern English’s “I Melt with You” playing in the background. This is a great version of a song that is entirely about sex, indicating that for Cristina and Burke, cardiac surgery is sex.

Bailey and Meredith are caring for a patient who presents with cholecystitis but when attempting to remove her gall bladder, they find it is “porcelain.” This finding indicates “an increased risk of gall bladder cancer” but is not, in fact, diagnostic for it, as they claim in this episode. After closing the woman up, they go to the waiting room and announce to her husband that she has 4-6 months to live. Pretty good prognostication skills, Dr. Bailey, given that there’s no way to know it was actually cancer.

The episode ends with Meredith in an elevator with McDreamy. She whispers, “I miss you.” And then he walks up behind her, breathes in her ear for a minute, and then says something like “I can’t.” Oh, for God’s sake. Do it or get the hell off the elevator. Don’t be such an asshole, McDreamy.

Seriously? Meredith: do yourself and the rest of us a favor and start using only the service elevators. The wait is usually shorter, anyway.

Meredith’s final voice-over:

“Even now, I believe for the most part that love is about choices. It's about putting down the poison and the dagger and making your own happy ending most of the time, and that sometimes despite all your best choices and all your best intentions, fate wins anyway.”

I guess I’m on board with making your own happy ending business, but I think the experience of the process of finding happiness is closer to something I learned at fitness camp. It was often hard to start a long hike. Those first steps are scary because it was just the beginning of something potentially difficult. Still, it was just a matter of putting one foot in front of the other again and again. It was steep and sometimes painful, but eventually, after staring at my feet, one in front of another, for hours, I would finally open my eyes to find I was in a whole new place, one that was more beautiful than I ever expected it could be. And I didn’t even know exactly how I got there.

Oh, last point: Bailey is pregnant. She seems angry about it. But this is going to be fun.

Chief: “Fine, go be a hotshot somewhere else.”

Bailey: “I’m not leaving. I’m pregnant, you blind moron.”

Interesting!

Episode 16: Something to Talk About

I mentioned in a previous post the indignities I suffered during my last bout of gastroenteritis. These last few days of The Bug were not quite so bad as the XXXL gown with a ruffle, but did have some really low moments. For one thing, I continued to go to work and to participate in activities of daily living despite three days of abdominal pain, only develop intractable diarrhea at the end of day 3. In 12 hours, I lost 5 pounds. I had to call in sick Monday morning, something I swore I would never do while I was on service (because it puts such a burden on my colleagues). And then I made an appointment to see my doctor, who wanted a stool sample.

It should have been easy. I had gone to the bathroom every 15 minutes for 12 straight hours, but when called to perform in the doctor’s office, stage fright ensued. I tried to force the issue by gulping down an entire bottle of water, but no dice. It was not going to happen. So, the lab ladies gave me a little cup, a label, a plastic bag, and two gloves, and told me to try it at home. The problem was that home was 20 minutes away, and after 30 seconds in the car, I was in an emergent situation. I screeched into a spot outside of Bruegger’s Bagels, ran into the bathroom, snapped on the gloves, held the cup in place, and prayed my positioning wasn’t too far off. After it was done, I tucked the still-warm plastic cup (encased in a biohazard bag) in my coat pocket and drove it back to the doctor’s office. Embarrassing, gross, and weird, I know, and the sort of thing that would make a person want to give up Bruegger’s Bagels (or at least their bathrooms) for life. It was one of the low points of my week, for sure.

But not the lowest point. There’s nothing like a stomach flu to make a single lesbian realize how alone she is in the world. That moment, at 3 AM, when you’re in pain, sick, and at your ugliest, is exactly when you realize that no matter how supportive your friends, they can't match having a partner who can see you at your ugliest and sickest and still love you. At that moment, it wouldn’t even matter if it happened to be the same partner had betrayed your trust and/or broken your heart. You just wish she was there, holding a damp cloth to your head, and telling you it’s going to be OK. (I apologize for my stylistically incorrect use of the “generalized you” in this paragraph. It just seemed to work.)

In other relevant news, I got this email this week:

“Dear Colleague,

We are writing to inform you that the Board of Regents of the American College of Surgeons met on Sunday, April 17, to consider the continued status of Lazar J. Greenfield, M.D., FACS, as an officer of the College. Dr. Greenfield recently authored an editorial in Surgery News that some members of the surgical community found offensive. The College received numerous communications from the surgical community about the editorial.

