Episode 24: Break on Through

Thanks for all the comments on the last post. The GF, who tends to comment in person rather than online said about it, “Wow, that post was a little…process-y, don’t you think?” Now, I cannot reveal GF’s real name, of course, but suffice to say that in addition to being a spin instructor, she is vaguely sort of Internet-famous. Her blog is very newsy and academic, sort of the opposite of process-y, meaning that comment was not really a compliment. Still, I guess I should just be glad that she at least reads the blog. I’ve had GFs who never read a single blog post of mine (back when I had a different blog).

I just turned in a huge grant (a day before the deadline, thank you very much) which means that the last thing I want to see right now is single-spaced Arial 11 point font (the standard font for federal grants and, apparently, this blog) and I’m also suffering from some serious post-grant letdown. I came home from turning in the grant to discover that my sewage pipe has backed up into my basement, making all of my plumbing unusable. Seeing as I’m literally knee-deep in, well, sh*t (more like ankle-deep, but still, you get my point), I’m shacked up at GF’s house until I can get a plumber in (to make this situation more sticky, I have been picking fights with her for days because I’ve been stressed out and pissed off about the grant). I also discovered, after turning the grant in, that I haven’t done any other work in 2 weeks or more, so I have a pile of stuff that needs my attention immediately. And although, for the last month (since September 7), I worked out like a fiend and counted calories, keeping my daily intake to 1500-2000 calories, I somehow gained three pounds. Ridiculous. Irritating. Pass me the macaroni and cheese and ice cream because I clearly live in opposite world where nothing is fair so I might as well eat whatever the heck I feel like eating.

Meanwhile, at Seattle Grace, there’s a nurses’ strike going on. The hospital is 2 million dollars short and is mandating overtime rather than hiring new nurses. The theme of the episode is “Lines we can’t cross,” so George is in a tricky “can’t cross the line” situation. He is unable to cross the picket line because of his working class values (hinted at in a previous episode where his family took him hunting) but, as a doctor, he believes he is not allowed to strike. Where does he get this idea? In 1998, Risa Lavizzo-Mourey, MD, MBA, FACP (then Chair of ACP-ASIM's Ethics and Human Rights Committee,  now head of the Robert Wood Johnson Foundaton) said that the problem with physician unions is that "One of the major tactics that unions use is to strike, to withhold services. If our professional ethic dictates that our services are to benefit our patients and we withhold them to get a gain that will benefit us directly, it creates a conflict." But don’t be fooled! Doctors have gone on strike, in the 1960s in Canada in response to the beginning their national health insurance program, and more recently, over reimbursement and hours in England and Israel. There have been isolated incidents of doctors’ strikes the in the US, so although most US doctors believe striking violates their professional oath, it’s actually a point of contention within the medical community whether striking is a tool that should sometimes be used. The interns in the episode quote the gospel of “doctors can’t strike,” but it’s not strictly true. It’s probably truer that most doctors wouldn’t strike over nursing overtime. Most of the doctors strikes in the past seem to be linked to physician concerns over patient quality of care or to physician reimbursement. And there’s one good way that (hospital-based) doctors can strike: keep seeing patients, but refuse to submit billing documentation. Then doctors don’t violate their oath but the hospital loses the revenue. In the end, George does not cross the picket line.

The "Proud to be a nurse" sign is funny. But why?

Inside the hospital, Meredith has made a classic six-month-intern mistake: with the nurses on strike, she walks into a room of a patient with respiratory failure and immediately intubates the patient, temporarily saving her life. The problem, and the sixth-month-intern aspect of the whole thing, is that the woman is DNR/DNI-the intubation should never have happened. In classic early-trainee fashion, she ran the code pretty darn well. 

Not bad technique. But you should've checked the chart first.

She just made the huge mistake of not looking at the chart first. Meredith is then surrounded by friends of the woman, one of whom hits her with a giant handbag for making the mistake. (Good one! Hit her a little harder. I’m pretty sure she’ll keel right over, given her desperate need for a sandwich.) Instead of immediately extubating the patient, Meredith demands a signed power of attorney form (odd, given the giant “DNR” on the chart) from the patient’s daughter. The friends, who are not the power of attorney, are a cute but contrived trio of television-style old ladies (thin, energetic, laxative-commercial types). They talk on and on, and some of the dialogue is kind of hilarious:

“Her daughter? She’s a lesbian. Well that’s OK, isn’t it? She can still be the power of attorney.”