Dr. Greenfield addressed the Board and expressed his deep regret that individuals had been offended by the article. After reaffirming his long-standing support for women in surgery, Dr. Greenfield resigned from his position as an officer of the College.

The contributions Dr. Greenfield has made to the field of surgery, including the invention of the Greenfield Filter, can not be overstated. We wish to honor Dr. Greenfield and celebrate his inestimable contributions to the College and the surgical community. We also know that at this critical juncture for surgery and health care in America, it is important that the American College of Surgeons not be distracted by any issues that would diminish its focus on improving care of the surgical patient.

Sincerely,

Carlos A. Pellegrini, MD, FACS, Chair, Board of Regents L. D. Britt, MD, FACS, President David B. Hoyt, MD, FACS, Executive Director American College of Surgeons”

So what is this about? Apparently, Dr. Greenfield, the famous and accomplished inventor of the Greenfield Filter, made a stunningly bad decision by writing an editorial about the antidepressant effects of semen. His most quoted line: “So there’s a deeper bond between men and women than St. Valentine would have suspected, and now we know there’s a better gift for that day than chocolates.” I mean, what was he thinking? He might actually be quite supportive of women surgeons, but he wrecked any chance that it mattered by publishing this article that sounds like a conversation between Don and Roger on Mad Men. Oh, Dr. Greenfield, I know this is surprise, but it’s not 1959 anymore. 

This episode of Grey’s opens in the locker room, to the endless chatter of Meredith’s colleagues. Clearly, the gossip mill has honed in on the Grey-McDreamy breakup:

 “She got what she deserved, dating an attending.”

The scene quickly transitions to McDreamy and Addison in couples therapy:

Couples therapy. A great way to spend your 12 hours off. (Sadly, practically every married resident does it at some point.)

McD: “I need her to move to Seattle.”

A: “I need him to stop talking to Meredith.”

McD: “I work with Meredith.”

A: “You want me to move here? Fine. I want him to give up his girlfriend.”

McD: “I did give up my girlfriend. You want me to take you back? Fine, I’ll take you back. Here in Seattle.”

A: “It’s all about what you want.’”

McD: “I am not the same person I was in Manhattan.”

A: “I know! You’re a flannel-wearing, wood-chopping fisherman!”

Therapist: “OK, we have to stop. Good progress!”

Yeah, that’s why couples therapy sucks. But, by the end of the episode, these two are holding hands in the therapist’s office and talking about their bright future together in Seattle.

In the meantime, to make Meredith feel better, Yang and Izzie have a special surprise for Meredith: a pregnant man. Or so it seems. Of course, there have been actual pregnant men, although all of these men were born women, transitioned into being men, and then were able to get pregnant because they kept their female reproductive organs in case they ever needed them. The man in this episode is in a different situation: he’s a bio-guy who actually has a kind of tumor called a teratoma. 

The medical plausibility of this scenario is near zero for the following reason: teratomas occur in men, but are most often testicular or mediastinal (in the chest). I was able to find one described case of mesenteric teratoma in a man, so it is theoretically possible, but very, very rare. 

George is caring for a woman who is demanding and horrible to her husband. She needs open heart surgery, then, during her surgery, her heart catches fire (an outcome that is consistent with the unbelievably bad cardiac surgery outcomes at Seattle Grace). Somehow, she survives, prompting her husband to leave her before she even is discharged from the PACU.

“Her heart caught on fire in the middle of her fifth open heart operation and she survived! She’s like a mythical monster. She’s never going to die!”

Cristina has a terrible episode after telling a nurse, “We’ll call you if we need a bedpan.” This dismissive comment leads the nurses to spend their day trying to make Cristina’s life hell. They give her stacks of charts and vomiting patients and all-around load her down with scut. This is a common theme in medical shows, and has been done well in the past, especially on ER. Still, it’s a great theme, because it’s true. 

Nurses can save your ass or ruin your life. So go ahead, be rude to them. See what happens.

There are lots of really bad jobs in the hospital and nurses can make interns’ lives as easy or as terrible as they choose to make them. It’s funny, because I keep telling my interns this, and about half of them believe me. And the half that don’t? Well, those are the interns who don’t bother being nice to the nurses. They are the interns whose pagers go off nonstop, every other minute, all day long. They are the interns getting paged with reports from nurses on borderline lab values, patients in need of emergent manual fecal disimpaction, and emesis that is “strange-looking” and therefore needs an intern to examine it for evidence of blood.

In other news, Bailey is trying to protect Meredith from McDreamy’s douchiness:

Bailey to McD who is walking towards Meredith: “Turn around. Walk away from my intern. You don’t have the right. Not anymore."

McD: "I just want to find out if she’s OK."

Bailey: “She’s not! She’s a human traffic accident and everyone is slowing down to look at the wreckage. She’s doing the best she can with what she has left. Look, I know you can’t see this but you can’t help her now! You’re making it worse. Walk away! Go on!”

Thank you, Dr. Bailey.

Episode 15: Into you like a train.

I've had quite a week-Lawrence Dai gave me a shout out this week on the Lawrence/Julie & Julia Project! It's been so gratifying to get the increased traffic and new reader comments. Of course, my first action should have been to immediately post about the next episode in a blatant act of pandering to my new fans, but this week has been horrible in other ways. I'm back on service, and it's busy. On Friday, I made an intern cry. Honestly, before 2011, I had never in my career made a trainee cry, but now I've somehow managed it twice in a month. Worst of all, I have this stomach bug that's just dragging on and on. It's all about crampy abdominal pain. And worse.


Today, I finally hit a wall. I was holding the transfer pager and had been repeatedly paged by outside hospitals. If you've never seen the video for outside hospital, watch it. It is not made by anyone I know and it's not about the place that I work, but regardless, it represents what doctors think of the way everybody else manages (but not the way we manage at our hospital) patients. And so taking transfers means that I'm asking again and again, "Why did you do that? And why does this patient need to be transferred here?") As I was sitting there, arguing with doctors in other places, and then, in turn, arguing with our doctors about accepting these patients, I was periodically gripped with stomach cramps and sweats. I became more and more short-tempered as the pain waxed and waned, and at some point really lost it. I hung up on at least one person. Worst of all, the transfer line is recorded and monitored because our hospital is trying to improve customer service. Not my finest moment, and it was caught on tape.


Still, as Meredith says at the beginning of this episode, "Sorry, gotta go tend to someone else's train wreck." So I went and finished seeing all my patients and came home to watch an episode of Grey's and suffer through my stomach cramps in peace. Finally.


Meredith's line sets up the theme of the episode. The post-call interns live in a pre-work hours world, and are therefore all called back into work an overnight shift because a huge train wreck (Grey's: It's so early on in your life span to use the train wreck scenario. ER didn't have a train wreck until season 7!) has brought hundreds of wounded and dying people to Seattle Grace. In one story line, two people, a man and a woman who did not previously know each other, are impaled by the same pole and therefore spend the entire episode simultaneously impaled and embracing each other. Because the pole goes directly though the woman’s spine and aorta, McDreamy and Burke decide that her chance of surviving is minimal once the bar is removed. The man's chance is not great, either, but McDreamy and Burke believe that by slowly removing the bar and repairing as they go, they might be able to save his life.

My issue with the scenario is this: Why can’t they move one person just slightly and cut the bar directly in between them, leaving each person with their piece of the pole (very King Solomon of me, I know)? Instead, they decide to move the woman off of the pole, effectively killing her. The man resists allowing this to happen, but she comforts him, saying, “It’s not fair either way.” In the end, McDreamy has to break the news of  the woman's death to her boyfriend, and he tells him, "She wanted you to know that if love were enough, she would still be here with you." This is a secret message to Meredith, and, possibly, to single lesbians everywhere.

In another story line, two pregnant women who have been best friends since 3^rd grade (but are not a couple) used the same sperm donor to become pregnant simultaneously, with a plan to raise the children as siblings. They then happened to be unfortunate enough to end up in this train wreck late in their pregnancies, and one of them is severely burned. In the rush to sign wills to make sure that the other friend can raise the children if one of them dies, their relationship is revealed to Izzy and Addison:

“We’re not lovers. We’re best friends. We just wanted our kids to have two parents.”

     So there's hope that my plan is more beautiful than pathetic. Note: I do not resemble, in the slightest, either one of these people.

The remarkably crazy thing about this is that since the breakup I’ve been trying to decide what to do next with my life, and one of the things I’ve thought seriously about is becoming a single parent. I have two parents who are aging rapidly, one sister, and no extended family. Sometimes I wonder if it’s fair to bring a child into this small family. If something were to happen to me, that child would be practically alone. So, a few weeks ago I called my best friend, who is a single mother who became pregnant via sperm donor, and I asked her if I could use her same donor so our children would be half siblings. We are not dating and we have never dated, but there would be something comforting about knowing that my child has a half sibling and a permanent connection to a friend I love very much. There are complications with this, of course, and maybe it’s crazy, but now that Grey's Anatomy gave this plan the nod, I'm thinking I might be onto something.