What the actors were actually saying to each other when the camera was off: "Haven't we met before? Oh, yes, that laxative commercial we did together. Or was it adult diapers? I can't remember. Oh, my memory is not what it used to be! Ha. Another Gingko joke. They never get old. Unlike character actors!"

After much angst and Meredith crying in a closet (where she is chased down by McDreamy, who McDreamily wipes away her tears. Insert gagging sounds here.) over her mother’s ongoing dementia and impending (but probably at least two seasons away, unfortunately) death, the poor woman is finally extubated. For the love of God! That woman was dying and you cruelly didn’t let her die and then you dragged it out and made it all about you. What is wrong with you? Leave the personal sh*t at home or in the supply closet. And, although I put this in an earlier post, I repeat: if it is me, please immediately withdraw care.

Gag me. Sensitive naked man of the week goes to: McDreamy!

Cristina is excited to scrub in on a case of necrotizing fasciitis. The woman with this "flesh-eating bacteria" is played by an over-the-top hetero version of Alice from the L word. She probably took this part because this was the height of the L word buzz and she wanted to prove she could still play it straight.

Everything about you and your flesh-eating bacteria reads "straight." Too bad this attempt at versatility didn't improve your post L word career chances. I know this because I am writing from the future.

Unfortunately for Cristina (but fortunately for the flesh-eating bacteria lady for reasons that we will soon see), Bailey is out on bedrest and the interns have a replacement resident, the peppy Sidney “Heal with love” Heron. She is too cutesy and touchy-feely for the Grey’s interns, save Alex who plays along to garner favor. 

Sidney "replacement resident" Heron. I've had residents like you. We all know that you got up at 4 AM so you could spend an hour on the stairmaster before coming to work. Don't tell us about it. Seriously. You are annoying enough as it is.

This “Heal with love” business irks no one more than Cristina, who wants to amputate immediately rather than try to save the flesh-eaten leg. Sidney is horrified, and instead opts for a longer, leg-saving surgery. Cristina recounts the whole story to Meredith in the bar later:

Cristina: “She called me unkind. Unkind and lacking in compassion. I am not unkind!”

Meredith: “I have to kill my patient tomorrow. I have to take out the tube that is keeping her alive.”

Cristina: “And that is a problem why?? And that is not unkind or lacking in compassion.”

For the record, Cristina, I’m with you. That is a problem why? And I agree that is not unkind or lacking in compassion. You’re just not making everything all about you all the time.

Burke, who got dragged into Cristina’s argument with her resident later tells Cristina: “I never understood what the problem was, an intern dating an attending, until today.” Well, that’s your problem there, Burke. You should know exactly what the problem is: You’re her boss; you have power over her; medicine is a hierarchy and you’re at the top and she’s at the bottom; you cannot effectively teach someone you’re sleeping with…the list goes on. But you never saw it because you’re, well, a dense and ridiculous character that should be pursuing his dreams somewhere other than this show. Burke leaves us with: “I’m an attending. I don’t apologize to residents. You, on the other hand, are an intern.” 

I’m an attending and I apologize to residents all the time. But maybe that’s my problem.

The nurses’ strike is finally resolved when:

Nurse manager: “I seem to remember pushing through paperwork for a multi-million dollar surgical robot.”

Chief: “That will bring in huge business”

NM: “Can you and the robot handle that business without nurses?”

Interestingly, a colleague of mine just wrote a very interesting paper on surgical robots. The chief is right. It’s very likely that robot would have generated significant revenue for the hospital, because it turns out that when hospitals buy a robot, their surgical volumes go way up, probably because surgeons begin performing unnecessary surgeries given the strong incentive for doctors and hospitals to use their new toy. So the best business decision (but, perhaps, not the most patient-centered decision) would have been to both buy the robot and hire new nurses. It was 2005. You so could have bought that robot on credit.

The show tries to end with a moral, but this one makes no sense: "Once you’ve crossed, it’s almost impossible to go back. If you do manage to make it back across that line, you’ll find safety in numbers."

I therefore initiate my first ever Grey's Miracle Cure Contest. What the hell does this moral mean? Or is it just Hollywood filler/drivel? Answers accepted via comments.

It's like the New Yorker cartoon contest. Except not as artistic. Or clever.