In McDreamy news, he's going back to Addison, which we knew had to happen at some point for reasons I've discussed elsewhere. Meredith, of course, takes this very personally and shows her frustration by going batsh*t for saving the impaled woman long after everyone else has given up, screaming, “What about her? We can’t just abandon her!”

Best lines:

“For what it’s worth, I take issue with her salmon-colored scrubs. I mean, what self-respecting surgeon wears salmon-colored scrubs?”

So true. Nurses wear colored scrubs, surgeons wear blue scrubs or hospital-issued-colored scrubs, but certainly not salmon-colored scrubs. For very interesting commentary on scrub colors, watch Nurse Jackie.

 

Yang: “Please tell me you’ve seen a cleanly severed right leg!”

Grey: “How weird is this job?”

Yes. (My weirdest moment this week was when I walked into the room of a man who was clearly touching his junk. I introduced myself and he took his hand out from under the sheets and extended it to shake my hand. I politely deferred but was internally freaking out. Well, I was freaking out and also thinking, "Some people are really right hand dominant.")

Bailey: “Why do I feel like we’re about to kill this girl?”

Well, it was funny at the time.

Yang: "I cannot go back home. It is too sunny in Los Angeles. It is sunny EVERY DAY."

Uh. So true. Except when I'm on vacation there.

"Rounds in 5 minutes."

When rounds are starting and the final 12 hours of your shift are beginning, the feeling is very good, but also exhausting, because you know you're going to spend the next 3 hours walking around and seeing the same patients you've been walking around and seeing the previous 24 hours.

“Time of death 2:51”

OK, last two notes. First, about this quote, I guess time of death is proclaimed because someone is keeping a code sheet and is writing it down, but announcing time of death after a code is not something they teach you in medical school or residency. In fact, I suspect the announcement of time of death is an instance of life imitating art. When I became a code leader, I always announced time of death because it was what I had seen on TV.

Second, I had this thought tonight: When Lawrence Dai goes out on a date (people don't date in college anymore, so maybe this isn't all that relevant), there's got to be this awkward moment during the evening when he has to tell his date, "Uh, I have to go watch Julie & Julia now." Poor guy.

Episode 14: Bring the Pain

OK, I have a confession to make. Although I pretend to be a good little lefty lesbian doctor, there is a significant gap in my education. I have somehow never read “The Spirit Catches You and You Fall Down.”

It’s not that it wasn’t assigned as pre-medical school reading. It was. And I even attended the discussion where all the medical students talked about how it forever changed the way they will think about cross-cultural clinical interactions. I might have even contributed to that discussion, telling some personal story and/or nodding with great interest as other people spoke about the book so that no one would know that I had not read it.

For those of you who are NOT familiar with the story (from Amazon), “Lia Lee was born in 1981 to a family of recent Hmong immigrants, and soon developed symptoms of epilepsy. By 1988 she was living at home but was brain dead after a tragic cycle of misunderstanding, overmedication, and culture clash. What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance. The Spirit Catches You and You Fall Down is a tragedy of Shakespearean dimensions, written with the deepest of human feeling.” So, basically, by not reading this book, this text of practically religious proportions to many in medical education, I have violated at least three of the laws of medical cultural competency. To make matters worse, I once had a nursing student girlfriend who had to write a paper about “The Spirit Catches You” and she was really busy with her other classes, so I wrote a good portion of the paper for her (without reading the book). Also, for years, I’ve purposefully kept it visible on my office shelves, in part because I want to someday read it, but also in part because people will see it and assume that it helped to shape me as a doctor. So, yeah, I’m a big faker. Some might even call me a liar.

This is relevant to this episode of Grey’s because one of the plot points centers around a patient who is Hmong. I am not going to comment on this plotline, because my lie ends here. I know nothing about the Hmong. I have never read the book. I am not qualified to comment. (Neither, I suspect, are the writers of Grey’s Anatomy, but I’m not going to criticize them, either, because I’m one to talk).

In other news, this episode was notable for the end of Izzie and Alex’s disastrous date (which was disastrous because he was freaking out because he just found out he failed the boards, but instead of being honest with her about his disappointment and fear, he barely spoke to her during their date. She’d gotten all dressed up and shaved her legs, so she was rightfully angry).

The title of the episode comes from this voice-over: “Pain comes in all forms. The small twinge, a bit of soreness, the random pain. The normal pains we live with everyday. Then there's the kind of pain you can't ignore. A level of pain so great that it blocks out everything else... It makes the rest of your world fade away, until all we can think about is how much we hurt. There are no solutions, no easy answers. You just breathe deep and wait for it subside.”

There’s a little bit of Kubler-Ross in that statement, and, as I’ve mentioned in the past, Kubler-Ross freaks me out a little bit now.

DHG and George get trapped in an elevator with a dying police officer with a GSW. George has to do exploratory thoracic surgery (because Alex freezes up) and emerges more confident and happy. Thank God, because his martyrdom act was getting old.

Cristina is taking care of a man who is allergic to all pain medications, and so uses pornography to manage his significant chronic pain. Bailey is infuriated that the patient has brought porn into the hospital, but when the power goes out, Cristina realizes that the porn is actually helping the patient, and so she is forced to narrate the entire plot of “Nasty, Naughty Nurses 4” to the man so that he will not suffer needlessly. It’s a great scene.

When Cristina asks the patient’s wife how she puts up with the man’s 24-hour a day porn watching, the wife answers, “It takes away Henry’s pain. And Henry takes away my pain.” Very noble, but not very grounded in reality. How can he “take away her pain” if he’s watching porn 24 hours a day?

Meredith initially tries to reject her desire to be with McDreamy because he is married, but by the end of the episode, she breaks down and gives this little speech:

“Okay, here it is. Your choice, it's simple, her or me. And I'm sure she's really great. But Derek, I love you. In a really, really big, pretend to like your taste in music, let you eat the last piece of cheesecake, hold a radio over my head outside your bedroom window, unfortunate way that makes me hate you... love you. So pick me. Choose me. Love me. “ (excellent reference to Say Anything, one of my favorite movies of all time. It also took place in Seattle.)

McDreamy never shows up to meet her, signaling that he will be going back to his wife (For now, at least).

If only both of these women would just figure out that this guy may be cute, but he is so not worth all this drama.  He’s the true douchebag on this show; he has proven himself to be a wishy-washy, narcissistic, characterless loser.  In a perfect world, Meredith and Addison would hook up and McDreamy would be out of the picture entirely. Please, drop him, both of you.

Best lines;

“Ellis Grey:  You grew up.

Meredith: I did.

Ellis: It’s a shame. It’s awful being a grownup. The Carousel never stops turning. You can’t get off.”

“Pain. You just have to fight through, because the truth is you can't outrun it... And life always makes more.”

Last point: Dr. McAwesome commented last week, “Have you ever considered that you might be Meredith Grey?” Since I’ve (clearly) gone off McDreamy, I am now looking for another character that might be me. However, I sincerely hope that I’m not nearly as boring or whiny as Meredith Grey. And I know I’m not that anorexic. Still, when I grilled Dr. McAwesome about this a little further she said, “Well, you are the narrator. I mean, the voice-over of your blog is in your voice.”

True. And interesting. This blog may not have many viewers, but it is, without a doubt, my show.

Upcoming events: I am considering introducing a rating system! 

Sorry no pictures this episode. I'm having some technical problems with picture capture.

Episode 13: Deny, Deny Deny

This has been a hard week. I worked all weekend, and I’m starting back on the wards next Monday, so there’s no time to rest this week. Add to this that my fitness camp-high has waned, and for the last two days, I’ve been feeling really discouraged about life, the universe, and everything. Not to mention the fact that at this rate I will never get through all the Grey’s episodes in time to meet the 1-year deadline. One post a week is not good enough, I know.

But my whining is not at all interesting, so let’s just jump right in to the episode. The opening, in our favorite bar across from the hospital, features one of the best exchanges on the show to date, as Izzie and George talk about Cristina's response to her recent ordeal:

Izzie: “She’s acting like she has no emotions or warmth, like she’s missing a soul.”

George: “God, she’s going to make a great surgeon.”

Cristina Yang is in the hospital, recovering from her surgery for her ectopic pregnancy. In the first scene we see her underwear as she drags an IV pole down the hall, and from rounds, Douche with a Heart of Gold (DHG) yells, "Nice panties, Yang!"

Oh, Cristina, I feel your pain, because the one time I was hospitalized overnight, they immediately stole all my clothes and put me in an XXXL johnny with a wide, unflattering ruffle at bosom-level. It hung off me (I'm not, like, skinny, but I'm not an XXXL and plus I was extremely dehydrated) and periodically the giant ruffle on the front pulled the whole thing forward, giving any bystanders a quick flash of my chest.  How quickly we strip our patients of their dignity.

                              How quickly we strip patients of their dignity.

Because she's bored or humiliated or maybe because her mother is in the room and is driving her absolutely crazy, she spends the episode sneaking around looking at charts of her co-interns’ patients. 

George: What are you doing?

Cristina: I’m trying to figure out what’s going on with the crazy woman on 4.

George: You are the crazy woman on 4.

The patient Cristina finally hones in on is a woman that we know has Munchausen’s from the first second she’s on-screen, when she’s surrounded by group of admiring health care workers. This is consistent with a typical Munchausen’s profile (making friends with the staff), but is certainly not subtle. Of course, this show isn’t about diagnostic dilemmas, so I’ll forgive them. I first learned about Munchausen’s from my medical school professor, Tom Duffy, who described a case of a patient he called "The Red Baron" because the patient had a habit of showing up at many different hospitals with a complaint of a syndrome that damages the lungs and kidneys, and he added blood to his urine to keep his doctors believing in his illness. I learned about Munchausen's by proxy when I was taking care of a pediatric patient who kept mysteriously getting sick whenever his mother showed up to visit. Or maybe that was just a Law and Order episode. It's so easy to mix up Law and Order with real life.

A few scenes later, we see the Munchausen’s patient take a mysterious pill and then drop to the floor in a sudden ventricular arrhythmia. This arrhythmia responds to a CPR technique that only works on TV: The precordial thump. Again, echos of Lost, season 1, where the precordial thump saved at least three lives. Don’t ask me the mechanism, because I’m not sure.

The nail in the coffin that this patient has Munchausen’s is when she asks Dr. Burke for specific medical interventions:

“An echo? What about  cardioversion or ablation? Won’t I need a pacemaker or a permanent internal defibrillator?”

(Later, Izzie refered to it as “The echo test.” It’s never called an “echo test.” Just an “echo.” ) This plot begins to really unravel when they see the patient has blue urine. Based on this evidence, the doctors blame self-administered amitryptiline for the whole thing, and this is just a little farfetched. Amitryptiline can turn the urine blue occasionally, but it’s unlikely that both her urine would be blue and she could have taken enough to cause an arrhythmia without being so sedated that she required intubation.

In the end, Cristina is right about the Munchausen’s diagnosis and, for some reason, this realization sends her into a spiral of disaster. She sobs and cries and and finally begs, “Somebody sedate me!"

Again, Cristina, I know how you feel. 

Later, Burke shows up in a white blazer and snuggles with her in bed, right there in front of her mother. It’s mortifying, but again, I refuse to care about this relationship. I’m going to ignore it until it goes away. Deny, Deny, Deny, is right.

In McDreamy news, i t seems like the McDreamies really are on the rocks this time, seeing as Addison showed up with divorce papers in this snappy scene:

McDreamy: You really are Satan. If Satan were to take physical form, he’d be you. Everywhere. All the time.

Addison: I am so not Satan.

McDreamy: How come haven’t you gotten back on your broomstick and gone back to New York where you belong?

Addison: You are going to forgive me eventually, right? There was a time when you thought of me as your best friend.

McDreamy: There was a time when I thought of you as the love of my life. Things change.

Addison: Have you ever thought that even if I am Satan, even if I am an adulterous bitch, that I still might be the love of your life?

                                              

In the meantime, McDreamy is caring for a man whose wife shot him because he’s cheating on her. He tells McDreamy at the end of the episode.

“You know what I am? I’m stupid. Nothing will make you feel more stupid than cheating on the woman you love.”

This comment makes McDreamy all reflective. Uh-oh. He may not sign those papers. 

Bailey is taking care of a triathlete/CF patient with pancreatitis, someone she describes as “very near and dear to her heart.” Again, he looks way too good to have the illness he’s supposed to have (and way too good to be a DNR, which he supposedly is), but then he codes in the OR and, once again, a Grey’s physician codes a patient with DNR status. After they (finally) call the code, it's very sad to watch Dr. Bailey make the call to tell his parents that he's dead. It reminded me of one of the most difficult moments of my career - losing a 20-something CF patient who was almost as adorable as this actor. I watched him say goodbye to his mother, and I’ve never forgotten that sad, horrible, scary moment.

Best Bailey Line of the episode (to McDreamy):

“You have put yourself between two very fine women, and you’re looking for an easy way out. It’s not gonna happen.”